Hepatitis in children of unknown origin: the SARS-CoV-2 hypothesis

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l’epidemic byhepatitis unknown origin affecting children around the world continues to spread. Since its discovery in early April 2022, more than 450 children have contracted the disease and eleven died in Indonesia, the United States and Palestine. Some of them also had to undergo grafting by liver

This hepatitis is a glue for scientists. Young patients are negative for hepatitis viruses from A to E which, as their name suggests, multiply in liver cells and cause damage there. Today’s favorite hypothesis is that of infection by another virus,adenovirus type 41. However, the latter is not known to cause liver problems in children, except in children with reduced immunity.

SARS-CoV-2 involved?

Published in correspondence in The Lancet Gastroenterology and HepatologyPetter Brodin, from theImperial College of London, and Moshe Arditi, of Cedar Sinai Hospital in Los Angeles, offer another train of thought related to the SARS-CoV-2without setting aside adenovirus type 41.” We speculate that the recent cases of severe pediatric hepatitis may be due to infection by an adenovirus with a tropism intestinal infection in children previously infected with SARS-CoV-2 and carriers of a viral reservoir† †

Several observations support their hypothesis. About 12% of young patients identified in Europe were positive for SARS-CoV-2 at the time of hospital admission. Tests are performed to look for the presence ofantibody anti-SARS-CoV-2, a sign of an infection several months old. Of the 19 European cases for which this information is available, 14 indeed have anti-coronavirus antibodies. In addition, most cases of hepatitis involve children under the age of 5, who are not eligible for: the vaccination

Mechanisms still hypothetical

The two scientists propose looking at whether children’s stools contain the SARS-CoV-2 genome, which would be a sign of the persistence of the infection in the intestinal tract, as well as characterizing the nature of the immune response that triggers a “superantigen” type mechanism.

Viral superantigens are different from: antigens classics. They activate not only the T lymphocytes that they specifically recognize, but all that carry an identical receptor, the TCR – whole cell families are thus stimulated. Some scientists believe that a superantigen, possibly part of the protein S of coronaviruswould be responsible for the severe form of COVID-19a generalized inflammatory condition that can affect the liver, in children.

What do we know about cases of hepatitis of unknown origin that have been affecting children for several months?

Article published on April 22, 2022 by Julie Kern

More than a hundred cases of hepatitis, initially still under debate, concern children in the United States, but also in Europe and France. Doctors have not yet formally identified its origin, but a virus other than hepatitis is suspected.

early April, WHO has received an unusual notification † ten children under 10 contracted severe hepatitis – one inflammation liver — in Scotland. Today, UK health authorities identify a total of 108 similar cases. On the other side of the Atlantic, the CDC just released a note indicating that as of November 2021, five cases of pediatric hepatitis have been identified at an Alabama hospital; and four more since then. In Europe, Spain, Denmark, Ireland, as well as France, with two cases reported in Lyon, are concerned.

Atypical liverworts in children

Affected children present with symptoms severe requiring hospitalization, including: jaundiceby diarrheavomiting and pains intense abs. Most children were treated quickly, although a minority had a liver transplant. To date, no deaths have been reported. Hepatitis is uncommon in children and the exact origin of these cases remains unknown, although doctors have a clue: a virus.

Liver infections can be caused by viruses,alcoholand excess of certain medications or due to underlying autoimmune diseases or genetic† The problem is that recent pediatric cases are negative for: hepatitis viruses from A to E, the most common cause of liver inflammation. Doctors suspect another virus, but one that is not known to attack the liver.

Adenoviruses are viruses DNA double stranded, large which are transmitted through contact with contaminated objects or respiratory droplets. This family includes about 50 different viruses, 40 of which can infect humans. In most cases they cause respiratory infections, but some types can also lead to gastroenteritisby cystitisby conjunctivitis and in very rare cases, encephalitis† There is no specific treatment for adenovirus infection.

Adenovirus type 41 suspected culprit

Doctors are especially interested in adenovirus type 41, which is known to cause gastroenteritis in children, often in combination with respiratory damage. Cases of hepatitis caused by infection with adenovirus type 41 have been documented, but only in immunocompromised children in healthy children, this virus is not known to cause such a symptom.

Sick children in the United States have all tested positive for adenovirus type 41, the remaining cases are being investigated. † If an adenovirus is responsible, it could be a new variant that can cause liver damage in children with naive immune systems. But to be sure, we need to know more. On the other hand, if adenovirus is the culprit of hepatitis in healthy children, then we should look for other infections or environmental causes that may exacerbate the inflammation caused by adenovirus. explains Zania Stamataki, associate professor of viral immunology at the Center for Liver and Gastrointestinal Research from Birmingham.

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