Features of the course of viral hepatitis A in a child with persistent mixed herpesvirus infection

Background. Today in the structure of viral hepatitis viral hepatitis A takes the lead position, the course of typical forms is usually favorable. Over the last few years, however, the frequency of viral hepatitis A has become higher, with increased morbidity in non-endemic areas of the Russian Federation, also with reactivation of chronic herpesvirus infections in re-convalescents of the new coronavirus infection Covid19. The research by the russian scienctists Volynets G. V., Potapov A. S., Pakhomovskaya N. L. in 2011 allowed to diagnose chronic herpesvirus hepatitis in 19.26% of children (18) during the examination of 107 children with chronic diffuse liver diseases. The etiology of liver damage in 39% of cases (7 children) was represented by monoherpesvirus infection: Ebstein – Barr virus infection or human herpes virus type 6. The other cases of chronic herpesvirus hepatitis were due to mixtforms of herpetic pathogens: Ebstein – Barr virus infection and human herpes virus type 6, or herpes simplex virus type 1-2 with human herpes virus type 6. In mixtforms of herpetic hepatitis there was a moderately severe course due to syndromes of cytolysis and cholestasis, but with rapid positive dynamics as a result of anti-herpetic therapy.
Objective. To investigate the course of viral hepatitis A in an 8-year-old child with reactivation of herpetic mixt-infection (VEB, CMV, HPV-1, type 2, HHV-6).
Materials and methods. The patient had a severe course of viral hepatitis A due to cytolysis syndromes (ALT increased to 76 norms), cholestasis and hepatoprivine syndrome (PTI decreased to 48.6%), associated with activation of persistent herpesvirus infection.
Results. There was a rapid positive dynamics of the patient's condition (within 4-5 days) according to laboratory and clinical data on the basis of anti-herpetic therapy (acyclovir) and interferon alfa-2b therapy. In this clinical case during the onset of viral hepatitis A there was reactivation of persistent mixtherpetic infection, and the latter was the trigger for the development of severe form of the underlying disease process.
Conclusion. In case of infection with a hepatotropic pathogen (hepatitis A virus) it is recommended to examine for comorbid chronic herpesvirus infection if there are indications, for example, belonging to the group of “frequently ill children”.

1. He althcare in Russia. 2023: Statistical Yearbook / Rosstat. M., 2023. 179 p. (In Russ.)

2. Mardanly S. G., Simonova E. G., Simonov V. V. Herpesvirus Infections: Etiology and Pathogenesis, Clinical and Laboratory Diagnostics, Epidemiology, and Prevention. Orekhovo-Zuevo: State Humanitarian-Technological University, 2020. 316 p. ISBN 978-5-87471-360-4. EDN BRNQXO. (In Russ.)

3. On the State of Sanitary and Epidemiological Well-being of the Population in the Russian Federation in 2020: State Report. Moscow: Federal Service for Surveillance on Consumer Rights Protection and Human Well-being, 2021. 256 p. (In Russ.)

4. Shamardina L. Rosstat recorded a sharp increase in the incidence of acute hepatitis and syphilis at the beginning of the year. Medvestnik. 2023. April 5. URL: https:// medvestnik.ru/content/news/Rosstat-zafiksiroval-rezkii-rost-zabolevaemosti-ostrymigepatitami-i-sifilisom-v-nachale-goda.html (accessed: June 22, 2024). (In Russ.)

5. Press release of the Office of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being in the Trans-Baikal Territory, 28.04.2024; URL: https://75.rospotrebnadzor.ru/press/relises/24303/. Accessed on: 02.06.2024. (In Russ.)

6. Bulykin Z. A., Danilovich S. D., Kuryanov A. P., et al. Hepatitis A: modern concepts of epidemiology, screening, and pathophysiological mechanisms. Universum: Meditsina i Fharmakologiya. 2022; 6 (89): 4-8. (In Russ.)

7. Abutaleb A., Kottilil S. Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterology Clinics of North America. 2020; 49 (2): 191-199. DOI: 10.1016/j.gtc.2020.01.002. PMID: 32389358.

8. Goryacheva L. G., Ventselovayte N. D., Greshnyakova V. A. Viral Hepatitis in Children: Current State and Prospects for Solving the Problem. Detskie infektsii. 2021; 20 (4): 35-41. DOI: https://doi.org/10.22627/2072-8107-2021-20-4-35-41. (In Russ.)

9. Kurglov I. V., Yumunova N. V. Chapter 9. Herpesviridae – Herpesviruses and the Infections They Cause. In: Current Problems of Modern Virology: A Collective Monograph / Ed. by I. V. Kurglov, N. V. Yumunova. Orekhovo-Zuyevo: State Humanitarian-Technological University; 2021. Pp. 175-203. (In Russ.)

10. Chudakova T. K., Mikhailova E. V., Tseka Y. S., et al. Liver involvement in infectious mononucleosis in children. Rossiiskii vestnik perinatologii i pediatrii. 2021; 66 (4): 318. (In Russ.)

11. Krupka J. A., Samelska K., Tomasik A., Stelmaszczyk-Emmel A., Pawelec K. Infectious mononucleosis-like syndrome with high lymphocytosis and positive IgM EBV and CMV antibodies in a three-year-old girl. Centr Eur J. Immunol. 2017; 42 (2): 210-212. DOI: 10.5114/ceji.2017.69364.

12. Spengler U., Fischer H. P., Caselmann W. H. Liver Disease Associated with Viral Infections. Zakim and Boyer's Hepatology. 2012: 629-43. DOI: 10.1016/B978-1-4377-0881-3.00034-6. Epub 2011 Oct 6. PMCID: PMC7152320.

13. Totolyan G. G., Storozhakov G. I., Fedorov I. G., at al. The Impact of Herpesviruses on the Course of Chronic Liver Diseases. Arkhiv vnutrennei meditsiny. 2013; 6 (14): 18-24. (In Russ.)

14. Totolyan G. G., Storozhakov G. I., Fedorov I. G., et al. Herpesvirus Group and Liver Damage. Lechebnoe delo. 2009; 2: 5-11. (In Russ.)

15. Volynec G. V., Potapov A. S., Pakhomovskaya N. L. Chronic Herpesvirus Hepatitis in Children: Clinic, Diagnosis, and Treatment Features. Rossiiskii pediatricheskii zhurnal. 2011; 4: 24–29. (In Russ.)

16. Akhunbaev S., Kutmanova A., Gupta A. Co-infection of Hepatitis A and Herpes Simplex Virus: A Case Report. Bulletin of Science and Practice. 2020; 7 (6): 158-162. DOI: 10.33619/2414-2948/56/18.

17. Bokovoy A. G., Yegorov A. I. Herpesvirus infections in children and parents: A textbook for students, pediatricians, infectious disease specialists, immunologists. M.: Tsentr strategicheskoi konyunktury, 2014. (In Russ.)

18. Egorova N. Yu., Molochkova O. V., Guseva L. N., at al. Active Herpes Virus Infection in Young Children. Detskie infektsii. 2018; 17 (4): 22-28. DOI: 10.22627/2072-8107-2018-17-4-22-28-2018-17(4)-22-28. (In Russ.)

19. Isakov V. A., Arkhipova Ye. I., Isakov D. V. Human herpesvirus infections: a guide for doctors. 2nd ed., revised. SPb: SpetsLit, 2013. (In Russ.)

20. Ruzhentsova T. A., Popova R. V., Garbuzov A. A., et al. Herpesvirus infections in the formation of ARVI episodes in children. Rossiiskii meditsinskii zhurnal. Mat' i ditya. 2023; 6 (4): 399-404. DOI: 10.32364/2618-8430-2023-6-4-12. (In Russ.)

21. Rybalkina T. N., Karazhas N. V., Savinkov P. A., et al. The importance of herpesviruses in the etiology of a number of infectious and somatic diseases of children. Detskie infektsii. 2017; 16 (3): 10-19. DOI: 10.22627/2072-8107-2017-16-3-10-19. (In Russ.)

22. Khakizimana J. K., Timchenko V. N., Shakmaeva M. A., et al. EBV mononucleosis in children in modern conditions. Detskie infektsii. 2020; 19 (2): 23-28. DOI: 10.22627/2072-8107-2020-19-2-23-28. (In Russ.)

23. Nadraga O. B., Klimenko K. P. Epstein – Barr and cytomegalovirus infection in children. Sovremennaya pediatriya. 2017; 7 (87): 7-11. DOI: 10.15574/SP.2017.87.7 2017-7(87)-7–11. (In Russ.)

24. Permyakova A. V., Pospelova N. S., Deryusheva A. Yu. Results of prospective follow-up observation of acute cytomegalovirus infection in children. Permskii meditsinskii zhurnal. 2019; 36 (1): 91-96. DOI: 10.17816/pmj36191%96. (In Russ.)

25. Iemura T., Kondo T., Hishizawa M., et al. NK-cell post-transplant lymphoproliferative disease with chronic active Epstein – Barr virus infectionlike clinical findings. Int J Infect Dis. 2019; 6; 88: 31-33. DOI: 10.1016/j.ijid.2019.07.039.

26. Kotlova V. B., Kokoreva S. P., Trushkina A. V. Optimization of Treatment for Epstein – Barr Virus Infectious Mononucleosis in Children. Detskie infektsii. 2015; 14 (3): 43-48. DOI: https://doi.org/10.22627/2072-8107-2015-14-3-43-48. (In Russ.)

27. Kharchenko Yu. P., Zaretskaya A. V., Gudz V. A., et al. Influence of etiological polymorphism on clinical manifestations and therapy of infectious mononucleosis in children. Sovremennaya pediatriya. 2017; 3 (83): 68-74. DOI: 10.15574/SP.2017.83.68. (In Russ.)

28. Drozdova N. F., Fazylov V. H. Infectious mononucleosis caused by Epstein – Barr virus: clinical and pathogenic aspects (review). Vestnik sovremennoi klinicheskoi meditsiny. 2018; 11 (3): 59-61. DOI: 10.20969/VSKM.2018.11(3).59-61. (In Russ.)

29. Kuselman A. I., Solovyeva I. L., Cherdantsev A. P. Herpesvirus Infections in Children: A Guide for Doctors. Edited by A. I. Kuselman. Ulyanovsk: Ulyanovsk State University, 2017. 280 p. (In Russ.)

30. Bondarenko A. L., Savinykh M. V., Savinykh N. A., et al. Age differences of the Eрshtein – Barr virus infectious mononucleosis. Zhurnal infektologii. 2018; 10 (1): 36-41. DOI: 10.22625/2072-6732-2018-10-1-36-41. (In Russ.)

31. Simovanyan E. N., Denisenko V. B., Grigoryan A. V., et al. Epstein–Barr Virus Infection in Children: Improving Diagnostic and Treatment Programs. Detskie infektsii. 2016; 15 (1): 15-24. (In Russ.)