2023-05-07 15:37:36
Acute hepatitis is an inflammatory process in the liver that has multiple causes. An increase in serious cases has been recorded, which has raised alarm.
The European Center for Disease Prevention and Control (ECDC) reported in its 14-week report, dated April 8, thatan increase in cases of acute hepatitis in children has been seen in the UK. However, the origin of this infantile hepatitis has not been elucidated.
Hepatitis, a pathology that affects the liver causing inflammation of the organ, has various causes. Among them are viral infections and intoxications, both by drugs and by toxins present in the environment.
What is the most common cause of childhood hepatitis?
There are different viruses capable of altering the functioning of the liver. For this reason, they are collectively called hepatitis virus or hepatotropes. They correspond to viruses A, B, C, D or delta and E.
However, these come from different viral families. Although they all affect liver tissue, they do not do so in the same way.
On the other hand, there are pathogens that have a certain predilection for liver tissue, but this is not so marked; we therefore say that they are non-hepatotropic. They serve as a differential diagnosis in acute hepatitis in children:
- Cytomegalovirus (CMV)
- Virus d’Epstein-Barr (EBV)
- Herpes simplex virus (HSV) 1 and 2
- Varicella zoster (VZV)
- Human herpes virus (HHV) 6 and 8
Other causes of liver disease
Certain situations condition the appearance of an alteration of the liver. These are the following:
- Drug poisoningparacetamol being one of the most incriminated drugs
- Vascular causes in patients with heart disease and arrhythmias
- Obstructive pathologies bile ducts
- Affection auto-immune
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What are the symptoms of acute childhood hepatitis?
One of the most striking signs of acute hepatitis is jaundice : the skin and mucous membranes take on a yellow tint. It’s not the first manifestation, but it’s usually the most obvious.
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In the early stages, the symptoms are innocuous and non-specific, hence a generally late diagnosis. The early clinical manifestations are as follows:
- Loss of appetite
- Fever
- Fatigue
- Muscle and abdominal pain
- Nausea and vomiting
- Diarrhea
Jaundice phase
After a few days, the characteristic yellow color of hepatitis appears., affecting the skin and mucous membranes. This color is the product of the presence of a pigment: bilirubin.
This molecule requires the action of the liver for its transformation into substances that are easier to eliminate. Because of these changes, bilirubin can pass into the intestine, where it helps give stool its color.
The bloodstream allows processed bilirubin to be transported to the kidney, where it is filtered into the urine. In acute hepatitis, the passage to the intestine presents an alteration, due to inflammation of the liver tissue. This is why it accumulates in the blood, giving the skin a yellowish tint.
Since there is not enough pigment in the intestine, the stools take on a pale color. This condition is called acholia. And as bilirubin accumulates in the blood, it has a greater facility to flow out in the urine, which constitutes choluria.
How is acute childhood hepatitis diagnosed?
Thorough questioning should always be done to direct the search to a probable cause. Although the bilirubin values show some elevation, the tests that characterize acute hepatitis are the dosages of transaminases.
These liver enzymes can increase up to more than 10 timess. It is important to emphasize that the severity of hepatitis is not associated with this increase, so a high number can only confirm the disease, but not classify it as severe.
Other tests may be ordered when evaluating a patient with acute hepatitis:
- Phosphatase alcaline
- prothrombin time
- Total, direct and indirect bilirubin
- Gamma-glutamyltranspeptidase (GGT)
To confirm a causative agent, the determination of specific antigens and antibodies for each of them is available. These serological studies may be requested, depending on the orientation of both the suspicion and the time of evolution of the pathology.
Is it possible to prevent childhood hepatitis?
Since the mode of acquisition of the disease differs depending on the cause, the transmission mechanisms have been grouped into two:
- of food origin
- Overt contagion
Recommendations can thus be promoted to prevent contagion. In addition, the vaccine against hepatitis A and B viruses is part of the vaccination schedule for children.
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Fecal-oral transmission
This is the classic route of transmission described for the acute hepatitis A and E viruses. The first is the most frequent in children.
In this mechanism, a person who excretes virus particles in the feces does not wash their hands properly after voiding. As a result, it contaminates different surfaces and foods.
The recommendations to prevent this contagion are as follows:
- Drinking water consumption
- Vigorous hand washing after going to the toilet
- Observance of hygiene rules when handling and consuming food
- Do not have intimate contact with someone who has hepatitis
Other forms of transmission
For the hepatitis B, C and D viruses, transmission takes place by routes other than the digestive tract. In addition, these types usually have a chronic course.
sexual contact and any exposure of a skin or mucous membrane lesion with bodily fluids from an infected person are the other routes.
The treatment
Overall, since acute hepatitis is often of viral origin, management of acute hepatitis includes general care with bed rest and tolerated diet, as well as management of symptoms affecting the patient.
However, the severity of the case could determine the need for hospitalization. There is no specific treatment for all acute childhood hepatitis.
Why has the cause of the appearance of childhood hepatitis not been determined?
Since the UK reported an increase in cases of severe acute hepatitis in children, it was difficult to establish the causeespecially since there is no common link.
On the other hand, hepatotropic viruses have already been ruled out as causative agents. Current research aims to determine if there are coincidental aspects in affected children, so that research can be directed.
This analysis becomes a little more complex, since the epidemic has spread to other countries, without following an apparent pattern. This puts more children at risk. The evolution was serious, with cases that required a liver transplant and even a patient who died.
All this panorama makes research a priority. In addition to ruling out classical hepatitis viruses, the presence of adenovirus was determined in some cases, while others were positive for SARS-CoV-2.
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