Persistent fever in acute hepatitis: think beyond acute viral hepatitis

Area of Science:

• Pediatrics
• Infectious Diseases
• Hepatology

Background:

• Acute hepatitis presents similarly across various causes, including tropical infections and acute viral hepatitis (AVH).
• Differentiating these conditions is vital for effective management and reducing morbidity and mortality.

Purpose of the Study:

• To identify clinical and laboratory markers differentiating acute hepatitis from tropical infections versus AVH in children.
• To improve diagnostic accuracy in cases of acute hepatitis with overlapping clinical presentations.

Main Methods:

• Retrospective analysis of 200 children (150 with AVH, 50 with tropical infections) from January 2013 to March 2023.
• Comparison of clinical features, laboratory investigations, complications, and outcomes between the two groups.

Main Results:

• Hepatitis A was the most common AVH cause; enteric fever, dengue, scrub typhus, and leptospirosis predominated in tropical infections.
• Persistent fever, skin rash, leukopenia, and thrombocytopenia were more frequent in tropical infections.
• Multivariate analysis identified thrombocytopenia as a positive predictor and elevated bilirubin/transaminases as negative predictors for tropical infections.

Conclusions:

• A high index of suspicion for tropical infections is necessary in patients with persistent fever post-jaundice, especially with rash and thrombocytopenia.
• Milder jaundice, lower transaminase levels, and thrombocytopenia are key indicators for acute hepatitis due to tropical infections.