Theories of mysterious liver diseases in children emerge

Children stand in a silhouette against a pond in a park in Leneksa, Canada, in December. 26, 2020. Health professionals are amazed by the mysterious cases of severe liver damage in hundreds of children around the world. (Charlie Riedel, Associated Press)

Estimated study time: 5-6 minutes

NEW YORK (Reuters) – Health care workers around the world are puzzled by the puzzles of the plight of hundreds of children around the world.

The best evidence available suggests a gastric defect that does not cause liver problems in healthy children. The virus was found in the blood of infected children, but surprisingly, it was not found in their diseased livers.

“There’s a lot of nonsense,” said Eric Kremer, a virus researcher at the Institute of Molecular Genetics in Montpellier, France.

As health workers in more than a dozen countries explore the mystery, they are asking:

  • Has there ever been a case in the stomach called adenovirus 41 that has caused many cases of previously undiagnosed problems?
  • Are children more susceptible to pandemic-related locks than usual?
  • Is there a mutated version of the adenovirus that causes this? Or another unidentified microbe, drug, or toxin?
  • Is this a reaction of the immune system that started with a previous COVID-19 infection and a subsequent invasion of another virus?

U.S. Centers for Disease Control and Prevention and investigators around the world are trying to determine what is happening.

Diseases are rare. Last week, CDC officials said they were now reviewing 180 possible cases across the United States, most of the children had been hospitalized, at least 15 had to undergo liver transplants and six had died.

More than 20 other countries reported hundreds more, but the largest numbers were in the United Kingdom and the United States.

Symptoms of hepatitis — or inflammation of the liver — include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice.

Lots of nonsense.

– Eric Kremer, Institute of Molecular Genetics

The scale of the problem became clear last month, but disease detectives said they had been working on the mystery for months. According to experts, it was very difficult to determine the cause.

The most common causes of hepatitis in healthy children are hepatitis A, B, C, D and E viruses. Not only that, the children came from different places and seemed to have no general impressions.

Adenovirus 41 was found. More than half of all cases in the United States are positive for adenovirus, with dozens of strains. From the small number of samples tested to determine the presence of adenovirus, adenovirus 41 was detected each time.

The persistent appearance of the adenovirus confirms its role, but it is not clear how. Jay Butler, the CDC’s deputy director of infectious diseases, told the Associated Press.

Many adenoviruses are accompanied by common symptoms of colds, such as fever, sore throat, and pink eyes. Some versions, including adenovirus 41, can cause other problems, including inflammation of the stomach and intestines. Adenoviruses have previously been associated with hepatitis in children, but are more common in immunocompromised children.

Recent genetic analysis has proven that a new mutant version of the virus is to blame, the doctor said. Umesh Parashar, head of the CDC, drew attention to viral intestinal diseases.

Adenovirus infections monitor viral activity, some of which are not recent. In fact, adenoviruses are so prevalent that researchers do not know what to do if they are present.

“If we start testing everyone for the adenovirus, they will find so many children,” he said. Helie Bhatt, a pediatric gastroenterologist who treated two Minnesota children with liver disease.

One of them was a boy who had been diagnosed with liver disease about five months earlier. The doctors could not understand why. Unfortunately, “lack of reason is something that can happen,” Bhatt said. According to experts, one-third of acute liver failure is unexplained.

Bhatt said the second child he saw fell ill last month. At that time, health workers took action, and he and other doctors began to return unexplained and have been examining patients since October.

Indeed, many of the cases included in the last few weeks were not recent illnesses but rather re-evaluated previous illnesses. Butler said about 10 percent of cases in the United States occurred in May. This figure has been relatively stable since the fall, he added.

According to some scientists, doctors may be discovering a phenomenon that has been going on for years.

Another possible explanation: COVID-19.

The CDC recently estimated that as of February, 75% of children in the United States were infected with the coronavirus.

According to a nasal swab test when health care workers were admitted to the hospital, only 10% to 15% of children with mysterious hepatitis had COVID-19.

But investigators are concerned about previous coronavirus infections. According to Peter Brody, a pediatric immunologist at Imperial College London, coronavirus particles in the gut play a role.

Earlier this month in the medical journal The Lancet, Brody and another scientist said that a combination of a chronic coronavirus and an adenovirus infection could trigger a liver-damaging immune system reaction.

“I think it’s a sad combination of circumstances to explain this,” Brody told the AP.

Butler said researchers have already seen such complex reactions, and investigators are discussing ways to better test the hypothesis.

According to him, this is “not beyond the realm of reliability.”

A preliminary study published by Case Western Reserve University, which has not yet been reviewed, said that children with COVID-19 have a significantly higher risk of liver damage.

Dr. Marcus Buchfelner, a pediatric infectious disease doctor at the University of Alabama in Birmingham, was involved in identifying the first cases in the fall of the United States.

Diseases are “weird” and scary, he said. Six months later, “we don’t know exactly what we’re struggling with.”

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