Acute severe hepatitis outbreak in children: a perfect storm. What do we know, and what questions remain?

During the first half of 2022, the World Health Organization reported an outbreak of acute severe hepatitis of unknown aetiology (AS-Hep-UA) in children, following initial alerts from the United Kingdom (UK) where a cluster of cases was first observed in previously well children aged <6 years. Sporadic cases were then reported across Europe and worldwide, although in most countries incidence did not increase above the expected baseline. There were no consistent epidemiological links between cases, and microbiological investigations ruled out known infectious causes of hepatitis. In this review, we explore the evidence for the role of viral infection, superimposed on a specific host genetic background, as a trigger for liver pathology. This hypothesis is based on a high prevalence of Human Adenovirus (HAdV) 41F in affected children, together with metagenomic evidence of adeno-associated virus (Adeno-associated viruses)-2, which is a putative trigger for an immune-mediated liver injury. Roles for superantigen-mediated pathology have also been explored, with a focus on the potential contribution of SARS-CoV-2 infection. Affected children also had a high frequency of the MHC allele HLA-DRB1*04:01, supporting an immunological predisposition, and may have been vulnerable to viral coinfections due to disruption in normal patterns of exposure and immunity as a result of population lockdowns during the COVID-19 pandemic. We discuss areas of ongoing uncertainty, and highlight the need for ongoing scrutiny to inform clinical and public health interventions for this outbreak and for others that may evolve in future

Pityriasis Rosea Associated with Pegylated Interferon Alfa and Ribavirin Treatment in a Patient with Chronic Hepatitis C

Background: Pityriasis rosea is an acute inflamatory skin disease that the etiology is unknown but some viral agents like human herpes virus-6 and 7 and drugs are suspected. Case report: A-58-year-old man with chronic hepatitis C was being followed up in our hospital. Pegylated interferon (PEG-IFN) alfa-2b (100 µg per week) and ribavirin (1000 mg/day) was started. In the third month of this treatment, the patient was diagnosed with pityriasis rosea (PR), which was confirmed by skin biopsy. PEG-IFN alfa-2b treatment for chronic hepatitis C was maintained and no therapy was given for PR. The lesions spontaneously improved within 5 weeks. Conclusion: Interferon and ribavirin have several cutaneous side effects. Our case is the first case of PR, emerged in a patient with chronic hepatitis C while receiving PEG-IFN alfa 2b and ribavirin

Fever of Unknown Origin After Cervical Spine Injury: Case Report

In cases with upper thoracal and cervical spine injury, it is difficult to distinguish fever based on autonomic dysfunction from that with infectious causes. Fever can be associated with autonomic dysfunction by eliminating all possible causes, primarily infectious and noninfectious diseases. We present a case with fever of unknown origin after cervical spine injury to call attention to autonomic dysfunction in the etiology of fever in such cases

Adherence to Nucleoside/Nucleotide Analogue Treatment in Patients with Chronic Hepatitis B

Background: Adherence to medication is an important aspect of preventing drug resistance and treatment failure in patients receiving nucleos(t)ide analogues for chronic hepatitis B. Aims: To assess adherence to nucleoside/nucleotide analogues in chronic hepatitis B treatment and to determine factors associated with non-adherence. Study Design: Cross-sectional study. Methods: The study enrolled 85 chronic hepatitis B patients who had been receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was completed by patients themselves, and adherence was evaluated based on patients’ self-reporting. The use of at least 95% of the drugs in the previous month was considered as adequate adherence. Results: Adherence was adequate in 82.4% of patients. Female gender (p=0.003), unemployment (p=0.041) and lower monthly family income (p=0.001) were related to lower adherence. Better adherence was significantly linked to adequate basic knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than 12 months (p<0.001), previous use of other medications for chronic hepatitis B (p=0.014) and regular follow-up by the same physician (p<0.001). Conclusion: Counselling patients about their disease state and the consequences of non-adherence is an important intervention for enhancing adherence. Naïve patients should be followed up more frequently to reinforce adherenc

Epidemiologic, Clinical and Laboratory Features of Pandemic Influenza (H1N1) 2009 Virus Infection

Introduction: After the definition of the first H1N1 case on 15 April 2009, the first case in our country was reported on 15 May 2009, and the first local case was seen on 18 June 2009. In this study, we evaluated patients hospitalized with a pre-diagnosis of H1N1 virus infection, according to epidemiologic, clinical and laboratory features. Materials and Methods: Cases hospitalized between October 2009 and January 2010 with a pre-diagnosis of pandemic influenza and for whom samples of nasal and oropharyngeal swabs were obtained were included in the study. Epidemiologic and laboratory properties of the cases (for both H1N1 positive and H1N1negative groups) were evaluated, as well as their prognoses and treatment. Results: Between October 2009 and January 2010, 155 patients with pre-diagnoses of H1N1 were hospitalized. Eighty-four H1N1 positive and 71 H1N1 negative patients were evaluated. Cough, fatigue and fever were the most frequently observed symptoms. Obesity, fatigue and diarrhea were more common in the H1N1 negative group. Abnormal chest X-ray, lymphopenia and leukopenia were more common in the H1N1 positive group. The fatality rate was determined as 7.1%. 21.4% of the patients (18/84) required intensive care. Twelve patients were monitored with invasive and 3 with non-invasive mechanical ventilation. None of the patients in the H1N1 negative group required intensive care. In the H1N1 positive group, 69 patients received oseltamivir and 47 patients received oseltamivir and antibiotherapy. Conclusion: The new pandemic influenza virus came under the spotlight because of its fast spread and the complications seen in young patients with no comorbidities, where normally influenza-related complications are not expected. The majority of our cases were young adult patients. Most of the cases hospitalized with H1N1 diagnosis had symptoms similar to pneumonia, low oxygen saturation and deterioration in their general condition. Antiviral treatment initiated during the early phases of the disease was successful. Respiratory support and intensive care play a vital role in the cases in which they are needed. Informing the population about the disease and educating them on its transmission and immunization are very important in preventing its spread

Remdesivir treatment for patients with moderate to severe COVID-19

Background/aim: Remdesivir, which was first developed for the treatment of Ebola disease but failed to meet expectations, has become hope in the fight against the COVID-19 pandemic. This study aimed to evaluate risk factors for mortality and prognosis of adult moderate/severe COVID-19 patients treated with remdesivir, and safety and tolerability of 5 days of remdesivir treatment