A retrospective study of severe acute hepatitis cases of unknown etiology in pediatric patients reveals the presence of adenovirus involvement in central India

Objectives

Human adenovirus (HAdV) is increasingly identified as a potential cause of pediatric acute hepatitis of unknown etiology. This study aimed to detect HAdV in children with acute hepatitis or jaundice who tested negative for common bacterial and viral causes of hepatitis, including hepatitis viruses (A-E) and other bacterial pathogens, by serological and molecular assays.

Methods

A retrospective study was conducted on pediatric patients (aged ≤14 years) with acute hepatitis or jaundice who tested negative for hepatitis A-E. HAdV was detected using real-time polymerase chain reaction, followed by Sanger sequencing for genotype identification. Biochemical markers of liver function were assessed to confirm hepatitis.

Results

Of 227 pediatric cases suspected of hepatitis/jaundice, 11 (4.85%) tested positive for HAdV using real-time polymerase chain reaction and Sanger sequencing. Of the 11 sequences, four were identified as HAdV type 41 and seven as HAdV type 7. Elevated liver enzymes were observed in nine HAdV-positive cases, supporting a clinical diagnosis of hepatitis.

Conclusions

This study highlights HAdV, particularly, types 7 and 41, as notable causative agents of hepatitis in children who tested negative for common hepatitis viruses. To the best of our knowledge, this is the first study from India to report HAdV as a potential etiological agent associated with hepatitis in a notable number of such cases.