Histopathological findings from the investigation of paediatric acute hepatitis of unknown aetiology, United Kingdom 2022

Author:

Callaby Helen12,McGuire Emma3,Rajwal Sanjay4,Stahlschmidt Jens5,Hartley Jane6,Brown Rachel M.7,Deheragoda Maesha8,Quaglia Alberto9,Rampling Tommy1,Houlihan Catherine F.1,Claire Gordon N.1,Brown Colin S.310,Simmons Ruth11,Samson Anda3,Mandal Sema11,Grammatikopoulos Tassos1213,Demirjian Alicia31415

Affiliation:

1. UKHSA Rare and Imported Pathogen Laboratory Porton Down London UK

2. Institute of Medical Sciences University of Aberdeen Aberdeen UK

3. HCAI, Fungal, AMR AMU & Sepsis Division, UKHSA London UK

4. Leeds Children's Hospital Leeds UK

5. Department of Histopathology and Molecular Pathology, St James's University Hospital Leeds Teaching Hospitals NHS Trust Leeds UK

6. Liver Unit Birmingham Women's and Children's Hospital Birmingham UK

7. Department of Histopathology Birmingham Children's Hospital Birmingham UK

8. Institute of Liver Studies King's College Hospital London UK

9. Department of Cellular Pathology Royal Free London London UK

10. NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance London UK

11. Blood Safety, Hepatitis, STI & HIV Division UK Health Security Agency London UK

12. Paediatric Liver, GI & Nutrition Centre and Mowat Labs King's College Hospital London UK

13. Institute of Liver Studies King's College London London UK

14. Department of Paediatric Infectious Diseases & Immunology Evelina London Children's Hospital London UK

15. Faculty of Life Sciences & Medicine King's College London London UK

Abstract

AbstractIn 2022, there were global reports of increased numbers of acute hepatitis not explained by hepatitis A–E virus infection in children. This manuscript summarises histopathology results from 20 patients in the United Kingdom who underwent liver transplant or had a liver biopsy as part of aetiological investigations. All available histopathological samples were reviewed centrally as part of the outbreak investigation. A working group comprised of infection specialists, hepatologists and histopathologists met virtually to review the cases, presentation, investigations and histopathology. All 20 liver samples had evidence of inflammation without significant interface activity, and submassive confluent pan‐lobular or multilobular hepatocellular necrosis. Overall, the predominant histopathological findings were of acute nonspecific hepatitis with submassive hepatic necrosis and central vein perivenulitis and endothelitis. Histopathological findings were a poor indicator of aetiology.

Publisher

Wiley

Reference9 articles.

1. WHO.Acute Hepatitis of Unknown Aetiology in Children—Multicountry. WHO; 2022.https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON400

2. United Kingdom Health Security Agency.Investigation into Acute Hepatitis of Unknown Aetiology in Children in England Technical Briefing 4. United Kingdom Health Security Agency; 2022.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1094573/acute-hepatitis-technical-briefing-4.pdf

3. Adeno-associated virus 2 infection in children with non-A–E hepatitis

4. Genomic investigations of unexplained acute hepatitis in children

5. Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause

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