Fig. 1: Epidemiology and histological appearance of cases of paediatric hepatitis in Scotland.
From: Adeno-associated virus 2 infection in children with non-A–E hepatitis
a, The emergence of acute non-A–E hepatitis in children in March–September 2022 (ref. 3). b–d, Cases of HAdV (b), SARS-CoV-2 (c) and HHV6 (d) infection in children aged ≤10 years in Scotland during the period January 2019 to September 2022. e–t, Histopathology of samples from cases of non-A–E hepatitis (e–l) and from healthy liver (m–t). e,i,m,q, Serial sections of formalin-fixed and paraffin-embedded liver tissue sections (one section for each stain per patient sample) stained with haematoxylin and eosin (H&E). f,j,n,r, Reticulin staining highlighting structural organization. g,k,o,s, Masson staining highlighting collagen fibres. h,l,p,t, Staining for MHCII+ cells. m–p, The regular lobular structure of the liver from a healthy individual (identifier 145783) is not recognisable in e–h, which are sections collected from patient CVR35 who received a liver transplant. h, Immunohistochemistry showed an increase in MHCII+ cells in tissue samples from patient CVR35 compared with healthy liver (l,t). i–l, Higher magnification micrographs of e–h showing details of liver histopathology. i,q, For patient CVR35 (i), enlarged (ballooned) and vacuolated hepatocytes (marked by asterisks) are evident compared with hepatocytes in healthy liver (q; from individual 145783) with regular morphology (indicated by the arrow) and regular sinus (indicated by the plus symbol). j,r, For the sample from patient CVR35 (j), reticulin staining shows destruction of the sinus structures and irregularly arranged fibres, whereas healthy liver (r) shows fibres lining the sinus (indicated by asterisks). k,s, For the sample from patient CVR35 (k), Masson staining shows an increase in collagen fibres (in blue, indicated by the asterisk) compared with minimal staining of fibres (indicated by the arrow) in healthy liver (s). l,t, High magnification image showing accumulation of MHCII+ cells in the liver (indicated by the asterisk) of patient CVR35 (l), whereas healthy liver (t), staining is limited to Kupffer cells (indicated by the arrow). Scale bars, 50 μm (i–l,q–t) or 400 μm (e–h,m–p).
