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6 minutes
Acute hepatitis is an inflammatory process of the liver that responds to multiple causes. An increase in serious cases has been reported in some countries, so the alarms have gone off.
The European Center for Disease Prevention and Control (ECDC) reported in its report on the week 14dated April 8, which in the United Kingdom an increase in cases of acute hepatitis in children was detected. However, the origin of this childhood hepatitis has not been clarified.
Hepatitis, a pathology that affects the liver causing inflammation of the organ, has various causes. Among them are viral infections and intoxications, both by drugs and by toxins present in the environment.
What is the most common cause of childhood hepatitis?
There are several viruses capable of altering the functioning of the liver. For this reason, they are collectively known as hepatitis viruses either hepatotrophs. They correspond to viruses A, B, C, D or delta and E.
However, these come from different viral families. Although they affect liver tissue, not all do it in the same way.
On the other hand, there are more pathogens that have a certain predilection for liver tissue, but this is not so marked, so they are considered non-hepatotrophs. serve as differential diagnosis in acute childhood hepatitis:
- Cytomegalovirus (CMV).
- Epstein-Barr virus (EBV).
- Herpes simplex virus (HSV) 1 and 2.
- Varicella-zoster (VZV).
- Human herpes virus (HHV) 6 and 8.
Other causes of liver disease
In addition, there are situations that condition the appearance of an alteration in the liver. Other alternatives include the following:
- drug poisoningparacetamol being one of the most implicated drugs.
- vascular causes in patients with heart disease and arrhythmias.
- Obstructive pathologies of the bile duct.
- autoimmune involvement.
What are the symptoms of acute childhood hepatitis?
One of the most striking signs in acute hepatitis is jaundice., that is, the yellow tint of the skin and mucous membranes. However, this is not the first manifestation that appears, although it is usually the most evident.
In the early stages, symptoms are trivial and nonspecific, making diagnosis unlikely. Early clinical manifestations include the following:
- loss of appetite
- Fever.
- Fatigue.
- Muscle and abdominal pain.
- Nausea and vomiting.
- Diarrhea.
icteric phase
After a few days, the characteristic yellow coloration of hepatitis appears., which affects skin and mucous membranes. This dye is the product of the presence of a pigment: bilirubin.
This molecule requires the action of the liver for its transformation into substances that are easier to eliminate. Because of these changes, bilirubin can pass into the intestine, where it helps color stool.
In the same way, the blood circulation allows the transformed bilirubin to be carried to the kidney, where it is filtered into the urine. In acute hepatitis, the passage to the intestine presents an alteration, product of the inflammation of the hepatic tissue. That is why it accumulates in the bloodgiving a yellowish tint to the skin.
Because there is not enough pigment in the intestine, the stool cannot be stained properly, so it takes on a pale hue. This condition is called acholia. Likewise, since bilirubin is accumulated in the blood, there is a greater ease for it to filter into the urine, which constitutes the coluria.
How is acute childhood hepatitis diagnosed?
A thorough questioning should always be conducted which can direct the search towards probable cause. Although bilirubin values show some elevation, the tests that characterize acute hepatitis are determinations of transaminases.
These liver enzymes can be increased by more than 10 times. It is important to note that the severity of the hepatitis is not associated with this increase, so a high figure only allows the disease to be confirmed, but not classified as serious.
There are other tests that may be requested when evaluating a patient with acute hepatitis:
- Alkaline phosphatase.
- prothrombin time.
- Total, direct and indirect bilirubin.
- Gamma-glutamyltranspeptidase (GGT).
To confirm a causal agent, the determination of antigens and antibodies is available. specific to each of them. These serological studies can be requested, following the orientation of both the suspicion and the time of evolution of the pathology.
Is it possible to prevent hepatitis in children?
As the way in which the disease is acquired differs with each cause, transmission mechanisms have been grouped into two:
- Of food origin.
- Patent transmission.
Thus, recommendations can be promoted to prevent contagion. In addition, the vaccine against hepatitis A and B viruses is part of the childhood immunization schedule.
Fecal-oral transmission
This is the classic route of transmission described for acute hepatitis A and E viruses. The first is the most common in childhood.
In this mechanism, a person who excretes the viral particles in the feces, not washing your hands properly after having a bowel movement. Therefore, it is capable of contaminating different surfaces and foods, which are consumed by a different person.
Recommendations to prevent this contagion include the following:
- Drinking water consumption.
- Vigorous handwashing after going to the bathroom.
- Follow hygiene standards when handling and consuming food.
- Do not have intimate contact with a person who has hepatitis.
Other forms of transmission
In contrast, for hepatitis B, C and D viruses, transmission occurs through routes other than the digestive tract. In addition, these types usually have a chronic course.
This mechanism includes sexual contact. and any exposure of a skin or mucosal lesion with body fluids of an infected person.
Treatment
In global terms, often having a viral cause, management of acute hepatitis includes general care with rest in bed and diet to tolerance, as well as the approach of the symptoms that affect the patient.
However, the severity of the case could condition the need for hospital admission. There is no specific treatment for all acute childhood hepatitis.
Why has the cause of the childhood hepatitis outbreak not been determined?
Since the notification made by the United Kingdom about the increase in cases of severe acute hepatitis in children, it has been difficult to establish the cause. Especially since the common link is not found.
On the other hand, because hepatotropic viruses have already been ruled out as causal agents. Current research focuses on determining whether there are coincidental aspects among affected children, so that the search can be oriented.
This analysis becomes a bit more complex, because the outbreak has spread to other countries, without following an apparent pattern. As he does so, he puts more children at risk. The evolution has been serious, with cases that required liver transplantation and even one deceased patient.
All this panorama makes research a priority. At the moment, in addition to ruling out the classic hepatitis viruses, the presence of an adenovirus has been determined in some cases, while others were positive for SARS-CoV-2.
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