The main hypotheses point to a possible consequence of covid-19 and an infection by adenovirus or by another still unknown virus
In recent weeks, an increase in cases of severe hepatitis of unknown origin in children between 2 and 6 years of age has been reported in several countries. For example, about 4 cases per year are detected in Scotland each year, but now there are more than 13 in a couple of months.
So far, 74 cases have been reported in the United Kingdom, 3 in Spain (Madrid, Aragón and Castilla-La Mancha) and some cases are being investigated in Denmark, the Netherlands and the USA (the CDC reports 9 suspected cases in the state of Alabama). Possible cases since October that may have gone unnoticed are being reviewed.
Causes and symptoms
Hepatitis is an inflammatory disease that affects the liver. Its cause can be very diverse: infectious (viral or bacterial), immune (autoimmune hepatitis) or toxic (alcohol, toxic substances or drugs).
All children were healthy one week before diagnosis. The symptoms are the usual ones in this disease: abdominal pain, vomiting, diarrhoea, jaundice (yellow discoloration of the skin and mucous membranes), skin itching, dark colored urine and poorly pigmented stools.
So far there has been no death. Some have recovered, but others have had to be hospitalized and seven have even required a liver transplant (one of the Spanish cases).
What hypotheses are considered?
What is disconcerting is the increase in cases in a very short period of time, their severity and that the cause is not known, at the moment. There are several possibilities and hypotheses:
1. The first possibility: Hepatitis A, B, C and E viruses are ruled out because no sample has been positive for these viruses.
2. Some food, drink or toy poisoning. Toxins or poisons can affect the liver very seriously. At the moment it does not seem likely because no common link has been found between all the cases, but the possibility of a still unknown toxin is not ruled out.
3. Neither does it seem to be of bacterial origin, it does not present with a fever.
4. None of the children had been vaccinated against covid-19, so it is also ruled out that it is a possible secondary effect of the vaccine.
5. Some, not all, have tested positive for SARS-CoV-2. One hypothesis would be that coronavirus infection leaves children more vulnerable to other infections. Nor can a possible complication or sequel of covid-19 be ruled out.
6. However, the hypothesis that seems most likely for some researchers at the moment is that of an adenovirus infection. Half of the cases have tested positive for these viruses, which typically cause diarrhea, vomiting and flu-like symptoms.
In very rare cases, adenoviruses can cause fulminant hepatitis. It has been suggested that it could be a new, more aggressive adenovirus variant. Another possibility is that it was a common adenovirus but now has a more serious impact on children with weakened immune systems due to lack of exposure to other pathogens due to lockdowns and other measures during the pandemic.
7. Nor can we rule out that the cause is a virus not yet identified.
At the moment, all these cases are under investigation. As always, you should not panic and you have to act following the health recommendations.
This article has been published in The Conversation
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