Changing Spectrum of Sporadic Acute Viral Hepatitis in Indian Children

Abstract

From August 1997 to January 2000, 172 children (< or = 14 years) with acute viral hepatitis were studied. Their clinical features, investigations and outcome were noted. Viral markers (IgM anti-HAV, IgM anti-HEV, HBsAg and anti-HCV) were measured by ELISA using commercial kits. The mean age of these children was 5.6 +/- 2.9 (range, 4 months to 14 years) with a male to female ratio of 120:52. Prodromal symptoms were present in 161 (94 per cent) and icteric hepatitis was diagnosed in 168 (98 per cent) cases. Splenomegaly was noted in 53 (31 per cent), ascites in 52 (30 per cent) and encephalopathy (ALF) in 56 (32.6 per cent) cases. Sixteen (31 per cent) children with ascites had spontaneous bacterial peritonitis (SBP). Fifteen (27 per cent) children with encephalopathy died. Viral markers were positive in 166 (96.5 per cent) and they were: A in 111 (64.5 per cent), E in 28 (16.3 per cent), B in 13 (7.6 per cent), A + E in 12 (7 per cent), A + E + C and A + C in one each. Mortality in acute liver failure was more when associated with SBP (100 per cent) than without (20 per cent) (p < 0.001). We conclude that HEV is the second most common cause of sporadic acute viral hepatitis in children. Atypical presentations, such as splenomegaly, ascites, and SBP were present in virtually one-third of cases. In cases of ALF, the presence of ascites and SBP depicts a worse outcome.

Lipid profile in acute viral hepatitis: A study from north eastern India

“…Studies have previously documented a variable prevalence of hepatotropic viruses: Hepatitis A Virus (HAV) (1.7-67%), Hepatitis B Virus (HBV) (7.3-42%), Hepatitis C Virus (HCV) (1.16-10.6%) and HEV (Hepatitis E Virus) (16.3-66.3%) [2][3][4][5].…”

Etiology of hepatitis in children

“…Although a slight preponderance of male as compared to females which was different from Poddar U et al study, spectrum of sporadic acute viral hepatitis in Indian children where they found that male to female ratio of 2.3:1. 13 It however would be difficult to conclude whether this disease shows any predilection for either sex.…”

Liver function tests in acute hepatitis in children

“…Chadha et al from Pune reported HBV as a cause for 5.4% of acute viral hepatitis cases ; similarly in studies from New Delhi in 1984 and 2002 the rates were 9% and 7.6% respectively; also from Lucknow, the rate was 9.79%. 3,[6][7][8] Study done from Hong Kong showed incidence of HBV to be 8% of all acute viral hepatitis in children less than 12 years. 9 From Kathmandu, Nepal HBV was responsible for 5% of causes of acute hepatitis in children under 15 years of age.…”

“…4 In 2002, study from Chandigarh done on children under 14 years showed HBV responsible for 7.6% of acute viral hepatitis. 5 Genetic factors and host susceptibility affects the persistent carriage stage of Australia antigen. This study tries to assess the incidence of acute hepatitis caused by hepatitis B virus and analyses the LFTs for early diagnosis and severity of acute hepatitis.…”