التظاهرات السريرية اللانموذجية لحالات التهاب الكبد الإنتاني بالحمة A عند الأطفال المقبولين في مستشفى الأطفال الجامعي بدمشق

الملخص EN

Objective: Hepatitis A virus (HAV) infection has several atypical manifestations, including relapsing hepatitis, prolonged cholestasis and extra-hepatic manifestations.

In this study, we aimed to describe the characteristics and outcomes of the pediatric patients with atypical manifestations of HAV infection, and its relationship with age, clinical symptoms and laboratory findings in patients admitted to Children’s University Hospital in Damascus.

Methods: The study was conducted at Children’s University Hospital in Damascus, a retrograde study in the period between January 2011 and January 2015 included 105 children were diagnosed with hepatitis A, 30 of these cases were with atypical manifestations (not excluding any case).

The information about the atypical manifestations, age, sex, clinical symptoms associated with infection (fever, abdominal pain, jaundice, nausea and vomiting) were collected and collected laboratory tests (aminotransferase, total bilirubin and gama-glutamil peptidase), and then we compared the results between the two groups by statistical tests (Student's t-test and Pearson's correlation coefficient).

Results: Atypical presentations were present in 30 (28%) children out of 105 children with HAV infection.

Patients with atypical presentations (9.6±1.4 years) were older than patients with typical presentations (4.94±1.3 years), p=0.004.

Children with atypical features of hepatitis A have statistically higher initial values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total and direct bilirubin than typical manifested group.

Also the clinical symptoms (jaundice and fever) were noted at a higher rate in patients with atypical presentations.

Conclusions: 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, total and direct bilirubin and clinical symptoms (jaundice and fever) could predict the atypical manifestation.