Between October 2021 and May 2022, in the United States and the United Kingdom, doctors recorded a sudden increase in the incidence of severe acute hepatitis of unknown etyology and severe liver failure . 920 cases were reported worldwide as of June 22, 2022. 920 cases of disease of unknown origin and at least 5 per cent of the total number of cases required liver transplantation and 2 per cent died.
What's the problem?
Despite the fact that SAHUC can be treated in a timely manner, the biggest problem for pediatricians remains the lack of clarity in its ethology; the lack of consensus to identify true confirmed cases further complicates diagnosis and follow-up treatment.
To understand the nature of SAHUC, Getu Jaori, editor-in-chief of Pediatric Investment and Doctor of Science, undertook an extensive review of literature available on PubMed, websites of the World Health Organization, the British Health Agency, the U.S. CDC and the European Center for Disease Prevention and Control, all of which was collected in a mini-review published in the magazine Pediatric Investment.
"This review — an attempt to understand the main characteristics of SAHUC, as well as to raise important issues about the disease and discuss preliminary recommendations for better understanding and control" explains the author of the new paper.
Main symptoms and tests
After studying 30 articles from the databases, the scientist found that the main symptoms observed by scientists were jaundice, vomiting and diarrhoea, but they varied according to the geographical location of the patients. With regard to the SAHUC laboratory markers, in most cases liver enzymes, such as alaninamine and asparathamine transferase, as well as serum bilrubin, were at a high level, and liver biopsy reports showed varying levels of inflammation.
The results of the study demonstrate the suitability of using these tests for SAHUC diagnostics. The reviewer also suggests the use of more sensitive laboratory tests and visualization techniques, such as computer tomography and ultrasonic liver and gill system studies, to provide a more accurate diagnosis.
Method of exclusion
The pediatrician also stresses that it is important to eliminate, in diagnostics, infections caused by known viruses that may cause similar symptoms, including hepatitis A, B, C, E; cytomegalovirus; Epstein-Barra virus and others. It turns out that although several patients have detected adenovirus, its role in the pathogenesis of SAHC remains unclear, and that a small part of the reported cases has had a positive impact on SARS-COV-2.
So there are several hypotheses about the causes of the disease, including co-factors that modify the activity of the adenovirus, co-factors that change the owner's immune response, and the immune deficiency caused by COVID-19. But further research is needed to understand their role in the Ethyology of SAHUC.
How do you treat it?
The treatment options available are mostly limited to supportive and symptomatic therapy, but in some cases doctors have been able to delay the progress of the disease by treating cases with high adenovirus loads of antiviral drugs such as cydophiles or by using a combination of Western and traditional Chinese drugs. Based on the experience of COVID-19 treatment, the reviewer recommends the use of antiviral therapy at an early stage, from 3 to 5 days after the onset of the disease.
However, for patients with liver failure, liver transplantation is the only treatment option. "The evidence for liver transplantation is very important. The pediatricians working in the hepatological ward, intensive care unit or local clinics must be familiar with the basic evidence for transplantation. This ensures that they do not miss critical time to prepare the patient and perform the transplant itself." The scientist concludes.
What's the outcome?
Experts around the world are currently conducting research on SAHUC, but a better understanding of etiology requires careful surveillance and timely reporting to scientists of all new cases of disease. Biologists hope that additional information will shed light on the early identification of SAHUC and the development of effective therapeutic approaches.