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Acute Hepatitis of Unknown Origin in Pediatric Age Group: Recent Outbreaks and Approach to Management
Neil Patel1,2, Yashendra Sethi1,3, Nirja Kaka1,2
1PearResearch, Dehradun 248001, India.
Insights
Recent pediatric acute hepatitis outbreaks, negative for common viruses, show symptoms like jaundice and vomiting. Adenovirus and SARS-CoV-2 are suspected causes, prompting a need for diagnostic and management protocols.
Area of Science:
- Hepatology
- Pediatric Infectious Diseases
- Public Health
Background:
- Acute hepatitis outbreaks have recently emerged globally, primarily affecting children.
- These cases are distinct as they test negative for common hepatotropic viruses (Hepatitis A, B, C, E).
- The condition, termed Hepatitis of Unknown Origin, presents with symptoms like jaundice, vomiting, and gastrointestinal distress, with a significant rate of liver failure.
Purpose of the Study:
- To comprehensively review and synthesize existing data on recent acute hepatitis outbreaks in children.
- To provide evidence-based conclusions to aid clinicians in diagnosis and management.
- To highlight the challenges posed by these unknown-origin hepatitis cases.
Main Methods:
- Systematic review and compilation of available data on global acute hepatitis outbreaks.
- Analysis of clinical presentations, etiological investigations, and outcomes.
- Evidence-based synthesis of findings to inform diagnostic and management strategies.
Main Results:
- Outbreaks reported in approximately 35 countries, predominantly in pediatric populations.
- Common symptoms include jaundice (68.8%), vomiting (57.6%), abdominal pain (36.1%), and nausea (25.7%).
- Adenovirus and SARS-CoV-2 are strongly implicated as potential causative agents.
Conclusions:
- International collaboration is crucial for establishing standardized diagnostic and management protocols.
- Further research is needed to fully elucidate the etiology and pathogenesis of these novel hepatitis cases.
- Clinicians require updated guidance to effectively manage pediatric patients presenting with acute hepatitis of unknown origin.
Abstract:
Acute hepatitis has always been a public health concern, but the recent clustering of cases in various parts of the world has drawn some special attention. The sudden rise in cases has mainly been among the pediatric population of around 35 countries around the world, including developed countries such as the United States, the United Kingdom, and European countries. The outbreaks have had a devastating impact, with around 10% of the affected patients developing liver failure. The clinical presentation of patients resembles any other case of acute hepatitis, with the major symptoms being: jaundice (68.8%), vomiting (57.6%), and gastrointestinal symptoms such as abdominal pain (36.1%) and nausea (25.7%). Interestingly, the cases have tested negative for hepatotropic viruses Hep A, B, C, and E, thus giving rise to the terms Hepatitis of Unknown Origin or non-HepA-E hepatitis. Many causes have been attributed to the disease, with major evidence seen for adenovirus and SARS-CoV-2. International agencies have stressed on establishing diagnostic and management protocols to limit these outbreaks. As the understanding has evolved over time, diagnostic and management faculties have found more shape. The current review was designed to comprehensively compile all existing data and whittle it down to evidence-based conclusions to help clinicians.
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