Skip to main content

Advertisement

SpringerLink
Log in

Hepatitis A in Children- Clinical Course, Complications and Laboratory Profile

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To study the course and complications of hepatitis A in children.

Methods

Seventy eight children diagnosed as acute viral hepatitis A by IgM antiHAV were prospectively studied for involvement of other systems and complications.

Results

The mean age of children was 7.85 ± 3.4 y. Jaundice was present in all the patients as this was the inclusion criteria. Fever was present in 82.1 %, hepatomegaly in 98.7 % and splenomegaly in 39.7 %. More than 5 fold rise in Aspartate transaminase (AST) and Alaninetransaminase (ALT), were seen in 62 cases (79.5 %) and 55 cases (70.5 %) respectively. Coagulopathy (Prothrombin time INR > 1.5) was observed in 12 cases (15.4 %) and abnormal APTT in 10 cases (12.8 %). Thrombocytopenia was observed in 5.1 % of children and 8.9 % had more than 2 hematological abnormalities. Ascites was noted in 35 cases (44.9 %), gallbladder wall thickening in 32 cases (41 %) and pleural effusion in 11 cases (14.1 %). Acute renal failure, acute glomerulonephritis and acute pancreatitis were present in 1 case (1.3 %) each. Raised CK-MB values more than 3 times the normal was noted in 5 cases (6.4 %). On follow up, most of the children recovered completely by 2 mo and prolonged cholestasis was observed in 2 of them. In the present study mortality was 1.3 % and it was attributable to fulminant hepatic failure.

Conclusions

Eventhough hepatitis A infection is a self-limiting disease, extrahepatic manifestations and mortality are not uncommon. All cases should be followed up till complete recovery and only a strong index of suspicion will enable us to recognize the complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. WHO/CDS/CSR/EDC/2000.7. Hepatitis A. World Health Organization. Department of Communicable Disease Surveillance and Response. Available at: http://www.who.int/csr/disease/hepatitis/HepatitisA_whocdscsredc2000_7.pdf. Accessed 1 March 2013.

  2. Tong MJ, el-Farra NS, Grew MI. Clinical manifestations of hepatitis A: Recent experience in a community teaching hospital. J Infect Dis. 1995;171:S15–8.

    Article  PubMed  Google Scholar 

  3. Samanta T, Ganguly S. Aetiology, clinical profile and prognostic indicators for children with acute liver failure admitted in a teaching hospital in Kolkata. Trop Gastroenterol. 2007;28:135–9.

    PubMed  Google Scholar 

  4. Samanta T, Das AK, Ganguly S. Profile of hepatitis A infection with atypical manifestations in children. Indian J Gastroenterol. 2010;29:31–3.

    Article  PubMed  Google Scholar 

  5. Uluğ M, Yaman Y, Yapıcı F, Ulag NC. The investigation of acute viral hepatitis A and its complications in childhood. Çocuk Enf Derg. 2010;4:65–70.

    Article  Google Scholar 

  6. Kamath SR, Sathiyasekaran M, Raja TE, Sudha L. Profile of viral hepatitis A in Chennai. Indian Pediatr. 2009;46:642–3.

    Google Scholar 

  7. Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. Serious hepatitis A: An analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 1998;128:111–4.

    Article  CAS  PubMed  Google Scholar 

  8. Yachha SK, Goel A, Khanna V, Poddar U, Srivatsava A, Singh U. Ascitic form of sporadic acute viral hepatitis in children: A distinct entity for recognition. J Pediatr Gastroenterol Nutr. 2010;50:184–7.

    Article  PubMed  Google Scholar 

  9. Akarsu S, Erensoy A, Elkıran O, Kurt A, Kurt ANC, Aygün AD. Hematological abnormalities in patients with acute viral hepatitis A and B. J Pediatr Inf. 2008;3:90–5.

    Google Scholar 

  10. Shenoy R, Nair S, Kamath N. Thrombocytopenia in hepatitis A—An atypical presentation. J Trop Pediatr. 2004;50:241–2.

    Article  PubMed  Google Scholar 

  11. de Souza LJ, Braga LC, de Souza N, Tavares RR. Acute acalculous cholecystitis in a teenager with hepatitis A virus infection: A case report. Braz J Infect Dis. 2009;13:74–6.

    Article  PubMed  Google Scholar 

  12. Suk KT, Kim CH, Baik SK, Kim MY, Park DH, Kim KH, et al. Gallbladder wall thickening in patients with acute hepatitis. J Clin Ultrasound. 2009;37:144–8.

    Article  PubMed  Google Scholar 

  13. Tanir G, Aydem C, Tuygun N, Yildirim I. Transient sinus bradycardia in a child during the course of acute hepatitis A. Turk J Gastroenterol. 2007;18:195–7.

    PubMed  Google Scholar 

  14. Lee EJ, Kwon SY, Seo TH, Yun HS, Hs C, Kim BK, et al. Clinical features of acute hepatitis A in recent two years. Korean J Gastroenterol. 2008;52:298–303.

    PubMed  Google Scholar 

  15. Jain P, Nijhawan S, Rai RR, Nepalia S, Mathur A. Acute pancreatitis in acute viral hepatitis. World J Gastroenterol. 2007;13:5741–4.

    PubMed  Google Scholar 

  16. Kim JM, Lee YS, Lee JH, Kim W, Lim KS. Clinical outcomes and predictive factors of spontaneous survival in patients with fulminant hepatitis A. Korean J Hepatol. 2008;14:474–82.

    Article  PubMed  Google Scholar 

  17. Debray D, Cullufi P, Devictor D, Fabre M, Bernard O. Liver failure in children with hepatitis A. Hepatology. 1997;26:1018–22.

    Article  CAS  PubMed  Google Scholar 

  18. Kumar P, Bhatia V. Prolonged cholestasis due to hepatitis A virus infection. Indian Pediatr. 2011;48:485–6.

    Google Scholar 

Download references

Acknowledgments

The authors are thankful to Dr. Narayanappa, Dr. Ravi and Dr. Vijay Kumar for their support and encouragement for the study. They also thank Dr. Srinivasa Murthy and Dr. Santhosh Kumar for their valuable suggestions. They are also thankful to Dr. Basavana Gowdappa, Principal, JSS Medical College for his constant support and encouragement.

Conflict of Interest

None.

Role of Funding Source

None.

Author information

Authors and Affiliations

  1. Department of Pediatrics, JSS Medical College, JSS University, Mysore, Karnataka, India

    K. Jagadish Kumar, V. G. Manjunath, C. Anitha & S. Mamatha

  2. Department of Pediatrics, AIMS, B.G Nagar, Mandya District, Karnataka, India

    H. C. Krishna Kumar

  3. 85/B, Navilu Poad, 9th Cross, Kuvempu Nagar, Mysore, Karnataka, India

    K. Jagadish Kumar

Authors
  1. K. Jagadish Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. C. Krishna Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. G. Manjunath
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Anitha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Mamatha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Jagadish Kumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumar, K.J., Kumar, H.C.K., Manjunath, V.G. et al. Hepatitis A in Children- Clinical Course, Complications and Laboratory Profile. Indian J Pediatr 81, 15–19 (2014). https://doi.org/10.1007/s12098-013-1114-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-013-1114-8

Keywords

Search

Navigation