Liaquat National Journal of Primary Care (Feb 2025)
Atypical Clinical Manifestation of Acute Viral Hepatitis A among Children
Abstract
Background: Hepatitis A virus infection is a tremendous public health problem with a particular incidence in developing countries like Pakistan. The country faces a significant burden of viral hepatitis, with varying rates among provinces due to socio-economic and environmental factors. Objectives: The primary purpose of this study was to determine the occurrence of atypical manifestations of acute viral hepatitis A infection among children admitted to the National Institute of Child Health in Karachi. Its secondary objective was to determine whether atypical presentations were linked to biochemical or serological modifications. Methodology: The present prospective case series study was conducted at the National Institute of Child Health in Karachi, Pakistan, from July 2023 to December 2023 enrolled 60 participants, aged between 1 and 15 years, who suffered from acute viral hepatitis A and were positive for the hepatitis A IgM antibody test. All the parents or guardians of the children signed the informed consent form. Results: The study was conducted on a total of 60 participants, which included 38 males and 22 females. The mean age was 7.89 years (SD = 3.74). Out of these 25 (41.6%) had atypical manifestations including intrahepatic manifestations such as prolonged cholestasis (5.0%), relapse (1.6%), and extrahepatic manifestations such as ascites (10.%), pleural effusion (1.7%), thrombocytopenia (3.3%), skin rash (3.3%), severe anemia (6.7%), aseptic meningitis (3.3%), pericardial effusion (3.3%), and myocarditis 2 (3.3%). Further, revealed that there were significant differences between typical and atypical manifestations of acute viral hepatitis in terms of laboratory parameters including SGPT (p=0.001), total serum bilirubin (p=0.001), direct serum bilirubin (p=0.001), prothrombin time (p=0.001), sodium (p=0.022), and potassium (p=0.022). Conclusion: This study found that an essential portion of participants had atypical manifestations of AVH-A. Additionally, there were significant differences observed in various laboratory parameters between the typical and atypical manifestation groups, Hence, clinicians should be familiar with and address these atypical manifestations to optimize the outcome and avert potential complications.
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