Coronavirus may be linked to cases of severe hepatitis in children

A firefighter from the Marins-Pompiers de Marseille (Marseille Naval Fire Battalion) administers a nasal swab to a child at a coronavirus disease (COVID-19) screening site in Marseille, France, September 17, 2020. REUTERS/Eric Gaillard

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May 16 (Reuters) – The following is a summary of some recent studies on COVID-19. They include research that deserves further study to substantiate the findings and that has not yet been certified by peer review.

SARS-CoV-2 could cause mysterious hepatitis in children

A chain of events possibly triggered by an unrecognized infection with the SARS-CoV-2 coronavirus could be behind the mysterious cases of severe hepatitis reported in hundreds of young children around the world, the researchers suggest.

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Children with COVID-19 are at significantly increased risk of liver dysfunction later on, according to a report published Saturday on medRxiv ahead of peer review. But most children with acute hepatitis – which is generally rare in this age group – do not report previous SARS-CoV-2 infection. Instead, the majority were found to be infected with an adenovirus called 41F, which is not known to attack the liver. It’s possible that the affected children, many of whom are too young to be vaccinated, had mild or asymptomatic COVID infections that went undetected, a separate team of researchers suggests in The Lancet Gastroenterology & Hepatology. If this were true, they theorize, then lingering coronavirus particles in the gastrointestinal tracts of these children could cause the immune system to overreact to adenovirus-41F with large amounts of inflammatory proteins that eventually damage the liver.

“We suggest that children with acute hepatitis be studied for persistence of SARS-CoV-2 in the stool” and for other signals indicating that liver damage is occurring because the coronavirus spike protein is a “superantigen” that oversensitizes the immune system, they said.

Face down position unnecessary for awake patients

For hospitalized COVID-19 patients who are breathing on their own but with supplemental oxygen, lying face down may not prevent them from possibly needing mechanical ventilation, a new study finds.

In the study, 400 patients were randomly assigned to usual care or standard care plus intermittent prone lying, a position known to improve disease course in sedated patients on mechanical ventilators. Over the next 30 days, 34.1% in the prone position group and 40.5% in the usual care group required intubation and ventilator treatment, a difference that was not statistically significant. There may have been a reduced risk of intubation with prone positioning in some patients, researchers said in JAMA on Monday, but they could not confirm this statistically from their data. The average prone positioning time per day was about five hours, below the target of eight to 10 hours per day.

“Long hours of awake supine positioning are challenging and strongly influenced by patient comfort and preference,” the researchers said. “The most common reason for discontinuation of prone positioning was patient request, which could have been related to overall subjective improvement or related to discomfort from prone positioning.”

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Reporting by Nancy Lapid and Megan Brooks; Editing by Bill Berkrot

Our standards: The Thomson Reuters Trust Principles.

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