Clinical course and consequences of hepatitis A infection
Section snippets
Transmission and risk factors
Over 95% of HAV infections are transmitted by the faecal–oral route, and crowded or insanitary conditions are commonly implicated. This infection can be easily spread by person-to-person contact, mainly within families, day-care centres, elementary schools or similar institutions. Although it is rare, parenteral transmission of HAV is possible due to use of contaminated blood products or needles during blood transfusion. This type of transmission has been documented in Italian patients
Clinical course
The disease is expressed in two major forms—symptomatic and asymptomatic—representing a broad spectrum of infection. Jaundice may (icteric) or may not (anicteric) be a feature in patients with symptomatic hepatitis. The likelihood of showing symptoms related to HAV infection is related to the age of the patient. Thus, most infections in children aged under 6 years are asymptomatic, whereas those in older children and adults are usually symptomatic, with jaundice occurring in more than 70% of
Treatment of fulminant hepatitis A
Few reports have been published of the treatment of liver failure related to hepatitis A in children. However, a recent study from the Hôpital de Bicêtre, which is the main paediatric liver transplantation centre in France, included 24 children with hepatitis A over a 15-year period. At this centre, hepatitis A is the main cause of fulminant liver failure (23%) in children and accounts for 10% of the liver transplants performed at the centre [11]. The Juan P. Garrahan Hospital is the largest
Outcome
The reasons for the development of liver failure and eventual progression to fulminant hepatitis in some children with hepatitis A are not clear. Host factors, as well as the virulence and the quantity of viral inoculum, may be important. Whether a genetic predisposition is also involved is not known.
Survival at 1 year following liver transplantation is 64%, compared with 43% in patients given medical treatment alone.
Overall in Argentina, the case fatality rate of fulminant hepatitis A in
Conclusions
HAV infection is the predominant aetiology of acute hepatitis and fulminant hepatic failure in children in Argentina, and probably elsewhere in the world. Hepatitis A accounts for 20% of liver transplantations performed in our centres, but this approach is appropriate only in some cases and mortality is still quite high. Prevention must be considered as the main means of averting this catastrophic illness.
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