ABSTRACT
Adenovirus hepatitis is of global concern due to its increasing incidence and poorly understood pathogenesis. Historically, adenovirus has contributed to the development of severe hepatitis in immunocompromised patients. The clinical course and management of such infections in previously healthy children remains elusive. We present a case of severe acute hepatitis in a previously healthy 12-month-old infant with a history of SARS-CoV-2 infection followed by multiviral infection including adenovirus. Additional evaluation revealed acute hepatitis without evidence of acute liver failure except for mild coagulopathy. She demonstrated clinical improvement with supportive therapy but later experienced reactivated hepatitis in the setting of a third new viral infection thereby warranting a second hospitalization. A liver biopsy was obtained due to concern for an underlying immunologic or metabolic etiology of her prolonged hepatitis. Our case provides insight into the medical management and clinical course of a previously healthy child with a history of SARS-CoV-2 and adenovirus infections leading to reactivated acute hepatitis.
ABSTRACT
PURPOSE OF REVIEW: The evidence supporting or contesting the prescription of proton pump inhibitors (PPIs) for children and updates on side effects are reviewed. RECENT FINDINGS: PPIs remain an important therapeutic option for esophagitis and gastritis. However, recent studies demonstrate no benefit when prescribing PPIs for chronic cough, infantile reflux, asthma, or functional gastrointestinal disorders. Recent studies suggest adverse effects on microbiome diversity and immune function, resulting in increased rates of gastrointestinal infections, bone fractures, and atopic disorders. PPIs influence a variety of cell types within the in the innate and adaptive immune systems. PPI prescriptions in children may be indicated for select conditions; however, multiple side effects and immune effects have been described. While most of these side effects are rare and mild, some studies suggest enduring adverse effects. Future studies to elucidate the mechanism behind some of these immune and infectious complications will be beneficial.
Subject(s)
Proton Pump Inhibitors/therapeutic use , Child , Humans , Proton Pump Inhibitors/adverse effects , Proton Pump Inhibitors/pharmacologyABSTRACT
OBJECTIVES: Eosinophilic esophagitis (EoE) is an inflammatory, atopic disease of the esophagus without a clear etiology. Our objective was to identify exposures and conditions in early infancy associated with the development of EoE. METHODS: A case-control study was performed using the Military Health System Database. Subjects diagnosed with EoE from October 2008 to September 2015 were matched 1:2 on age and sex. Early infant risk factors from the first 6 months of life were investigated. RESULTS: A total of 1410 cases with EoE were matched to 2820 controls. The median (interquartile range) age at diagnosis of EoE was 4.2 years (2.1-7.2) and 68.7% were boys. Proton pump inhibitors (adjusted odds ratio [aOR], 2.73; 95% confidence interval [CI] 1.93-3.88), histamine-2 receptor antagonists (aOR, 1.64; 95% CI 1.27-2.13), and antibiotics (aOR, 1.31; 95% CI 1.10-1.56) were associated with EoE. Prematurity (aOR, 1.46; 95% CI 1.12-1.89) and early manifestations of atopic disease such as milk protein allergy (aOR, 2.37; 95% CI 1.26-4.44) and eczema (aOR, 1.97; 95% CI 1.64-2.36) were related to increased odds for EoE. Erythema toxicum in infancy was strongly associated with a diagnosis of EoE (aOR 3.52; 95% CI 1.03-12.04). Infants with feeding difficulty (aOR, 1.45; 95% CI 1.18-1.77) and gastroesophageal reflux disease (aOR, 1.79; 96% CI 1.43-2.26) were also at increased risk for EoE. CONCLUSIONS: Acid-blocking medications and antibiotics during infancy were associated with later diagnosis of EoE. Erythema toxicum neonatorum, an eosinophilic immune phenomenon, was strongly associated with EoE. Identifying early infant risk factors for EoE may help to risk stratify the need for endoscopy.
