Acute hepatitis in children

Acute hepatitis in children is a clinical syndrome characterized by the abrupt onset of hepatocellular inflammation and injury, with illness duration of less than six months. It manifests along a continuum—from subclinical transaminase elevation to jaundice, coagulopathy, and fulminant hepatic failure. The pediatric presentation is often nuanced, requiring a high index of suspicion to ensure timely recognition and intervention. Etiology spans infectious, immune-mediated, metabolic, and toxic insults. Viral hepatitis remains the predominant cause worldwide, with hepatitis A and E prevalent in regions of lower sanitation, and hepatitis B and C now declining in incidence due to universal immunization and perinatal screening. Other hepatotropic or systemic viruses—including Epstein-Barr virus, cytomegalovirus, herpes simplex virus, adenovirus, and enteroviruses—can produce significant hepatic injury. Non-infectious causes include autoimmune hepatitis, Wilson disease, mitochondrial and metabolic disorders, and drug- or toxin-induced liver injury. Despite comprehensive investigation, recent global reports underscore that a subset of cases remains idiopathic, including acute severe hepatitis of unknown origin in previously healthy children. Diagnosis demands a meticulous approach: detailed history (travel, exposures, medications, family predisposition), targeted physical examination, and a structured laboratory work-up comprising liver biochemistry, coagulation profile, metabolic screening, viral serologies, and autoimmune markers. Abdominal ultrasonography with Doppler is indispensable for assessing parenchymal changes and vascular integrity. In selected cases, liver biopsy remains the gold standard for histological characterization and therapeutic guidance. Management integrates etiology-specific interventions with vigilant supportive care. Viral hepatitis A and E are self-limited, requiring hydration, nutrition, and observation. Autoimmune hepatitis necessitates prompt immunosuppression. Drug-induced injury mandates immediate withdrawal of the offending agent. Supportive measures aim to prevent metabolic decompensation, control coagulopathy, and avert complications such as hypoglycemia and hepatic encephalopathy. Children meeting acute liver failure criteria require urgent referral to a pediatric liver transplant unit to maximize survival. Prevention: widespread hepatitis B vaccination, targeted hepatitis A immunization, improved sanitation, and rational prescribing of potentially hepatotoxic agents remain the most effective strategies. Acute hepatitis in children demands a multidisciplinary, time-sensitive approach, etiologic identification with supportive care. Advances in molecular diagnostics and pathogen discovery promise to refine our understanding, enabling earlier detection and targeted therapy for this complex and evolving condition.

کلیدواژه ها:

acute hepatitis ، pediatric hepatology ، viral hepatitis ، acute liver failure ، diagnosis ، management ، prevention ، transplantation