Pediatric Hepatitis C Clinical Presentation

Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD more...

Updated: May 21, 2012

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History and Physical Examination
Complications
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History and Physical Examination

The incubation period of hepatitis C virus (HCV) infection varies widely, with a mean of 7-10 weeks and a range of 2-20 weeks. Infections are often inapparent or subclinical. Only 25-35% of patients have nonspecific symptoms such as weakness, malaise, and anorexia; likewise, patients with chronic HCV infection often have few or no symptoms. Fatigue is reported most often.

Screen patients for HCV infection if any of the following applies:

History of illegal injected drug use
Transfusion with clotting factor concentrates before 1987
Transfusion with blood or blood components or receipt of organ transplants before July 1992
Use of HCV-contaminated blood from a donor
Long-term hemodialysis or persistently abnormal serum alanine aminotransferase (ALT) levels
Needle sticks, accidents with sharps, or mucosal exposures to HCV-positive blood

Considering HCV testing in patients with HIV infection may be prudent, especially in those who acquired HIV through intravenous drug use. HCV is more easily transmitted than HIV, and the 2 viruses are often co-infections.

Approximately 25% of patients with acute HCV infection have jaundice, whereas less than one third have hepatomegaly. Some patients with chronic infection have findings consistent with chronic liver disease; these include hepatomegaly, ascites, splenomegaly, and spider nevi.

Complications

Complications may include the following:

Fulminant hepatitis (rare)
Cirrhosis, which may result in portal hypertension and liver failure
Hepatocellular carcinoma

Extrahepatic manifestations may include the following:

Porphyria cutanea tarda
Sialadenitis resembling Sjögren syndrome
Mooren corneal ulcers, a form of chronic ulcerative keratitis
Type II cryoglobulinemia
Membranoproliferative glomerulonephritis
Non-Hodgkin lymphoma

Proceed to Differential Diagnoses

Contributor Information and Disclosures

Author

Nicholas John Bennett, MB, BCh, PhD, Assistant Professor in Pediatrics, Division of Infectious Diseases, Connecticut Children's Medical Center

Nicholas John Bennett, MB, BCh, PhD, is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Donald K Strickland, MD,to the development and writing of the source article.

References

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Narciso-Schiavon JL, Schiavon LL, Carvalho-Filho RJ, Freire FC, Cardoso JR, Bordin JO, et al. Anti-hepatitis C virus-positive blood donors: are women any different?. Transfus Med. Jun 2008;18(3):175-83. [Medline].
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Jonas MM, Balistreri W, Gonzalez-Peralta RP, Haber B, Lobritto S, Mohan P, et al. Peginterferon for chronic hepatitis C in children affects growth and body composition: Results from the pediatric study of hepatitis C (PEDS-C) Trial. Hepatology. Mar 2 2012;[Medline].
Bacon BR, Gordon SC, Lawitz E, Marcellin P, Vierling JM, Zeuzem S, et al. Boceprevir for previously treated chronic HCV genotype 1 infection. N Engl J Med. Mar 31 2011;364(13):1207-17. [Medline].
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