TABLE 3.
Summary of data presented from United States, United Kingdom and European case series of children with AS-Hep-UA.
| Cohort and citation | Clinical outcomes | Liver histology | Microbiological investigations |
|---|---|---|---|
| 9 children with acute hepatitis in Alabama, United States; Baker et al. (2022); Gutierrez Sanchez et al. (2022) | 2/9 transplanted. No deaths | Liver biopsy from 6 patients: various degrees of hepatitis with no viral inclusions, no evidence of adenovirus (immunohistochemistry), no viral particles (electron microscopy) | > Whole blood: adenoviral RNA positive in all patients (adenovirus type 41 in 5 specimens) |
| > Other viruses detected: EBV, enterovirus/rhinovirus, metapneumovirus, RSV, human coronavirus OFC43 | |||
| 13 children (median age 3.9 years, M/F: 5/7) in Scotland; Marsh et al. (2022) | 1/13 transplanted. No deaths | No data | >5/13 children HAdV-positive by PCR (2 on throat swab, 2 in blood and 1 in stool) |
| >5/13 cases had a recent positive SARS-CoV-2 test | |||
| 270 children aged 10 and under; United Kingdom Health Security Agency (UKHSA Investigation into acute hepatitis, 2022) | 15/270 transplanted. No deaths | > Analysis of 6 explanted livers and 8 biopsies: Severity ranging from mild hepatocellular injury to massive hepatic necrosis, with non-specific inflammatory response | > Detection rate for adenoviral DNA: 170/258 (65.9%) |
| > No evidence of adenovirus on immunohistochemistry | >4.4% of cases were positive for SARS-CoV2 in 2 weeks prior to hospital admission | ||
| > One case underwent adenovirus PCR of liver tissue: negative | |||
| 65 children with severe hepatitis (n = 59) or PALF (N = 33) in European countries and Israel; de Kleine et al. (2022) | 4 transplanted 4 deaths | No data | > Adenovirus (n = 4), SARS-CoV-2 (n = 2), SARS-CoV-2 (n = 4), rotavirus (n = 1), influenza virus type A (n = 1), EBV (n = 2), enterovirus (n = 2), rotavirus (n = 2) |
| 5 patients with indeterminate paediatric acute liver failure (PALF)(Netherlands) Lexmond et al. (2022) | 4 transplanted patients | Pt 1: massive hepatic necrosis with periportal steatotic changes; no signs of inflammatory activity | Pt 1: HAdV DNA in stool and plasma |
| Pt 2: lobular disarray and spotty necrosis of remaining hepatocytes, moderate lymphocytic infiltrate | Pt 2: Plasma: HAdV DNA positive anti-SARS-CoV-2 IgG (past infection) | ||
| Pt 3: signs of hepatitis, predominantly portal, with extensive hepatocyte loss | Pt 3: anti-SARS-CoV-2 IgG (past infection) | ||
| Pt 5: portal and lobular inflammatory infiltrate with condensation and collapse of reticulin, some lobular disarray | Pt 5: Stool: HAdV DNA positive -recovered from SARS-CoV-2 infection 10 weeks before presentation | ||
| 28 children in United Kingdom Morfopoulou et al. (2022) | 5 transplanted patients | - no data | - AAV2 detected in explanted livers |
| - AAV2 detected in whole blood of 10/11 non-transplanted cases | |||
| - low levels of HAdV and HHV-6B in 5 explanted livers and blood from 15/17 and 6/9 respectively, of the 23 non-transplant cases tested |