Does norovirus induce acute hepatitis?

Carmen Lok Tung Ho; Olivia Oligbu; Fatma Asaid; Godwin Oligbu; Carmen Lok Tung Ho; Olivia Oligbu; Fatma Asaid; Godwin Oligbu

doi:10.3934/publichealth.2020013

AIMS Public Health

2020, Volume 7, Issue 1: 148-157. doi: 10.3934/publichealth.2020013

Previous Article Next Article

Review

Does norovirus induce acute hepatitis?

1.
Imperial College School of Medicine, London, UK
2.
Department of Paediatrics, Dr Gray's Hospital, NHS Grampian, Elgin, Scotland, UK
3.
Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, UK

Received: 26 December 2019 Accepted: 28 February 2020 Published: 09 March 2020

Background Norovirus is the commonest cause of acute viral gastroenteritis with significant morbidity. Extra intestinal manifestation following norovirus infection is rare and the mechanism is unknown.
Methods We undertook a review of the English literature published from January 1967 to April 2019 to evaluate the risk of acute viral hepatitis due to norovirus gastroenteritis. Data sources included MEDLINE, EMBASE, Cochrane library, and references within identified articles.
Results We identified 126 potential studies and included 5 publications involving 17 cases of norovirus induced hepatitis, and all had elevated ALT (31.7–458IU/l) and AST levels (45.6–1150IU/l). Majority of the cases were below the age of 18 (88%, n = 15) and almost two-third (64.7%, n = 11) had supportive treatment, mainly intravenous fluid administration. In cases reporting sex, there were more females than males (62.5%, 5/8 vs. 37.5%, 3/8). The duration of illness was longer, on average 10 days, compared to 3 days in those without elevated transaminitis and it took an average of 22.5 days for liver enzymes to settle. All patients recovered fully with no progression to chronic liver disease.
Conclusion Norovirus gastroenteritis is a self-limiting illness with majority not requiring hospitalisation and invasive investigations. We recommend that clinicians should be aware of norovirus induced transaminitis, and to suspect this especially in children who are likely to have protracted illness and require hospitalisation due to norovirus acute hepatitis.
- norovirus,
- acute hepatitis,
- transaminitis,
- gastroenteritis,
- liver
Citation: Carmen Lok Tung Ho, Olivia Oligbu, Fatma Asaid, Godwin Oligbu. Does norovirus induce acute hepatitis?[J]. AIMS Public Health, 2020, 7(1): 148-157. doi: 10.3934/publichealth.2020013

Related Papers:

Abstract

Background Norovirus is the commonest cause of acute viral gastroenteritis with significant morbidity. Extra intestinal manifestation following norovirus infection is rare and the mechanism is unknown.

Methods We undertook a review of the English literature published from January 1967 to April 2019 to evaluate the risk of acute viral hepatitis due to norovirus gastroenteritis. Data sources included MEDLINE, EMBASE, Cochrane library, and references within identified articles.

Results We identified 126 potential studies and included 5 publications involving 17 cases of norovirus induced hepatitis, and all had elevated ALT (31.7–458IU/l) and AST levels (45.6–1150IU/l). Majority of the cases were below the age of 18 (88%, n = 15) and almost two-third (64.7%, n = 11) had supportive treatment, mainly intravenous fluid administration. In cases reporting sex, there were more females than males (62.5%, 5/8 vs. 37.5%, 3/8). The duration of illness was longer, on average 10 days, compared to 3 days in those without elevated transaminitis and it took an average of 22.5 days for liver enzymes to settle. All patients recovered fully with no progression to chronic liver disease.

Conclusion Norovirus gastroenteritis is a self-limiting illness with majority not requiring hospitalisation and invasive investigations. We recommend that clinicians should be aware of norovirus induced transaminitis, and to suspect this especially in children who are likely to have protracted illness and require hospitalisation due to norovirus acute hepatitis.

Author's contributions

C.H. reviewed the literature, analysed the data, was involved in the interpretation of the data and writing the report (including the first draft), co-ordinated the production of the manuscript, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, and approved the final manuscript as submitted. O.O. carried out the initial analyses, was involved in the interpretation of the data and writing the report and approved the final manuscript as submitted. G.O. conceptualised and designed the study, was involved in the interpretation of the data and writing the report, co-ordinated the production of the manuscript, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Conflicts of interest

The authors declare no conflicts of interest.

Funding

There was no external funding received for the conduction of this study.

References

[1]	Sosnovtsev SV, Belliot G, Chang KO, et al. (2006) Cleavage map and proteolytic processing of the murine norovirus nonstructural polyprotein in infected cells. J Virol 80: 7816-7831. doi: 10.1128/JVI.00532-06
[2]	Patel MM, Hall AJ, Vinjé J, et al. (2009) Noroviruses: a comprehensive review. J Clin Virol 44: 1-8. doi: 10.1016/j.jcv.2008.10.009
[3]	World Health Organisation (2015) Foodborne viral disease in the European region.Avaliable from: http://www.euro.who.int/__data/assets/pdf_file/0007/294604/Factsheet-Foodborne-viral-disease-EU-Norovirus-HepatitisA-en.pdf.
[4]	Robilotti E, Deresinski S, Pinsky BA (2015) Norovirus. Clin Microbiol Rev 28: 134-164. doi: 10.1128/CMR.00075-14
[5]	Minemura M, Tajiri K, Shimizu Y (2014) Liver involvement in systemic infection. World J Hepatol 6: 632-642. doi: 10.4254/wjh.v6.i9.632
[6]	Nakajima H, Watanabe T, Miyazaki T, et al. (2012) Acute liver dysfunction in the course of norovirus gastroenteritis. Case Rep Gastroenterol 6: 69-73. doi: 10.1159/000336202
[7]	Centers for Disease Control and Prevention (2002) Outbreak of acute gastroenteritis associated with Norwalk-like viruses among British military personnel-Afghanistan, May 2002. MMRW Morb Mortal Wkly Rep 51: 477-479.
[8]	Kawano G, Oshige K, Syutou S, et al. (2007) Benign infantile convulsions associated with mild gastroenteritis: a retrospective study of 39 cases including virological tests and efficacy of anticonvulsants. Brain Dev 29: 617-622. doi: 10.1016/j.braindev.2007.03.012
[9]	Moher D, Liberati A, Tetzlaff J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. P Med 6: e1000097.
[10]	Kucuk O, Ugras M, Bicer S, et al. (2016) Hypertransaminasaemia in children with viral gastroenteritis. Le Infezioni in Medicina 24: 32-37.
[11]	Zenda T, Miyamoto M, Kaneko S (2011) Norovirus gastroenteritis accompanied by marked elevation of transaminases. Hiroshima J Med Sci 60: 41-43.
[12]	Tsuge M, Goto S, Kato F, et al. (2010) Elevation of serum transaminases with norovirus infection. Clincal Pediatrics (Phila) 49: 574-578. doi: 10.1177/0009922809353593
[13]	Khayat AA, Telega GW (2019) Persistent elevation of aminotransferases in liver transplant in association with chronic norovirus infection. Clin Mol Hepatol 25: 408-411. doi: 10.3350/cmh.2019.0018
[14]	Kimura H, Nagasaka T, Hoshino Y, et al. (2001) Severe hepatitis caused by Epstein-Barr virus without infection of hepatocytes. Hum Pathol 32: 757-762. doi: 10.1053/hupa.2001.25597
[15]	Tănăsescu C (2004) Correlation between cholestasis and infection. Rom J Gastroenterol 13: 23-27.
[16]	Murata T, Katsushima N, Mizuta K, et al. (2007) Prolonged norovirus shedding in infants ≤ 6 months of age with gastroenteritis. Pediatr Infect Dis J 26: 46-49. doi: 10.1097/01.inf.0000247102.04997.e0

Reader Comments

Your name:*

Email:*
© 2020 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)