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. Author manuscript; available in PMC: 2023 Aug 18.
Published in final edited form as: N Engl J Med. 2022 Jul 13;387(7):620–630. doi: 10.1056/NEJMoa2206294

Table 1.

Demographic and Clinical Characteristics of Nine Patients with Acute Hepatitis and Human Adenovirus Viremia, Alabama, October 2021-February 2022.*

Characteristic Value (N = 9)
Demographic characteristics
Age at admission — no. (%)
 0–2 yr 5 (56)
 3–4 yr 1 (11)
 5–6 yr 3 (33)
Sex — no. (%)
 Female 7 (78)
 Male 2 (22)
Race — no. (%)
 White 9 (100)
 Other 0
Ethnic group — no. (%)
 Hispanic 6 (67)
 Non-Hispanic 3 (33)
Clinical characteristics
Reported symptoms at admission — no. (%)
 Emesis 7 (78)
 Diarrhea 6 (67)
 Fever 5 (56)
 Fatigue 4 (44)
 Upper respiratory symptoms 3 (33)
 Poor appetite 3 (33)
 Dark urine 2 (22)
Findings on initial physical examination — no. (%)
 Scleral icterus 8 (89)
 Hepatomegaly 7 (78)
 Jaundice 6 (67)
 Hepatic encephalopathy 1 (11)
 Splenomegaly 1 (11)
 Ascites 0
Median liver-function measures at admission (range)§
 ALT — U/liter 1724 (602–4696)
 AST — U/liter 1963 (447–4000)
 Total bilirubin — mg/dl 7.0 (0.2–13.5)
 INR 1.2 (1.0–7.3)
 Ammonia — μmol/liter 73 (49–85)
Median peak liver-function measures (range)§
 ALT — U/liter 1724 (602–4696)
 AST — U/liter 1963 (447–4000)
 Total bilirubin — mg/dl 7.0 (0.2–28.8)
 INR 1.3 (1.1–9.1)
 Ammonia — μmol/liter 64 (49–210)
Pathogen tests
 Adenovirus whole-blood qPCR — no. positive/no. tested (%) 9/9 (100)
  Median human adenovirus viral load at admission (range) — copies/ml 11,060 (991–70,680)
  Median peak human adenovirus viral load (range) — copies/ml 11,130 (991–156,400)
 EBV blood qPCR — no. positive/no. tested (%) 6/9 (67)
  Median EBV level at admission (range) — IU/ml 1680 (80–2240)
 HHV-6 blood qPCR — no. positive/no. tested (%) 1/9 (11)
 CMV blood qPCR — no. positive/no. tested 0/7
 HSV blood qPCR — no. positive/no. tested 0/6
 Enterovirus blood PCR — no. positive/no. tested (%) 2/7 (29)
 Hepatitis A, B, and C virus testing — no. positive/no. tested 0/9
 Respiratory panel tests — no. positive/no. tested (%)**
  Enterovirus or rhinovirus 4/8 (50)
  Human metapneumovirus 1/8 (12)
  Respiratory syncytial virus 1/8 (12)
  Human coronavirus OC43 1/8 (12)
  Human adenovirus 1/8 (12)
  SARS-CoV-2†† 0/9
 Liver-biopsy tests — no. positive/no. tested (%)
  Enterovirus tissue PCR 0/6
  SARS-CoV-2 tissue PCR 0/6
  Human adenovirus tissue PCR‡‡ 3/6 (50)
*

To convert the values for bilirubin to micromoles per liter, multiply by 17.1. CMV denotes cytomegalovirus, EBV Epstein-Barr virus, HHV-6 human herpesvirus 6, HSV herpes simplex virus, INR international normalized ratio, and qPCR quantitative polymerase chain reaction.

Race and ethnic group were reported by the patients’ parents or guardians.

Upper respiratory symptoms included nasal congestion, nasal discharge, cough, sore throat, wheezing, and dyspnea, among other symptoms.

§

Normal ranges are as follows: alanine aminotransferase (ALT), 9 to 25 U per liter; aspartate aminotransferase (AST), 21 to 44 U per liter; total bilirubin, 0.1 to 1.0 mg per deciliter; and ammonia, 18 to 72 μmol per liter.

The laboratory has a maximum reported AST level of 4000 U per liter; two of the patients had this maximum value.

Patients were tested for hepatitis A IgM, hepatitis B surface antigen, hepatitis B core IgM, and hepatitis C antibody.

**

The respiratory viral panels (ePlex Respiratory Pathogen Panel [GenMark] and BioFire Respiratory Panel [Biomérieux]) tested for adenovirus, coronavirus (229E, HKU1, NL63, and OC43), human metapneumovirus, human rhinovirus or enterovirus, influenza A, influenza A/H1, influenza A/H1–2009, influenza A/H3, influenza B, parainfluenza 1, parainfluenza 2, parainfluenza 3, parainfluenza 4, respiratory syncytial virus A, respiratory syncytial virus B, Chlamydia pneumoniae, Mycoplasma pneumoniae, Bordetella parapertussis (BioFire only), and Bordetella pertussis (BioFire only). Specimens were obtained with a nasopharyngeal swab.

††

All patients were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the use of nucleic acid amplification tests.

‡‡

Two of six patients (33%) were positive for human adenovirus in formalin-fixed, paraffin-embedded (FFPE) liver tissue, and two of three patients (66%) were positive for human adenovirus in fresh-frozen liver tissue. One patient was negative in FFPE tissue but positive in fresh-frozen tissue. This resulted in a total of three patients who were positive for human adenovirus by polymerase-chain-reaction (PCR) testing of either FFPE or fresh-frozen liver tissue.