National health authorities relate to past cases that may meet the definition of acute childhood hepatitis of unknown origin. No case has been confirmed so far in Portugal, says the coordinator of the Program for Viral Hepatitis

The national health authorities registered until May 17, 12 suspected cases of acute of unknown origin in children, told CNN Portugal Rui Tato Marinho, coordinator of the National Program for Viral Hepatitis of the Directorate-General for Health (DGS) ) .

All cases of investigation and there has been no confirmation so far, sign the expert, adding at least that there are five cases in which there are five cases in which every year in children with a tendency of the vast majority are verified.

The case of suspected suspects passed in Portugal “has not risen much”, refers Marinho, also explaining the increase in cases under investigation is due to the fact that the specialists exist “at least October of the year ago”: the DGS suspected cases are all acute hepatitis in children up to 16 years of age and which do not originate from viruses A, B, C, D and E, with secret enzymes at values ​​above 500. “Some cases are old, looked at with others”, adds the coordinator of the National Program for Viral Hepatitis of the DGS.

Speaking about the working hypotheses of the viruses that, at this time, they perceive as the causes of these diseases, whose origin remains unknown, Tato Marinho the possible infection by adeno infantile and also his illness with the SARS-CoV-2, “not only in terms of of co-infection but also of the changes that viruses can have”. And he stresses that information is still needed on the consequences that “greater confinement and how masks will be caused in the obligation of children”.

The hypotheses on the table

In a study recently published in the journal LancetIn the area of ​​Gastroenterology and Hepatology, researchers report that a SARS-CoV-2 superantigen may be related to cases already identified in 22 countries around the world, in a total of 429 cases reported until Tuesday, revealed a WHO.

According to Lance Aguda, 72% of adult children in the UK who were diagnosed with hepatitis had a previous infection with an adenovirus, with them having the presence of subtype 41 (known as large inflammation) which researchers define as common, being that “affecting young people, children and immunocompromised patients”.

Additionally, the presence of covid-19 was reported in 18% of British cases. “Serological tests that are in progress or number of current hepatitis must be acute and an infection with anticipation or by covid-19”, adds the study, which points out that the vast majority of atypical acute hepatitis were acute hepatitis in children without increasing old enough for vaccine that protects from SARS-CoV-2.

“Covid-19 induction will result in the formation of a viral reservoir”, the researchers indicate, suggesting that “a viral persistence of SARS-CoV-2 in the gastrointestinal tract may result in an increase in immune severity”, which, in this case, , “can be measured by a superantigen features a SARS-CoV-2 protein spike.

Basically, something similar to what occurs when a Multisystem Inflammatory Syndrome (MIS-C) occurs, identified in children after recovery from covid-19. In this case, an alternative is given to the cells of the immune system, which responds by an automatic response. And if hepatitis, this viral reservoir, is exposed to an adenovirus, the immune reaction can be even a bigger reaction of the body, exactly what happens in this atypical.

Dogs, paracetamol or adenovirus?

In addition to this most recent hypothesis, which even reaches several cases of investigation, the researchers have a course of investigation, yet to be proven, and some sequences for all patients, made to families.

No technical report of the British experts who started the European struggle, published in the month of May, refers, for example, that a high number of families with dogs: about 70% of families that had one, which is common in the United Kingdom. “The significance of this discovery is being explored,” the document stresses.

Dogs have their own adenoviruses, which can cause illness or hepatitis, but there is no information that these can infect humans. And suspected cases of a new virus in children do not suggest any link between patients, as does a new virus derived from the little ones.

About three-quarters of respondents also mentioned the use of acetaminophen, but fewer reported the use of ibuprofen and no reference to the use of aspirin. “While paracetamol is an important agent, there are reports of presentations of toxic or hepatotoxic paracetamol cases in one of the clinical units”, refers to the report of the British experts, which appears to remove paracetamol as a cause of harm in either.

With regard to the pathogens detected, experts refer to adenovirus as the most common. “In a review of some cases where adenovirus tests were not made it became apparent that several others were blood tested and additional retrospective testing,” he says.

But adenovirus is not normally associated with liver inflammation. “There are several types of adenovirus and they can infect organs with very different pathologies”, explained Celso Cunha, from the Institute of Hygiene and Tropical Medicine at the University of Lisbon, to CNN Portugal. “The necessary pathologies, however, are like more treatments in relation to a pediatric disease, adding the specialist, the possibility of altering the pediatric adenovirus disease to cause this pediatric disease.

One possibility that there was an alteration, by a strain of virus, could be adenovirus genetics, admitting for an adenovirus modification capacity, however, mentioning that a cause of the alert emergency could not be just a virus but a stronger immune system. weak, caused by the confinements imposed by the covid-19 pandemic.

Investigations with “important progress”

In a press conference on May 10, the researcher of the global hepatitis program of the World Health Organization, Philippa Easterbrook, admits “important progress with the investigations” that have been led by the United Kingdom – where more cases have been reported – explaining that studies have focused on the genetics and immune response of children and various viruses.

“Does not present the strongest hypothesis continues seriously, an adenovirus”seek an expert. Since it is an “ethological hepatitis”, the World Health Organization has assured that it is giving “absolute priority” to the investigation of this disease.

According to the most recent data, on Tuesday, the number of reported cases of acute children of origin increased to 429, indicated a WHO, adding that six children died and 26 required a hepatitis liver transplant.

According to the WHO, more than 81 cases have been reported than a week ago, with the majority of situations occurring in Europe. Three out of four children are under five years old and 15% of patients seen in care.