Etiology of hepatitis in children
Keywords:Etiology of hepatitis, Infective hepatitis, Pediatric liver disease
Background: Hepatitis (plural hepatitides) is inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. Although infectious hepatitis, autoimmune hepatitis and metabolic diseases are the cause but in majority of the cases etiology remain obscure. Worldwide, the overall frequency of pediatric liver disease is 1:8,000. According to a study in U.S, it amounts to almost 15,000 hospital admissions per year. Objective of present study was to study and determine etiologies of the hepatitis in non-neonatal age group and find out the commonest etiological cause, along with to study clinical course of acute hepatitis and average time for recovery from the illness
Methods: A prospective study of 100 children presented with the clinical jaundice between the age group of 1 month to 18 years were evaluated using inclusion criteria utilizing clinical proforma, complete history, clinical examination and blood investigations, in the pediatric out-patient, in-patient and emergency department at Moolchand Medcity, New Delhi from August 2008 to August 2010.
Results: Hepatitis A was positive in 88 children (88%) which was the highest in frequency, followed by Typhoid in 5 of children (5%), while Hepatitis E (3%), B (2%) and dengue 1(1%) were the least in the incidence respectively. Two patients had fulminant hepatitis and both were positive for Hepatitis A, of which one was referred for liver transplant. Period for clinical recovery was found to be 12-24 days (19.87±3.489) and for biochemical recovery was range from 23- 59 days (36.71±5.9437) while all 99 (99%) patients were recovered from the illness in 99 % of cases.
Conclusions: Hepatitis A is the most common cause of acute hepatitis. Clinical recovery occurred in 2 to 3 weeks, followed by biochemical recovery in 3 to 8 weeks respectively.
Christian P, Strassburg P, Michael P, Manns. Approach to the patient with liver disease. In: Boyer TD, Wright TL, Manns MP, editors. Zakim and Boyer's Hepatology: A Textbook of Liver Disease. 5th ed. Philadelphia:Saunders;2006:185-90.
Kim WR, Brown RS Jr, Terrault NA, El-Serag H. Burden of liver diseases in the United States: Summary of workshop. Hepatology. 2002;36(1):227-42.
Hanif M, Raza J, Qureshi H, Issani Z. Etiology of chronic liver disease in children. J Pak Med Assoc. 2004;54(3):119-22.
Bhave S, Bavdekar A, Pandit A. Changing pattern of chronic liver disease (CLD) in India. Indian Pediatri. 1994;61(6):675-82.
Tandon BN, Gandhi BM, Josh YK. Etiological spectrum of viral hepatitis and prevalence of markers of hepatitis A and B virus infection in north India. Bull World Health Organ. 1984;62(1):67-73.
Thapa BR, Singh K, Singh V, Broor S, Singh V, Nain CK. Pattern of hepatitis A and hepatitis B virus markers in cases of acute sporadic hepatitis and in healthy school children from North West India. J Trop Pediatr. 1995;41(6):328-9.
Forsyth JRK. Typhoid and paratyphoid. In: Collier L, Balows A, Sussaman M, editors. Topley and Wilson’s Microbiology and Microbial Infection. 9th ed. London: Arnold Press; 1998:450-78.
El-Newihi HM, Alamy ME, Reynold TB. Salmonella Hepatitis: Analysis of 27 cases and comparison with acute viral hepatitis. Hepatology. 1996;24(3):516-9.
Jagdish K, Patwari AK, Sarin SK, Prakash C, Srivastava DK, Anand VK. Hepatic Manifestation in typhoid fever. Indian Pediatr. 1994;31(7):807-11.
Panda SK, Datta R, Gupta A, Kamat RS, Madangopalan N, Bhan MK et al. Etiologic spectrum of acute viral hepatitis in children in India. Trop Gastroenterol. 1989;10(2):106-10.
Fathalla SE, Al-Jama AA, Al-Sheikh IH, Islam SI. Seroprevalence of hepatitis A virus markers in Eastern Saudi. Saudi Med J. 2000;21(10):945-9.
Mohanavalli B, Dhevahi E, Menon T, Malathi S, Thyagarajan SP. Prevalence of antibody to hepatitis A and hepatitis E virus in urban school children in Chennai. Indian Pediatr. 2003;40(4):328-31.
Poddar U, Thapa BR, Prasad A, Singh K. Changing spectrum of Sporadic acute viral hepatitis In India. J Trop Pediatr. 2002;48(4):210-3.
Yaccha SK, Sharma BC, Khanduri A, Srivastava A. Current spectrum of hepatobiliary disorders in north India. Indian Pediatr. 1997;34(10):885-90.
Shah U, Habib Z, Kleinman RE. Liver failure attributable to hepatitis A virus infection in a developing country. Pediatrics. 2000;105(2):436-8.
Arora NK, Nanda SK, Gulati H, Ansari IH, Chawla MK, Gupta SD et al. Acute viral hepatitis types E, A and B singly and in combination in acute liver failure in children in North India. J Med Virol. 1996;48(3):215-21.
Bendre SV, Bavdekar AR, Bhave SA, Pandit AN, Chidmbar SD, Arankalle VA. Fulminant hepatic failure: etiology, viral markers and outcome. Indian Pediatr. 1999; 36(11):1107-12.
Khanna S, Vohra P, Jyoti R, Vij JC, Kumar A, Singal D, et al. Changing epidemiology of acute hepatitis in a tertiary care hospital in north India. Indian J Gastroenterol. 2006;25(2):101-2.