A puzzling outbreak of sudden liver disease in nearly 200 children has health authorities in Europe and the U.S., including in Illinois, racing to find answers.
The illnesses have no known connection, although a possible link with a virus that can cause colds is being investigated. At least one child died and several others have required liver transplants.
What's known so far:
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Previously healthy children are suddenly developing hepatitis, or liver inflammation often caused by viruses. Jaundice, diarrhea and abdominal pain are among reported symptoms. Children aged 1 month to 16 years have been affected.
Most cases have occurred in Europe. The first U.K. cases were recorded in January. The Centers for Disease Control and Prevention said in a nationwide health alert last week that the first U.S. cases were identified in October in Alabama.
Hepatitis is usually caused by one of several contagious hepatitis viruses that have not been found in the affected children. Sometimes the disease is mild and requires no specific treatment. But severe cases require hospitalization and can lead to liver failure.
The symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice.
Diarrhea and nausea are reported in patients with both hepatitis and adenoviruses, but doctors say there are ways to differentiate between the two.
Parents should keep an eye on sick children and look out for severe abdominal pain, fever, dark-colored urine or light-colored stools. The most telling symptom to be aware of is jaundice, or a yellow coloring in the skin or in whites of the eyes, said Dr. Nipunie Rajapakse, a pediatric infectious disease specialist at Mayo Clinic Children’s Center.
"The symptoms of hepatitis in childhood can be vague at first - abdominal pain, loss of appetite, severe fatigue - but then, as it progresses, the children do start to have dark urine, pale stools, yellowing of the whites of their eyes," said Dr. Estella Alonso, a hepatologist at Lurie Children's Hospital in Chicago. "These are the things that parents notice. And if parents do notice that they should seek medical attention from their pediatrician or in an emergency or urgent care setting as soon as possible."
According to Lurie Children's Hospital, the most common symptoms of acute hepatitis include:
- Flu-like symptoms
- Nausea and/or vomiting
- Decreased appetite
- Not feeling well all over
- Abdominal pain or discomfort
- Later symptoms include dark-colored urine and jaundice (yellowing of the skin and eyes). The symptoms of hepatitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
The hospital notes that symptoms will likely vary by child.
Authorities are uncertain what is causing the outbreak. Nine children in the Alabama cluster tested positive for adenovirus. Some types of the virus can cause colds but authorities are also looking at a version that can cause digestive problems.
It is unknown whether that virus is a cause or is somehow contributing to the outbreak.
Cases have been reported in at least a dozen countries, including Denmark, England, France, Ireland, Israel, Italy, the Netherlands, Norway, Scotland, Spain, and the United Kingdom. In the United States, cases have also occurred in Illinois and North Carolina.
The CDC says all physicians should be on the lookout for symptoms and report any suspected case of what's called hepatitis of unknown origin.
At least three Illinois children have been stricken with suspected severe cases of hepatitis in recent weeks, with one of those children requiring a liver transplant after contracting the illness.
According to a press release from the Illinois Department of Public Health, the cases of hepatitis, which all occurred in children under the age of 10, are potentially linked to a strain of adenovirus.
Two of the cases occurred in suburban Chicago, and one occurred in western Illinois, officials said.
A 4-year-old boy was brought to Advocate Children's Hospital in Park Ridge roughly two weeks ago with hepatitis, or "inflammation of the liver," Dr. Vincent Biank, who specializes in pediatric gastroenterology, told NBC Chicago.
Biank said the child also tested positive for adenovirus, a test they conducted following the CDC warning. "That seems to be the virus that's being identified both in the UK individuals and in the individuals that were identified in Alabama," Biank said.
Doctors are still waiting on results to see whether the strain is the specific one linked to the unexplained cases.
"His liver numbers spiked to over 3,000 and we followed him in the hospital for three, four days and actually got a liver biopsy to kind of see how bad the injury was on his liver and it was pretty severe," Biank said.
The good news is that the child's condition improved and his liver started recovering on its own, not requiring a transplant, as in some cases reported previously.
He was discharged from the hospital last week.