Hepatitis in children: The Covid trace becomes stronger

What if Covid had something to do with it? A wave of cases of acute hepatitis in children worries health authorities. In a few weeks, at least 450 cases have been documented worldwide, of which 31 required liver transplantation and 11 died. The cause of this hepatitis, which mainly affects children under the age of five, is still unknown. The most likely suspect at the moment is adenovirus AD-41, known to cause gastroenteritis-like diseases in children, as it was traceable in the blood of most children who developed this hepatitis. But this trace is not yet very solid: primarily because this adenovirus usually does not affect the liver; also because it was not found in liver biopsies taken from these patients, suggesting that this organ was not directly infected with this virus. Another hypothesis being investigated is that of SARS-CoV-2 coronavirus, which is responsible for Covid-19. Hypothesis supported by recent studies suggesting that coronavirus would play an important role in the triggering of these hepatitis.

Covid in children may affect liver function

Several studies have already shown that Covid-19 can cause an increase in the concentration of several liver enzymes in the blood, especially alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as observed during a hepatitis. This observation has just been confirmed in children by researchers at Case Western Reserve University (Cleveland, USA) in a pre-print published online on May 14, 2022 (not yet peer review).

They compared a cohort of 245,000 children with Covid with a cohort of 550,000 children with other respiratory infections. After checking for several risk factors, such as age, weight and ethnicity, they found that the risk of liver damage was higher in Covid patients with abnormally high levels of these enzymes (ALT and AST) as well as bilirubin, a pigment that accumulates during hepatitis and causing jaundice (or jaundice). This increased risk was present for up to six months after infection, as the authors say, “suggests acute and prolonged hepatic consequences in pediatric Covid-19 patients “.

This liver effect can be severe

However, this liver damage in covid patients is usually insignificant, except in patients who already have a liver disease. But a study published in May in Journal of Pediatric Gastroenterology and Nutrition showed that these disorders can be severe even in patients without any particular history of liver disease. Doctors at the Children’s Hospital in Cincinnati (USA) have listed the case of a 3-year-old patient who developed autoimmune hepatitis after having a mild form of Covid.

This child, who was in good health before the infection, was hospitalized three weeks after Covid with fatigue and jaundice.

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