Atypical Presentation of Hepatitis A in Children

To determine the frequency of atypical presentation of hepatitis A virus (HAV) infection in children.

A cross-sectional study. Place and Duration of the Study: Department of Paediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital and the Institute of Child Health, Multan, Pakistan, from November 2023 to April 2024.

Children of either gender, aged 1-18 years, who visited the outpatients or emergency department, and were diagnosed with HAV infection were included in the study. HAV infection was diagnosed based on clinical and laboratory findings. Atypical manifestations of HAV were also documented. The Chi-square test for categorical data and the Independent sample t-test or Mann-Whitney U test for the comparison of quantitative variables were applied, considering p <0.05 as statistically significant.

In a total of 246 children, 144 (58.5%) were boys. The mean age was 6.52 ± 4.25 years. Atypical presentation of HAV infection was recorded in 60 (24.4%) children. The most frequent atypical presentations were ascites, pleural effusion, thrombocytopenia, and cholestasis, noted in 21 (35.0%), 16 (26.7%), 13 (21.7%), and 9 (15.0%) children, respectively. A relatively younger age was found to have a significant association with atypical presentation of HAV (p = 0.014). When compared to children with typical HAV manifestations, children with atypical manifestations had significantly less serum bilirubin (p <0.001), higher INR (p <0.001), and lower haemoglobin (p = 0.004).

Atypical manifestations of HAV are common among children, with ascites, pleural effusion, thrombocytopenia, and cholestasis being the most frequent occurrences. A relatively younger age was significantly associated with atypical HAV manifestations. Distinct laboratory parameters were observed among children with atypical manifestations of HAV.

Ascites, Cholestasis, Hepatitis A virus, Pleural effusion, Thrombocytopenia.