Acute liver dysfunction not resulting from hepatitis virus in immunocompetent children

• Published in: Pediatrics international Vol. 59; no. 5; pp. 551 - 556
• Main Authors: Tsunoda, Tomoyuki, Inui, Ayano, Iwasawa, Kentaro, Oikawa, Manari, Sogo, Tsuyoshi, Komatsu, Haruki, Ito, Yoshinori, Fujisawa, Tomoo
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.05.2017
• Subjects: Children; Cytomegalovirus; Deoxyribonucleic acid; DNA; Epstein-Barr virus; Hepatitis; Hepatitis A; herpesvirus; Immunocompetence; immunocompetent; Immunoglobulin G; Immunoglobulin M; Infections; Liver; Liver diseases; liver failure; multiplex; Pediatrics; Poisoning; Polymerase chain reaction; real‐time polymerase chain reaction; Serology; Viremia; immunocompetent; liver failure; multiplex; herpesvirus; real-time polymerase chain reaction
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.13249

Background The aim of the present study was to clarify the roles of cytomegalovirus (CMV), Epstein–Barr virus (EBV), and human herpesvirus 6 (HHV‐6) in immunocompetent children with acute liver dysfunction not resulting from hepatitis virus. Methods Sixty‐eight children (median age, 3 years) hospitalized as a result of acute liver dysfunction were enrolled in this study. Hepatitis A, B, and C were excluded. The prevalence of CMV, EBV, and HHV‐6 and viral DNA load in whole blood was prospectively evaluated on multiplex real‐time polymerase chain reaction (PCR). Results Of the 68 children with acute liver dysfunction, multiplex real‐time PCR was positive in 30 (44%). CMV, EBV, and HHV‐6 DNA were detected in 13 (19%), 14 (21%), and seven (10%), respectively. Serum CMV immunoglobulin (Ig)G/IgM and EBV viral capsid antigen IgG/IgM were measured in 40 (CMV DNA positive, n = 10; negative, n = 30) and 45 (EBV DNA positive, n = 14; negative, n = 31) of the 68 children, respectively. Eighteen percent (CMV, 7/40) and 9% (EBV, 4/45) were positive for both PCR and viral‐specific IgM. There was no significant difference in CMV and EBV viral load between IgM‐positive and ‐negative children with viremia. Conclusions CMV, EBV, and HHV‐6 DNA were frequently detected in immunocompetent children with acute liver dysfunction, but primary CMV and EBV infection were confirmed in 10–20% of the children with acute liver dysfunction. The combination of PCR assay and serology is necessary to make a diagnosis of acute liver dysfunction due to primary CMV, EBV and/or HHV‐6 infection in immunocompetent children.