CLINICAL AND EPIDEMIOLOGICAL FEATURES OF THE COURSE OF VIRAL HEPATITIS A IN CHILDREN IN THE VORONEZH REGION

  • Authors: Trishina S.D.1
  • Affiliations:
    1. Voronezh State Medical University named after N. N. Burdenko
  • Issue: Vol 10 (2021): Материалы XVII Международной Бурденковской научной конференции 22-24 апреля 2021 года
  • Pages: 201-203
  • Section: Инфекционные болезни и иммунология
  • URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/6520

Cite item

Abstract

Viral hepatitis A (HAV) is still the most common liver disease in humans.
Objective: in this study, we analyze the clinical and laboratory features of the course of HAV in children in Voronezh and the Voronezh region for the period from 2019 to 2020.
Methods: we analyzed 44 medical records of children diagnosed with acute HAV. The average age of the patients was 8.1±3.9 years. The diagnosis was established on the basis of clinical and laboratory studies conducted in accordance with the International Classification of Diseases of the tenth revision. In all patients, anti-HAV IgM was detected in the blood by enzyme immunoassay.
Results: in most patients, the disease was mild to moderate in severity. The pre-jaundice period in 78.5% of patients was mixed. The duration of the symptoms of intoxication was significantly different: in patients with mild HAV, it was 7.5±4.2 days, moderate 11.9±4.7 and severe 19.4±6.4 days. In most patients, the level of total bilirubin was 2.5 times higher than normal. The cytolysis parameters were increased by 6 times compared to the normal values. The symptom of cholestasis was detected in 100% of patients. Biochemical parameters of cholestasis were 2 times higher than normal.
Conclusions: HAV remains an urgent public health problem to date. The clinical picture is dominated by the cholestatic symptom.

Full Text

Relevance. Hepatitis A (HA) continues to be a widespread liver disease among children. According to the Federal Center for Hygiene and Epidemiology of Russia, the incidence of HAV in the country ranges from 70 to 90%.

Both the HAV causative agent and the principles of laboratory diagnostics have been well studied. The clinical picture, variants of the course, outcomes and long-term consequences of the disease have been fully studied. It is precisely established that HA is a benign infection, with it extremely rarely malignant forms are observed and there is no transition to a chronic form at all. However, HAV is a significant childhood disease and can lead to significant economic damage.Goal.

Description, as well as analysis of epidemiological, clinical and laboratory features of the course of HAV in children in Voronezh and the Voronezh region for the period from 2019 to 2020.

Materials and methods: 44 medical records of children who underwent examination and treatment in the infectious diseases department of the CSTO No. 2 with a diagnosis of acute HAV were studied. The average age of the patients was 8.1±3.9 years. The diagnosis was established on the basis of clinical and laboratory studies conducted in accordance with the International Classification of Diseases of the tenth revision. Anti-HAV IgM was detected in the blood of all patients by enzyme immunoassay (ELISA). A biochemical study revealed an increased concentration of bilirubin and thymol samples in the blood. Indicators of alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) were also higher than normal. These blood parameters were examined every 7-10 days, depending on the length of the child's stay in the hospital and the severity of the condition.

The obtained results were statistically processed using the nonparametric Mann - Whitney, Kruskal - Wallis criteria using the SPSS Statistics 19.0 computer program.

Results: The disease was mild in 30% of patients, moderate severity was observed in 65%, severe severity – in 5% of children.

Upon admission to the hospital, 100% of patients complained of general weakness, increased fatigue, and decreased appetite. 86% of the children had epigastric pain, nausea, and vomiting.

The majority of patients (72.5%) were admitted to the hospital on the 3rd - 7th days of the disease, 10.1%-on the 8th - 11th day of the disease, only 3.5% of children - on the 12th day of the disease and later.

The duration of the pre-jaundice period was 3.5±0.7 and 5.9±2.1 days, respectively, in patients with mild and moderate course of the disease. In patients with severe HAV, the above-mentioned period was 5.5±2.5 days. The pre-jaundice period in 78.5% of patients was mixed. Dyspeptic variant was observed in 21.5% of patients.

The duration of the jaundice period in children with mild HAV was 7.4±3.8 days, with a moderate form-14.2±8.0 days and with a severe form-18.4±7.7 days.

The duration of symptoms of intoxication, such as weakness, increased fatigue, sleep disorders, decreased appetite, nausea, vomiting, varied significantly. In children with a mild form of the disease, it was 7.5±4.2 days, with moderate-11.9±4.7 and severe-19.4±6.4 days.

85.4% of people complained of itching. In most patients, this symptom disappeared by the 8th-10th day of the disease.

The level of total bilirubin in patients with moderate course of the disease was 2.5 times higher than in patients with mild course and 1.8 times lower than in patients with severe course of the disease.

In children with a mild course of the disease, ALT activity indicators in the first 10 days of the disease exceeded normal values by 5 to 6 times. Almost complete normalization of this indicator was determined in this group only by the 21st day of the disease. In patients with moderate to severe forms of HAV during the same period of the disease, ALT activity was 6 to 10 times higher than normal values. Normalization of ALT indicators in these patients was observed only by the 35th day of the disease.

Patients who had the disease in moderate severity, the level of GGTP was 2.4 times higher than in children with mild severity, and 2.1 times lower than in patients with severe HAV. The level of alkaline phosphatase y in patients with moderate forms of the disease was 2 times higher than in mild forms, and 1.1 times lower than in patients with severe HAV.

Discussion: Summarizing the analysis of clinical and laboratory features of the course of HAV in children, we can draw the following conclusion. The clinical picture proceeds classically, laboratory confirmation is not difficult. However, in our studies, the symptom of cholestasis was detected in 100% of patients, which differs from the literature data.

Conclusions: HAV remains to date an urgent health problem. Timely vaccination increases the immunity of the child population to HAV. The use of normal immunoglobulin in the HAV focus also helps to reduce the incidence of hepatitis c by the enteral transmission mechanism in children's groups.

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About the authors

Sofiya D. Trishina

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: 79202256757@yandex.ru
ORCID iD: 0000-0002-6499-3326
SPIN-code: 2514-0860
Russian Federation, 10 Studencheskaya str., Voronezh, Russia, 394036

References

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