Characteristics and outcomes of acute hepatitis of unknown etiology in Egypt: first report of adult adenovirus-associated hepatitis

Haidi Karam-Allah Ramadan; Ibrahim M Sayed; Amal A Elkhawaga; El-Zahraa M Meghezel; Ashraf A Askar; Abdelmajeed M Moussa; Asmaa O B S Osman; Azza Abo Elfadl; Walaa A Khalifa; Ahmed M Ashmawy; Mohamed A El-Mokhtar

doi:10.1007/s15010-022-01945-1

Characteristics and outcomes of acute hepatitis of unknown etiology in Egypt: first report of adult adenovirus-associated hepatitis

Infection. 2023 Aug;51(4):887-895. doi: 10.1007/s15010-022-01945-1. Epub 2022 Nov 5.

Authors

Affiliations

¹ Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
² Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
³ Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States.
⁴ Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Sohag, Egypt.
⁵ Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt.
⁶ Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan, Egypt.
⁷ Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
⁸ Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
⁹ Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt. elmokhtarma@aun.edu.eg.

Abstract

Purpose: Several outbreaks of acute hepatitis of unknown etiology (AHUE) in children were reported in 2022 in many countries, with adenovirus identified as the etiological agent in most of them. We aimed to evaluate the characteristics and outcomes of AHUE cases in Egypt.

Methodology: Hospitalized patients with acute hepatitis were included in the study. Drug-induced, alcoholic hepatitis, autoimmune hepatitis, and Wilson's disease were identified either by medical history or by routine laboratory diagnosis. Molecular and serological approaches were used to investigate common viral causes of hepatitis, such as hepatitis A-E viruses, cytomegalovirus, Epstein-Barr virus, herpes simplex viruses (HSV1/2), adenovirus, parvovirus B19, and coxsackie virus.

Results: A total of 42 patients were recruited and divided into two groups: 24 cases of unknown hepatitis after excluding the common causes and 18 cases of known hepatitis. About two-thirds of the patients were male (61.9%), and the mean age was 34.55 ± 16.27 years. Jaundice, dark urine, abdominal pain and diarrhea were recorded at a higher incidence in group 1, while jaundice and fever were frequent in group 2. Fulminant hepatitis occurred in 28.6% of the cases, but the two groups did not differ significantly in terms of patient outcome, duration of hospitalization, ascites, and development of fulminant hepatitis. Adenovirus was detected in five cases (20.8%) in group 1, and one case co-infecting with hepatitis E virus in group 2. Herpes simplex virus 1/2, coxsackie virus, and parvovirus B19 were not detected in any case, while etiologies of 75% of the cases were still not confirmed. One out of the six adenovirus-infected patients died. The outcome significantly correlated with the severity of the liver disease.

Conclusion: This is the first report describing etiologies and characteristics of AHUE cases in Egypt, and interestingly, adenovirus was detected in adults. Further studies are required to determine the prevalence of this newly emerging viral hepatitis pathogens.

Keywords: AHUE; Acute hepatitis; Acute liver failure; Adenovirus; Adult; Egypt; Non-A–E hepatitis.

MeSH terms

Adenoviridae
Adenoviridae Infections*
Adolescent
Adult
Child
Egypt / epidemiology
Epstein-Barr Virus Infections*
Female
Hepatitis, Viral, Human* / epidemiology
Herpesvirus 4, Human
Humans
Jaundice* / epidemiology
Jaundice* / etiology
Male
Massive Hepatic Necrosis*
Middle Aged
Young Adult