Samanta Arghya, Poddar Ujjal, Sen Sarma Moinak, Srivastava Anshu, Yachha Surender Kumar, Mishra Prabhakar
Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Infect Dis (Lond). 2024 Jun;56(6):476-483. doi: 10.1080/23744235.2024.2325568. Epub 2024 Mar 11.
Acute hepatitis due to various tropical infections can mimic the clinical picture of acute viral hepatitis(AVH), leading to increased morbidity and mortality. We aimed to identify clinical and laboratory parameters that could help to distinguish acute hepatitis due to tropical infections from AVH.
We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared.
Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group ( < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections.
High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia.SUMMARYAcute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.
各种热带感染所致的急性肝炎可模仿急性病毒性肝炎（AVH）的临床表现，导致发病率和死亡率增加。我们旨在确定有助于区分热带感染所致急性肝炎与AVH的临床和实验室参数。
我们回顾性分析了2013年1月至2023年3月期间150例AVH患儿（107例男孩）和50例热带感染所致急性肝炎患儿（34例男孩）的数据库。比较了临床特征、检查、并发症和结局。
甲型肝炎（75%）是AVH最常见的病因，而伤寒（34%）、登革热（26%）、恙虫病（20%）和钩端螺旋体病（16%）构成了热带感染的大部分。热带感染组分别有88%和16%的患者出现持续发热和皮疹，而AVH组均无（<0.001）。单因素分析显示，前驱症状、临床可检测到的黄疸、胆汁淤积模式、总胆红素和直接胆红素以及肝酶在AVH中显著更高，而头痛、肌痛、白细胞减少、血小板减少、低钠血症在热带感染组中显著更高（均<0.05）。多因素分析确定血小板减少（比值比[OR]4.237）为热带感染所致急性肝炎的独立阳性预测因素，而总胆红素（OR 0.575）、直接胆红素（OR 0.498）、天冬氨酸转氨酶（OR 0.841）和丙氨酸转氨酶（OR 0.863）显著升高为独立阴性预测因素。
黄疸出现后持续发热的患者，尤其是伴有皮疹和血小板减少的患者，对热带感染应高度怀疑。总结急性病毒性肝炎和热带感染所致急性肝炎可能具有相似的临床和生化参数。黄疸程度较轻、血清转氨酶升高较低和血小板减少可能是热带感染所致急性肝炎的有用预测指标。
