Acute hepatitis in children: stable cases in Italy, hypotheses about the causes

On cases of acute hepatitis of unknown origin, “from the UK there is no information other than what we had weeks ago, I imagine they publish the data. With us the situation has not changed and we have not had other cases ift the 6 children assisted to date.So there has been no increase and even the little patient who arrived from Bergamo who had a more serious clinical situation to be able to undergo a liver transplant has gotten better and is being followed.The impression, always “with great caution, is that we do not know if there will be an improvement. We could even imagine that it was a self-limiting acute episode.” He said so Giuseppe Maggiorehead of the Hepatogastroenterology and Nutrition Operational Unit at Bambino Gesù Pediatric Hospital in Rome, taking stock of the situation.

The hypotheses: adenoviruses and mutations

On the possibility that adenovirus F41 is one of the main suspects behind these cases of acute hepatitis, “it may be, but in some cases. It is there, it was found in the blood, while it may be much less when it was intercepted in the faeces where it is present even in healthy subjects – points out Maggiore – In addition, adenovirus can rarely and only in immunosuppressed subjects cause acute hepatitis “.

Acute hepatitis in children, the adenovirus genome will give us the answers

by Elvira Naselli

While we, based on the hypothesis of a more ‘bad’ mutation of adenovirus due to the 2 years of the Covid pandemic and of the children who are less vulnerable due to the shutdown, “we are not aware – the specialist specifies – that this type viruses can cause a number of such serious cases in such a short time ”.

Oriented against the adenovirus hypothesis, the virologist Giorgio Palùformer CTS member and president of Aifa: “For now, it has not had the spread that was feared, although it has mainly affected children under the age of 5 who have not been vaccinated against Sars-Cov-2. The most likely cause is human adenovirus F41, already associated with gastrointestinal forms “.

Case in Italy: Situation

For now, we are in an evaluation phase “for acute hepatitis of mysterious origin in pediatric age, but” in Italy the reports are under control, there is no increase in liver transplants related to this type of hepatitis, which is usually a few nationwide. “He said so Claudio Mastroiannichairman of the Italian Society of Infectious Diseases and Tropical Diseases (Simit) and full professor of infectious diseases at the University of Sapienza in Rome.

Regarding the origin of these acute hepatitis, the infectious disease specifies that “we are still talking about probable cases and we do not know if there is a cofactor together with a pathogen – he warns – So we do not have a well-defined cause and active monitoring takes place … But we also see that at European level, following the escalation of reports in recent months, there is now a stabilization and the increase has stopped. Simit’s message is “to reassure citizens in the most absolute way”, concludes Mastroianni.

Among the possible causes of acute hepatitis of mysterious origin, which has affected about 200 children worldwide, is “adenovirus F41, perhaps with mutations, included. However, this type of virus is very common in healthy children and has not always been found in healthy children. children. cases recorded to date. In addition, adenovirus is not normally perihepatic, except in immunosuppressed subjects. subjects “. These are the words from Massimo AndreoniHead of Infectious Diseases at the Tor Vergata Outpatient Clinic in Rome and Scientific Director of the Italian Society for Infectious Diseases and Tropical Diseases (Simit).

Acute hepatitis in children, the crisis unit for territorial control is born

According to Andreoni, in the “approximately 200 cases of unknown acute hepatitis in children diagnosed to date, retrospective cases have been included, at least in the first reported cases, and this has affected the sudden number. Now – emphasizes the expert – we are witnessing a stabilization of the reports and at least in Italy no new cases have been registered.We remember that 200 cases in the world are not many but they fall within the numbers we had even before compared to unknown acute hepatitis “.

“Dogs? A hypothesis without a scientific basis”

Among the most diverse factors investigated by the Uk Health Security Agency, there are also pets. “That with dogs seems to me to be a hypothesis without a scientific basis. Like shooting in the air and hoping to catch a bird. It’s true that in Britain it is the most common pet, but so is the cat. ‘Binding’. leaves me more confusion “, he comments Giuseppe Maggiorehead of the Hepatogastroenterology and Nutrition Operational Unit at Bambino Gesù Pediatric Hospital in Rome.

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