Pediatric Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
Departments of Clinical and Chemical Pathology, National Hepatology and Tropical Medicine Research Institute "NHTMRI", Cairo, Egypt.
Eur J Clin Microbiol Infect Dis. 2018 Oct;37(10):1941-1947. doi: 10.1007/s10096-018-3329-0. Epub 2018 Jul 20.
Acute hepatic illness is an important health issue in children. Our work aimed to determine the prevalence of viral hepatitis in symptomatic children. It is a prospective cohort study of 268 children presented with acute hepatitis. Complete blood count, liver panel, and anti-hepatitis A virus (HAV) IgM were done initially. Cases negative for HAV were tested for anti-hepatitis E (HEV) IgM, anti-Epstein-Barr virus viral capsid antigen (EBV VCA) IgM, anti-cytomegalovirus virus IgM, hepatitis B surface antigen, anti-hepatitis B core IgM antibody, and anti-HCV antibody. Anti-HCV was repeated after 12 weeks to exclude seroconversion. In cases with negative viral serology, ceruloplasmin, total immunoglobulin G, antinuclear antibody, and abdominal ultrasound were done. Follow-up visits were bimonthly till recovery, then after 6 months. The mean age ± SD was 7.1 ± 3.7 years (1.5-18), and 56% were males. Acute HAV infection was diagnosed in 260 (97%) of cases and acute EBV infection in one case (0.4%). HAV/HEV coinfection was excluded in 70 HAV-positive cases. Six (2.2%) children remain undiagnosed and one child lost follow-up. About 80% of HAV-cases had normal laboratory results within 45 days. Unusual presentation of HAV infection was noticed in six children: four (1.5%) were relapsing, one had a cholestatic course, and one case had severe hemolytic anemia. Acute HAV infection was the chief etiology of acute hepatitis in our Egyptian children. The majority of the presentations were mild and children recover within a few weeks. An unusual pattern of HAV in children can be observed in endemic areas.
急性肝损伤是儿童的一个重要健康问题。我们的工作旨在确定有症状儿童中病毒性肝炎的流行率。这是一项针对 268 名急性肝炎患儿的前瞻性队列研究。最初进行了全血细胞计数、肝功能检查和甲型肝炎病毒（HAV）IgM 检测。HAV 阴性的病例进行了戊型肝炎（HEV）IgM、EB 病毒衣壳抗原（EBV VCA）IgM、巨细胞病毒 IgM、乙型肝炎表面抗原、乙型肝炎核心 IgM 抗体和丙型肝炎抗体检测。抗 HCV 抗体在 12 周后复查以排除血清转换。在病毒血清学阴性的病例中，进行了铜蓝蛋白、总免疫球蛋白 G、抗核抗体和腹部超声检查。随访每两个月一次，直至康复，然后在 6 个月后。平均年龄为 7.1±3.7 岁（1.5-18 岁），其中 56%为男性。260 例（97%）诊断为急性 HAV 感染，1 例（0.4%）诊断为急性 EBV 感染。在 70 例 HAV 阳性病例中排除了 HAV/HEV 合并感染。6 例（2.2%）患儿仍未确诊，1 例患儿失访。约 80%的 HAV 病例在 45 天内实验室检查结果正常。6 例 HAV 感染患儿出现异常表现：4 例（1.5%）为复发，1 例为胆汁淤积型，1 例为严重溶血性贫血。急性 HAV 感染是埃及儿童急性肝炎的主要病因。大多数表现为轻度，患儿在几周内康复。在流行地区可观察到儿童 HAV 的不典型表现。
