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Atypical manifestations of acute viral hepatitis A in children in Bangladesh: Are these really uncommon?

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Abstract

Background/Aim

The aim of this study was to find out the clinical spectrum of acute viral hepatitis A (AVH-A) infection in children, the relationship between atypical manifestations and laboratory findings and the outcome of patients with typical and atypical hepatitis A virus (HAV) manifestations.

Methods

From January 2018 to September 2019, consecutive children (<18 years of age) with features suggestive of AVH with positive IgM anti-HAV both from inpatient and outpatient services were included in this study. Detailed history, physical findings, and investigations were recorded in the study questionnaire. Patients were followed up weekly until complete recovery. The Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical analysis.

Result

The mean age of 200 children who were finally included in the study was 8.3±3.5 years with male to female ratio of 134:66. Atypical features were present in 30 (15%) children; prolonged cholestasis (17, 8.5%), ascites (12, 6%), pleural effusion (4, 2%), thrombocytopenia (2, 1%), and hemolysis (1, 0.5%) were observed. Pruritus (p=0.005), higher serum total and direct bilirubin (p=0.00 and 0.001 respectively), and lower serum albumin (p=0.01) levels were statistically significant in children with atypical manifestations. Moreover, this group had prolonged mean duration of jaundice and hospital course (p=0.00 and 0.083 respectively).

Conclusion

Atypical manifestations such as prolonged cholestasis and ascites are not uncommon in children with AVH-A in developing countries and seen in almost one-sixth of patients.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh

    Rubaiyat Alam, A. S. M. Bazlul Karim, Md. Wahiduzzaman Mazumder, Subarna Rani Das, Md. Benzamin, Zannatul Ferdous Sonia & Sharif Md. Habibur Rahman

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  1. Rubaiyat Alam
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  2. A. S. M. Bazlul Karim
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  3. Md. Wahiduzzaman Mazumder
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  4. Subarna Rani Das
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  5. Md. Benzamin
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  6. Zannatul Ferdous Sonia
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  7. Sharif Md. Habibur Rahman
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Correspondence to Rubaiyat Alam.

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Conflict of interest

RA, ASMBK, MWM, SRD, MB, ZFS, and SMHR declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Alam, R., Karim, A.S.M.B., Mazumder, M.W. et al. Atypical manifestations of acute viral hepatitis A in children in Bangladesh: Are these really uncommon?. Indian J Gastroenterol 40, 470–476 (2021). https://doi.org/10.1007/s12664-021-01200-9

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  • DOI: https://doi.org/10.1007/s12664-021-01200-9

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