Hepatitis and covid in childhood, this is how infection causes liver disorder in children

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While worldwide hepatitis cases are already around 700, the researchers laid the foundation for a hypothesis that looks at SARS-CoV-2 as a trigger.

The exterior of St Thomas' Hospital in London.
The exterior of St Thomas’ Hospital in London.Andy RenEFE

Already registered worldwide About 700 children with childhood hepatitis of unknown originAccording to the World Health Organization (WHO). Of 650 cases, we must regret nine deaths, According to the latest bulletin from the Coordination Center for Health Alerts and Emergencies (CCAES) in Spain, 30 minors have been counted whose records are being scrutinised. Of these, 26 are under 10 years of age and no link has been found between them. In addition, there are five infections with pending results and the other six files have been omitted: four of them due to other pathology and two because the onset of symptoms occurred in December 2021.

whereas Physicians continue to retrospectively study cases of infection of unknown origin in minorsResearchers are narrowing down its possible causes. Following the hypothesis of adenovirus 41F, which gained strength in the United Kingdom but was not shared by all countries, another has been established: co-infection of SARS-CoV-2 with adenovirus. “now One of the options we initially considered has already been developed: Combination of covid plus adenovirus”, explains EL Mundo Antonio Rivero-Jurez, a researcher at CYBERINFAC (which focuses the CIBER infectious disease area) and the infectious diseases unit of the Reina Sofia University Hospital and the Maimonides Biomedical Research Institute of Cordoba (Imibic) tells.

This is the development of the hypothesis How the existence of a cofactor superseded the virus’s pre-existence, “They have established that the coronavirus has been latent in children: there were some in the digestive tract virus reservoir that, when exposed to other pathogens, such as adenoviruses, have multiplied the strength of their disease mechanisms”, Rivero-Jurez explains.

from an editorial in the magazine Lancet Gastroenterology and Hepatology, this option is placed on the Table. Peter Brodin, from the Department of Immunology and Inflammation at Imperial College London, and Moshe Arditi, from the Department of Pediatrics, Department of Infectious Diseases and Immunology at Cedars Sinai Medical Center in Los Angeles, explain in the article that “SARS-CoV-2 was identified in 18% of cases reported in the UK and in 11 (11%) of 97 cases in England with available data who tested positive for SARS-CoV-2 upon entry; Three other cases tested positive in the eight weeks prior to admission.”

One of the drawbacks of this new theory is that “Serological test was not done to check the marks of Kovid on the body of all the children, And there’s also no study to prove that the coronavirus was lurking in their digestive tract.” Nevertheless, the article’s signers speculate that “ongoing serological testing is likely to show a higher number of children with severe acute hepatitis.” and past or current infections. by SARS-CoV-2. Eleven out of 12 Israeli patients were reported to have Covid-19 in recent months, and the majority of hepatitis cases were in patients who had to be vaccinated against the coronavirus.

How does COVID interfere with the development of rare childhood hepatitis?

As such, new clues about these rare cases of hepatitis bet on the fact that SARS-CoV-2 infection can lead to the formation of a viral reservoir. ,SARS-CoV-2 viral persistence in the gastrointestinal tract can lead to repeated release of viral proteins Through the intestinal epithelium, leading to immune activation. Such repeated immune activation may be mediated by the motif of superantageno SARS-CoV-2 within the spike protein that resembles staphylococcal enterotoxin B triggers widespread and non-specific T-cell activation. This superantigen-mediated activation of immune cells has been proposed as a causal mechanism of multisystem inflammatory syndrome in children.”

In this case, Federico Martín-Torres, member of the World Health Organization (WHO) Vaccine Advisory Committee and head of pediatrics at the University Clinical Hospital in Santiago, explains that “What they put forward is a new hypothesis based on the mechanism of superantigens.“And here it is related to multisystem inflammatory syndrome in children, which is a severe form of COVID in this population.” the picture that happened in the children and Brodin’s group previously addressed the causal mechanism, it may be an overactivation of the immune system. or mediated by cellular or superantigens”. Martin-Torres recalls that this is a new theory and that while there is still no evidence on the validity of this over others, “nothing changes yet about the alert, including Cause continues to work”.

To this clarification by Brodin and Arditi, a more recent editorial from the same journal’s titles has been added. lancet infectious disease, which reviews the answers to the current hepatic infectivity mystery. “Not everyone is convinced of the adenovirus hypothesis”, explains the article in line with the explanation that Rivero-Jurez has given on more than one occasion. ,Adenovirus subtype 41 previously associated with only mild to moderate gastrointestinal symptoms“, he explains. And he says that “other infectious causes are being investigated, including the role of SARS-CoV-2.”

The rationale is based on the fact that the reduction in reports of new cases of pediatric hepatitis of unknown cause in the UK in the two weeks prior to 6 May has been observed to coincide with a decrease in SARS-CoV-2 cases. “The UKHSA (UK Public Health Agency) reported that serological investigations were ongoing, and Baker and colleagues reported that none of the children in Alabama had a documented history of SARS-CoV-2 infection. These cases of hepatitis in children were contagious. Following the sequence are SARS-CoV-2, which may fit under the umbrella of multisystem inflammatory disease.”

Furthermore, Martin-Torres clarifies that “It doesn’t seem like cases are increasing in our environment [se han sumado 4 en estudio en dos semanas], In the active search and retrospective analysis of all globally visible and reported cases, caution should be exercised, as there may be infections that were already present prior to the alert that were not reported.”

Martin-Torres put it on the table to see if there is no clear marker to see if the data on these cases is worrying, as this type of pediatric infection had not been recorded before. We have to look for a more specific, At least 38 of the affected children (6% of the total) required a transplant and nine died. from the disease, says the international organization.

“What is clear is that the most reliable system is the strictest: hair transplant control, One percent of this group needs it, so as long as the number of such interventions does not increase compared to the childhood years, it will serve to send a message of peace,” emphasizes the head of pediatrics.

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