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

Helen Callaby^{1

2}, Emma McGuire³, Sanjay Rajwal⁴, Jens Stahlschmidt⁵, Jane Hartley⁶, Rachel M Brown⁷, Maesha Deheragoda⁸, Alberto Quaglia⁹, Tommy Rampling¹, Catherine F Houlihan¹, N Claire Gordon¹, Colin S Brown^{3

10}, Ruth Simmons¹¹, Anda Samson³, Sema Mandal¹¹, Tassos Grammatikopoulos^{12

13}, Alicia Demirjian^{3

14

15}

Affiliations

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.

PMID: 38327256
DOI: 10.1002/jpn3.12133

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

Helen Callaby et al. J Pediatr Gastroenterol Nutr. 2024 Mar.

. 2024 Mar;78(3):534-538.

doi: 10.1002/jpn3.12133. Epub 2024 Feb 8.

Authors

Affiliations

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.

PMID: 38327256
DOI: 10.1002/jpn3.12133

Abstract

In 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.

Keywords: hepatitis; histopathology; liver failure; paediatric; transplant.

© 2024 The Authors. Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

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References

REFERENCES

1. WHO. Acute Hepatitis of Unknown Aetiology in Children-Multicountry. WHO; 2022. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON400
1. 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/uploa...
1. Ho A, Orton R, Tayler R, et al. Adeno-associated virus 2 infection in children with non-A-E hepatitis. Nature. 2023;617(7961):555-563.
1. Morfopoulou S, Buddle S, Torres Montaguth OE, et al. Genomic investigations of unexplained acute hepatitis in children. Nature. 2023;617(7961):564-573.
1. Kelgeri C, Couper M, Gupte GL, et al. Clinical spectrum of children with acute hepatitis of unknown cause. N Engl J Med. 2022;387(7):611-619.

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

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

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous