A study of clinical profile of viral hepatitis A and E among children at tertiary care centre

              

 

Abstract              Background: Viral hepatitis is an infection of the Liver caused by a virus. It is a common health problem in children across the world. The present study is done to study the clinical profile of viral hepatitis A and E in children at a tertiary care hospital. Methods: This observational study was done from April 2020 to March 2021 in the department of Paediatrics, Viswabharathi General Hospital, Kurnool among the children from 1 year to 18 years of age. A total of 35 children diagnosed as Hepatitis virus positive were included in the study. clinical profile and Laboratory parameters were entered in a predefined format and analysis was performed using SPSS 16 version. Results: Among 35 cases 20(57.14%) were boys and 15 were girls (42.85%). 25 (71%) patients were positive for hepatitis A (HAV) and 10(29%) patients were positive for hepatitis E (HEV). common presenting complaints were fever, followed by jaundice, high colored urine and pain abdomen. Icterus was the most common finding followed by hepatomegaly, pallor and oedema. Liver enzymes(AST,ALT) and serum bilirubin raised in all the HAV, HEV cases Conclusion: Hepatitis A and E are common causes of Hepatitis found among the children. These can be preventable by good sanitation and awareness among the people.

 Key Word: Hepatitis virus infection, Jaundice, Children

 

INTRODUCTION

Hepatitis is an inflammation of liver which can be caused by collection of different viruses such as hepatitis A, B, C, D and E. as liver disease is characterized by jaundice, patients serum is tested for the presence of specific antiviral antibodies or antigens.to diagnose the hepatitis`.^1,2 The incidence of infection with these five viruses is generally lowest in industrialised and developed countries and highest in less developed regions. Hepatitis A virus and hepatitis E virus spread mainly through faeco-oral route is a mode of transmission for Hepatitis A virus and the blood transfusion is a mode of transmission for hepatitis B, C and D.³ All the viruses can cause acute illness characterised by nausea, malaise, abdominal pain and jaundice.⁴ The clinical spectrum of acute viral hepatitis ranges from entirely subclinical and inapparent infection to rapidly progressing and fulminant hepatic failure. Hepatitis A (HAV) and E (HEV) viruses are selflimiting, whereas hepatitis B (HBV), C (HCV) and D (HDV) may progress to chronic hepatitis. India is hyperendemic for hepatitis A and E.⁵ In tropical nations, Congestion, poor cleanliness, ill-advised disinfection and pollution of food and water are the predisposing factors for viral hepatitis.⁶ this study was conducted to study the clinical profile of viral hepatitis A and E among children at a tertiary care hospital.

 

MATERIALS AND METHODS

The present observational prospective study was conducted among children aged 1 to 18 years at department of pediatrics, Viswabharathi General Hospital for a period of one year from April 2020 to March 2021. The inclusion and exclusion criteria were as follows.

Inclusion criteria:

1. Patients having age from one year to 18 years.
2. Patients with symptoms like weakness, lethargy, early fatigue, joint pains, jaundice (yellow skin) and Abdominal pain; an elevated liver enzymes; and positivity of serological markers for of HAV and HEV .
3. Patients willing to participate

Exclusion criteria:

1. Children having hepatitis B and hepatitis C,
2. Patients with non-viral causes of hepatitis
3. Patients who were not willing to participate in the study

 Ethical clearance was taken from the Institutional ethical committee before start of the study and written informed consent was taken from all the subjects/guardians participating. Pre-tested and pre-designed questionnaire was used for collecting data. Data included demographic information, clinical history regarding illness including clinical symptoms and signs, clinical examination specially related to hepato biliary system. The patients were subjected to the laboratory tests like liver function tests, The serological confirmations of viral hepatitis done for anti HAV immunoglobulin M, and anti HEV Immunoglobulin M. To study serological parameters, from every patient, 5 ml of blood was collected, Serum was separated and stored at -20^Oc until further tests were conducted. Serum was tested for bilirubin and aminotransferase levels in Erba-2 analyser. Tests for Anti HAV Ig M and anti HEV IgM were done using commercially available kits based on enzyme linked assay (ELISA) as per manufacturers instruction.

 

RESULT

Total 35 children were included in study. Among 35 cases 20(46%) were boys and 15 (54%) were girls. About 4 (11.42%) children were between age 1to 5 years, 11(31.42%) children were >10yrs old and highest incidence 20 (57.14%) is seen in children between 6-10 yrs of age

 

Table 1: Age and sex distribution of cases.

Out of 35 cases 25 (71%) cases were having infection with hepatitis A, followed by 9(29%) cases of hepatitis E

 

Table 2: Type of Hepatitis

Table 3 describes symptoms. The common symptoms presented were fever (100%), jaundice and vomiting in 31 cases (88%), these followed by dark coloured urine in 26 cases (74%), abdominal pain in 20 cases (57%), nausea in 4 cases (11%), anorexia and loose stools in 2 cases 6%.

 

Table 3: Symptoms distribution

Table 4 describes physical findings. The common findings were Icterus in 35(100%) cases, hepatomegaly in 28 (80%) cases followed by pallor in 12 (34%) cases, edema in 7 (20%) cases, ascitis in 3 (9%) cases, splenomegaly in 2 (6%) cases.

 

Table 4: Various physical findings distribution

Table 5 describes biochemical parameters. Liver enzymes(AST,ALT) and serum bilirubin raised in all the HAV, HEV cases. AST >1000 U/L was seen in 17% of the cases and ALT >1000U/L was seen in 11% of the cases and total bilirubin 5-10 mg/dl was seen in 34% of the cases.

Table 5: Biochemical parameters

 

DISCUSSION

We studied 35 children admitted with viral hepatitis and found that children between age group of 6 to 10 years were mostly affected. kamath et al.⁷, Behra et al.⁸ and kumar et al.⁹ also reported similarly in their studies. In our study, HAV (71%) was detected to be the most common cause of acute hepatitis followed by HEV (29%); Poddar U et al.¹⁰ in their study observed that in children HAV infection (64.5%) is the most common cause of viral hepatitis followed by HEV infection (16.3%), Behera MR et al.¹¹ reported that in children HAV (63.15%) infection is most common cause of viral hepatitis followed by HBV (10.52%), and HEV (5.26%). Also comparable with study done by sumit das et al. from Assam India who reported that 73.21% children were infected with HAV infection¹² symptoms and examination findings were highlighted in case of viral hepatitis. Common complaints reported in our study were Fever (100%) followed by jaundice (88%), vomiting (88%). Parekh Z et al. in his study found common complaints as jaundice (94%) followed by fever (82%).¹³ Behera AK et al. in his study observed the common compliant as yellowish discolouration of eye and urine.¹⁴ In our study common findings reported were Icterus (100%), followed by hepatomegaly (76%). The other study also reported the jaundice and hepatomegaly as most common sign.¹⁵ The extent of hepatic damage can be provided by Biochemical study. In our study Total serum bilirubin and hepatic enzymes were increased.

 

CONCLUSION

In our study it was found that Hepatitis A was the common cause of hepatitis among children. It’s important to create awareness in the society regarding preventive measures. It is also important to educate the society regarding clinical presentation of disease so that they can seek medical intervention early and can reduce significant mortality associated with it.

 

REFERENCES

1. Satsangi S, Dhiman R. Combating the wrath of viral hepatitis in India. Indian J Med Res. 2016; 144(1):1.
2. Kumar M, Sarin SK. Viral hepatitis eradication in India by 2080- gaps, challenges and targets. Indian J Med Res. 2014; 140: 1-4.
3. Jain P, Prakash S, Gupta S, Singh KP, Shrivastava S, Singh DD, et al. Prevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: a hospital based study. Indian J Med Microbiol. 2013; 31(3):261-5.
4. International Journal of Advances in Medicine Birajdar SV et al. Int J Adv Med. 2017 Apr;4(2):412-416
5. Behera MR, Patnaik L. Clinicobiochemical profile and etiology of acute viral hepatitis in hospitalized children: A study from Eastern India. Indian J Child Health. 2016; 3(4):317-320.
6. Zakaria S, Fouad R, Shaker O, Zaki S, Hashem A, El-Kamary SS, et al. Changing patterns of acute viral hepatitis at a major urban referral center in Egypt. Clin Infect Dis [Internet]. 2007 Feb 15;44(4):e30-6.
7. Kamath SR, Sathiyasekaran M, Raja TE, Sudha L. Profile of viral hepatitis A in Chennai. Indian Pediatr, 2009; 46(7): 642-3.
8. 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): 317-320.
9. Kumar, K.J., Kumar, H.C.K., Manjunath, V.G. et al. Indian J Pediatr, 2014; 81: 15.
10. Poddar U, Thapa BR, Prasad A, Singh K. Changing Spectrum of Sporadic Acute Viral Hepatitis in Indian Children. Journal of Tropical Pediatrics. 2002; (48).
11. Behera MR, Patnaik L. Clinicobiochemical profile and etiology of acute viral hepatitis in hospitalized children: A study from Eastern India. Indian J Child Health. 2016; 3(4):317-320.
12. Dr Sumit Das , Dr Anupama Deka, Dr Tanmay Biswas, Clinical Profile of Acute Viral Hepatitis in Children – In Southern Assam.jmscr.2021;9(3):111-118
13. 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
14. 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.
15. 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.

 

 

 

 

 

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