Atypical presentations of hepatitis A infection in children

Background Hepatitis A is the most common cause of acute viral hepatitis, with a typical simple, self-limiting course. But it is not free from complications. Atypical presentations, such as in the form of prolonged cholestasis, ascites, pleural effusion, relapsing hepatitis, or fulminant hepatic fai...

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Autores principales:	Sayma Rahman Munmun, Archana Shrestha Yadav, Mohammad Benzamin, Abu Sayed Mohammad Bazlul Karim, Mohammad Rukunuzzaman, Mohammad Wahiduzzaman Mazumder, Suborna Rani Das
Formato:	article
Lenguaje:	EN
Publicado:	Indonesian Pediatric Society Publishing House 2021
Materias:	hepatitis a; ascites; prolonged cholestasis; hepatic encephalopathy; atypical Medicine R Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/0651b6ea0a614555abf209d5d52c785b
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spelling	oai:doaj.org-article:0651b6ea0a614555abf209d5d52c785b2021-11-29T02:29:22ZAtypical presentations of hepatitis A infection in children0030-93112338-476X10.14238/pi61.6.2021.317-21https://doaj.org/article/0651b6ea0a614555abf209d5d52c785b2021-11-01T00:00:00Zhttps://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2451https://doaj.org/toc/0030-9311https://doaj.org/toc/2338-476XBackground Hepatitis A is the most common cause of acute viral hepatitis, with a typical simple, self-limiting course. But it is not free from complications. Atypical presentations, such as in the form of prolonged cholestasis, ascites, pleural effusion, relapsing hepatitis, or fulminant hepatic failure, pose challenges to disease management. Knowledge about varying presentations and identification of factors associated with atypical presentations will help to early diagnosis of atypical courses of disease. Objective To describe various atypical clinical presentations, biochemical findings of hepatitis A infection, and possible related factors. Methods Ninety-five children aged 1 to 18 years, diagnosed with hepatitis A infection, and admitted to the Department of Pediatric Gastroenterology & Nutrition, BSMMU, Dhaka, Bangladesh from January 2015 to May 2018 were studied retrospectively. Results Atypical presentations were manifested in 19 (20%) out of 95 children with hepatitis A virus (HAV) infection. The mean age of atypical patients [6.32 (SD 3.45) years] was significantly lower than that of typical patients [8.22 (SD 3.58) years] (P=0.0041). The most common atypical manifestation was ascites (11/19), followed by hepatic encephalopathy (9/19), acute liver failure (719), thrombocytopenia (2/19), pleural effusion (2/19), and cholestasis (1; 1.1%). Children with atypical features had significantly higher international normalized ratio (INR) and serum bilirubin, as well as lower hemoglobin level than the typical group. Children of atypical group had significantly higher number of organomegaly and coagulopathy. Conclusion Ascites, hepatic encephalopathy, acute liver failure, thrombocytopenia, pleural effusion, and prolonged cholestasis were common forms of atypical presentation. Younger age, organomegaly, higher bilirubin level, prolonged PT, and decreased hemoglobin level could be predictive of an atypical presentation of HAV in children.Sayma Rahman MunmunArchana Shrestha YadavMohammad BenzaminAbu Sayed Mohammad Bazlul KarimMohammad RukunuzzamanMohammad Wahiduzzaman MazumderSuborna Rani DasIndonesian Pediatric Society Publishing Housearticlehepatitis a; ascites; prolonged cholestasis; hepatic encephalopathy; atypicalMedicineRPediatricsRJ1-570ENPaediatrica Indonesiana, Vol 61, Iss 6, Pp 317-21 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hepatitis a; ascites; prolonged cholestasis; hepatic encephalopathy; atypical Medicine R Pediatrics RJ1-570
spellingShingle	hepatitis a; ascites; prolonged cholestasis; hepatic encephalopathy; atypical Medicine R Pediatrics RJ1-570 Sayma Rahman Munmun Archana Shrestha Yadav Mohammad Benzamin Abu Sayed Mohammad Bazlul Karim Mohammad Rukunuzzaman Mohammad Wahiduzzaman Mazumder Suborna Rani Das Atypical presentations of hepatitis A infection in children
description	Background Hepatitis A is the most common cause of acute viral hepatitis, with a typical simple, self-limiting course. But it is not free from complications. Atypical presentations, such as in the form of prolonged cholestasis, ascites, pleural effusion, relapsing hepatitis, or fulminant hepatic failure, pose challenges to disease management. Knowledge about varying presentations and identification of factors associated with atypical presentations will help to early diagnosis of atypical courses of disease. Objective To describe various atypical clinical presentations, biochemical findings of hepatitis A infection, and possible related factors. Methods Ninety-five children aged 1 to 18 years, diagnosed with hepatitis A infection, and admitted to the Department of Pediatric Gastroenterology & Nutrition, BSMMU, Dhaka, Bangladesh from January 2015 to May 2018 were studied retrospectively. Results Atypical presentations were manifested in 19 (20%) out of 95 children with hepatitis A virus (HAV) infection. The mean age of atypical patients [6.32 (SD 3.45) years] was significantly lower than that of typical patients [8.22 (SD 3.58) years] (P=0.0041). The most common atypical manifestation was ascites (11/19), followed by hepatic encephalopathy (9/19), acute liver failure (719), thrombocytopenia (2/19), pleural effusion (2/19), and cholestasis (1; 1.1%). Children with atypical features had significantly higher international normalized ratio (INR) and serum bilirubin, as well as lower hemoglobin level than the typical group. Children of atypical group had significantly higher number of organomegaly and coagulopathy. Conclusion Ascites, hepatic encephalopathy, acute liver failure, thrombocytopenia, pleural effusion, and prolonged cholestasis were common forms of atypical presentation. Younger age, organomegaly, higher bilirubin level, prolonged PT, and decreased hemoglobin level could be predictive of an atypical presentation of HAV in children.
format	article
author	Sayma Rahman Munmun Archana Shrestha Yadav Mohammad Benzamin Abu Sayed Mohammad Bazlul Karim Mohammad Rukunuzzaman Mohammad Wahiduzzaman Mazumder Suborna Rani Das
author_facet	Sayma Rahman Munmun Archana Shrestha Yadav Mohammad Benzamin Abu Sayed Mohammad Bazlul Karim Mohammad Rukunuzzaman Mohammad Wahiduzzaman Mazumder Suborna Rani Das
author_sort	Sayma Rahman Munmun
title	Atypical presentations of hepatitis A infection in children
title_short	Atypical presentations of hepatitis A infection in children
title_full	Atypical presentations of hepatitis A infection in children
title_fullStr	Atypical presentations of hepatitis A infection in children
title_full_unstemmed	Atypical presentations of hepatitis A infection in children
title_sort	atypical presentations of hepatitis a infection in children
publisher	Indonesian Pediatric Society Publishing House
publishDate	2021
url	https://doaj.org/article/0651b6ea0a614555abf209d5d52c785b
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Atypical presentations of hepatitis A infection in children

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