DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180555

A clinical study of viral hepatitis in children: a prospective hospital-based study

Girish N., Sunil B., Ranganatha A. Devaranavadagi

Abstract


Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children; Clinical presentation may vary from asymptomatic to hepatitis, cirrhosis, liver failure and cancer. This study is aimed at understanding the clinical profile of viral hepatitis in children.

Methods: Prospectively, 48 children admitted in paediatric unit with confirmed viral hepatitis from August 2015 to July 2016 at KIMS hospital, Bangalore were included. In each case, age, sex, clinical presentation and laboratory investigations were collected and analysed.

Results: Out of 48 patients, 26 were girls and 22 were boys. Out of which 40 cases were positive for IgM Hepatitis A, 1 case of HbsAg positive, 7 cases were non-A non B Hepatitis. All cases presented with fever (100%), jaundice found in 40 cases (83.3%), 33 cases had abdominal pain (68.7%), vomiting was present in 40 cases (83.7%), 34 cases presented with dark colored urine (70.8%), altered sensorium in 3 cases (6.2%). Icterus was found in 48 (100%) cases, pallor was found in 17 cases (35.4%), Ascitis in 8 cases (16.7%), hepatomegaly in 37 cases (76%), oedema in 10 cases (21%). Liver enzymes elevated at admission in almost all cases, 16 cases had SGPT b/w 200-500. 10 cases had SGPT b/w 500-1000, 19 cases had SGPT b/w 1000-3000 and 2 cases had SGPT of more than 3000. 18 cases had total bilirubin between 5-10 mg/dl, 6 cases had total bilirubin >10 mg/dl. 44 cases had PT <1.5 at admission, 1 case had PT INR between 1.5-2.5, 1 case had INR between 2.5-3.5, 2 cases had INR>3.5. Out of 48 cases 2 cases died. Out of 2 deaths, 1 case of hepatitis A and 1 case positive for Hepatitis B. The cause of death was hepatic encephalopathy in both the cases.

Conclusions: Majority of cases in children were hepatitis A cases, followed by non-A non B. Most of the cases were aged above 3 years with slight girl’s predominance. Those cases with elevated liver enzymes (SGOT >3000) and those with PT INR >3 at admission has higher mortality.


Keywords


Children, Clinical profile, Hepatotropic, Viral hepatitis

Full Text:

PDF

References


Park K. Park textbook of Preventive and social medicine; 23rd ed. Jabalpur: Banarsidas Bhanot Publisher; 2015:210

WHO. What is hepatitis? Available at http://www.who.int/features/qa/76/en/

Suri AD, Jain RK, Jain SC. Study of jaundice profile in pregnancy in tertiary care centre in central India. Int J Med Res Rev. 2014;2(1):3-7.

Krugman S. The Gordon Wilson Lecture. The ABC’s of viral hepatitis. Trans Am Clin Climatol Assoc. 1992;103:145-56.

Kliegman R, Behrman, Schor, Stanton, Joseph. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier; 2015;2:1942-9.

Hadler SC, Webster HM, Erben JJ, Swanson JE, Maynard JE. Hepatitis A in day care centres. A community- wide assessment. N Engl J Med. 1980;302:1222-7.

Acharya SK, Batra Y, Bhatkal B. Sero epidemiology of hepatitis A virus infection among school children in Delhi; implications for HAV vaccination. J Gastroenterol Hepatol. 2003;18:822-7.

Chadha MS, Walimbe AM, Chobe LP, Arankalle VA. Comparison of etiology of sporadic acute and fulminant viral hepatitis in hospitalised patients in Pune, India during 1978-81 and 1994-97. Indian J Gastroenterol 2003;22:11-5.

Mall ML, Rae RR, Phillip M. Seroepidemiology of hepatitis A in India. Ind J Gastroenterol 2001;20:130-2.

Mauss, Berg, Rockstroh; Hepatology: a clinical textbook, 7th ed. Koblenz: Druckerei Heinrich GmbH; 2016:31-47.

Hoofnagle JH, Di Bisceglie AM. Serologic diagnosis of acute and chronic viral hepatitis. Semin Liver Dis. 1991;11(2):73-83.

Suchy FJ. Fulminant hepatic failure. In: Kliegman RM, editor. Nelson Textbook of Pediatrics. 1st ed. New Delhi: Elsevier India; 2016:1966.

Sathiyasekaran M. IAP textbook of pediatrics. 6th ed. N Jaypee Brothers Medical Publishers (P) Ltd; 2016:631-4.

Tandon BN, Gupta H, Irshad AM, Joshi YK, Chawla TC. Associated infection with NANB virus as possible cause of liver failure in Indian HBV carriers. Lancet. 1984;2:750-1.

Hepatitis Central. What Is Non-A, Non-B Hepatitis and Hepatitis C? Available At http://www.hepatitiscentral.com/hcv/whatis/nanb/

Behera MR, Patnaik L. Clinico-biochemical profile and etiology of acute viral hepatitis in hospitalized children: a study from Eastern India. Indian J Child Health. 2016;3(4):317-20.

Das AK. Changing patterns of aetiology of acute sporadic viral hepatitis in India: newer insights from north-east India. Int J Cur Res Rev. 2014;6(19).

Parekh Z, Modi R, Banker D. Clinical study of hepatitis in children with special reference to viral markers. NHL J Med Sci. 2013;2(1):23-7.

Kc S, Sharma D, Poudyal N, Basnet BK. Acute viral hepatitis in pediatric age groups. JNMA J Nepal Med Assoc. 2014;52(193):687-91.

Poddar U, Thapa BR, Prasad A, Singh K. Changing spectrum of sporadic acute viral hepatitis in Indian children. J Trop Pediatr. 2002;48(4):210-3.

Nandi B, Hadimani P, Arunachalam R, Ganjoo R. Spectrum of acute viral hepatitis in Southern India. Med J Armed Forces India. 2009;65(1):7-9.

Kamath SR, Sathiyasekaran M, Raja TE, Sudha L. Profile of viral hepatitis A in Chennai. Indian Pediatr. 2009;46(7):642-3.

Behera AK, Jit BP, Purohit P, Nahak SR, Chhatar S, Marndi C, et al. Clinical profile of viral hepatitis in a tertiary health care centre of eastern India. Int J Med Res Rev 2016;4(7):1276-80.

Nagaich N, Raghav M, Sharma R. Clinical profile of outbreak of viral hepatitis and its outcome at tertiary care Centre in Jaipur. Int J Current Advanced Res. 2016;5(1):577-80.

Sudhamsu KC. Ultrasound findings in acute viral hepatitis. Kathmandu Univ Med J. 2006;4:415-8.

Kumar S, Ratho RK, Chawla YK, Chakraborti A. The incidence of sporadic viral hepatitis in North India: a preliminary study. Hepatobiliary Pancreat Dis Int. 2007;6:596-9.

Das K, Agarwal A, Andrew R, Frösner GG, Kar P. Role of hepatitis E and other hepatotropic virus in aetiology of sporadic acute viral hepatitis: a hospital-based study from urban Delhi. Eur J Epidemiol. 2000;16:937-40.

Chadha MS, Walimbe AM, Chobe LP, Arankalle VA. Comparison of aetiology of sporadic acute and fulminant viral hepatitis in hospitalized patients in Pune, India during 1978-81 and 1994-97. Indian J Gastroenterol. 2003;22:11-5.

Bansal J, He J, Yarbough PO, Sen S, Constantine NT, Sen D. Hepatitis E virus infection in eastern India. Am J Trop Med Hyg. 1998;59:258-60.

Jain A, Kar P, Madan K, Das UP, Budhiraja S, Gopalkrishna V, et al. Hepatitis C virus infection in sporadic fulminant viral hepatitis in North India: cause or co-factor. Eur J Gastroenterol Hepatol. 1999;11:1231-7.

Sarguna P, Rao A, Ramana SKN. Outbreak of acute viral hepatitis due to hepatitis E virus in Hyderabad. Indian J Med Microbiol. 2007;25:378-82.