RESUMO
AIM: To report a patient with typhoid fever who presented with fulminant hepatitis and was found to have a co-infection with hepatitis A. CASE: An 11-year-old girl presented with fever and jaundice after arrival from India. Her blood culture was positive for Salmonella typhi. While on treatment with ceftriaxone, she had worsening of her jaundice with abrupt elevation of liver transaminases associated with coagulopathy. She was found to have an associated hepatitis A infection. Liver enzymes all reverted back to normal upon follow up. Conclusion: The association of typhoid fever with hepatitis A can result in fulminant hepatitis but in this case, is associated with complete recovery.
RESUMO
To describe the epidemiology, clinical features and outcome of hepatitis A virus [HAV] infection in children in Kuwait. The medical records of 350 patients [age 0-16 years] admitted to the Infectious Diseases Hospital, Kuwait, between January 2000 and December 2002, with hepatitis A infection were reviewed. The mean age was 8.6 +/- 3.8 years and 47% of patients were between 7 and 12 years old. Kuwaiti children comprised 44% of admitted patients. The largest proportion of children with hepatitis A [34%] were from the northern part of the country. HAV infection was prevalent throughout the year with a peak during the months of August to October. Of the Kuwaiti children, 31% reported a history of contact with jaundiced patients, while 52% of the non-Kuwaiti children had a history of recent travel prior to their illness. Patients had symptoms for a mean of 6 +/- 3.6 days prior to presentation. The mean length of hospitalization was 5.8 +/- 2.9 days. The rate of complications of HAV infection was 6% and only one child required admission to the intensive care unit for fulminant hepatitis. None of the patients had permanent sequelae. HAV infection is a significant cause of morbidity for children in Kuwait. The disease is mostly prevalent in preschool and school age children. Despite the excellent outcome of all patients, a considerable number of patients tend to have a complicated course and prolonged hospitalization. In view of these data, hepatitis A vaccine should be considered as a part of routine childhood immunization in Kuwait