Hepatitis A and fulminant, hepatitis A viral infection: risk factors among children of Menoufiya Governorate

ABSTRACT

Hepatitis A viral infection is a common disease among Egyptian infants and children, although it has a benign course in the great majority of cases, severe fulmination which may be fatal can occur. In this study we try to highlight the risk factors associated with both acute hepatitis [A] and that of fulminat cases in attempt to propose preventive measures for both conditions. The study was carried out on 80 children [50 with hepatitis A and 30 fulminat cases along with 50 control cases of matched age and sex. All children were subjected to questionnaire assessing the hygienic measures, housing, food habits, type of feeding, past history of diseases, contaminated needle injection operations blood transfusion and history of drug administration. Anthropometric measures were recorded for all children who subjected to investigation included CBC, blood sugar, liver and renal function test serological marker of HAV, HBV, HCV and abdominal ultrasound. The study revealed that the major risk factors of fulminant hepatitis A include, medical history of infantile diabetes and bilharziasis, drug history of diuretics and anticonvulsant intake, elevation of serum bilirubin [total bilirubin] > 9.56 mg/dL, direct bilirubin > 5.11 mg/ dl, elevation of AST > 635.78 micro /L and ALT > 365.78 micro /L, GGT > 982.62 micro /L and ALP > 756.91 micro /L, prolonged prothrombin time [more than 25.87sec] and prothrombin concentration < 40.67%, reduced Hb level [< 7.4gdL], malnourishment [weight / age% < 1.97, weight / height%< 0.15, MAMC < 11.65cm and TSF < 0.84mm] and lastly reduced hepatic artery resistive index < 0.63, low socioeconomic standards, artificial feeding, bad personal hygiene and medical history of neonatal jaundice and anemia