Acute hepatitis in children, what’s the matter?

A sudden increase in the number of cases of severe acute hepatitis of unknown cause (SAHUC) and acute liver failure in children was reported between October 2021 and May 2022 in adolescent populations in the United States and the United Kingdom. As of June 22, 2022, 920 cases of SAHUC have been reported. The pathogenesis of the disease is currently unknown, but at least 5% of cases require liver transplantation, and 2% of cases have died.

With timely detection, this acute hepatitis remains treatable, but a lack of understanding of the cause remains the greatest challenge facing pediatric health care providers today. Due to unclear causative factors, there is currently a lack of consensus on the definition of “confirmed cases”, which complicates the process of diagnosis and subsequent treatment.

Currently there is a lack of consensus on the definition of “confirmed cases”, which complicates the diagnosis and subsequent treatment process | Tu Wo Creative

In order to learn more about the specific incidence of SAHUC, Dr. Zhaorigtu, editor-in-chief of Pediatric Investigation, told PubMed, World Health The literature and data published on the websites of the organization, the UK’s Health Security Agency, the US CDC and the European Centre for Diseases were analysed and a review article published July 11 in Paediatric Survey aimed to understand SAHUC’s Key features, discussion of existing problems and initial recommendations for better understanding and control of the disease. “Physicians want to clarify the cause early and provide a specific, effective and safe medical plan to treat it.”

After analyzing fewer than 30 articles in the database, the Dr. Ri found that the main symptoms of SAHUC were jaundice, vomiting and diarrhea, and the symptoms of patients varied by geographical location. In terms of experimental markers, the patients’ liver enzymes, such as alanine aminotransferase and aspartate aminotransferase, as well as serum bilirubin were high in most cases. In addition, liver biopsy reports all showed varying degrees of liver inflammation. Therefore, SAHUC can be diagnosed by detecting the above indicators. The article also mentions that more sensitive detection and imaging techniques, such as computed tomography and ultrasound, can also be used to help diagnose conditions in the liver and biliary system more precisely.

In the diagnosis process, it is also important to exclude infections caused by known viruses, including various types of hepatitis viruses, cytomegalovirus, Epstein-Barr virus (EBV) Wait. Based on the current findings, although human adenovirus has been detected in multiple patients, its role in SAHUC pathogenesis is unclear. Additionally, only a small fraction of reported cases tested positive for SARS-CoV-2.

In summary, the article proposes several hypotheses about the induction of SAHUC, including exposure to cofactors that alter adenovirus activity or alter host immune responses, and COVID-19-induced immune deficiency, etc., but further research is needed to understand their role in the etiology of SAHUC.

What are the current treatment options? According to Dr. Zhaori, the existing treatment options are mostly limited to supportive and symptomatic treatments. However, in individual cases and symptoms, some drugs may act to delay the progression of the disease, such as the treatment of patients with high adenoviral load by antiviral drugs such as cidofovir or a combination of Chinese and Western medicines. The authors suggest that lessons learned from recent COVID-19 clinical trials should be applied to patients with antiviral therapy as early as possible, especially in the critical window period of 3 to 5 days after disease onset.

However, for patients who have developed liver failure, their only option is a liver transplant. “Clinical indicators are very important for patients who need liver transplantation. Pediatricians working in liver wards, intensive care units or community clinics should ensure that they are familiar with the basic indicators of organ transplantation, this will ensure that patients do not miss preparation and transplantation This is a critical period.”

Currently, research on SAHUC is still ongoing, and relevant units need to continue to monitor and report cases in a timely manner to better understand the disease. More information in the future will hopefully shed light on key early detection and effective treatments for the disease.


[1] Zhaori G. Severe acute hepatitis of unknown causes in children–Current findings, questions, opinions, and recommendations, a mini ‐review[J]. Pediatric Investigation, 2022. DOI:

[2] 959195

Compiler: Yin Chen

Editor: Jin Xiaoming< /span>

Typesetting: Yin Ningliu

Source of title map: worldofnic / CC BY-NC-SA (https://creativecommons .org/licenses/by-nc-sa/3.0)

Research Team< /p>

Corresponding Author Zhao Rigetu: Editor-in-Chief of Pediatric Investigation. Affiliated to the Pediatric Investigation Editorial Department of Beijing Children’s Hospital Affiliated to Capital Medical University, National Children’shealth Center. Former Pediatrician and Pediatric Researcher of Beijing Children’s Hospital. Before that, he served as Deputy Director of Beijing Pediatric Research Institute and Director of Virology Laboratory. He has served on the editorial board of “Chinese Medical Tribune” (CMT, 1996-2006), “Chinese Journal of Medicine” (English version, CMJ, 2006-2014), and “New England Journal of Medicine” (2007-2016).

Paper Information

< span>Published Journal Pediatric Investigation Pediatric Investigation

Published July 11, 2022

Title of the paperSevere acute hepatitis of unknown causes in children – Current findings, questions, opinions, and recommendations, a mini-review


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