Recent Increase in Incidence of Severe Acute Hepatitis of Unknown Etiology in Children is Associated with Infection with Adenovirus and Other Nonhepatotropic Viruses - 22/08/23
Doi : 10.1016/j.jpeds.2023.113439
Anna L. Peters, MD, PhD 1, 2, ⁎ 
, Seung Kim, MD 1, Reena Mourya, MSc 1, Akihiro Asai, MD, PhD 1, 2, Amy Taylor, MD 1, 2, Michael Rogers, MD 1, 2, Kathleen Campbell, MD 1, 2, Lin Fei, PhD 1, 3, Alexander Miethke, MD 1, 2, William F. Balistreri, MD 1, 2, Jorge A. Bezerra, MD 4
, Seung Kim, MD 1, Reena Mourya, MSc 1, Akihiro Asai, MD, PhD 1, 2, Amy Taylor, MD 1, 2, Michael Rogers, MD 1, 2, Kathleen Campbell, MD 1, 2, Lin Fei, PhD 1, 3, Alexander Miethke, MD 1, 2, William F. Balistreri, MD 1, 2, Jorge A. Bezerra, MD 4 1 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
2 Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
3 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
4 Children's Medical Center at Dallas and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
∗Reprint requests: Anna L. Peters, MD, PhD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039Cincinnati Children's Hospital Medical Center3333 Burnet AveCincinnatiOH45229-3039
Abstract |
Objective |
To evaluate whether the nature and severity of non-A-E severe acute hepatitis in children noted by the World Health Organization from late 2021 through early 2022 was indeed increased in 2021-2022 compared with prior years.
Study design |
We performed a single-center, retrospective study to track the etiology and outcomes of children with non-A-E severe acute hepatitis in 2021-2022 compared with the prior 3-year periods (2018-2019, 2019-2020, and 2020-2021). We queried electronic medical records of children ≤16 years of age with alanine or aspartate aminotransferase levels of >500 IU. Data were analyzed for the periods of October 1, 2021, to May 1, 2022, and compared with the same time periods in 2018-2021.
Results |
Of 107 children meeting entry criteria, 82 cases occurred from October to May of 2018-2022. The average annual case number was 16.3 in 2018-2021 compared with a 2-fold increase (to 33) in 2021-2022 (P = .0054). Analyses of etiologies showed that this increase was associated with a higher number of children who tested positive for viruses (n = 16) when compared with the average of 3.7 for 2018-2021 (P = .018). Adenovirus (26.1%) and severe acute respiratory syndrome coronavirus-2 (10.3%) were the most frequently detected viruses in 2021-2022. Despite evidence of acute liver failure in 37.8% of children in the entire cohort and in 47% of those with viral infection, the overall survival rate was high at 91.4% and 88.9%, respectively.
Conclusions |
The number of children with severe acute hepatitis in our center increased from 2021 to May 2022, with a greater frequency of cases associated with adenovirus, yet transplant-free survival remains high.
Le texte complet de cet article est disponible en PDF.Keywords : hepatitis, adenovirus, pediatrics, acute liver failure
Abbreviations : AAV, ALT, ANA, AST, CMV, EBV, HHV6, HSV, INR, PCR, SARS-CoV-2
Plan
| Conflicts of interest: None. |
|
| Financial support statement: This project was supported in part by the NIH P30 DK078392 Statistical Analysis Core of the Digestive Diseases Research Core Center in Cincinnati, OH and Cincinnati Children's Research Foundation. A.P. was supported by NIH 5K12HD028827-28,29. |
© 2023
Elsevier Inc. Tous droits réservés.
Vol 259
Article 113439- août 2023 Retour au numéro
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