Common virus may be linked to liver failure in healthy children ::

Common virus may be linked to liver failure in healthy children ::
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Editor’s Note: This article originally appeared on Let’s Talk Health UNC.

Doctors around the world are trying to understand what causes children to develop severe hepatitis (inflammation of the liver) which in some cases leads to liver failure. These puzzling cases have been linked to a common adenovirus that typically causes colds, conjunctivitis (pink eye), stomach cramps and diarrhea.

The number of known cases is very low, according to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). Still, both organizations ask doctors to report any cases of otherwise healthy children who develop liver disease.

In North Carolina, two school-aged children with severe hepatitis and acute liver failure were recently treated at UNC. But both tested negative for adenovirus type 41, the strain suspected of causing hepatitis.

However, nine cases positively linked to adenovirus have been reported in Alabama in children younger than 10, according to the University of Alabama at Birmingham. Two of these patients required a liver transplant.

So what’s going on? No one is quite sure yet, but doctors and researchers are working hard to figure it out.

“There’s a lot of speculation right now regarding the cause,” says Steven Lichtman, MD, UNC Health pediatric gastroenterologist.

North Carolina Acute Liver Failure Cases Not Linked to Adenovirus

Dr. Lichtman says the two children hospitalized at UNC, ages 9 and 11, were very ill with acute liver failure.

“These children were sick enough to be listed for a transplant,” he says, “but luckily they both recovered without a transplant and went home.”

While the two children lived in the same part of the state, they did not know each other and had no connection.

“They arrived a day apart,” says Dr. Lichtman. “It was very unusual. We usually see about one case of liver failure in one child per year, maybe one every two years.

Dr Lichtman says he was aware of the cases in Alabama and also of a cluster in the UK, so he ordered tests for adenovirus type 41 and other common viruses known to cause hepatitis , but no cause was found. Tests were carried out to see if the children had come into contact with a toxic substance, but there were no signs of this either.

No other cases have been reported in North Carolina, he said. However, following the CDC’s health advisory, the North Carolina Department of Health and Human Services asked all medical professionals in the state to be on the lookout for cases of acute pediatric hepatitis of unknown cause and to report any such cases to the state so that any spread of the disease can be tracked.

WHO reports that as of April 21, at least 169 cases of acute hepatitis of unknown cause have been reported in 11 countries in Europe and the United States. Of these, 17 children required a liver transplant. These cases are not believed to be related to COVID-19.

What parents need to know

While doctors are monitoring the situation to see if any patterns appear, parents should be aware that if the whites of your child’s eyes start to turn yellow, even a little, you should contact your pediatrician immediately. The doctor may do a blood test to see if your child has hepatitis. In most cases of hepatitis, the liver recovers on its own without treatment.

Hepatitis A and B vaccines are part of the CDC’s recommended routine immunization schedule for children. Although these vaccines are important to protect your child against hepatitis A and B, they will not prevent infection with an adenovirus which could affect the liver. Just make sure your child is up to date on all their vaccinations, including those for hepatitis A and B, to prevent illnesses caused by these specific viruses.

But parents shouldn’t panic, says Dr. Lichtman. So far, there is no evidence that childhood hepatitis is spreading in the United States. Cases can disappear as mysteriously as they started, he says. But in case they increase in number and affect more children, it is important for doctors and parents to be aware of them.

If you notice that the whites of your child’s eyes are yellowish or discolored, see your doctor as soon as possible or find one near you.

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