ACUTE HEPATITIS IN CHILDREN-CAUSE UNKNOWN

Acute Hepatitis in Children-Cause Unknown

In late December 2019, our world witnessed the first cluster of cases of COVID-19 which is still creating a massive havoc for the entire human population of the world. We have been skeptical since then because the first few cases of Wuhan,China engulfed the entire world in no time.

Now, the first few cases causing acute hepatitis have been notified to WHO on April 5 2022. Acute hepatitis– a medical terminology to describe the period of inflammation( local response to cellular injury marked by swelling, redness,heat,pain and loss of function) in the liver lasting less than six months of duration.
10 cases were reported from Central Scotland- the cause for severe acute hepatitis is unknown till date.

What do we know as of today?
74 cases had been reported in the UK till April 8,2022 with similar symptoms. All the cases are reported among children less than 16 years of age.
Hepatitis viruses(A,B,C,D,E) were excluded in the laboratory.However,viruses causing COVID-19 i.e. SARS-CoV-2 and/ or Adenovirus have been found in many cases.
Less than 5 cases from Ireland and 3 cases from Spain are on the investigation with similar symptoms.

So, what is the working case definition?
A confirmed case is a person presenting with an acute hepatitis (non-hepatitis Virus A,B,C,D,E) with AST or ALT over 500 U/L who is 10 years and under, since 1 Jan, 2022.
AST and ALT are enzymes found mostly in liver which increases during liver injury( Normal value varies based on laboratory-ALT 7-55 U/L, AST 8-48 U/L).

Signs and Symptoms :

A child can present with any one or more of the following:

Discoloration of Urine (dark) and/or Stool(pale)

Jaundice (yellowish discoloration of skin, sclera etc)

Pruritis (Itching)

Arthralgia/Myalgia( joint pain/Muscle pain)

Pyrexia(fever)

Nausea,Vomiting or Abdominal Pain

Lethargy and/or loss of appetite

Diarrhea

How severe is it?
All the first 10 cases were detected during hospitalization. All of them were healthy, prior to illness.As of April 11,2022, no deaths had occurred amongst reported cases.However, six children required liver transplantation.

What next?

WHO is monitoring the situation with other member states and the UK along with partners for cases with similar profiles.

Many questions are left unanswered. With time,we hope to find the cause(etiology) of acute hepatitis of this unknown etiology because we are all exhausted to have another outbreak in any form.Hence, it is our duty to stick with the basics to contribute to the better health of everyone.

For more,click on the link below:

https://www.who.int/emergencies/disease-outbreak-news/item/acute-hepatitis-of-unknown- aetiology—the-united-kingdom-of-great-britain-and-northern-ireland https://www.gov.uk/government/publications/hepatitis-increase-in-acute-cases-of-unknown- aetiology-in-children/increase-in-acute-hepatitis-cases-of-unknown-aetiology-in-children

POST COVID

The term “Post-COVID Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection.These consequences include both general complications of prolonged illness as well as hospitalization and post-acute sequelae of SARS-CoV-2 infection (PASC), which are more specific to effects of SARS-CoV-2 infection.

The frequency of long-term symptoms and conditions following SARS-CoV-2 infection varies widely in the literature, ranging from 5% to 80%.

Multiple possible onset patterns for post-COVID conditions have been identified that further exemplify their heterogeneity, including, but not limited to: 

1. persistent symptoms and conditions that begin at the time of acute COVID-19 illness; 
2. new-onset late sequelae following asymptomatic disease or a period of acute symptom relief or remission; or
3. an evolution of symptoms and conditions that include some persistent symptoms (e.g., shortness of breath) with the addition of new symptoms or conditions over time (e.g., cognitive difficulties). 

Some presentations may share similarities with other post-viral syndromes, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), dysautonomia (e.g., postural orthostatic tachycardia syndrome [POTS]), or mast cell activation syndrome (MCAS).

Types of Post-COVID Condition

Long COVID

Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:

Tiredness or fatigue

Difficulty thinking or concentrating (sometimes referred to as “brain fog”)

Headache

Loss of smell or taste

Dizziness on standing

Fast-beating or pounding heart (also known as heart palpitations)

Chest pain

Difficulty breathing or shortness of breath

Cough

Joint or muscle pain

Depression or anxiety

Fever

Symptoms that get worse after physical or mental activities

Multiorgan Effects of COVID-19

Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. 

Multiorgan effects can also include conditions that occur after COVID-19, like multisystem inflammatory syndrome (MIS) and autoimmune conditions. MIS is a condition where different body parts can become swollen.

 Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing painful swelling in the affected parts of the body.

It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.

Effects of COVID-19 Treatment or Hospitalization

Post-COVID conditions also can include the longer-term effects of COVID-19 treatment or hospitalization. Some of these longer-term effects are similar to those related to hospitalization for other respiratory infections or other conditions.

Effects of COVID-19 treatment and hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that remain after a critical illness. These effects can include severe weakness and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.

Assessment and Testing

Before ordering laboratory testing for post-COVID conditions, the goals of testing should be clear to the healthcare professional and to the patient. Laboratory testing should be guided by the patient history, physical examination, and clinical findings.

• 

Medical  Management

For most patients, the goal of medical management of post-COVID conditions is to optimize function and quality of life. 

Ideally, healthcare professionals, in consultation with the appropriate specialists, should develop a comprehensive management plan based on their patients’ presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals. 

Many post-COVID conditions can be improved through already established symptom management approaches (e.g., breathing exercises to improve symptoms of dyspnea). Creating a comprehensive rehabilitation plan may be helpful for some patients and might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms.

Optimizing management of underlying medical conditions might include counseling on lifestyle components such as nutrition, sleep, and stress reduction (e.g., meditation).

FDA-approved or over the counter medications as well as vitamin or electrolyte supplements may be helpful for indicated illnesses (e.g., headache, anxiety) or documented deficiencies (e.g., vitamin deficiency) after carefully weighing the benefits and risks of pharmaceutical interventions.

The information might change as we go on learning about COVID-19. This blog is just replicated to circulate informations on POST COVID.All the materials has been copied from CDC. For the detailed information,kindly visit the link in the source.

Source:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-index.html

#POSTCOVID #COVID19 #LONGCOVID #CDC #WHO #MISC #SARSCoV2