ABSTRACT
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases. © 2022 The Authors
ABSTRACT
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases.
ABSTRACT
INTRODUCTION: Since the beginning of this year, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic which has affected the entire world. Researchers are still trying to understand the characteristics and treatment options. Clinical manifestations may differ between children and adults. In rare cases, however, pediatric patients can present with a severe life-threatening complication called Multisystem Inflammatory Syndrome in Children (MIS-C), a term recognized by the CDC on May 14. (2) METHODS: A 25-year-old Hispanic male who previously tested positive for SARS-CoV-2 presents to the ICU with 1 week of sore throat, dysphagia, fever, non-bloody diarrhea, conjunctivitis, and mild confusion. He also reported he had a positive SARS-CoV-2 test 6 weeks prior to admission. On physical examination, the patient was febrile and found to have tender submandibular lymph nodes, redness on the oropharynx. The laboratory at admission shows an increase in inflammatory markers. The COVID-19 RT-PCR test was negative, coronavirus IgG was positive, and a normal chest radiograph. On the third day of admission, the patient's clinical status required ICU admission due to increased lethargy, shortness of breath, hypotension, and hypoxemia requiring vasopressor support. Additional tests including toxicology screen, blood culture, urinalysis, Histoplasma antigen, cryptococcal, coccidioidomycosis IgM and IgG, Clostridium Difficile PCR were all negative. An echocardiogram showed left ventricular ejection fraction (EF) of 35% with some hypokinesia. CT scan of the chest with contrast showed no pulmonary embolism but mild pleural effusions with atelectasis. Due to lack of improvement, we decided to start him on methylprednisolone at 1.5 mg/kg daily. After 24 hours of starting steroids, the clinical status and inflammatory markers improved significantly. RESULTS: This is the first case report of Multisystem Inflammatory Syndrome (MIS) in a young adult with clear documentation of increase inflammatory markers. MISChildren can present at any time but often occurs 6- 51 days following infection. Until now, it was unknown if this syndrome was specific to children or if it also occurs in adults with COVID-19. We treated our patient with steroids, resulting in improvement on his clinical status.