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SUMMARY: Yilmaz-Çiftdogan D, Köse E, Aslan S, Gayyurhan E. Atypical clinical manifestations of hepatitis A among children aged 1-16 years in South-Eastern region of Turkey. Turk J Pediatr 2015; 57: 339-344.
Hepatitis A virus (HAV) infection has several atypical manifestations, including fulminant hepatitis, relapsing hepatitis, prolonged cholestasis and extrahepatic manifestations. In this study, we aimed to describe the characteristics and outcomes of the pediatric patients with atypical manifestations of HAV infection. Four hundred twelve children with symptomatic hepatitis A infection admitted to Gaziantep Children's Hospital Department of Pediatric Infectious Disease between August 2011 and January 2013 were analyzed retrospectively. Atypical presentations were present in 53 (12.8%) children of 412 children with HAV infection. Patients with atypical presentations (8.3±3.7 years) were older than patients with typical presentations (5.9±3.1 years) (p=0.001). Children with atypical features of hepatitis A statistically had higher initial and peak values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), international normalized ratio (INR), serum total and direct bilirubin than typical manifested group.
We can conclude that older age is the major risk factor for atypical presentation of HAV infections. Higher initial and peak levels of AST, ALT, INR, total and direct bilirubin could predict the atypical manifestation.
Key words: hepatitis A, atypical, child.
Hepatitis A is generally an acute, self-limiting liver infection transmitted through the fecaloral route by a positive-strand RNA virus, the hepatitis A virus (HAV), which causes 10 million infections worldwide each year1,2. The clinical spectrum ranges from mostly asymptomatic infection to rarely fulminant hepatitis3,4. In addition to fulminant hepatitis, hepatitis A has several atypical manifestations, including relapsing hepatitis, prolonged cholestasis and extra-hepatic manifestations5. Age is the major factor that influences the clinical course of the primary HAV infection; it is symptomatic in only 4%-16% of children compared to 75%-95% of adults3,4. Furthermore, high peak value of serum bilirubin was associated with the atypical manifestation4.
Although a highly effective and safe vaccine for HAV was implemented since November 2012, HAV is still an important etiology of acute viral hepatitis in Turkey. HAV infection prevalence has a strong relationship with social, economical and environmental factors. The prevalence rate of hepatitis A for Turkey has been reported as 64.4% and it was more than 90% for south-eastern region of Turkey6.
In this...