Spotlight on cases of acute hepatitis of unknown etiology in children, on symptoms and hypotheses and on the identikit of pediatric patients. “Adenovirus infections are common and usually cause a mild illness, with symptoms similar to colds, vomiting and diarrhea – highlights the circular of the Ministry of Health, signed by the general director of Health Prevention Giovanni Rezza – Most of the infected people do not presents complications Adenovirus they do not commonly cause hepatitis, which is a rare complication usually known among immunocompromised individuals. It could be hypothesized or the appearance of a new variant in circulation that it causes severe hepatitis in children, or that a variant commonly in circulation is affecting mainly younger children perhaps immunologically unprotected in relation to the reduced circulation of Adenovirus during the Covid-19 pandemic “.
“The health authorities who are investigating in the United Kingdom, where most of the cases have occurred to date, believe, based on the clinical and epidemiological characteristics of the cases in question – the circular reports – that an infectious cause is the most likely , and in particular Adenovirus infection “.
PATIENT IDENTIKIT TO REPORT – Age: less than 10 years, a negative test for hepatitis A, B, C, D, E viruses, and greatly altered values of the enzymes that signal liver pain. It is the identikit that must activate an alarm bell, because – if these characteristics were found in a patient who came to the attention of doctors in 2022 – we could find ourselves in front of a confirmed case of “acute hepatitis of unknown etiology in pediatric age “such as those on which the international spotlight has turned on in recent days for alerts issued after unusual peaks recorded in some countries, such as England.
To give the case definitions for surveillance is the circular issued by the Ministry of Health. These are provisional definitions based on early indications from the World Health Organization. The document lists both the characteristics of the case to be classified as “confirmed” and those of the patient to be considered as a “possible case”. The confirmed case criteria are: patient aged 10 years or less who has acute hepatitis (with negative test for hepatitis A, B, C, D, E viruses) with the value of specific enzymes, “aspartate aminotransferase (AST) or alanine aminotransferase (ALT), higher than 500 U / L “. The date on which to discriminate cases is also significant, ie starting from “January 1, 2022”.
Instead, it falls within the case of “possible case” the patient “aged 11-16 years, presenting with acute hepatitis (with negative test for liver viruses A, B, C, D, E)” and with the same peaks in the values indicating hepatic suffering, again from January 2022. Then there is the “epidemiologically related case”, who is a patient of any age with the acute hepatitis criteria outlined, “close contact of a confirmed case, as of January 1, 2022”. These definitions, it is explained in the circular, will be updated on the basis of WHO indications. And “both the number and the classification of cases may change as a result of new reports, new diagnostic tests, or changes in the case definition”.
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