Samanta Arghya, Srivastava Anshu, Patel Sangram S, Sen Sarma Moinak, Poddar Ujjal, Mishra Prabhakar
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102416. doi: 10.1016/j.jceh.2024.102416. Epub 2024 Sep 24.
BACKGROUND/AIMS: Acute liver injury is a common manifestation of parvovirus B19 (PVB19) infection in immunocompromised patients. However, literature in immunocompetent children is scarce. We aimed to study the clinicolaboratory features and outcome of hepatic involvement by PVB19 infection in hospitalized children.
We retrospectively analyzed our prospectively kept database of all children (<18 years old) admitted with acute viral hepatitis (AVH), acute liver failure (ALF) or acute-on-chronic liver failure (ACLF), and PVB19 infection between January 2010 and December 2023. Clinical features, laboratory parameters, and complications were evaluated. Poor outcome was defined as death or liver transplantation.
A total of 35 children (19 boys [54%], median age: 7.25 [interquartile range: 4-10.8] years) with PVB19-related hepatitis were studied (28 [80%] isolated PVB19 infection and 7 [20%] coinfections [3 with Epstein-Barr virus, 2 with hepatitis A, and 1 each with hepatitis-E and cytomegalovirus]). AVH (17, 49%) was the most common presentation, followed by ALF (13, 37%) and acute insult in ACLF (5, 14%). Patients with coinfection had significantly higher bilirubin (14.6 [9.4-21.5] vs 6.8 [4.3-10.9] mg/dl; =0.004) and transaminases (ALT: 697 [428-1296] vs. 277 [157-478] U/L; =0.02) but similar mortality (1/7 vs 6/23; =1.0) than PVB19 alone. Nine cases (25.7%) had extrahepatic complications (hemophagocytic lymphohistiocytosis [HLH]: 3, acute kidney injury: 3, aplastic anemia: 2, and myocarditis: 1). Poor outcome occurred in 38% (5/13) ALF, 11.7% (2/17) AVH (HLH: 1, myocarditis: 1), and none (0/5) of the ACLF cases.
PVB19 should be considered in children presenting with indeterminate acute liver injury, especially in younger children or those with complications such as aplastic anemia, HLH, or myocarditis.
背景/目的：急性肝损伤是免疫功能低下患者感染细小病毒B19（PVB19）的常见表现。然而，关于免疫功能正常儿童的文献较少。我们旨在研究住院儿童感染PVB19后肝脏受累的临床实验室特征及预后。
我们回顾性分析了2010年1月至2023年12月期间前瞻性保存的所有因急性病毒性肝炎（AVH）、急性肝衰竭（ALF）或慢加急性肝衰竭（ACLF）入院且感染PVB19的18岁以下儿童的数据库。评估了临床特征、实验室参数及并发症。不良预后定义为死亡或肝移植。
共研究了35例与PVB19相关肝炎的儿童（19例男孩[54%]，中位年龄：7.25[四分位间距：4 - 10.8]岁）（28例[80%]为单纯PVB19感染，7例[20%]为合并感染[3例合并爱泼斯坦-巴尔病毒，2例合并甲型肝炎，1例分别合并戊型肝炎和巨细胞病毒]）。AVH（17例，49%）是最常见的表现，其次是ALF（13例，37%）和ACLF中的急性损伤（5例，14%）。合并感染的患者胆红素（14.6[9.4 - 21.5]对6.8[4.3 - 10.9]mg/dl；P = 0.004）和转氨酶（ALT：697[428 - 1296]对277[157 - 478]U/L；P = 0.02）显著更高，但与单纯PVB19感染的死亡率相似（1/7对6/23；P = 1.0）。9例（25.7%）有肝外并发症（噬血细胞性淋巴组织细胞增生症[HLH]：3例，急性肾损伤：3例，再生障碍性贫血：2例，心肌炎：1例）。38%（5/13）的ALF、11.7%（2/17）的AVH（HLH：1例，心肌炎：1例）出现不良预后，ACLF病例无一例（0/5）出现不良预后。
对于出现不明原因急性肝损伤的儿童，尤其是年幼儿童或伴有再生障碍性贫血、HLH或心肌炎等并发症的儿童，应考虑PVB19感染。
