Enteroviral hepatitis in children

Background: The pathogen causing enteroviral hepatitis is often not found despite careful examination. Methods: This study investigates the enterovirus genome in serum and liver tissue obtained from patients who showed abnormal liver function without negative data of usual studies and cytomegalovirus (CMV) serologically positive cases.' Results: Nine out of 21 serum samples were positive by using reverse transcriptase-polymerase chain reaction (RT-PCR) for enterovirus. The 21 samples had CMV-IgM antibodies in five cases. These CMV serologically positive cases were all negative for enterovirus using RT-PCR. Therefore, nine out of 16 (60%) were of unknown etiology. Some cases showed liver dysfunction over a period of more than 6 months. The liver function revealed that all cases finally improved. The sequences coincided with those of Coxsackie B5 or B6 with the highest score by gene homology search. The liver pathology revealed that two of three subjected cases had mild fibrosis and small cell infiltration. RT-PCR of liver tissue for enterovirus were positive in all three cases comparing the house keeping gene. The viral load was high in acute phase and low in convalescent phase. Conclusion: In more than half of children with illnesses of unknown etiology, the pathogen was found to be enteroviruses, and RT-PCR and quantification of serum is an easy method to identify these diseases.