ACUTE PARVOVIRUS B19 INFECTION ASSOCIATED WITH FULMINANT-HEPATITIS OFFAVORABLE PROGNOSIS IN YOUNG-CHILDREN

Background The cause of fulminant hepatitis (FH) in children is unexpl ained in up to 50% of cases. We report parvovirus B19 as an agent asso ciated with FH in children and compare clinical characteristics of the se patients with those of age-matched patients with FH of other origin . Methods 45 patients presented with FH. No cause was apparent in 21 p atients. Parvovirus B19 genome was retrospectively sought by PCR in se rum collected admission in 41 patients. Findings Parvovirus B19 genome was detected in serum from four of 21 patients with unexplained FH (f our of 11 younger than 5 years). No B19 DNA was detected in serum from patients with other types of FH or from 82 patients with biliary atre sia. Parvovirus B19 IgM was detected in one of the four patients. Pati ents with parvovirus B19 infection had significantly lower bilirubin c oncentrations than age-matched patients with FH due to hepatitis A (ni ne) or other causes (nine) (poisoning with amanita excluded). All pati ents with parvovirus B19 survived without orthotopic liver transplanta tion, with restoration of normal liver function within 17 days. Interp retation In patients younger than 5 years with FH of unexplained origi n, evidence of acute parvovirus B19 was associated with a distinct cli nical pattern. In particular, low bilirubin concentrations and rapid r ecovery of liver function without transplantation were distinctive fea tures.