title: Acute liver dysfunction not resulting from hepatitis virus in immunocompetent children.
abstract: BACKGROUND
  The aim of the present study was to clarify the roles of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6) in immunocompetent children with acute liver dysfunction not resulting from hepatitis virus.
  
  
  METHODS
  Sixty-eight children (median age, 3 years) hospitalized as a result of acute liver dysfunction were enrolled in this study. Hepatitis A, B, and C were excluded. The prevalence of CMV, EBV, and HHV-6 and viral DNA load in whole blood was prospectively evaluated on multiplex real-time polymerase chain reaction (PCR).
  
  
  RESULTS
  Of the 68 children with acute liver dysfunction, multiplex real-time PCR was positive in 30 (44%). CMV, EBV, and HHV-6 DNA were detected in 13 (19%), 14 (21%), and seven (10%), respectively. Serum CMV immunoglobulin (Ig)G/IgM and EBV viral capsid antigen IgG/IgM were measured in 40 (CMV DNA positive, n = 10; negative, n = 30) and 45 (EBV DNA positive, n = 14; negative, n = 31) of the 68 children, respectively. Eighteen percent (CMV, 7/40) and 9% (EBV, 4/45) were positive for both PCR and viral-specific IgM. There was no significant difference in CMV and EBV viral load between IgM-positive and -negative children with viremia.
  
  
  CONCLUSIONS
  CMV, EBV, and HHV-6 DNA were frequently detected in immunocompetent children with acute liver dysfunction, but primary CMV and EBV infection were confirmed in 10-20% of the children with acute liver dysfunction. The combination of PCR assay and serology is necessary to make a diagnosis of acute liver dysfunction due to primary CMV, EBV and/or HHV-6 infection in immunocompetent children.
authors.affiliation: Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tsunoda
authors.affiliation: Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Ayano
authors.initials: A
authors.lastname: Inui
authors.affiliation: Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwasawa
authors.affiliation: Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Manari
authors.initials: M
authors.lastname: Oikawa
authors.affiliation: Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sogo
authors.affiliation: Department of Pediatrics, Sakura Medical Center, Toho University, Chiba, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Fujisawa
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D005260:Female; D048550:Hepatic Insufficiency / Q000276:immunology / Q000821:virology*; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D007121:Immunocompetence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D019349:Roseolovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D019562:Viral Load
keywords: herpesvirus; immunocompetent; liver failure; multiplex; real-time polymerase chain reaction