"Parvovirus B19-related Acute Hepatitis: Clinical Spectrum and Outcome in Children"

Overview

Journal J Clin Exp Hepatol

Publisher Elsevier

Specialty Gastroenterology

Date 2024 Oct 30

PMID 39473446

Authors

Arghya Samanta

Anshu Srivastava

Sangram S Patel

Moinak Sen Sarma

Ujjal Poddar

Prabhakar Mishra

Affiliations

Soon will be listed here.

Abstract

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.

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

Retrospective and Prospective Surveillance and Clinical Presentation of Parvovirus B19 in Veneto, Italy, 2024.

Tonon M, Panaite S, Gentili D, Ferraresso A, Da Re F, Ballarin D Microorganisms. 2025; 13(2).

PMID: 40005795 PMC: 11858032. DOI: 10.3390/microorganisms13020430.

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