Review

Does norovirus induce acute hepatitis?

  • 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.

    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

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  • 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.


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    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.

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