Viral Hepatitis in Children
Chawhan, R.N., M.D. (Med.), Reader in Medicine Talib, S.H., M.D. (Med.), Registrar in Infectious Diseases, Talib,V.H., M.D. (Path. and Bact.), Reader in Pathology, Sengupta, S.R., M.D. (Path.), Reader in Microbiology and Patil, S.D., M.D. (Path.), Reader in Pathology, Medical College, Aurangabad, India.
INTRODUCTION
During the past few decades, particularly since World War II, viral hepatitis has become an increasingly important public health problem throughout the world. Viral hepatitis is one of the commonest causes of jaundice in children and is one of the diseases still unconquered even in the West. In recent years, there has been a better understanding of the epidemiology and clinical picture of the disease which has helped in the formulation of control measures. However, in the absence of isolation of the specific virus and specific serological diagnosis, many lacunae in our knowledge still persist. Infective hepatitis is endemic in most of the urban areas in India. Large number of epidemics have been investigated and reported in recent years. (Mehta and Acharya, 1973). Aurangabad is an area of endemic hepatitis. Dhamahere and Nadkarni (1962) reported water-borne epidemic of infective hepatitis in part of Aurangabad city. As a general rule, infective hepatitis is a mild disease with low mortality. However, the commonest cause of death in this disease is acute liver failure leading to coma and death. In children, its course is usually mild but can lead to post-hepatic cirrhosis, chronic cholestasis, subacute necrosis and hepatic failure. The chances of such complications are high, particularly in our country, where malnutrition is extremely rampant (Rao et al., 1975). Viral hepatitis in children has many interesting facets. Of particular interest is its possible relationship to Indian childhood cirrhosis (Madhavan et al., 1973); a theory of viral aetiology (Achar et al., 1960, Chandra, 1970) is based on a frequent occurrence of jaundice at the onset, history of jaundice and hepatitis - like illness in other family members and clinical resemblance of the acute fulminant variety to submassive necrosis of the liver seen in infective hepatitis.
There is no specific therapy for viral hepatitis and evaluation of any drug in the treatment of infective hepatitis is difficult as it is a variable disease. There are many clinical types having a variable course and prognosis. However, a drug which can restore liver function quickly without producing harmful effects and is reasonably inexpensive is most welcome. Various reports of corticoid therapy are available (Evans et al., 1953; Huber and Willey, 1956; Vakil et al., 1965; Vakil, 1973). However of late, there have been number of reports about the efficacy of Liv.52 in this disease (Arora, 1961. Ramalingam et al., 1971, Sule et al., 1961, Mitra et al., 1974, Rao et al., 1975).
We present a clinical profile of viral hepatitis in children from Aurangabad.
MATERIAL AND METHODS
One hundred and thirty cases of viral hepatitis admitted to the Medical College Hospital, Aurangabad, during the period January 1972 to July 1975, were studied. The majority of cases were admitted in the summer months. A detailed clinical history was recorded, physical examination and routine laboratory investigations such as complete blood picture, urinalysis for bile salts, bile pigments, urobilinogen and liver function tests, which included serum bilirubin, serum transaminases etc. were done. Liver biopsy could be done only in 40% of cases on admission and it could not be repeated after treatment in any of the cases.
OBSERVATIONS
The ages of these children ranged from 5 months to 12 years: the highest incidence being in the age group 4-7 years. (Table 1). Sixty-five percent belonged to the poor socio-economic group, 20% to the middle income and the rest to the high income group.
Jaundice lasted for less than 10 days prior to admission in 50% of cases and 10-20 days in 30.7% of cases (Table 2).
During the past few decades, particularly since World War II, viral hepatitis has become an increasingly important public health problem throughout the world. Viral hepatitis is one of the commonest causes of jaundice in children and is one of the diseases still unconquered even in the West. In recent years, there has been a better understanding of the epidemiology and clinical picture of the disease which has helped in the formulation of control measures. However, in the absence of isolation of the specific virus and specific serological diagnosis, many lacunae in our knowledge still persist. Infective hepatitis is endemic in most of the urban areas in India. Large number of epidemics have been investigated and reported in recent years. (Mehta and Acharya, 1973). Aurangabad is an area of endemic hepatitis. Dhamahere and Nadkarni (1962) reported water-borne epidemic of infective hepatitis in part of Aurangabad city. As a general rule, infective hepatitis is a mild disease with low mortality. However, the commonest cause of death in this disease is acute liver failure leading to coma and death. In children, its course is usually mild but can lead to post-hepatic cirrhosis, chronic cholestasis, subacute necrosis and hepatic failure. The chances of such complications are high, particularly in our country, where malnutrition is extremely rampant (Rao et al., 1975). Viral hepatitis in children has many interesting facets. Of particular interest is its possible relationship to Indian childhood cirrhosis (Madhavan et al., 1973); a theory of viral aetiology (Achar et al., 1960, Chandra, 1970) is based on a frequent occurrence of jaundice at the onset, history of jaundice and hepatitis - like illness in other family members and clinical resemblance of the acute fulminant variety to submassive necrosis of the liver seen in infective hepatitis.
There is no specific therapy for viral hepatitis and evaluation of any drug in the treatment of infective hepatitis is difficult as it is a variable disease. There are many clinical types having a variable course and prognosis. However, a drug which can restore liver function quickly without producing harmful effects and is reasonably inexpensive is most welcome. Various reports of corticoid therapy are available (Evans et al., 1953; Huber and Willey, 1956; Vakil et al., 1965; Vakil, 1973). However of late, there have been number of reports about the efficacy of Liv.52 in this disease (Arora, 1961. Ramalingam et al., 1971, Sule et al., 1961, Mitra et al., 1974, Rao et al., 1975).
We present a clinical profile of viral hepatitis in children from Aurangabad.
MATERIAL AND METHODS
One hundred and thirty cases of viral hepatitis admitted to the Medical College Hospital, Aurangabad, during the period January 1972 to July 1975, were studied. The majority of cases were admitted in the summer months. A detailed clinical history was recorded, physical examination and routine laboratory investigations such as complete blood picture, urinalysis for bile salts, bile pigments, urobilinogen and liver function tests, which included serum bilirubin, serum transaminases etc. were done. Liver biopsy could be done only in 40% of cases on admission and it could not be repeated after treatment in any of the cases.
OBSERVATIONS
The ages of these children ranged from 5 months to 12 years: the highest incidence being in the age group 4-7 years. (Table 1). Sixty-five percent belonged to the poor socio-economic group, 20% to the middle income and the rest to the high income group.
Table 1: Age distribution of infective hepatitis cases |
||
Age |
No. of cases |
Percentage |
Below 1 year |
10 |
7.7 |
1 - 3 years |
35 |
27.0 |
4 - 7 years |
45 |
34.6 |
8 - 12 years |
40 |
30.7 |
Jaundice lasted for less than 10 days prior to admission in 50% of cases and 10-20 days in 30.7% of cases (Table 2).
Table 2: Duration of jaundice prior to admission |
<