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"Parvovirus B19-related Acute Hepatitis: Clinical Spectrum and Outcome in Children"

Arghya Samanta1, Anshu Srivastava1, Sangram S Patel2

  • 1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Journal of Clinical and Experimental Hepatology
|October 30, 2024
PubMed

Insights

Parvovirus B19 infection can cause acute liver injury in children, even without immune compromise. Consider this virus in pediatric liver disease, especially with complications like aplastic anemia or HLH.

Area of Science:

  • Pediatric Hepatology
  • Viral Hepatitis
  • Infectious Diseases

Background:

  • Parvovirus B19 (PVB19) infection is a known cause of acute liver injury in immunocompromised individuals.
  • Data on PVB19-related liver disease in immunocompetent children is limited.
  • This study investigates the clinical and laboratory features of PVB19 hepatitis in hospitalized children.

Purpose of the Study:

  • To characterize the clinical presentation and laboratory findings of parvovirus B19 infection in children hospitalized with acute liver injury.
  • To evaluate the outcomes and complications associated with PVB19-related hepatitis in pediatric patients.
  • To determine the significance of PVB19 as a cause of acute liver injury in immunocompetent children.

Main Methods:

  • Retrospective analysis of a prospectively maintained database of children (<18 years) admitted with acute viral hepatitis, acute liver failure, or acute-on-chronic liver failure and PVB19 infection (January 2010 - December 2023).
  • Evaluation of clinical features, laboratory parameters, and complications.
  • Definition of poor outcome as death or need for liver transplantation.

Main Results:

  • 35 children (median age 7.25 years) with PVB19 hepatitis were studied; 80% had isolated PVB19 infection, 20% had coinfections.
  • Acute viral hepatitis (49%) was the most common presentation, followed by acute liver failure (37%).
  • Coinfections were associated with higher bilirubin and transaminase levels but similar mortality. Extrahepatic complications occurred in 25.7% of cases, including hemophagocytic lymphohistiocytosis, acute kidney injury, aplastic anemia, and myocarditis. Poor outcome occurred in 38% of ALF cases and 11.7% of AVH cases.

Conclusions:

  • Parvovirus B19 should be considered in the differential diagnosis of indeterminate acute liver injury in children.
  • Particular attention should be paid to younger children or those presenting with extrahepatic complications such as aplastic anemia, hemophagocytic lymphohistiocytosis, or myocarditis.
  • PVB19 is a significant, though often overlooked, cause of acute liver injury in pediatric populations.
Abstract

Keywords:
aplastic anemiachildrenhemophagocytic lymphohistiocytosishepatitisparvovirus B19

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