A review on acute, severe hepatitis of unknown origin in children: A call for concern

Unmasking Hepatitis A: A Case Study of Atypical Presentation in a Returning Traveler From Egypt

Hepatitis, characterized by inflammation of the liver, arises from various infectious and noninfectious causes, with viral hepatitis being caused by a diverse group of viruses including hepatitis A, B, C, D, and E. Infection with the Hepatitis A virus (HAV) can result in liver inflammation and damage, primarily spread through fecal-oral contamination. Clinical symptoms often overlap with other infections, complicating diagnosis in returning travelers from endemic regions. This case study focuses on a 46-year-old Sudanese housewife who presented with symptoms of fever, chills, headache, and muscle aches, along with a high temperature of 103.5°F, following a recent visit to Egypt. The initial assessment showed hemodynamic stability and abnormal liver function tests. This raise suspicion about the potential involvement of several infections including malaria, hepatitis, arboviral diseases such as Chikungunya, Yellow, and dengue fevers. Further investigations revealed acute hepatitis A infection confirmed through positive serology. Notably, the patient displayed atypical features such as atypical lymphocytosis, splenomegaly, and mild anemia. This case emphasizes the significance of essentially considering a wide range of diseases among travelers including hepatitis A among people coming from highly endemic areas such as Egypt, even when the patient is not manifested with the typical clinical presentation of specific disease. Particular attention is needed for epidemic-prone infections like hepatitis A.

Label-Free Proteomics of Severe Acute Hepatitis of Unknown Origin in Children by High-Resolution Mass Spectrometry

Acute hepatitis of unknown etiology (non-HepA-E hepatitis) emerged affecting children in 2021 and in parallel with the COVID-19 pandemic. In the present article, we performed an analysis between two plasma samples from pediatric patients, one with non-HepA-E hepatitis and the other healthy, to evaluate possible proteomic alterations associated with viral targets as possible causative agents and pathophysiological processes using the high-resolution and label-free LC-MS/MS technique. We identified 72 altered differentially expressed proteins, 45 upregulated and 27 downregulated. Gremlin-1, a protein associated with tissue fibrosis, was detected exclusively in the positive sample. Proteins involved in immunological processes, coagulation cascade, complement cascade, lipid transport, oxidative stress, acute inflammatory response, and those related to extracellular matrix deposition were also identified. In addition, some proteins of viral origin were detected, mainly from respiratory viruses. Proteomic studies of diseases such as hepatitis and other hepatopathologies have become essential for understanding pathophysiological processes and detecting molecular triggers.

First evidence on the occurrence of multi-mycotoxins and dietary risk exposure to AFB1 along the cassava value chain in Uganda

This study investigated the occurrence and distribution of multiple mycotoxins (aflatoxin B1, B2, G1, G2, fumonisins B1, B2, ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN), and citrinin (CIT)) in cassava products and as assessed the potential risk of aflatoxin B1 (AFB1) exposure among cassava consumers. A total of 192 samples of cassava products (96 flour and 96 chips, each with 48 samples from farmer and 48 from wholesaler) were analysed using LC/MS-MS. All positive samples irrespective of their origin (flour or chips) exhibited AFB1 levels exceeding the EU regulatory threshold of 5 µg/kg. The sum of fumonisins (FB1 + FB2), ZEN, and DON were significantly (P < 0.05) higher in cassava flour (14.3 µg/kg; 3.71 µg/kg; 25.1 µg/kg) compared to chips (6.54 µg/kg; 1.25 µg/kg; 0.25 µg/kg), respectively. Aflatoxins G2 was not detected in any of 192 samples. Cassava flour samples from farmers exhibited significantly (P < 0.05) higher mean concentrations of AFB1 (27.1 µg/kg), total aflatoxins (78.2 µg/kg), and ochratoxin A (79.6 µg/kg) in contrast to wholesalers, whose mean levels were notably lower at 8.91, 5.79 µg/kg, and 2.44 µg/kg, respectively, pointing the likely critical source of mycotoxin contamination. Cassava consumers in Northern Uganda are at a higher risk, with an estimated 2.06 cancer cases per 100,000 individuals per year compared to those in Eastern Uganda at 0.25. This study underscores the urgent need for interventions to manage aflatoxins in cassava flour, particularly at farm level in Northern Uganda. It accentuates a shift market to household-level sampling and the need for analytical methods targeting multiple mycotoxins.

Potential Impact of Current Agricultural Practices on Mycotoxin Occurrence and Mycotoxin Knowledge Along the Cassava Value Chain in Uganda

Cassava is the second most important staple food crop for Uganda and is prone to contamination with mycotoxins. This study aimed at understanding the current agricultural practices, their potential influence on mycotoxin occurrence, as well as assessing mycotoxin knowledge among key cassava value chain actors, including farmers, wholesalers, and processors. Data were collected through individual interviews (210), key informant interviews (34), and 4 focus group discussions. The findings revealed that 51% of farmers peeled cassava directly on bare ground, resulting in direct contact with soil that potentially harbors mycotoxin-producing fungi, such as Aspergillus section Flavi. During postharvest handling, 51.6% of farmers dried cassava chips directly on bare ground. Nearly, all (95.2%) of wholesalers packed cassava chips in local gunny bags and placed them on ground instead of pallets. In the processing of cassava chips into flour, only one of the 14 processing machines was certified by the Uganda National Bureau of Standards. Additionally, there was only one processing machine available for every 180 (1:180) consumers bringing their cassava for processing. 50.8% of cassava consumers interviewed admitted to consuming cassava flour regardless of quality, while 73% blended cassava flour with flour from mycotoxin-susceptible crops mainly maize, millet, and sorghum. Most (96.2%) of the people along the cassava value chain did not understand what the term mycotoxins meant. However, 56% of interviewed respondents were familiar with the term aflatoxins. Of the cassava value chain actors aware of mycotoxins, 82.9% knew of methods for reducing aflatoxin contamination, but only 40.9% were putting such methods into practice. More farmers (47.9%) managed aflatoxins compared to wholesalers (33.3%) and processors (21.4%). Knowledge on aflatoxins was significantly associated with value chain actor (P = 0.026), head of household (P = 0.004), region (P = 0.033), age (P = 0.001), and experience (P = 0.001). This study highlights the critical areas of mycotoxin contamination within the cassava value chain in Uganda and underscores the need to improve the knowledge among value chain actors especially farmers.

The protective association of HLA-C*12:02 and HLA-DQB1*06:01 with severe acute hepatitis of unknown origin in the Japanese population

Global surveillance has been conducted to elucidate the pathogenesis of acute hepatitis of unknown origin (AHUO), However, the factors associated with the aggravation of this serious disease are unclear. Therefore, we conducted a HLA association study to identify HLA alleles or haplotypes predisposing or protective against Japanese AHUO. The HLA 5 locus (HLA-A, HLA-B, C, DRB1, and DQB1) 4-digit genotyping results of 72 AHUO patients who underwent liver transplantation at our institution between 2000 and 2021 were compared to those of 873 healthy Japanese controls. Protective associations of HLA-B*52:01 (p-corrected (pc) = 3.15 × 10-3 ), HLA-C*12:02 (pc = 1.66 ×10-3 ), HLA-DQB1*06:01 (pc = 1.42 × 10-2 ), and HLA-DRB1*15:02 (pc = 1.36 × 10-2 ) with severe AHUO in Japanese patients were observed. The amino acid residues of tryptophan at position 156, which are located in the antigen-binding grooves of the HLA-C protein, showed a protective association with AHUO, showing a significant difference from other amino acid variations (pc = 9.0 × 10-4 ). Furthermore, 5 amino acid residues of the HLA-DQB1 protein were also protectively associated with AHUO with a significant difference from other amino acid variations (pc = 1.42 × 10-2 to 2.89 × 10-2 ). These alleles have a protective association with the aggravation of AHUO in the Japanese population.

Pathogenicity and virulence of human adenovirus F41: Possible links to severe hepatitis in children

Over 100 human adenoviruses (HAdVs) have been isolated and allocated to seven species, A-G. Species F comprises two members-HAdV-F40 and HAdV-F41. As their primary site of infection is the gastrointestinal tract they have been termed, with species A, enteric adenoviruses. HAdV-F40 and HAdV-F41 are a common cause of gastroenteritis and diarrhoea in children. Partly because of difficulties in propagating the viruses in the laboratory, due to their restrictions on growth in many cell lines, our knowledge of the properties of individual viral proteins is limited. However, the structure of HAdV-F41 has recently been determined by cryo-electron microscopy. The overall structure is similar to those of HAdV-C5 and HAdV-D26 although with some differences. The sequence and arrangement of the hexon hypervariable region 1 (HVR1) and the arrangement of the C-terminal region of protein IX differ. Variations in the penton base and hexon HVR1 may play a role in facilitating infection of intestinal cells by HAdV-F41. A unique feature of HAdV-F40 and F41, among human adenoviruses, is the presence and expression of two fibre genes, giving long and short fibre proteins. This may also contribute to the tropism of these viruses. HAdV-F41 has been linked to a recent outbreak of severe acute hepatitis "of unknown origin" in young children. Further investigation has shown a very high prevalence of adeno-associated virus-2 in the liver and/or plasma of some cohorts of patients. These observations have proved controversial as HAdV-F41 had not been reported to infect the liver and AAV-2 has generally been considered harmless.

Updated information regarding acute severe hepatitis of unknown origin in children: Viewpoints of and insights from pediatricians

Recently, the morbidity of acute severe hepatitis of unknown origin in children (SHIC) has tended to decrease, but this condition should not be ignored because of its uncertain but severe nature. The current study briefly summarizes updated information regarding the epidemiological, clinical, and etiological aspects of SHIC based on the newest information available. Opinions from pediatricians are also presented. In light of the status quo of SHIC and COVID-19 globally, several suggestions are proposed to improve future studies, which could help to further explore the underlying mechanisms of SHIC in the context of COVID-19.

Human Adenovirus Gene Expression and Replication Is Regulated through Dynamic Changes in Nucleoprotein Structure throughout Infection

Human adenovirus (HAdV) is extremely common and can rapidly spread in confined populations such as daycare centers, hospitals, and retirement homes. Although HAdV usually causes only minor illness in otherwise healthy patients, HAdV can cause significant morbidity and mortality in certain populations, such as the very young, very old, or immunocompromised individuals. During infection, the viral DNA undergoes dramatic changes in nucleoprotein structure that promote the rapid expression of viral genes, replication of the DNA, and generation of thousands of new infectious virions-each process requiring a distinct complement of virus and host-encoded proteins. In this review, we summarize our current understanding of the nucleoprotein structure of HAdV DNA during the various phases of infection, the cellular proteins implicated in mediating these changes, and the role of epigenetics in HAdV gene expression and replication.

Hepatitis A virus outbreak in Lebanon: Is it a matter of concern?

Lebanon has been grappling with hepatitis A virus (HAV) outbreaks for 3 decades, to an extent that it has been now termed an endemic zone for HAV. However, the rise in cases above the annual average concerns a potential outbreak in the North, and the Bekaa governorates of Lebanon must be highlighted. Although the Lebanese health authorities have ordered a probe into the possible causes of the outbreak, it has been speculated that the immigration of Syrian refugees has overburdened public health services. Reduced seroprevalence of HAV immunoglobulin G has also led to an epidemiological shift from child to adult populations. The current economic crisis affecting Lebanese society is another significant problem that could have contributed to the rise in incidents. This article examines Lebanon's current HAV outbreak and epidemiological status, offering suggestions for the future. In the event of an outbreak, the infrastructure for water sanitation and sewage is known to allow HAV to spread via the faecal-oral pathway. Maintaining personal hygiene, early detection, and vaccination have all been recommended as significant regional and individual control measures.

Measles outbreak in Zimbabwe: An urgent rising concern

Introduction

Measles, one of the most common infections in the world, accounts for more than over 100.000 deaths every year. Measles outbreaks are still ravaging the African continent, and the 2010 Measles outbreak in Zimbabwe is one to be noted, where more than 7754 infections and 517 deaths were reported, ultimately leading to the UN initiation of the vaccination program. COVID-19 could have been delaying the vaccination process in Africa. This article aims to shed the light on the current Measles outbreak in Zimbabwe and how global health organizations are taking measures to fight off this outbreak.

Methodology

Data was collected from online databases PubMed, Science Direct, and the Lancet, as well as news and conferences and press releases on the current measles outbreak. All articles and news related to the measles outbreak in Zimbabwe were taken into consideration.

Results

A measles outbreak was reported earlier in August of 2022, with more than 2000 confirmed cases out of which 157 were reported dead. Since the outbreak this year, cases of measles in Zimbabwe have been rapidly growing. The government in Zimbabwe started a massive vaccination campaign for children in and near the areas where the outbreak is present. Traditional and faith leaders are involved in the campaigns to encourage the public to volunteer to be vaccinated.

Conclusion

Efforts to control the measles outbreak in Zimbabwe are being mitigated by the government as well as the WHO and other global health organizations. With many people refusing the vaccination, this outbreak might not see an end, and more cases, as well as deaths, will increase by the end of the year.

Yellow fever outbreak in Kenya: A review

Yellow fever (YF) is a viral acute hemorrhagic illness caused by infected mosquitoes of the flavivirus family. The first yellow fever outbreak in Kenya was in 1992. Similar outbreaks were recorded in the western part of the country in 1993, 1995, and 2011, particularly in the Rift Valley province of Kenya. In early 2022, the viral acute illness resurfaced and hit Kenya. On January 12, 2022, the first case was discovered, with over 14 patients suffering from fever, jaundice, and joint and muscle pains. On March 4, 2022, a yellow fever outbreak re-emerged in Kenya, affecting 11 wards in Isiolo County. The fatality rate recorded was 11.3% (six deaths), with Chari accounting for 39.6% of the total 21 cases, Cherab 14 (26.4%), and 5 Garba Tulla (9.4%). This has the potential to further endanger the nation's economic growth while also negatively impacting people's daily lives in a part of the world that is already dealing with the catastrophic impacts of the coronavirus pandemic. However, there is no curative therapy for yellow fever. The only options for curbing its spread are through vaccination and preventive measures. Hence, Kenya's government must take responsibility for requiring vaccination of its citizens, implement an active national disease surveillance protocol, and set up anti-yellow fever campaigns in the country.

Polio returns to the USA: An epidemiological alert

On July 21, 2022, the USA witnessed the first case of poliomyelitis after 3 decades of its eradication. Poliomyelitis is a crippling disease that results from infection with any one of the three related poliovirus types (referred to as types P1, P2, and P3), members of the enterovirus (picornavirus) family. The New York State Department of Health confirmed that a case of paralytic poliomyelitis was reported from a 20-year-old Hungarian traveller residing in Rockland County. The detected viral sequence has been found to have vaccine-derived poliovirus type 2 (VDPV2) suggesting an origin from the live attenuated oral polio vaccine (OPV). Since immunisation remains the only preventable measure, this article explores suggestions from the Centers for Disease Control and Prevention on reliable Inactivated (killed) polio vaccination in high-risk patients along with early case detection and treatment. In light of the above-mentioned findings, this research further details future recommendations like cessation of the OPV, encouragement of inactivated polio vaccine (IPV) in vaccination schedules, sensitive epidemiological surveillance system and appropriate training for healthcare providers. The affected countries have been further advised to have effective outbreak response strategy plans in place so that they can respond and stay prepared for such outbreaks in the future.