Fulminant Hepatitis A in Children, its Incidence, Presentation, Complications and Outcome: A Study from Eastern India

Abstract

Introduction: Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. The disease is usually mild and self-limited, and complications are very rare. But sometimes hepatitis A can cause acute liver failure (ALF), a severe, life-threatening condition. The objective was to do clinicoepidemiological evaluation of hepatitis A patients who were admitted to the In patients department of our hospital along with analyze the complications seen in the disease.Materials and Methods: It was a prospective study, done in Department of paediatrics, Maharaja Krushna Chandra Gajapati from May 2014-April 2016. Total number of patients was 80. Patients having history or features of prodromal symptoms like fever, nausea, vomiting, anorexia, yellowish discoloration of urine and body, pain abdomen, change in mental status and coagulopathy with suspicion of acute hepatitis (within 8 wks) with positive IgM for hepatitis A were included in the group. Statistical analysis was done by SPSS software version 20.Results: Total number of patients was 80. Mean age of hospitalisation was 5.5 years. 90% children were having jaundice. 85% patients were having liver enzyme high. Most common complication was gallbladder wall thickening followed by ascitis, pleural effusion etc. Encephalopathy was observed in three patients. Total three patients died. Maximum death was seen in infancy with delay in hospitalisation.Conclusions: Viral hepatitis due to hepatitis A is a benign disease. But fulminant hepatic failure due to it is not uncommon. The lesser the age, presence of cardinal features like jaundice may not be apparent. So clinicians must be conscious of these lethal complications while managing a child of probable viral hepatitis. This study will raise the consciousness of urgency of vaccination for hepatitis A, which is thought to be sparingly optional for many parents as well as doctors.

Causes of death in children under-age of five years in Babylon province

“…In 6.8% of our sample, hepatic encephalopathy was the predominant problem; Kamath et al(19) reported 5.8% of hepatitis A children had difficulties. 3.2% of our sample had hepatic encephalopathy, similar to Mohanty et al[28]. (3.7%) In a study from Korea, hepatic encephalopathy due to hepatitis…”

“…This high percent of encephalopathy in our study in compares with global percent (0.5%) possible due to our hospital is pooling hospital of province, many cases of hepatitis treated as out-patient at private clinic, most cases of hepatitis go undiagnosed and small sample of our study. 2.4% had ascites and 1.2% had pleural effusion, according to Mohanty et al [28] pleural effusion is an uncommon consequence of acute hepatitis. Tesovic et al [29] claim pleural effusion is a benign early consequence of acute hepatitis A that resolves spontaneously.…”

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

“…Another study of AVH in children ≤ 15 years (N = 138) found only the 10–15-year group (5.8%, n = 8/22) had complications [gastrointestinal bleeding, intracerebral bleeding and hypoglycemia in one child each, grade I encephalopathy in two children, acute liver cell failure in four children and prolonged cholestasis (> 12 weeks) in three children] [30]. A study from Eastern India reported the following complications in adolescents ( n = 10 aged 10–14 years): coagulopathy ( n = 4), ascites ( n = 3), two cases each of thrombocytopenia, gall bladder wall thickening and pleural effusion, and one case of congestive heart failure [36]. In a study conducted in Pakistan including 185 acute hepatitis A patients (26% > 16 years), FHF occurred in a comparable number of < 15 and > 15 year olds (2% vs. 3%, respectively) and required longer hospital stays (9 days compared with 2.9 without FHF; mean length of stay).…”