Data map. Xinhua| , and the high proportion of severe cases has attracted widespread attention. At present, the etiology of the disease is unknown, and there are no related case reports in my country.
On June 16, the cover reporter learned from the National Health and Medical Commission that in order to prepare for medical treatment in advance, the National Health and Medical Commission organized the “Guidelines for Diagnosis and Treatment of Severe Acute Hepatitis in Children of Unknown Cause (Trial)” (referred to as the “Guidelines”), including the epidemiological profile, etiology and pathogenesis, clinical manifestations, case definition and diagnosis, laboratory examinations, imaging manifestations, treatment measures and prevention and control measures.
Not yet supported as a contagious disease
March 31, 2022, Scotland, UK Severe acute hepatitis of unknown etiology was reported for the first time in children aged 3 to 5 years. On April 5, 2022, the United Kingdom reported to the WHO (World Health Organization) an increase in cases of unexplained acute hepatitis in healthy children under the age of 10. Most of the children had vomiting, jaundice, and elevated transaminases.
As of May 20, 2022, the European Surveillance System data showed that the disease can be seen in children of all ages, and is more common in children under the age of 5; 14.1% of hospitalized children need to be admitted to the intensive care unit. On May 27, 2022, WHO announced that 33 countries reported 650 suspected cases, at least 38 required liver transplantation, and 9 died. There are no related case reports in my country.
The “Guidelines” pointed out that the existing evidence has not found obvious epidemiological correlation between cases, and it is not yet supported as an infectious disease.
The association with adenovirus needs to be further clarified
The etiology and pathogenesis of severe acute hepatitis in children of unknown etiology The mechanism is still under study.
Currently, WHO believes that although the hypothesis of adenovirus infection as the etiology is reasonable, adenovirus usually causes mild, self-limited gastrointestinal or respiratory tract infections in young children, and cannot fully explain the disease Some more serious clinical manifestations, so the association between the disease and adenovirus needs to be further clarified. Most of the children have not been vaccinated against the new coronavirus, which does not support the hypothesis that the disease is related to the side effects of the new coronavirus vaccine.
Other causative factors are still being explored, for example, during the epidemic of new coronary pneumonia, the low level of adenovirus prevalence has increased the susceptibility of children; the emergence of new adenoviruses; adenovirus combined with new coronavirus infection; new coronavirus infection complicated Symptoms lead to the activation of immune cells mediated by superantigens, thereby causing multisystem inflammatory syndrome in children. The exploration of other pathogens is also underway, and non-infectious factors need to be further ruled out.
Most manifested as nausea, vomiting, diarrhea and other gastrointestinal symptoms
The Guidelines are clear and unclear Cause Severe acute hepatitis in children is an acute onset, mostly manifested as fatigue and anorexia, nausea, vomiting, diarrhea, abdominal pain and other gastrointestinal symptoms, followed by yellow-red urine, yellow-stained skin and sclera, and some children may have stool White color, liver enlargement, fever and respiratory symptoms, individual may have spleen enlargement. A small number of cases can progress to acute liver failure in a short period of time, with progressive aggravation of jaundice and hepatic encephalopathy.
There are currently no diagnostic criteria for confirmed cases. Suspected cases and epidemiologically related cases should be excluded from hepatitis caused by drugs, common non-hepatitis virus infections (such as Epstein-Barr virus, cytomegalovirus, etc.), autoimmune diseases, and genetic metabolic diseases.
In the diagnosis of acute liver failure, the “Guidelines” emphasize that suspected cases or epidemiologically related cases meet the following three criteria:
1. Acute onset of liver disease, No evidence of chronic liver disease;
2. Biochemical evidence of severe liver damage;
3. Coagulation abnormalities that cannot be corrected by vitamin K, and one of the following 2: (1. ) Prothrombin time (PT) ≥ 15s or International Standard Ratio (INR) ≥ 1.5, with hepatic encephalopathy; (2) PT ≥ 20s or INR ≥ 2, with or without hepatic encephalopathy.
The “Guide” reminds people to strengthen hand hygiene, pay attention to wearing masks and food hygiene, etc. In clinical work, medical staff need to take standard precautions and report suspected cases in a timely manner as required.
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