The World Health Organization (WHO) has reported hundreds of cases of acute childhood hepatitis of unknown origin, which is why the institution has considered the disease an urgent and “top priority” issue.
Many of these cases may be associated with the Coronavirus super-antigen, according to the latest study published in the prestigious international academic publication The Lancet. It is a new hypothesis taken into account. But so far no clear link has been made.
“There are still several hypotheses being considered to explain the occurrence of cases of hepatitis of unknown cause, but especially severe forms, which quickly lead to liver failure and the need for liver transplantation,” said the president of the Center for Innovation in Medicine, Dr. Marius Geantă, for Ziare.com.
Why is it so difficult to find a cause of this disease
Although the number of cases is growing, it seems that scientists have not yet discovered the cause of these serious symptoms that can be fatal in some children.
“Although data are still being collected in several countries (both for new cases and individualized data for each case), the analysis is hampered by the unavailability of key information (for example, from liver biopsy; in the few cases where they have liver biopsy data were found to be non-suggestive of direct involvement of adenovirus 41F) or incomplete data (e.g., data on recent SARS-CoV-2 infection were taken into account, not data about an older infection, which has passed the acute phase) “, the specialist also mentioned.
What is the link between fulminant hepatitis and coronavirus super antigen?
“Why is it so important to have as much information as possible? In order to be able to eliminate or validate the working hypotheses “, the public health specialist also pointed out.
The expert also explained the possible link with the coronavirus super-antigen.
“A case study recently published in The Lancet, based on laboratory studies, suggests that many researchers find it plausible to explain why these fulminant forms of hepatitis occur in children who have been diagnosed with adenovirus 41F (but other data available to date have not supported or explained the mechanism by which fulminant hepatitis occurs, given that adenovirus 41F causes gastrointestinal as well as respiratory damage; fulminant hepatitis).
In the study, analyzes were performed that were not included in most of the previous research: SARS-CoV-2 analysis in faeces. After an acute SARS-CoV-2 infection, it is known that the virus can persist in the gut for a long time, even if the acute episode has subsided and the person has healed.
The study’s authors state that the presence of overlapping SARS-CoV-2 in the gut with an infection with 41F adenovirus (gastrointestinal damage) favors the emergence of a mechanism of excessive activation of immune cells, mediated by the so-called SARS-CoV-2 super antigen (in fragments of Spike protein that persist and accumulate in the gut, and the interaction with adenovirus 41F results in an exaggerated immune response, similar to that described in multisystemic inflammatory syndrome, which occurs in a minority of children in the acute phase of SARS-CoV infection. -2) “, the doctor also specified.
How the coronavirus super antigen works. It causes severe forms of the disease that can go as far as septic shock
The same study states that the intestinal SARS-CoV-2 superantigen has structural similarities to enterotoxin B secreted by Staphylococcus aureus. This causes an exaggerated and unspecific activation of the immune system, causing severe forms of the disease that can go as far as septic shock.
“If confirmed by other independent research, the data from the study published by The Lancet will prove to be extremely important from a diagnostic and therapeutic point of view, allowing a faster identification of cases and interventions that block the pathways of the exaggerated immune response, thus preventing complications, including fulminant hepatitis, ”the doctor explained.
Hepatitis is spreading globally
In recent weeks, there has been a significant increase in cases of hepatitis in children. Globally, about 450 children have been infected with the mysterious disease while 12 have lost their lives, according to the European Center for Disease Prevention and Control (ECDPC).
232 cases have been reported in Europe. 229 are classified as probable and three as epidemiologically related.
Of the 229 probable cases, 122 are cured, while 18 remain under treatment. The reports come from a total of 14 countries and cover: United Kingdom (131 cases), Spain (26), Italy (24), Belgium (12), Sweden (9), Denmark (6), Ireland (6) ), The Netherlands (6), Norway (5), Cyprus (2), Greece (2), Poland (1), Serbia (1), Slovenia (1).
Of the 143 reported cases, 22 (15.4%) were admitted to an intensive care unit.
Of the 98 cases for which this information was available, six (6.1%) received a liver transplant.
What hypotheses have been analyzed so far
Although no cause has been identified so far, adenovirus – a common family of infections responsible for colds to eye infections – could cause the condition. Of the 176 cases in the UK, approximately 126 were tested for adenovirus, of which 91 were detected (72%). Among the cases, adenovirus was detected mainly in the blood.
Other hypotheses and possible cofactors are being investigated. Most cases continue to be reported as unrelated sporadic cases.
However, adenovirus has only been detected in blood or plasma samples for many cases and also in low viral loads.
Thus, even the WHO noted that since “adenovirus has not yet been identified in the liver tissue samples analyzed and therefore may be a coincidence rather than a causal factor”.
The UK Health Security Agency (UKHSA) also detected SARS-CoV-2, the virus that causes Covid-19, in 24 of 132 cases with available results (18%).
The agency noted that “SARS-CoV-2 serological testing is ongoing”.
In a bizarre speech last week, UK health chiefs said they were also investigating whether “exposure to dogs” was to blame, The Guardian reported.
However, officials have not explained how the dogs may be to blame, but they are known carriers of adenovirus strains.
Symptoms of hepatitis of unknown cause
According to experts, so far the symptoms associated with this disease are the presence of jaundice (which translates into a high concentration of bilirubin in the blood), a situation that is accompanied by abdominal pain and vomiting that have led to liver failure that have suggested even studying the need for transplants.
In the same vein, other signs of the disease described by the health authorities are nausea, dark urine, light stools, and skin and eyes tend to turn yellow.
Regarding its contagion, it was pointed out that it can be associated with the acquisition of some of the other variants of hepatitis, denouncing that it has an acute connotation, due to the speed with which the inflammation appears and the symptoms begin to appear.
In this regard, it is important to note that in the case of variants A and E, they are associated with the ingestion or contact with food or water of people who already have the virus.
In the case of variants B, C and D, the contagion occurs through contact with fluids; including blood.
Regarding the possible presentation of symptoms, specialists refer to the importance of consulting experts, avoiding self-medication and ensuring rest conditions for the child.
In this regard, they also sound the alarm against the use of medicines such as Paracetamol, explaining that this could be risky, warning that if the liver is really affected, the body would process the substance as toxic.