Pediatric Hepatitis B Clinical Presentation
- Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD more...
History
A thorough history should be taken. Special emphasis is placed on risk factors for coinfection, alcohol use, and family history of hepatitis B virus (HBV) infection and liver cancer.
The incubation period for HBV infection ranges from 6 weeks to 6 months. The clinical manifestations depend on the age at infection, the level of HBV replication, and the host's immune status. Perinatally infected infants generally have no clinical signs or symptoms, and infection produces typical illness in only 5-15% of children aged 1-5 years. Older children and adults are symptomatic in 33-50% of infections.
Clinicopathologic syndromes include the following:
- Acute asymptomatic infection with recovery: Serologic evidence only
- Acute hepatitis with resolution: Anicteric or icteric
- Chronic hepatitis, with or without progression to cirrhosis
- Fulminant hepatitis with massive liver necrosis
- Coinfection with hepatitis D virus (hepatitis delta virus)
Following acute infection, the disease remains subclinical in 60-65% of patients; 20-25% develop acute hepatitis, 5-10% become carriers, and 4% develop chronic hepatitis.
Physical Examination
Acute hepatitis
Clinical signs and symptoms of acute HBV infection include anorexia, nausea, malaise, vomiting, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, coryza, jaundice, dark urine, clay-colored or light stools, and abdominal pain.
Upon physical examination, with the onset of clinical jaundice, the liver becomes enlarged and tender, and the patient may have right upper quadrant pain and discomfort. Splenomegaly and cervical adenopathy are present in 10-20% of patients with acute hepatitis. A few spider angiomas may appear during the icteric phase and disappear during convalescence, although angiomas are rare.
Chronic hepatitis
Chronic hepatitis is symptomatic, and affected individuals have biochemical or serologic evidence of continuing or relapsing hepatic disease for longer than 6 months, with histologically documented liver inflammation. The clinical features vary. The common symptoms include fatigue, loss of appetite, and occasional bouts of mild jaundice.
Fulminant hepatitis occurs in 1-2% of persons with acute disease and has a case-fatality ratio of 63-93%. It may present as jaundice, encephalopathy, and fetor hepaticus. Life-threatening extrahepatic complications include coagulopathy, renal failure, adult respiratory distress syndrome, electrolyte and acid-base disturbances, and sepsis. Without liver transplantation, the overall mortality ranges from 25-90%.
Consider hepatitis D virus infection if a patient who is a carrier of chronic hepatitis B presents with recurrent acute hepatitis or sudden fulminant hepatitis.
Rare Complications
Rare complications of viral hepatitis are as follows:
- Pancreatitis
- Myocarditis
- Atypical pneumonia
- Aplastic anemia
- Transverse myelitis
- Peripheral neuropathy
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