COVID-19 may be associated with cases of acute hepatitis in children

COVID-19 may be associated with cases of acute hepatitis in children

Here is a summary of some recent studies on COVID-19. They include research that requires further study to confirm results and that has not yet been approved by peer review.

SARS-CoV-2 could be the root cause of occult hepatitis in children

Researchers suggest that a chain of events that may be caused by unrecognized infection with SARS-CoV-2 may cause the mysterious cases of acute hepatitis that have been reported in hundreds of young children around the world.

Children with COVID-19 are at a significantly increased risk of developing liver dysfunction afterward, according to a report published Saturday on medRxiv ahead of peer review. But most children with acute hepatitis – which is generally rare in this age group – do not report a previous infection with SARS-CoV-2. Instead, the majority were found to have an adenovirus called 41F, which is not known to attack the liver.

A separate team of researchers in The Lancet Gastroenterology and Hepatology suggested that it was possible that infected children, many of whom were too young to be vaccinated, had mild or asymptomatic COVID infection. If true, they hypothesized that coronavirus particles stuck in the GI tract of these children could prime the immune system to overreact to adenovirus 41F with large amounts of inflammatory proteins that eventually damage the liver.

“We suggest that children with severe hepatitis be screened to ensure that SARS-CoV-2 persists in the stool” and for other signs that liver damage is occurring because the coronavirus spike protein is a “super antigen” that increases the sensitivity of the immune system, they said.

Face down position is not helpful for awake patients

A new study shows that hospitalized COVID-19 patients who are breathing on their own but with supplemental oxygen, lying face down may not help prevent them from eventually needing mechanical ventilation.

In the study, 400 patients were randomly assigned to either standard care or standard care in addition to intermittently lying on their stomachs, a position known to improve disease course in ventilator-anaesthetized patients. Over the next 30 days, 34.1% in the prone group and 40.5% in the usual care group required intubation and ventilator placement, a difference that was not statistically significant. There may have been a reduced risk of intubation with the prone position among some patients, researchers said Monday in JAMA, but they were unable to confirm this statistically from their data. The average daily positioning time in the prone position was about five hours, below the target of eight to 10 hours per day.

“The long hours from the waking position while awake is challenging and strongly influenced by patient comfort and preference,” the researchers said. “The most common reason for disruption of the prone position is patient demand, which may be related to general self-improvement or related to discomfort from the prone position.”

(Reporting by Nancy Lapid and Megan Brooks) Editing by Bill Bercrot

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2022-05-19 14:18:25

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