Scotland recorded its first case of acute severe hepatitis of unknown etiology in children (ASHep-UA) on March 31, 2022. Since then, multiple cases have emerged worldwide, with a higher proportion of severe instances. The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) updated their websites in early April with diagnostic recommendations. As of May 27, 2022, the WHO reported 650 suspected cases across 33 countries, with at least 38 requiring liver transplants and nine fatalities. China has yet to report any cases but has issued trial guidelines for diagnosis and treatment based on global data.
Etiology and Pathogenesis
The WHO posits that while adenovirus infection might be a plausible cause for ASHep-UA, it typically causes mild, self-limiting gastrointestinal or respiratory infections in young children, insufficient to explain the severe clinical presentations observed. Most affected children globally have not received COVID-19 vaccines, suggesting the disease is unlikely linked to vaccination side effects.
Clinical Manifestation
The disease presents with acute onset, primarily characterized by asthenia, anorexia, nausea, vomiting, diarrhea, and abdominal pain. These symptoms are followed by jaundice, dark urine, yellowing of the skin and sclera. Some children may experience pale stools, hepatomegaly, fever, respiratory symptoms, and splenomegaly. In severe cases, rapid progression to acute liver failure can occur, marked by worsening jaundice and hepatic encephalopathy.
Treatment
Management should focus on comprehensive symptomatic and supportive care, close monitoring of condition changes, mental status assessment, laboratory indicator tracking, and prevention of complications. Patients with liver failure should be promptly transferred to specialized treatment centers.-Fineline Info & Tech
