Abstract
Purpose: Acute viral hepatitis A is a widespread, usually self-limited disease in children. This study was conducted to see any change in the pattern of clinico-epidemiological and laboratory profile of this disease and to find out hepatic and extra-hepatic complication in children.
Methodology: 43 children diagnosed as acute viral hepatitis A by HAV IgM serology (ELISA) were included in this Hospital based cohort study.
Results: Mean age was 6.65 ± 2.46 y (48.8% male, 51.2% female).29 children were from lower socio-economic status. Anicteric hepatitis was found in 6.98%. Fever, dark colored urine and hepatomegaly were present in all. Other signs and symptoms were icterus (93.02%), nausea (83.72%), vomiting (76.74%), pain abdomen, abdominal distention, clay colored stool, pruritus and splenomegaly (16.28%). Most common complication was prolonged (> 12 weeks) cholestasis (16.3%) followed by ascites (6.99%), bleeding manifestations (4.65%), fulminant hepatic failure (4.65%). By comparative study, in children with prolonged cholestasis and/or palpable left lobe of liver(20.9%) with the rest of the study populations: it showed that the serum bilirubin (mean14.48 mg/dl), AST( p 0.001)and ALP(p 0.008) value were much higher with statistically significant hypoalbuminemia (p 0.042), edema (p 0.011), splenomegaly (p 0.008), altered hepatic echotexture (p 0.010),GB wall thickening (p 0.003) and altered ALT : AST ratio( p 0.005) at initial presentation.
Conclusion: This study showed that there is a changing trend in terms of increased frequency of prolonged cholestasis and left lobe hepatomegaly with significant changes of some relevant laboratory parameters.
Keywords: Hepatitis A, Cholestasis , Palpable left lobe of liver, Hypoalbuminemia, Cohort study
References
- WHO/CDS/CSR/EDC/2000.7. Hepatitis A. World Health Organization. Department of communicable disease surveillance and response: available at: http://www.who.int/cs/disease/hepatitis/HepatitisA_whocdsredc2000_7.pdf .Accessed 1st December 2014.
- Lemon SM. Hepatitis A virus. In: Webster RG and Granoff A, eds. Encyclopedia of Virology, London, Academic Press Ltd, 1994:546-554.
- Stapleton JT and Lemon SM. Hepatitis A and hepatitis E. In:Hoeprich PD, Jordan MC, and Ronald AR, eds. Infectious Diseases, 5th ed. Philadelphia, Lippincott Co, 1994:790-797.
- Hollinger FB and Ticehurst JR. Hepatitis A virus. In: Fields BN, Knipe DM, and Howley PM, eds. Fields Virology, 3rd ed. Philadelphia, Lippincott -Raven, 1996:735-782.
- Lemon SM. Type A viral hepatitis: epidemiology, diagnosis, and prevention. Clinical Chemistry,1997, 43(8(B)):1494-1499.
- Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 1996, 45(RR15):1 -30.
- Jacobsen K. The Global Prevalence of Hepatitis a Virus Infection and Susceptibility: A Systematic Review. Immunization, Vaccines and Biologicals. Geneva:WorldHealthOrganization;2009.Availablefrom:http://whqlibdoc.who.int/hq/2010/WHO_IVB_10.01_eng.pdf. Accessed December 26, 2012.
- Kar P. Is there a change in seroepidemiology of hepatitis A infection in India? Indian J Med Res. 2006;123:727–729.
- Acharya SK, Batra Y, Bhatkal B, Ojha B, Kaur K, Hazari S, et al. Seroepidemiology of hepatitis A virus infection among school children in Delhi and north Indian patients with chronic liver disease: Implications for HAV vaccination. J Gastroenterol Hepatol 2003; 18: 822-7.
- Dhawan PS, Shah SS, Alvares JF, et al. Seroprevalence of hepatitis A virus in Mumbai, and immunogenicity and safety of hepatitis A vaccine. Indian J Gastroenterol. 1998;17:16–18.
- Dhamdhere MR, Nadkarni Infectious hepatitis at Aurangabad. Report of an outbreak. Indian J Med Sci 1962;16 : 1006-15.
- Jagadish Kumar, H. C. Krishna Kumar, V. G. Manjunath, C. Anitha, S. Mamatha,: Hepatitis A in Children- Clinical Course, Complications and Laboratory Profile; The Indian Journal of Pediatrics ,January 2014, Volume 81, Issue 1, pp 15-19 Date: 01 Aug 2013 .
- Naik SR, Aggarwal R, Salunke PN, Mehrotra NN. A large waterborne viral hepatitis E epidemic in Kanpur. India. Bull World Health Organ 1992; 70 : 597-604.
- Thapa BR, Singh K, Singh V, Broor S, Singh V, Nain CK. Pattern of hepatitis A and hepatitis B virus markers in cases of acute sporadic hepatitis and in healthy school children fromnorth west India. J Trop Pediatr1995; 41 : 328-9.
- Malathi S, Mohanavalli B, Menon T, Srilatha P, Sankaranarayanan VS, Reju B, et al. Clinical and viral markers pattern of acute sporadic hepatitis in children at Madras, South India. J Trop Pediatr1998; 44 : 275-8.
- Samanta T, Ganguly S. Aetiology, clinical profile and prognostic indicators for children with acute liver failure admitted in a teaching hospital in Kolkata. Trop. Gastroenterol.2007 Jul-Sep;28(3):135-9
- Arankalle V, Mitra M ,Bhave S, Ghosh A , Balasubramanian S , Chatterjee S et al: changing epidemiology of hepatitis a virus in indian children ; Dovepress journal : Vaccine: Development and Therapy;18th January Volume 2014:4, p 7-13. https://doi.org/10.2147/VDT.S53324
- Kliegman R M., Stanton B F. , St. Geme J.W., Schor N. F. , Behrman R. E.: Nelson Textbook of Pediatrics; 19th Edition, an imprint of Elsevier Inc.,p1374.
- Jeong SH, Lee HS. Hepatitis A: Clinical manifestations and management. Intervirol 2010;53:15-19. https://doi.org/10.1159/000252779 [last accessed on 8th June,2019]
- Park GJH, Lin BPC, Ngu MC et al. Aspartate aminotransferases: alanine aminotransferases ratio in chronic hepatitis C infection : is it a predictor of cirrhosis? 2000; 15 : 386-389.
Corresponding Author
Shibasish Banerjee
Demonstrator, Department of Community Medicine, Medical College, Kolkata, West Bengal, India