Solved the enigma of pediatric severe acute hepatitis of unknown origin?

Case Report: HLA-DRB1 04:01 found in a child with adenovirus type 2 -linked hepatitis

Since 2022, cases of hepatitis of unknown origin have been reported in children worldwide. Adeno-associated virus type 2 (AAV2) was identified as a cause, with most affected children having the HLA-DRB1 04:01 genotype. In this study, we hypothesized that HLA-DRB1 04:01 in the host may also be a potential predisposing factor of acute hepatitis caused by other viruses. We report a case that met the definition of severe hepatitis of unknown cause in a child; adenovirus type 2 (AV2) was detected in her specimens. The patient was a 1-year-old girl who visited a doctor because of fever occurring 1-2 days per week, respiratory symptoms, and diarrhea. One month later, the patient was referred to our hospital because of prolonged elevated liver enzyme concentrations. Two weeks after the initial visit, her aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations increased to 1558 and 1843 IU/L, respectively. The patient's liver enzyme concentrations decreased markedly with only observation and intravenous hydration during hospitalization within a few days. Thereafter, hepatic enzymes were transiently elevated with each common cold, but all recovered spontaneously. The adenovirus (AV) antibody levels increased substantially 2 weeks after admission. The patient's human leukocyte antigen (HLA) was determined to be of the DRB1 04:01 genotype. The presence of HLA-DRB1 04:01 is consistent with that reported in pediatric patients with AAV2 hepatitis in the United Kingdom, indicating that it may have been involved in the host immune response and acute hepatitis in this child. HLA-DRB1 04:01 may predispose children to acute hepatitis from various viruses, including AV2, AAV2, and possibly respiratory viruses, which requires clinical attention.

Mechanism of Action of Dihydroquercetin in the Prevention and Therapy of Experimental Liver Injury

Liver disease is a global health problem that affects the well-being of tens of thousands of people. Dihydroquercetin (DHQ) is a flavonoid compound derived from various plants. Furthermore, DHQ has shown excellent activity in the prevention and treatment of liver injury, such as the inhibition of hepatocellular carcinoma cell proliferation after administration, the normalization of oxidative indices (like SOD, GSH) in this tissue, and the down-regulation of pro-inflammatory molecules (such as IL-6 and TNF-α). DHQ also exerts its therapeutic effects by affecting molecular pathways such as NF-κB and Nrf2. This paper discusses the latest research progress of DHQ in the treatment of various liver diseases (including viral liver injury, drug liver injury, alcoholic liver injury, non-alcoholic liver injury, fatty liver injury, and immune liver injury). It explores how to optimize the application of DHQ to improve its effectiveness in treating liver diseases, which is valuable for preparing potential therapeutic drugs for human liver diseases in conjunction with DHQ.

Respiratory adenovirus infections in children: a focus on Africa

PURPOSE OF REVIEW

Lower respiratory tract infections (LRTIs) are an important cause of child morbidity and mortality globally, especially in children under the age of 5 years in Africa. Respiratory viruses, including human adenoviruses (HAdVs), are common causes of LRTIs in children. This review aims to shed light on the epidemiology, clinical manifestations, sequelae, and treatment options specific to adenovirus respiratory infections in African children.

RECENT FINDINGS

Recent evidence has challenged the perception that adenovirus is a negligible cause of LRTIs. Studies show HAdV emerging as the third most common viral pathogen in fatal pneumonias among under-5 children in low-income and middle-income African countries, contributing to 5.5% of all pneumonia deaths and ranking second in hospital-associated viral pneumonia deaths. Predominant HAdV serotypes associated with disease differ by country and region, and have changed over time. Risk factors for increased disease severity and long-term respiratory sequelae in previously healthy African children with HAdV LRTIs are not well established.

SUMMARY

Although respiratory viruses, including HAdV, are recognized contributors to LRTIs, the prevalence and impact of adenovirus infections have been under-recognized and understated. Available data suggests that African children, particularly those under 5 years old, are at risk of severe sequelae from respiratory HAdV infections. Long-term sequelae, including bronchiectasis and postinfectious bronchiolitis obliterans, further underscore the significant impact of HAdV infections. However, the scarcity of comprehensive data hampers our understanding of the extent of the impact of HAdV infections on child lung health in Africa. We recommend scaled-up HAdV surveillance, ensuring its consistent inclusion in population-level LRTI assessments, and expanded and equitable access to diagnostics for early recognition of African children at risk of developing chronic sequelae and death. Enhanced understanding of adenovirus epidemiology and clinical outcomes and the availability of therapeutic options are essential for informed public health strategies and clinical care.