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Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic

The 2022 worldwide epidemic of acute hepatitis and liver failure in young children has led to a focus on unusual causes for childhood acute hepatitis. In the UK epidemic, human herpes virus subtype 6B (HHV-6B) was detected along with adenovirus subtype-41F in severely affected children, especially i...

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Autores principales: Warner, Suz, Brown, Rachel M., Reynolds, Gary M., Stamataki, Zania, Kelly, Deirdre A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169701/
https://www.ncbi.nlm.nih.gov/pubmed/37181429
http://dx.doi.org/10.3389/fped.2023.1143051
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author Warner, Suz
Brown, Rachel M.
Reynolds, Gary M.
Stamataki, Zania
Kelly, Deirdre A.
author_facet Warner, Suz
Brown, Rachel M.
Reynolds, Gary M.
Stamataki, Zania
Kelly, Deirdre A.
author_sort Warner, Suz
collection PubMed
description The 2022 worldwide epidemic of acute hepatitis and liver failure in young children has led to a focus on unusual causes for childhood acute hepatitis. In the UK epidemic, human herpes virus subtype 6B (HHV-6B) was detected along with adenovirus subtype-41F in severely affected children, especially in those requiring liver transplantation (LT). The lifting of COVID lock-down measures has coincided with the rise in these common childhood infections with a higher than expected rate of systemic complications. The sudden exposure of young children to common childhood infections from which they were protected during the pandemic may have induced an abnormal immune mediated response potentiated by multiple pathogen exposure. Primary HHV-6 infection is one such common childhood infection. Classically known as Roseola infantum due to the appearance of a widespread erythematous rash on fever subsidence (exanthema subitem), it has a peak incidence of 6–12 months of age and almost all children will have been infected by age 2. It is the virus most frequently associated with febrile convulsions but the more serious complications of hepatitis and liver failure are rare. We report on the historic cases of three female infants who had suspected primary HHV-6B infection, acute hepatitis and rapid progression to acute liver failure (ALF) requiring LT. Appearances of their native liver were identical to those described in children in the recent hepatitis epidemic. Deteriorating clinical trajectories of recurrent graft hepatitis and rejection-like episodes followed and all three succumbed to graft failure with HHV-6B detected posthumously in their liver allografts. Our case series and the serious complications observed with the recent rise in common childhood infections is a reminder that these routinely encountered pathogens can be deadly especially in the young immunologically untrained. We advocate for HHV-6 to be screened for routinely in children with acute hepatitis and the use of effective HHV-6 anti-viral prophylaxis to prevent recurrence post-transplant.
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spelling pubmed-101697012023-05-11 Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic Warner, Suz Brown, Rachel M. Reynolds, Gary M. Stamataki, Zania Kelly, Deirdre A. Front Pediatr Pediatrics The 2022 worldwide epidemic of acute hepatitis and liver failure in young children has led to a focus on unusual causes for childhood acute hepatitis. In the UK epidemic, human herpes virus subtype 6B (HHV-6B) was detected along with adenovirus subtype-41F in severely affected children, especially in those requiring liver transplantation (LT). The lifting of COVID lock-down measures has coincided with the rise in these common childhood infections with a higher than expected rate of systemic complications. The sudden exposure of young children to common childhood infections from which they were protected during the pandemic may have induced an abnormal immune mediated response potentiated by multiple pathogen exposure. Primary HHV-6 infection is one such common childhood infection. Classically known as Roseola infantum due to the appearance of a widespread erythematous rash on fever subsidence (exanthema subitem), it has a peak incidence of 6–12 months of age and almost all children will have been infected by age 2. It is the virus most frequently associated with febrile convulsions but the more serious complications of hepatitis and liver failure are rare. We report on the historic cases of three female infants who had suspected primary HHV-6B infection, acute hepatitis and rapid progression to acute liver failure (ALF) requiring LT. Appearances of their native liver were identical to those described in children in the recent hepatitis epidemic. Deteriorating clinical trajectories of recurrent graft hepatitis and rejection-like episodes followed and all three succumbed to graft failure with HHV-6B detected posthumously in their liver allografts. Our case series and the serious complications observed with the recent rise in common childhood infections is a reminder that these routinely encountered pathogens can be deadly especially in the young immunologically untrained. We advocate for HHV-6 to be screened for routinely in children with acute hepatitis and the use of effective HHV-6 anti-viral prophylaxis to prevent recurrence post-transplant. Frontiers Media S.A. 2023-04-26 /pmc/articles/PMC10169701/ /pubmed/37181429 http://dx.doi.org/10.3389/fped.2023.1143051 Text en © 2023 Warner, Brown, Reynolds, Stamataki and Kelly. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Warner, Suz
Brown, Rachel M.
Reynolds, Gary M.
Stamataki, Zania
Kelly, Deirdre A.
Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic
title Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic
title_full Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic
title_fullStr Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic
title_full_unstemmed Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic
title_short Case report: Acute liver failure in children and the human herpes virus 6-? A factor in the recent epidemic
title_sort case report: acute liver failure in children and the human herpes virus 6-? a factor in the recent epidemic
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169701/
https://www.ncbi.nlm.nih.gov/pubmed/37181429
http://dx.doi.org/10.3389/fped.2023.1143051
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