The new 'suspect' of the mysterious wave of hepatitis

Besides the adeno virus, many people believe that mysterious hepatitis is a long-lasting Covid-19 symptom. Experts began to find common ground among the cases.

According to the most recent report of the World Health Organization (WHO), there are currently at least 348 cases of mysterious hepatitis in children globally. From the moment the first cases appeared, what caught the attention of medical professionals about this epidemic was that the culprit was not the common hepatitis virus or any other obvious source.

Then scientists began to focus their attention on adenoviruses, which are found in a large number of pediatric patients. But that is not the final answer. Because there are too many holes to conclude that the cause of the mysterious hepatitis is adeno.

After more than a month of discovering the first case, once again, the clues led scientists to turn to a new suspect. That is the theory that mysterious hepatitis is a symptom of prolonged Covid-19.

The link between Covid-19 and mysterious hepatitis

According to CBC Canada, in mid-May, experts in the US published findings in the Journal of Pediatric Gastroenterology and Nutrition about the analysis data of a 3-year-old girl with mysterious hepatitis. The baby had acute liver failure a few weeks after recovering from a mild form of Covid-19.

Dr Anna Peters, a pediatric gastroenterologist at Cincinnati Children's Hospital Medical Center, lead author of the study, said: 'This baby had a liver biopsy and blood test that were consistent with an inflammatory type of inflammation. Autoimmune liver can be activated by nCoV infection'. She said that it is not possible to prove that Covid-19 directly causes hepatitis in this case, but it is possible that the virus triggered an "abnormal immune response", which then attacked the liver.

Many children, including newborns, are in critical condition because of mysterious hepatitis. (Photo: The Financial Express).

"I think it's important for doctors to understand this is a rare condition that can happen during or after Covid-19. We need liver testing in patients who don't fully recover. Parents don't either. should panic, but see the pediatrician if the child is sick. Timely diagnosis and treatment is the key to the child's recovery,' added Dr. Anna.

The author of the study also said that the baby in this case recovered from the disease after a period of treatment, without the need for a liver transplant. However, the situation is likely to be similar in cases reported in the UK and many other countries.

Israeli doctor, doctor, Yael Mozer Glassberg, once told CBC News that Schneider Children's Medical Center where she works has treated at least 8 children with hepatitis of unknown cause from February 2021. This was before the WHO received the warning about this wave of disease (October 2021).

When analyzing these cases, the only thing in common was that all eight children had a history of Covid-19. They determine this through serological testing and taking medical history from relatives. None of the children tested positive for adenovirus.

A research result that also caught the attention of world experts was the discovery from Indian scientists. Their study assessed whether Covid-19 may have caused dozens of mysterious hepatitis cases of unknown cause in children in Central India between April and July 2021. The authors assessed 475 children who tested positive for nCoV across India. In which, 47 children have severe hepatitis.

In particular, 10 children with multisystem inflammatory syndrome (MIS-C) should be excluded. The remaining 37 cases are classified as child-related hepatitis with Covid-19 (CAH-C).

Assoc. Prof. Dr. Sumit Rawat, Bundelkhand Medical College in Madhya Pradesh, India, lead author of the study, said: "The common factor that we found was that all children were infected or had a history of the disease. Covid-19. We did an antibody test for nCoV in these children. All had antibodies."

Indian researchers also looked for other common causes behind 37 cases of severe acute hepatitis such as hepatitis A, C, and E viruses and many other diseases such as varicella-zoster virus, herpes and cytomegalovirus (CMV). . But they found nothing that could reasonably explain the symptoms.

17 samples were analyzed and only 3 were positive for adeno - showing very thin evidence. According to Assoc. Prof. Dr. Sumit Rawat, it takes a lot of time to prove that Covid-19 causes mysterious hepatitis. He said the most important suggestion at this point is that mysterious hepatitis cases seem to decrease when Covid-19 stops spreading. But every time the Covid-19 wave increases, so does the number of mysterious hepatitis cases.

Adeno is the leading suspect that experts say may have caused the mysterious wave of hepatitis. (Photo: BSIP/Universal Images Group).

Adenovirus is still the leading theory in the UK

Dr Philippa Easterbrook, the WHO's lead scientist, said she had changed her mind after several more plausible theories about the suspect causing the mysterious hepatitis were put forward by the UK Health Security Agency. .

"The leading hypotheses are still related to the adeno virus, but I think it is also worth considering the role of Covid-19 as a co-infection or a precondition for this condition," the expert said.

In the UK, more than 170 cases have been reported in children under the age of 16 since January 1. 11 children need a liver transplant. About 70% tested positive for adeno virus and less than 20% were positive for nCoV.

The UK Health Security Agency (UKHSA) is also doing serological tests, to see if samples contain antibodies from a previous Covid-19 infection. In Europe, according to the ECDC report, 74% of samples tested have nCoV antibodies.

Experts in the UK are studying many theories that cause mysterious hepatitis. It is possible that the child has a common adenovirus infection but is unusually severe because he has not been exposed to the virus during the pandemic. Or this is a particularly large episode of infection that makes a rare complication common. Another theory is that hepatitis is the body's response when a child is co-infected with nCoV with adeno or is a sequelae of Covid-19.

Dr. Jordan Feld, Western Toronto Hospital Liver Clinic, Canada, emphasized that adenovirus can cause mild illness in many people, but, there are still cases where a small group of people become severe. This is similar to the situation where some people with Covid-19 have no symptoms but others are in critical condition.