Hepatitis A Associated with Chylothorax: An Uncommon Presentation of a Common Infection

Mehta, Kayur; Shinde, Supriya S.; Rego, Sylvan; Shet, Anita

doi:10.1093/tropej/fmv059

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…[49], [51-52], [54-58], [60-64], [66], [70][71][72][73][74][75][76][77][78][79][80][81], [84][85][86][87][88], [90][91][92][93], [95][96][97][98][99][100][101][102][103].…”

Section: Resultsmentioning

confidence: 99%

“…Less common methods of nutritional treatment include low-fat diet (2.6 % patients [32], [38], [44], [49], [54], [57], [61], [92], [95], [96]), completely fat-free diet (5,8 % [13], [14], [20], [46], [51], [73], [75], [76], [97], [98]) or in infants -milk with modified fat content (7,5 % [3], [23], [84]). At the same time, authors of many publications do not provide specific diet modifications (10,9 %) [22], [26], [29], [31], [42], [60], [66], [70], [73], [80], [86], [99], [100].…”

Section: Resultsmentioning

confidence: 99%

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Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Knop

Kochanowska

Piasecka

et al. 2022

J Educ Health Sport

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Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe. The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.

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“…[49], [51-52], [54-58], [60-64], [66], [70][71][72][73][74][75][76][77][78][79][80][81], [84][85][86][87][88], [90][91][92][93], [95][96][97][98][99][100][101][102][103].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Knop

Kochanowska

Piasecka

et al. 2022

J Educ Health Sport

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show abstract

“…All patients were managed supportively. Furthermore, no invasive additional treatments were used in five cases, including intravenous fluids, vitamin K, oral lactulose, and antibiotics prophylactically for bacterial superinfection [ 12 , 14 ], while thoracostomy and chest tube insertion were only needed in one patient of chylothorax [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

et al. 2022

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Introduction Hepatitis A virus infections are mostly asymptomatic or mildly symptomatic, and generally this disease has a benign course and resolves spontaneously. However, intrahepatic and rarer extrahepatic manifestations can complicate typical cases of acute hepatitis. Pleural effusion is an extremely rare extrahepatic entity with 20 cases reported in literature. Case presentation We report herein a recent case of both pleural effusion and ascites accompanying hepatitis A infection in a 5-year-old middle eastern child, diagnosed using serological testing and imaging studies, who was treated with supportive management with full resolution after 2 weeks. In addition, we review available literature regarding hepatitis A virus associated with pleural effusion using PubMed and summarize all reported cases in a comprehensive table. Results Literature contains 20 reported cases of serology-confirmed hepatitis A virus presenting with pleural effusion, most in the pediatric population with average age at presentation of 9 years 8 months. The majority of reported patients had right-sided pleural effusion (50%) or bilateral effusion (45%), while only 5% presented with pleural effusion on the left side. Hepatomegaly and ascites occurred concurrently in 80% and 70% respectively. Supportive treatment without invasive procedures (except one chylothorax case) yielded complete recovery in 95% of cases, while only one case progressed to fulminant liver failure followed by death. Conclusion Acute hepatitis A virus rarely presents with pleural effusion, usually following a benign course with spontaneous resolution in most patients. Pleural effusion does not change the prognosis or require any invasive treatment. Thus, further invasive procedures are not recommended and would only complicate this self-resolving benign condition.

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“…Infections may also lead to chylous effusions with Mycobacterium tuberculosis described most commonly and in several cases of immune reconstitution syndrome [74,75]. A chylothorax has also been reported with hepatitis A, paragonimiasis, and paracoccidioidomycosis [76][77][78].…”

Section: Infectionsmentioning

confidence: 99%

Clinical approach and review of causes of a chylothorax

Riley

Ataya

2019

Respiratory Medicine

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A chylothorax, also known as chylous pleural effusion, is an uncommon cause of pleural effusion with a wide differential diagnosis characterized by the accumulation of bacteriostatic chyle in the pleural space. The pleural fluid will have either or both triglycerides > 110 mg/dL and the presence of chylomicrons. It may be encountered following a surgical intervention, usually in the chest, or underlying disease process. Management of a chylothorax requires a multidisciplinary approach employing medical therapy and possibly surgical intervention for post-operative patients and patients who have failed medical therapy. In this review, we aim to discuss the anatomy, fluid characteristics, etiology, and approach to the diagnosis of a chylothorax.

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Hepatitis A Associated with Chylothorax: An Uncommon Presentation of a Common Infection

Cited by 4 publications

References 10 publications

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

Clinical approach and review of causes of a chylothorax

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