Abstract

Background: Viral hepatitis defined as infection of the liver caused by hepatotropic and/or non-hepatotropic viruses. Acute hepatitis is a self-limiting illness characterized by an abrupt onset of symptoms with the hepatocellular inflammation usually resolving completely within 4-6 weeks. The clinical spectrum of acute viral hepatitis ranges from entirely subclinical and in apparent infection to rapidly progressing and fulminant hepatic failure. India is hyper-endemic for hepatitis A and E virus infection. Purpose of this study was to identify the etiology, and to assess the clinical and biochemical profile, complications and final outcome of acute viral hepatitis in children.

Method: This was a prospective observational study, conducted in department of Pediatrics, Silchar Medical College and Hospital, among the children from 6month to 12years of age over a period of 1 year (July 2019 to June 2020). A total of 56 children with clinical diagnosis of acute viral hepatitis were included in the study. Data on clinical profile, laboratory parameters were obtained and analysis was performed.

Results: Among 56 cases 32(57.14%) were boys and 24 were girls (42.85%). Mean age group was 7.37± 2.49 years. Virology marker revealed 41 (73.21%) cases positive for hepatitis A(HAV), 6(10.71%) cases positive for hepatitis E (HEV), and co-infection with HAV and HEV in 1(1.78%) case, no specific etiology was detected in 8(14.28%) cases, no positive hepatitis B and hepatitis C cases were detected. Jaundice was the most common (100%) presenting complaint, followed by fever (96.42%), high colored urine (83.92%), pain abdomen (80.35%). Conjugated hyperbilirubinemia was detected in all (100%) the HAV, HEV positive cases, hepatic enzymes raised above 5 times of normal limit in all the HAV, HEV positive cases. Significant elevations in hepatic enzymes were seen more commonly in children with HEV infection. INR more than 2.5 was noticed among 4 HAV positive cases (9.75%) and 1 HEV positive case (16.67%). Acute liver failure was seen in3 children, and among them 2(66.67%) children were infected with HAV and 1(33.33%) child was infected with HEV. All the 3 cases of acute liver failure died after 4-5 days of admission.

Conclusion: Hepatitis A is most common cause of acute viral hepatitis in pediatrics population. Hepatitis E infection leads a more severe clinical course than HAV infection.

Keywords:  Acute viral hepatitis, hyperbilirubinemia, Hepatitis A, Hepatitis E.