Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
Eur J Pediatr. 2019 Jan;178(1):61-67. doi: 10.1007/s00431-018-3262-3. Epub 2018 Sep 29.
Various atypical manifestations have been described in acute viral hepatitis (AVH). We evaluated the prevalence, clinical features, response to treatment and outcome of various atypical manifestations of AVH in children. Consecutive children (≤ 18 years) with AVH due to hepatitis A, B, or E were studied while patients with acute or acute on chronic liver failure were excluded. Diagnosis of atypical manifestations was based on standard criteria. A total of 477 children with AVH (median age 7.0 (5-11) years, 74% boys) were seen; 22% (n = 106) had atypical manifestations. Prolonged cholestasis was the most common (11%), followed by ascites (7%), intravascular hemolysis (3%), relapsing hepatitis (2%), acute pancreatitis (1.3%), and thrombocytopenia (0.7%). Atypical manifestations were more common in HAV as compared to HBV (30% vs. 3%, p = 0.00) and HEV (30% vs. 15%, p = 0.07). Prolonged cholestasis was significantly more common in older children (20% in > 10 years vs. 9% in 6-10 years ; p = 0.009 and 5% in 0-5 years of age [p < 0.000]). Ascites was more common in younger children, although not significant. All patients recovered with supportive treatment.Conclusions: Twenty-two percent of children with AVH have atypical manifestations, more often with HAV infection, and prolonged cholestasis is most common. Recognition of these manifestations ensures correct diagnosis and treatment. What is Known: • Acute viral hepatitis is a major public health problem in developing countries. • There is limited information about atypical manifestations which may lead to unnecessary investigations, delayed diagnosis and morbidity. What is New: • Atypical manifestations are common in children, seen most often with HAV infection, and prolonged cholestasis is most common. • Prompt recognition of these manifestations helps in early diagnosis, appropriate management, and preventing unnecessary investigations. • Ensure follow-up until complete recovery and not to miss underlying chronic liver disease.
各种非典型表现已在急性病毒性肝炎（AVH）中描述。我们评估了儿童急性病毒性肝炎的各种非典型表现的患病率、临床特征、治疗反应和结局。研究了连续因甲型肝炎、乙型肝炎或戊型肝炎导致 AVH 的儿童，排除了急性或急性加重的慢性肝衰竭患者。非典型表现的诊断基于标准标准。共观察到 477 例 AVH 患儿（中位数年龄 7.0（5-11）岁，74%为男性）；22%（n=106）有非典型表现。最常见的是持续性胆汁淤积（11%），其次是腹水（7%）、血管内溶血（3%）、复发性肝炎（2%）、急性胰腺炎（1.3%）和血小板减少症（0.7%）。与 HBV（30%比 3%，p=0.00）和 HEV（30%比 15%，p=0.07）相比，HAV 中更常见非典型表现。年长儿童中持续性胆汁淤积更为常见（>10 岁为 20%，6-10 岁为 9%；p=0.009，0-5 岁为 5%[p<0.000]）。腹水在年龄较小的儿童中更为常见，但无统计学意义。所有患者均接受支持治疗后康复。结论：22%的急性病毒性肝炎患儿有非典型表现，更常见于 HAV 感染，以持续性胆汁淤积最为常见。认识到这些表现可确保正确的诊断和治疗。已知：急性病毒性肝炎是发展中国家的一个主要公共卫生问题。关于非典型表现的信息有限，这些表现可能导致不必要的检查、诊断延迟和发病率增加。新发现：非典型表现在儿童中很常见，最常见于 HAV 感染，以持续性胆汁淤积最为常见。及时认识这些表现有助于早期诊断、适当治疗和防止不必要的检查。确保随访直至完全康复，不要漏诊潜在的慢性肝病。
