A STUDY ON RECENT SPECTRUM OF ACUTE VIRAL HEPATITIS IN CHILDREN IN A TERTIARY CARE CENTRE IN EASTERN BIHAR

Abstract

INTRODUCTION:  Acute  viral  hepatitis  in  children  is  a  serious  health  problem  throughout  the  world affecting millions of children every year despite the availability of vaccines, prophylactic measures and improved sanitation.

OBJECTIVES: To determine the etiologies, clinical features and biochemical parameters of acute viral hepatitis among hospitalized children in a tertiary care centre in Eastern Bihar.

METHODS: A prospective, descriptive study was done in the department of Pediatrics, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar from November 2017 to Octoberber 2019 among 200 consecutive hospitalized children who presented with acute hepatitis of viral etiology in between 1-12 years of age were included in the present study.

RESULTS: Out of 200 icteric children, most of the children were positive for anti-HAV IgM 152 (76.0%), followed by anti-HEV IgM 28 (14.0%). 8 (4.0%) cases were found with positive for HBsAg & anti-HBcIgM, anti-HCV 4 (2.0%) and anti-HAV with anti-HEV co-infection 8 (4.0%). In 1-5 year age group, only anti-HAV IgM 18 (11.8%) was found. In 5-10 year age group, again anti-HAV IgM 84 (55.2%) was the dominant one followed by anti-HEV IgM 10 (35.7%). Anti-HEV IgM (64.3%) was the supreme one in 10-12 year age group followed by anti-HAV IgM 50 (33%). Total 8 (4.0%) children having (anti-HAV IgM with anti-HEV IgM) co-infection. Four of them in 5-10 year age group and another 4 in >10 year age group. 8 (4.0%) children having acute HBV infection evident by HBsAg & anti-HBcIgM positive. Again 4 of them in 5-10 year age group and another 4 in >10 year age group. Only 4(2.0%) child having HCV evident by anti-HBC positive. Two in 5-10 year age group and another 2 in >10 year age group. Most of the children presented with jaundice 200 (100%), anorexia 200(100%), nausea & vomiting 176 (88%), low grade fever 130 (65%), with right upper abdominal pain 146(73%). Pale stool 36(18%) & pruritus 32(16%) may present due to cholestasis except HCV. On examination, hepatomegaly (94%) may present almost all cases of viral hepatitis and in 24.0% cases splenomegaly present. In 14% cases, sign’s of ascites present with the evidence of fluid thrill and/or shifting dullness. No significant difference observed regarding clinical presentation. Maximum number 200(100%) of patients had increase serum bilirubin, ALT & AST. Alkaline phosphatase 40(20.0%) may increase in a case of pale stool (cholestasis). ALF 28(14.0%) may develop with low serum albumin 28(14.0%) and increase prothrombin time/INR 28(14.0%). No significant difference observed regarding biochemical parameter. In ultrasound findings, hepatomegaly (93.0%) was found in most of the cases followed by splenomegaly (23.0%), gall bladder wall thickening (33.0%), gall bladder sludge (23.0%), hepatosplenomegaly (23.0%) and ascites (16.0%). Normal ultrasound was found in 3.0% cases. Out of 200 admitted patients, 134(67.0%) were having herbal medicines at the time of admission.

CONCLUSION: Acute viral hepatitis due to HAV is the commonest followed by HEV. HAV is supreme in 1-10 year age group & HEV is superior in >10 year age group. There was no significant difference between clinical and biochemical parameter of different viruses. Although increasing awareness, education & knowledge, most of the children having herbal medicines at the time of admission.