Hepatitis A in children: evaluation of atypical manifestations

  • Derya Kalyoncu SBU Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
  • Nafiye Urganci SBU Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
  • Seda Geylani Gulec SBU Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
Keywords: complication; hepatitis A; infection; liver failure

Abstract

Background  Although hepatitis A infection is known as a benign, self-limited disease without chronicity, the rate of complications increases over time.

Objective To evaluate atypical manifestations of hepatitis A infection in children.

Methods A total of 130 children with hepatitis A infection were reviewed. Subjects’ demographic and clinical characteristics, laboratory examinations, and clinical courses were evaluated retrospectively.

Results Twenty-one subjects had atypical manifestations of disease as follows: immune thrombocytopenic purpura (1 patient), pleural effusion (1), autoimmune hepatitis and hemolytic anemia (1), nephrotic syndrome (2), meningoencephalitis (2), autoimmune hepatitis (2), acalculous cholecystitis (3), relapsing hepatitis (4), and fulminant hepatitis (5). Only gender was significantly different, with males having more atypical manifestations than females (P=0.03). Mortality rate was 3% (3 patients with fulminant hepatitis and 1 with meningoencephalitis died in the intensive care unit).

Conclusion Although hepatitis A virus infection has a benign, self-limited course without chronicity, recognition of atypical cases which carry mortality risk is important.

Author Biography

Seda Geylani Gulec, SBU Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

Department of Pediatrics, Associated Professor

References

American Academy of Pediatrics, Committee on Infectious Diseases. Hepatitis A. Red Book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2003. p. 309–18.

Brundage SC, Fitzpatrick AN. Hepatitis A. Am Fam Physician. 2006;73:2162-8. PMID: 16848078.

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. DOI: 10.3350/kjhep.2008.14.4.474.

Muñoz-Martínez SG, Díaz-Hernández HA, Suárez-Flores D, Sánchez-Ãvila JF, Gamboa-Domínguez A, García-Juárez I, et al. Atypical manifestations of hepatitis A virus infection. Manifestaciones atípicas de la infección por el virus de la hepatitis A. Rev Gastroenterol Mex. 2018;83(2):134-143. DOÄ°:10.1016/j.rgmx.2017.10.004.

Samanta T, Das AK, Ganguly S. Profile of hepatitis A infection with atypical manifestations in children. Indian J Gastroenterol. 2010;29:31–3. DOI: 10.1007/s12664-010-0006-3.

Singh SK, Borkar V, Srivastava A, Mathias A, Yachha SK, Poddar U. Need for recognizing atypical manifestations of childhood sporadic acute viral hepatitis warranting differences in management. Eur J Pediatr. 2019;178:61-7. DOI: 10.1007/s00431-018-3262-3.

Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S. Hepatitis A in children- clinical course, complications and laboratory profile. Indian J Pediatr. 2014;81:15-9. DOI: 10.1007/s12098-013-1114-8.

de Souza LJ, Braga LC, Rocha NSM, Tavares RR. Acute acalculous cholecystitis in a teenager with hepatitis A virus infection: A case report. Braz J Infect Dis. 2009;13:74–6. DOI: 10.1590/s1413-86702009000100017.

Tanir G, Aydemir 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. PMID: 17891695.

Debray D, Cullufi P, Devictor D, Fabre M, Bernard O. Liver failure in children with hepatitis A. Hepatology. 1997;26:1018–22. DOI: 10.1053/jhep.1997.v26.pm0009328329

Arcana R, Frisancho O. Acute pancreatitis and acalculous cholecystitis associated with viral hepatitis A. Rev Gastroenterol Peru. 2011;31:178-82. PMID: 21836659.

Mehta K, Shinde S, Rego S, Shet E. Hepatitis A associated with chylothorax: an uncommon presentation of a common infection. J Trop Pediatr. 2015;61:468-73. DOÄ°: 10.1093/tropej/fmv059.

Poddar U, Agarwal J, Yachha SK. Atypical manifestations of hepatitis A in children. Indian J Gastroenterol. 2010;29:209. DOI: 10.1007/s12664-010-0050-z.

Pal RB, Saha P, Das I, Sinha MK. Fulminant hepatitis and glomerulonephritis--a rare presentation of hepatitis A virus infection. Acta Paediatr. 2011;100:e132-4. DOI: 10.1111/j.1651-2227.2011.02231.x.

Latif N, Mehmood K. Risk factors for fulminant hepatic failure and their relation with outcome in children. J Pak Med Assoc. 2010;60:175-8. PMID: 20225771.

Velev V, Popov M, Tomov L, Golemanov B. Involvement of the gallbladder in the course of viral hepatitis A in childhood. Trop Doct. 2019;49:271-3. DOI: 10.1177/0049475519858893.

Kwon SY, Park SH, Yeon JE, Jeong SH, Kwon OS, Lee JW, et al. Clinical characteristics and outcomes of acute hepatitis A in Korea: a nationwide multicenter study. J Korean Med Sci. 2014;29:248-53. DOI: 10.3346/jkms.2014.29.2.248.

Kim JD, Choi JY, Park CH, Song MJ, Jang JW, Bae SH, et al. [Clinical features of patients with fulminant hepatitis A requiring emergency liver transplantation: comparison with acute liver failure due to other causes]. Korean J Hepatol. 2010;16:19-28. DOI: 10.3350/kjhep.2010.16.1.19.

Ng VL, Li R, Loomes KM, Leonis MA, Rudnik DA, Belle SH, et al. Outcomes of children with and without hepatic encephalopathy from the Pediatric Acute Liver Failure Study Group. J Pediatr Gastroenterol Nutr. 2016;63:357–364. DOI: 10.1097/mpg.0000000000001178.

Squires RH Jr, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, et al. Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr. 2006;148:652–8. DOİ: 10.1016/j.jpeds.2005.12.051.

Jung YJ, Kim W, Jeong JB, Kim BG, Lee KL, Oh KH, et al. Clinical features of acute renal failure associated with hepatitis A virus infection. J Viral Hepat. 2010;17:611-7. PMID: 17585190.

Oh SH, Lee JH, Hwang JW, Kim HY, Lee CH, Gwak GY, et al. [Four patients with hepatitis A presenting with fulminant hepatitis and acute renal failure and who underwent liver transplantation]. Korean J Hepatol. 2009;15:362-9. DOI: 10.3350/kjhep.2009.15.3.362.

Jung YM, Park SJ, Kim JS, Jang JH, Lee SH, Kim JW, et al. Atypical manifestations of hepatitis A infection: a prospective, multicenter study in Korea. J Med Virol. 2010;82:1318-26. DOI: 10.1002/jmv.21822.

Hayashi M, Shimizu T, Tsunematsu I, Hirokawa F, Asakuma M, Takeshita A, et al. Hepatitis A virus-related late-onset hepatic failure: a case report. Exp Clin Transplant. 2011;9:150-2. PMID: 21453235.

Allen O, Edhi A, Hafeez A, Halalau A. A very rare complication of hepatitis A infection: acute myocarditis-a case report with literature review. Case Rep Med. 2018;2018:3625139. DOI: 10.1155/2018/3625139.

Israel S, Fruchtman H, Hakimian D, Ackerman Z. Ascites and gallbladder abnormalities are frequent findings in adults with hepatitis A virus infection. Isr Med Assoc J. 2019;21:24-8. PMID: 30685901.

Ferreira CT, Vieira SM, Kieling CO, Silveira TR. Hepatitis A acute liver failure: follow-up of paediatric patients in southern Brazil. J Viral Hepat. 2008;2:66-8. DOI: 10.1111/j.1365-2893.2008.01033.x.

Ó’Grady J. Modern management of acute liver failure. Clin Liver Dis. 2007;11:291-303. DOI: 10.1016/j.cld.2007.04.011.

Taylor RM, Davern T, Muñoz S, et al. Fulminant Hepatitis A Virus INfection in the United States: Incidence Prognosis, and Outcomes. Hepatology 2006;44:1589-1597. DOI: 10.1002/hep.21439.

Advisory Committee on Immunization Practices (ACIP), Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55:1–23.

Published
2020-08-03
How to Cite
1.
Kalyoncu D, Urganci N, Geylani Gulec S. Hepatitis A in children: evaluation of atypical manifestations. PI [Internet]. 3Aug.2020 [cited 22Dec.2024];60(5):239-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2392
Section
Pediatric Gastrohepatology
Received 2020-03-04
Accepted 2020-08-03
Published 2020-08-03