Liver Failure Attributable to Hepatitis A Virus Infection in a Developing Country

Abstract

In young children hepatitis A virus (HAV) infections are usually subclinical events. However, HAV is also associated with progressive hepatic failure and even death in some patients. This study was undertaken to characterize the course of hepatitis A-related acute liver failure in children from a developing country where hepatitis A is endemic and produces significant morbidity. Patients <15 years of age with confirmed hepatitis A, seen at the Aga Khan University Hospital between January 1991 and August 1998 were identified using the patient registry. Of the 2735 patients seen with hepatitis A, 232 were admitted to the hospital. Of these 30 patients developed progressive hepatic dysfunction and liver failure. During this period, 45 children were admitted with liver failure attributable to other causes. Of the patients admitted with hepatitis A-related liver failure, 25 (83.3%) were encephalopathic at presentation and 36.7% of the patients died. The prothrombin time was the most significant predictor of survival. There was a significant difference between those who survived and those who died on discriminant analysis with respect to age, grade of hepatic encephalopathy, duration of hospitalization, prothrombin time, and duration of jaundice when taken as a group. There is a striking prevalence of liver dysfunction progressing to hepatic failure among children seen at a hospital in Karachi, Pakistan. This study demonstrates the significant morbidity and mortality that can attend HAV infections in children in a developing country despite tertiary medical facilities. The risk of HAV and its sequelae could probably be effectively reduced in these settings with improved sanitation and universal immunization.

Acute liver failure in children: The first 348 patients in the pediatric acute liver failure study group

“…Nevertheless, these infections are common causes of ALF in children living in endemic areas where hepatitis A can represent up to 40% of ALF cases. (20) Respiratory viruses, enterovirus, or perhaps medications used for symptomatic treatment of these conditions might be implicated given the surge of cases in the winter months however, these viruses were rarely identified.…”

Etiologies, outcomes, and prognostic factors of pediatric acute liver failure: A single center’s experience in Turkey

“…Age and geographical location affect the etiology of PALF. In developing countries, hepatitis A is the most significant etiological agent causing acute liver failure (ALF) in children (2,3); however, infectious causes are rarely seen in developed countries (4). Pediatric ALF Study Group data (4) indicated that metabolic diseases were the most common cause of ALF in children under 3 years.…”

Etiology of hepatitis in children

“…Studies reported that commonest causes of acute liver failure in Indian children is acute viral hepatitis due to infection with Hepatitis A and E virus either alone or in combination while in the west, it is due to Hepatitis B, C viruses and drugs and toxin related. [13][14][15][16][17][18] The difference in clinical presentation, in children with severe hepatitis and those with non-sever hepatitis with different etiology group were not significant in present study. Biochemical derangement in sever hepatitis group were not significantly higher than in non-sever hepatitis patient as would be expected from sever nature of liver damage in severe cases.…”