Acute liver dysfunction not resulting from hepatitis virus in immunocompetent children

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.