According to media reports: Recently, many countries in Europe and the United States have reported cases of childhood hepatitis of unknown etiology, which has become another public health hotspot besides the new crown epidemic. As of April 23, the World Health Organization reported that a total of 169 unidentified hepatitis cases had been reported in 12 countries, and at least one child had died.
These children with hepatitis are basically between 1-16 years old, and 17 of them need liver transplantation.
According to the WHO survey results, the common cold virus adenovirus was detected in 74 cases, the new coronavirus was detected in 20 cases, and the two viruses appeared in 19 cases at the same time. As of April 23, about 10 percent of sick children required liver transplants.
In its risk assessment, WHO strong>organizationpoints out that adenovirus is currently considered a hypothesis of etiology, but this does not fully explain the severity of clinical symptoms . Other factors such as the reduced level of adenovirus transmission during the COVID-19 pandemic and the possible emergence of a new type of adenovirus require further investigation.
Recently, a new clinical study from Germanydisclosed Bimodal flares of acute hepatitis following 2 doses of Pfizer mRNA vaccine together (onset after both vaccinations).
The study was published on April 21 in the Journal of Hepatology, an international authoritative journal in the field of liver disease. Hepatology), author units include Freiburg University School of Medicine, Institute of Pathology, Technical University of Munich, Germany, German Cancer Society, etc.
So, is there a link between these unexplained childhood hepatitis cases and this new case of autoimmune hepatitis?
The male patient in the study was 52 years old and had no medical history other than hypothyroidism.
Jaundice developed 10 days after the first dose of mRNA vaccine, and liver function tests (LFT) showed acute mixed Hepatocellular/cholestatic hepatitis. 25 days of inoculation and hospitalization. The patient received a second dose of BNT162b2 vaccine 41 days later. After 20 days, the patient developed symptoms such as fatigue and nausea, and laboratory tests showed that he had a recurrence of acute mixed hepatitis. The patient was transferred to a tertiary care center for treatment 26 days after the second vaccination.
After autoimmune serological testing, the patient had mild hyperglobulin Blood test, antinuclear antibody (ANA), antimitochondrial M2 antibody (AMA-M2), and antismooth muscle antibody were borderline positive, while LKM antibody test was negative. The investigators then performed a liver biopsy from the patient and found that the patient’s hepatitis had moderate lymphoplasmacytic infiltration and foci of lobular necrosis and apoptosis. Symptoms are consistent with those of autoimmune hepatitis.
In addition, the researchers observed that the 52-year-old patient’s liver was Immune cells increased 5.3-fold.
It is worth noting that T lymphocytes in the patient’s liver tissue Clusters of cells (CD8) are the most abundant in its immune cells, which differs from typical autoimmune hepatitis. At the same time, B cells and plasma cells were relatively low in this patient, whereas B cells and plasma cells were more abundant in typical autoimmune hepatitis. Spatial analysis of the liver parenchyma of different immune cell subsets revealed more extensive immune cell infiltration in the periportal region of the patients. Although the patient’s B cells and plasma cells were mainly enriched in the periportal region of the liver, (CD8) T lymphocytes showed a pan-lobular distribution. Notably, patients had a high accumulation of cytotoxic (CD8) T cells, while levels of other granzyme B-expressing cells remained unchanged.
Mechanistically speaking, the symptoms of this 52-year-old patient are different For typical spontaneous immune hepatitis, vaccination with BNT162b2 may induce immune-mediated hepatitis through a cellular immune mechanism triggered. These results suggest that:T cells are responsible for this vaccine-related immunity A key pathogenic immune cell type in hepatitis, a new subtype of autoimmune hepatitis.
Judging from the currently known data, there are differences in the pathogenic factors currently attributed to the two, and it cannot be determined that there is a relationship between the two. Whether it is related needs further investigation.
It is worth noting that The new crown mRNA vaccine (BNT162b2) jointly developed by Pfizer and BioNTech is currently one of the most vaccinated vaccines in the world.This study suggests Pfizer mRNA vaccine may cause autoimmune hepatitis, worthy of attention.
Source: China Net, Fast Information, Beiqing Net
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