Hepatitis In Children: Signs, Symptoms, Causes And Treatment

Hepatitis refers to an inflammatory liver condition that can damage liver cells. Since the disease is usually caused by contagious bacteria or viruses, prompt management and treatment of hepatitis in children is crucial.

Hepatitis can cause various changes in the liver’s structure and function. The clinical manifestations of the disease may vary from asymptomatic to severe liver failure. If a child has hepatitis with no symptoms, the disease may go unnoticed, raising the risk of complications.

Read on to know more about the types of hepatitis, its symptoms, risk factors, prevention, and treatment in children.

Causes Of Hepatitis

Hepatitis can be caused by various reasons ranging from viral infections to autoimmune conditions. Children are more likely to develop viral hepatitis.

Hepatitis viruses are one of the most common causes. There are five types of hepatitis viruses (1).

• Hepatitis A virus (HAV) may cause mild to severe hepatitis. This can be spread from direct contact or fecal-oral route through contaminated food or water.

• Hepatitis B virus (HBV) is a severe hepatitis infection often resulting in chronic hepatitis in children. This can be spread from direct contact with infected people or their body fluids and usually lasts for six months.

• Hepatitis C virus (HCV) can cause severe and chronic hepatitis in children. This can be spread from infected blood and other body fluids.

• Hepatitis D (delta) virus (HDV) causes hepatitis only in children who have hepatitis B infection. This is also spread through blood and body fluids.

• Hepatitis E virus (HEV) may cause self-resolving hepatitis. This can be transmitted through the fecal-oral route and direct contact.

• Hepatitis G virus has also been discovered in recent years. The virus may not cause liver tissue changes despite being present in the blood. It means the child can be infected with the hepatitis G virus but may not develop the disease. This is transmitted from contact with infected people and their body fluids.

Other causes of viral hepatitis may include (1):

• Cytomegalovirus

• Varicella-zoster virus (causes chickenpox)

• Epstein-Barr virus (causes infectious mononucleosis)

• Herpes simplex virus

• Rubella

• Enteroviruses, such as echovirus and coxsackievirus

• Adenovirus

• Parvovirus (causes the fifth disease or slapped cheek disease)

Non-viral causes of hepatitis can be of the following categories.

• Infectious agents such as bacteria and parasites.

• Autoimmune liver disease may lead to autoimmune hepatitis, where the immune system attacks liver cells.

• Ischemic hepatitis or shock liver is inflammation of the liver tissue due to insufficient blood flow to the liver.

• Genetic diseases, such as Wilson’s disease, hemochromatosis, and alpha-1 antitrypsin deficiency, may cause hepatitis in some children.

• Metabolic diseases, such as lysosomal storage disorders and glycogen storage disorders, can also cause hepatitis.

• Drug-induced hepatitis can be due to toxic levels of certain medications metabolized in the liver.

• Toxins and certain compounds may also cause hepatitis.

Hepatitis due to non-pathogen-related causes, such as autoimmune conditions, ingestion of toxins, and genetic disorders, is non-infectious, meaning an affected child cannot spread hepatitis to other children. You may seek medical care to identify the exact cause of hepatitis since the signs and symptoms can be similar in most cases.

Risk Factors For Hepatitis

Children exposed to hepatitis viruses are at increased risk of developing the disease.

Hepatitis A and E can mainly spread in the following conditions (2).

• Poor sanitation
• Unsafe drinking water
• Contaminated food

The following conditions may increase the risk of hepatitis B, D, and C in children (2).

• Continuous dialysis for kidney failures
• Long term stays in care facilities
• Blood transfusions for bleeding disorders and other conditions
• Childhood alcohol and drug abuse

Rarely, unprotected sex and sharing needles for intravenous drug use can be reasons for developing hepatitis in some children, especially among teenagers.

Types Of Hepatitis

Hepatitis can be subdivided into infectious and non-infectious hepatitis. Infectious hepatitis occurs due to pathogens, such as viruses and bacteria, while non-infectious hepatitis is due to non-pathogen-related causes, such as autoimmune conditions.

Both infectious and non-infectious hepatitis can be further classified into acute and chronic hepatitis based on the illness’ duration and clinical features (3).

1. Acute hepatitis

Acute hepatitis is liver inflammation lasting less than six months. The illness period can be in three stages, including an initial prodromal phase with nonspecific symptoms, such as flu-like illness and vomiting. You may notice signs of liver damage or dysfunction, such as jaundice, within a week or two.

The liver and spleen may also enlarge in this stage, and this may resolve within four weeks in some children. Clinical symptoms may disappear in the third phase (recovery phase). Hepatitis A and E may resolve within a month or two, whereas B and C hepatitis may take three to four months.

Acute B, D, and E hepatitis may result in fulminant hepatitis that causes massive hepatic cell death. Autoimmune hepatitis and drug-induced hepatitis may also have similar clinical courses and complications.

2. Chronic hepatitis

Hepatitis lasting more than six months is called chronic hepatitis. The initial stage can be asymptomatic in many children, and liver dysfunction is often seen in lab analysis. Symptoms may appear when chronic hepatitis progresses. However, jaundice is often presented in advanced stages of chronic hepatitis.

Liver cirrhosis is a complication of chronic hepatitis. If left untreated, this may result in life-threatening complications, such as liver failure.

Signs And Symptoms Of Hepatitis

Signs and symptoms of hepatitis may vary in each child. Some children can be asymptomatic for a longer time. Symptoms of acute (sudden onset) hepatitis may include (4):

• Flu-like symptoms
• Jaundice (yellow skin and whites of the eye)
• Lack of appetite
• Nausea
• Vomiting
• Fever
• Joint pain
• Sore muscles
• Dark urine
• Clay color or pale stools
• Diarrhea
• Itchy rashes on the skin

The liver’s hormonal functions can be altered in the beginning stages of chronic hepatitis. This may often go unnoticed in some children. The symptoms may include:

• Abnormal hair growth (hirsutism)
• Acne
• Amenorrhea or lack of menstruation in girls

Damaged liver tissue can be replaced by scar tissue over time. This condition is called cirrhosis, where the liver functions are permanently impaired. Liver cirrhosis may cause the following signs and symptoms:

• Unintentional weight loss
• Ascites (fluid in the abdominal cavity)
• Leg swelling or peripheral edema
• Jaundice

Fulminant hepatitis may cause bleeding and neurological signs with signs of acute hepatitis. Hepatitis symptoms are also seen in other medical conditions. You may seek medical care for exact diagnosis and treatment.

Prevention Of Hepatitis

The following ways may help to reduce the chance of hepatitis in children (5).

• Get hepatitis A and B vaccine; hepatitis D can also be prevented with hepatitis B vaccination

• Practice good hand hygiene; use alcohol-based sanitizer when soap and water are unavailable

• Avoid sharing personal items with infected people

• Drink safe water or bottled water while traveling

• Eat freshly-prepared, well-cooked food

• Observe good sanitation practices

• Ensure to use new needles and sanitized instruments while getting body piercings and tattoos

• Avoid reuse or sharing of needles and syringes

• Do medical procedures and blood transfusion.

Diagnosis Of Hepatitis

Physical examination and health history may suggest a diagnosis of hepatitis in some children.
The following blood tests are ordered to confirm hepatitis diagnosis (6).

• Liver function tests, including liver enzyme levels

• Cellular blood count

• Bilirubin levels

• Coagulation tests to determine liver function

• Antibodies and PCR (polymerase chain reaction) help to identify the type of hepatitis

The following imaging tests are also ordered in some children.

• Ultrasound helps to visualize the liver

• CT scan of the liver and other body parts may help diagnose hepatitis

• MRI may give a more accurate image of the liver

• Liver biopsy uses needles to collect tissue samples from the liver for examination under a microscope

Your doctor may order additional tests depending on the initial evaluation to exclude or identify underlying causes or complications.

Treatment For Hepatitis

There is no specific cure for hepatitis. Treatment options may vary depending on the child’s underlying cause, age, symptoms, severity, and health status. Preventing liver damage and relieving symptoms is the primary goal of hepatitis treatment. Doctors usually recommend the following treatment modalities (7).

• Antiviral medications are prescribed for viral infections.

• Immunosuppressants are given for autoimmune hepatitis.

• Liver transplantation may be required for children with end-stage liver failure.

• Supportive care, such as a high-calorie diet and good rest, is recommended for all children with hepatitis.

• Intravenous feeding is recommended for children with severe vomiting and nausea.

• UDCA (ursodeoxycholic acid) may be prescribed for pruritus (itching) in older children.

• Hepatitis A may rarely require hospitalization and may not progress to a chronic form, so supportive treatment is given.

• Interferon-alpha is the first-line antiviral for hepatitis B in children without cirrhosis.

• Nucleotide analogs (NAs), such as lamivudine, tenofovir, and entecavir, are given for hepatitis B in children with liver cirrhosis.

• Ledipasvir/sofosbuvir combination drugs are prescribed for hepatitis C.

• Hepatitis D infection may be treated with supportive care and hepatitis B treatment.

• Ribavirin is given for hepatitis E infection in children with high mortality risk factors or causes. No treatment is needed for self-limiting acute hepatitis E infection.

• Cessation of drug and supportive care is given for drug-induced hepatitis.

Some children with severe hepatitis may require hospitalization and supportive care. Doctors may order blood tests during the hospital stay and follow-ups to identify the progression or improvement of hepatitis.

References

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Reviewer

Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha