Viral hepatitis in children

• Viral hepatitis in children is a group of infectious

diseases that affect the liver and cause various
disorders of this organ. Microorganisms provoking
types of these pathologies are extremely resistant in
the external environment, perfectly tolerate negative
temperatures, poorly disinfectants and can remain
viable for 3-6 months. Pediatric gastroenterologists,
infectious disease specialists, pediatricians, and other
specialists are involved in evaluating symptoms,
finding causes, and treating hepatitis in children.
• Pediatric viral hepatitis occupies a special place
in modern gastroenterology, since this group of
diseases is fraught with serious complications
for the body and the transition of acute disease
to the chronic stage (except for hepatitis A,
which never acquires a chronic form). For
children, hepatitis B is the most dangerous, since
it has no specific treatment and can lead to
serious complications in a short time.
• The modern classification suggests five main
forms of the disease in children: hepatitis A, B,
C, D and E. Some of them are enteric, which
means they enter the body through the digestive
tract, while others are parenteral, which means
they are transmitted through blood and other
body fluids.
Types of hepatitis in children

• Hepatitis A or Botkin's disease (aka "dirty hands" disease) is the most common variant of
enteric pathology, after which long-term immunity remains. It is characterized by acute
damage to the liver and gastrointestinal tract, passes fairly quickly and in the vast
majority of cases without any consequences.
• Hepatitis B. It is also often called serum hepatitis, as it is transmitted exclusively through
biological fluids, such as blood, semen. It is characterized by a severe course with high
fever, pain, marked enlargement of the liver and spleen. Can progress to the chronic
form. Can have life-threatening complications, such as liver coma and cirrhosis.
• Hepatitis C. Most unpredictable variant of parenteral pathology, as viruses causing the
disease have a tendency to permanent mutations, which multiplies their survival rate and
activity. The main danger of this form of the disease is a long asymptomatic course. After
passing hepatitis C there is no stable immunity, it can fall ill again.
• Hepatitis D. Most often occurs in the form of co-infection, ie occurs simultaneously with
another form of hepatitis, most often variant B. It is parenteral and can cause
superinfection and cirrhosis of the liver.
• Hepatitis E. Refers to enteric group of pathologies. It almost never occurs in developed
countries.
• According to the nature of the course of the specialists
also distinguish acute (up to 3 months), subacute (up to
6 months) and chronic (more than six months) forms of
pathology.
• Causes of hepatitis in childhood
• There are three main routes of transmission of enteric
infection (A and E):

• Contact-domestic, when the virus from the surface of toys,

household objects, and other contaminated surfaces
reaches the skin of the hands and from there into the
esophagus;
• Aquatic, when a child drinks poor-quality water or
swallows contaminated liquids while bathing in a body of
water;
• Foodborne, when an infectious agent enters the body with
food contaminated during manufacturing in a factory.
• Parenteral forms of hepatitis (B, C, and D) can be transmitted by:

• By direct contact of the skin with wounds and scratches with blood and
other body fluids of the host or sick person;
• During various medical procedures involving blood transfusions, unsafe
injection methods of diagnosis or treatment, performed with non-sterile
or reused instruments;
• During childbirth;
• during the use of patient's items on which elements of contaminated
body fluids may have remained (manicure scissors, towels, razors,
toothbrushes, etc.).
• In adolescence, unprotected sexual intercourse can cause a child to get
hepatitis. Sometimes the disease is the result of self-expression, such as
piercings, tattoos, done in non-sterile conditions.
•Symptoms of viral hepatitis in children
• Acute forms of the disease develop in certain stages, each characterized by different signs.

• Incubation period. It lasts from 7 days to 24 weeks. During this time, there are usually no
symptoms.
• Prodormal (pre-yellowing) stage. Lasts at least 3-5 days, in some forms of the disease may
be absent. At this stage of hepatitis in children the first symptoms appear in the form of
general malaise, increased body temperature, nausea, decreased appetite and other signs.
• Jaundice stage. Comes on day 3-10 from the moment of development of the pathology
and lasts for 1-2 weeks. It is characterized by darkening of the urine, yellowing of the skin,
sclerae of the eyes, an increase in the liver and sometimes the spleen. In most cases,
during this phase, the general well-being of the sick child improves.
• Recovery phase. This phase is characterized by a gradual return of normal skin coloring
and whites of the eyes, improvement of appetite, increased vital tonus. This phase lasts
from 3 weeks to 6 months, depending on the form of the disease.
• In general, the common symptoms of viral hepatitis in children are:

• Increased body temperature;

• General weakness, malaise;
• loss of appetite and, consequently, weight loss;
• jaundice;
• Various rashes on the skin;
• pain in the right subcostal area;
• joint tenderness;
• headache;
• change in the color of the urine to a darker color;
• lighter stools;
• skin itching;
• nausea, vomiting, dyspeptic phenomena.
• A sign of hepatitis is also an increase in the size of
the liver, which can be detected by palpation and
an ultrasound examination.

• Parents should be concerned and take their child

to the doctor if he complains of fatigue, poor
performance, weakness, refuses to eat and loses
weight for a week or more. Such signs may
indicate a latent type of hepatitis or the acute form
passing into the chronic stage.
diagnostics
• The main significance in diagnosing viral hepatitis in children
is visual examination, during which the gastroenterologist
palpates the liver, determines its size and position, collects
history and listens to the complaints of the young patient or his
representatives.

• Auxiliary examination techniques become:

• Ultrasound of the abdominal organs;

• General blood and urine tests;
• Serological tests (ELISA and PCR);
• Biochemical blood tests with analysis of bilirubin levels.
• In some cases, fibrogastroduodenoscopy is also
indicated if the esophagus, stomach, or other
parts of the gastrointestinal tract are suspected.
Sometimes liver elastometry is also performed to
assess the degree of liver tissue damage
(fibrosis).
• Treatment of viral hepatitis in
children
• The therapy depends on the form of the disease (acute, sub-acute, or
chronic) and the type of disease. In uncomplicated acute hepatitis the
following are indicated:

• bed rest;
• Strict diet with a rejection of fried, fatty, smoked, sweet foods,
carbonated and tonic beverages;
• abundant drinking - at least 1.5 liters of pure water a day.
• Medical support involves detoxification measures, taking sorbents,
hepatoprotectors, antihistamines and anti-inflammatory drugs. In
some cases, hormonal and antioxidant agents are also prescribed.

• In severe forms of parenteral viral hepatitis in children is shown

antiviral treatment with shock doses of interferons. In such cases, as a
rule, the child is hospitalized in a specialized hospital.
Prognosis and prevention
• The prognosis depends on the type of hepatitis, the initial state of
the sick child's body at the time of going to the doctors, the
presence of concomitant diseases and a number of other criteria.
Mild, uncomplicated versions of the disease in most cases pass
quickly without any consequences and form a long-lasting
immunity.

• Possible serious complications of viral hepatitis in children can be:

• hepatic coma;
• Inflammatory diseases of the biliary tract;
• Cirrhosis of the liver.
• To reduce the risk of infection with hepatotropic viruses, experts recommend:

• Vaccinate children in a timely manner with available hepatitis A and B

medications;
• Teach children personal hygiene skills;
• Not allow children to swim in unknown pools and polluted pools;
• Buy food from licensed outlets;
• give bottled, boiled, or otherwise purified water to children;
• thoroughly wash fruits, vegetables, and berries before eating;
• not give undercooked meat to kids;
• teach children not to use other people's personal items (toothbrushes,
deodorants, etc.)
• inform teenagers about the risks of unprotected sex and visiting unlicensed
tattoo parlors.