I have a two year old daughter. He was admitted to the Mother-Child Hospital in Granada at 22:35 last Tuesday. He had a fever of 41 degrees, hepatomegaly, and changes in liver enzymes. All alarms went off. Recently, the European Center for Disease Control had issued an alert for an unknown acute hepatitis that has already affected more than 60 children in the UK.

Three cases were under investigation in Spain when Aina entered. One of them needed a liver transplant. As I write these lines, while the girl is already out of danger (and after she’s ruled out that weird hepatitis), there are at least two more suspected cases, and Denmark, Ireland, the Netherlands, and the US have identified cases. More cases are expected and certainly more suspicions, officials said. That’s all we know so far about this mysterious disease.

What happened? On 5 April, the World Health Organization reported ten cases of severe acute hepatitis in central Scotland. As of 8 April there were 74 cases in the UK. In total, patients were 10 years old (mostly between two and five); in all, hepatitis viruses (A, B, C, E, and D) and other similar possible causes were excluded. So the etiology was unknown.

It should be said that the occurrence of cases of hepatitis of unknown origin is not uncommon. It is actually quite common, and each year hundreds (or even thousands) of patients with liver disorders of uncertain etiology are admitted to emergency rooms. The striking thing about stimulus is that it occurs in children with a similar profile and happens very quickly. Also, since the WHO and ECDC raised the alarm, cases compatible with this strange disease haven’t stopped popping up.

What does the disease consist of? ‘Hepatitis’ means ‘inflammation of the liver’ and therefore one of the first signs is a larger-than-normal liver on palpation of the abdomen. However, the most important clinical manifestation of this pathology is the change in liver enzymes; especially tansaminases and bilirubin. National and international authorities use this as a criterion: if serum transaminase values ​​exceed 500 IU/L and the source is unknown, it should be reported.

Other than these laboratory findings, little is known about the progression of the disease. The most recent investigations show that most of the cases had jaundice (yellowish color of the skin and mucous membranes) during the previous week, as well as abdominal pain, vomiting and diarrhoea. It is also noteworthy that high fiber is not very common.

On the other hand, although it is a severe hepatitis and progresses very rapidly; In most cases, children recover. Few seem to need a transplant or experience liver problems in the medium term.

Why does it happen? Here’s the big mystery: we don’t know for now. Setting aside the major known viruses, WHO is clear that “the priority is to identify the etiology of these cases to guide future clinical and public health action”. In other words, international teams are trying to understand the common points of all cases and perform laboratory tests to detect possible additional infections, chemicals and toxins in detected cases. The idea is to identify the epidemiological links that allow treatments to be developed and to introduce measures that prevent their possible expansion.

This also means that many of the theories and hypotheses considered are unreliable. For example, connection with the coronavirus vaccine is ruled out (due to age, almost none of the children are vacua). And the adenovirus hypothesis, which has been used recently, needs to be confirmed. After all, adenoviruses are not very common and not very dangerous viruses. It has been documented to cause liver problems in rare cases; but until the cause is found and analyzed in detail, they remain mere speculation.

Next steps. With the international authorities behind the disease, more cases are likely to emerge in the coming days and epidemiological links are likely to begin to become clear. Until then, it’s best to remain calm, be vigilant, and hope that any cases that arise will be as mild as possible.

Image | pexel