[The relationship between adenovirus infection and severe acute hepatitis of unknown etiology]

Adenovirus infection can occur in all regions or countries of the world, with no obvious seasonality, but pandemics mostly occur in winter or early spring. Adenovirus infection is self-limited among immunocompetent host with supportive care, however fatal infection can occur among immunocompromised patients, mainly affecting respiratory, gastrointestinal tract and adjunctiva and very rarely causing hepatitis, cholecystitis, pancreatitis, hemorrhagic cystitis, myocarditis, meningitis or encephalitis. Adenovirus hepatitis mainly occur in malignant tumors or organ transplantation patients, but acute severe hepatitis can occur even in immunocompetent children or adults. On 5 April 2022, WHO was notified of 10 cases of severe acute hepatitis of unknown etiology in children. As of 21 April 2022, at least 169 cases of acute hepatitis of unknown origin have been reported from 12 countries (including 11 WHO European Region countries and the United States). Adenovirus has been detected in at least 74 cases; SARS-CoV-2 was identified in 20 cases of those that were tested. Furthermore, 19 were detected with a SARS-CoV-2 and adenovirus co-infection. At present, the etiology has not been fully elucidated. The leading hypotheses center around adenovirus, and the relationship with SARS-CoV-2 needs to be further ruled out.腺病毒感染在全球各地区均可出现，无明显季节性，但大流行多发生在冬季或早春。腺病毒在免疫功能正常的人中常引起轻度、自限性感染，主要累及呼吸道、消化道、眼结膜等，偶尔可导致肝炎、胆囊炎、胰腺炎、出血性膀胱炎、心肌炎、脑膜炎或脑炎。一般预后良好，但在免疫功能缺陷者，可发生严重或致命的感染。腺病毒肝炎主要见于恶性肿瘤及组织器官移植等处于免疫功能抑制状态的人群，但也有在免疫功能正常的小儿或成人引起急性肝炎的个案报道。2022年4月5日，世界卫生组织收到英国通报10例原因不明的儿童严重急性重症肝炎病例，至4月21日增至169例，遍及12个国家（11个世界卫生组织欧洲区国家及美国），其中74例腺病毒阳性、20例新型冠状病毒阳性，19例新型冠状病毒和腺病毒同时阳性。其病因尚未完全阐明，但病因假说主要围绕腺病毒感染，与新型冠状病毒的关系也需进一步排除。.