Acute Hepatitis and Pancytopenia in Healthy Infant with Adenovirus

Matoq, Amr; Salahuddin, Asma

doi:10.1155/2016/8648190

Cited by 25 publications

(27 citation statements)

References 16 publications

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“… 2 4 Some case reports also show that these respiratory viruses can cause liver injury during systemic infection. 9 10 11 12 13 14 In addition to viruses, bacterial pneumonia (e.g., Streptococcus pneumonia , Haemophilus influenza , Staphylococcus aureus , or Pseudomonas aeruginosa ) and mycoplasma pneumonia can cause hepatocellular damage and cause laboratory abnormalities, including hyperbilirubinemia. 1 …”

Section: Discussionmentioning

confidence: 99%

A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute Infectious Diseases

Lee

et al. 2021

J Korean Med Sci

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Background Abnormal liver function tests (LFTs) are commonly seen in pediatric patients with acute infectious diseases. Few studies and no definite clinical guidelines for these conditions are available. The present study aimed to elucidate the causes and factors associated with prolongation of liver enzyme elevation. We also investigated actual real-world practices in Korea. Methods A retrospective study was performed on all patients younger than 18 years, who visited six tertiary teaching hospitals around Korea in 2018 for acute infectious diseases and showed alanine aminotransferase (ALT) levels above 60 IU/L without other specific conditions that could cause ALT elevation. We categorized the infections that cause LFT elevation into six groups: respiratory infection, gastrointestinal infection, urinary tract infection, other febrile disease, Epstein-Barr virus infection, and cytomegalovirus infection. We collected data on the medical specialty of the attending physician who followed up the subject, follow-up duration, percentage of follow-up loss, and their investigation. Results A total of 613 patients were enrolled in this study, half of whom (50.7%) were younger than 12 months. The mean initial aspartate aminotransferase and ALT values were 171.2 ± 274.1 and 194.9 ± 316.1 IU/L (range 23–2,881, 60–2,949 IU/L), respectively; however, other LFTs were within the normal range. Respiratory infection was the most common diagnosis (45.0%), and rhinovirus was the most commonly identified pathogen (9.8%). The follow-up rate was higher with pediatric gastroenterologists (90.5%) and non-gastroenterology pediatricians (76.4%) than with pediatric residents and emergency doctors. Older age was related to better ALT recovery (odds ratio [OR] of age for month = 1.003; 95% confidence interval [CI], 1.001–1.004; P = 0.004), while the number of infection episodes (OR = 0.626; 95% CI, 0.505–0.777; P < 0.001) was associated with poor ALT recovery. Abdominal sonography was the most commonly used diagnostic tool (36.9%), followed by the hepatotropic virus workup. The modalities of hepatitis workup were significantly differently applied by physicians based on their specialties and institutions. Conclusion Abnormal liver function test after a systemic infection was common in respiratory infection and under the age of 1 year. Age, number of infections, and initial results of LFTs were related to ALT recovery time. Inter-physician, inter-institution, and inter-specialty variances were observed in real-world practice.

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Section: Discussionmentioning

confidence: 99%

A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute Infectious Diseases

Lee

et al. 2021

J Korean Med Sci

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“…Previous Korean studies also reported that respiratory infection was the most common infection focus in NRH; however, adenovirus and respiratory syncytial virus were more common than rhinovirus (2,4). Some case reports also show that these respiratory viruses can cause liver injury during systemic infection (5)(6)(7)(8)(9)(10). In addition to viruses, bacterial pneumonia (e.g., Streptococcus pneumonia, Haemophilus in uenza, Staphylococcus aureus, or Pseudomonas aeruginosa) and mycoplasma pneumonia can cause hepatocellular damage and cause laboratory abnormalities, including hyperbilirubinemia (1).…”

Section: Discussionmentioning

confidence: 97%

“…We found that the older age of patients was related to a shorter duration of hepatic enzyme elevation; the mean age of our study patients was 3.5 years, and 311 (50.7%) were younger than 12 months. Other studies have also shown that children younger than 5 years commonly experience increased liver enzyme levels during systemic infections (4,5,8,11,12). As the exact mechanism of NRH remains unknown, the explanation of the poorer prognosis in younger infants is even more di cult.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Prognostic Factors, and Real-World Practice of Abnormal Liver Function Tests in Children with Acute Infectious Diseases: A Multicenter Study

Lee

et al. 2021

Preprint

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Background Abnormal liver function tests (LFTs) are commonly seen in pediatric patients with acute infectious diseases; few studies and no definite clinical guidelines for these conditions are available. This study aimed to elucidate the causes and factors associated with prolongation of liver enzyme elevation. We also investigated actual real-world practices in Korea.Methods A retrospective study was performed on all patients younger than 18 years, who visited six tertiary teaching hospitals around Korea in 2018 for acute infectious diseases and showed alanine aminotransferase (ALT) levels above 60 IU/L. We categorized the infections that cause LFT elevation into six groups: respiratory infection, gastrointestinal infection, urinary tract infection, other febrile disease, Epstein-Barr virus infection, and cytomegalovirus infection. We collected data on the medical specialty of the attending physician who followed up the subject, follow-up duration, percentage of follow-up loss, and their investigation.ResultsA total of 613 patients were enrolled in this study, half of whom (50.7%) were younger than 12 months. The mean initial aspartate aminotransferase and ALT values were 171.2±274.1 and 194.9±316.1 IU/L (range 23~2881, 60~2949 IU/L), respectively; however, other LFTs were within the normal range. Respiratory infection was the most common diagnosis (45.0%), and rhinovirus was the most commonly identified pathogen (9.8%). The follow-up rate was higher with pediatric gastroenterologists (90.5%) and non-gastroenterology pediatricians (76.4%) than with pediatric residents and emergency doctors. Older age was related to better ALT recovery (odds ratio [OR] of age for month was 1.003, with 95% confidence interval [CI] 1.001-1.004, p=0.004), while the number of infection episodes (OR=0.626, 95% CI 0.505-0.777, p<0.001) was associated with poor ALT recovery. Abdominal sonography was the most commonly used diagnostic tool (36.9%), followed by the hepatotropic virus workup. The modalities of hepatitis workup were significantly differently applied by physicians based on their specialties and institutions.Conclusions An LFT abnormality after a systemic infection was common in respiratory infection and under the age of 1 year. Age, number of infections, and initial results of LFTs were related to ALT recovery time. Inter-physician, inter-institution, and inter-specialty variances were observed in real-world practice.

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“…We speculated that these abnormal laboratory test results were partly related to adenovirus infection and partly related to their underlying diseases. For example, adenovirus infection could result in hepatitis and pancytopenia [11].…”

Section: Discussionmentioning

confidence: 99%

“…We speculated that these abnormal laboratory test results were partly related to adenovirus infection and partly related to their underlying diseases. For example, an adenovirus infection could result in hepatitis and pancytopenia [ 11 ]. Therefore, it is reasonable that hypoalbuminaemia, anaemia and thrombocytopaenia could present in RAI patients.…”

Section: Discussionmentioning

confidence: 99%

Immune status affects the clinical features and outcomes of adult patients with respiratory adenovirus infection

et al. 2021

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The differences in the clinical features and outcomes of respiratory adenovirus infection (RAI) between immunocompetent and immunocompromised adult patients remain unclear. Thirty-nine adult RAI patients, including 28 (71.8%) immunocompetent patients and 11 (28.2%) immunocompromised patients were enrolled in this retrospective study. Demographic characteristics, symptoms, laboratory tests, radiographic findings, therapies and clinical outcomes were compared between the two groups. We found fever (94.9%), cough (66.7%) and sputum production (56.4%) were the most frequent symptoms. Compared with immunocompetent RAI patients, the immunocompromised RAI patients were more likely to experience anemia (g/L; 90.8 ± 24.0 vs 134.3 ± 14.6, P ＜ 0.001), thrombocytopenia (×10 9 /L; 116.9 ± 92.7 vs 178.4 ± 74.6, P = 0.037), hypoalbuminemia (g/L; 29.6 ± 5.5 vs 36.9 ± 5.2, P ＜ 0.001), hyponatremia (mmol/L; 134.8 ± 5.6 vs 138.5 ± 3.9, P = 0.026) and low levels of cholinesterase (U/L; 2650.5 ± 1467.4 vs 5892.8 ± 1875.1, P ＜ 0.001). Chest computed tomography (CT) scans indicated that lung infiltrate was the most common finding (64.1%).Immunocompromised patients had a higher likelihood of bilateral lung involvement (72.7%) and lower lobe involvement (81.8%) of both lungs. The hospitalized mortality rate was 27.3% in immunocompromised RAI patients, but no deaths

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Acute Hepatitis and Pancytopenia in Healthy Infant with Adenovirus

Cited by 25 publications

References 16 publications

A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute Infectious Diseases

A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute Infectious Diseases

Clinical Characteristics, Prognostic Factors, and Real-World Practice of Abnormal Liver Function Tests in Children with Acute Infectious Diseases: A Multicenter Study

Immune status affects the clinical features and outcomes of adult patients with respiratory adenovirus infection

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