PEDBASE.org - The Pediatric Database -
Detailed information of HEPATITIS C
HEPATITIS C
DEFINITION:
An infectious disease of the liver caused by the hepatitis C
virus (HCV) resulting in a chronic hepatitis.
EPIDEMIOLOGY:
- incidence: may cause 20-40% of all acute hepatitis cases
- age of onset:
- risk factors:
- endemic (worldwide with an estimated 100 million HCV
carriers)
- transfusion recipients, IV drug users, hemodialysis
patients, health care workers with frequent blood contact
PATHOGENESIS:
- a single-stranded RNA flavivirus <80 nm in diameter
- the genome has been cloned
- routes of infection:
- usually parenteral
- occasionally through intimate sexual contact
2. Hepatitis C
- previously called "parenterally-transmitted non-A, non-B
hepatitis"
- causes sporadic or posttransfusion hepatitis
2. Pathogenesis
- infection -> 1-5 month incubation period ->
noncytopathogenic injury to hepatocytes but hepatocellular
necrosis due to the cellular and immune response of the host to
HCV infection
- acute hepatitis represents an effective immune response
which is able to eliminate the virus-infected cells
- chronic hepatitis - represents an ineffective immune
response which is unable to totally eliminate the virus-infected
cells
CLINICAL FEATURES:
- arthritis and rash may be present
2. Hepatitis
- insidious onset with duration of illness ranging from
several weeks to months
- while the preicteric phase can last up to 5 days, the
icteric phase lasts from days to months with a mean of 8-11 days
in children
- generally the signs/symptoms of the acute illness are milder
than with HAV and HBV infections
- may be absent in children but last up to 5 days in
adolescents
- ranges from 37.8-40 C
2. Accompanying Signs/Symptoms
- abdominal pain
- anorexia
- headache
- lethargy
- nausea/vomiting
- hepatomegaly (tender)
- lymphadenopathy
- splenomegaly
2. Icteric Phase
- most patients with HCV infection are anicteric
- transition to the icteric phase is marked by the
disappearance of preicteric signs/symptoms in young children
but the exacerbation of these signs/symptoms in older
children and adolescents
3. Hepatic Complications
- a pathological diagnosis based on finding an inflammatory
process on liver biopsy involving only the portal areas -
anicteric and asymptomatic except for mild hepatomegaly
- - moderate elevation of ALT
- lasts longer than 6 months and may resolve after years or
progress to chronic active hepatitis
2. Chronic Active Hepatitis
- chronic and recurrent episodes of jaundice and elevated
- ALT and AST
- may progress to cirrhosis +/- portal hypertension with
ascites
3. Liver Failure
- liver failure occurring within days to 4 weeks after the
onset of acute hepatitis
- associated with mental confusion, emotional instability,
restlessness, bleeding, and coma
2. Subacute Hepatitis
- liver failure occurring 1-3 months after the onset of
acute hepatitis
4. Hepatocellular Carcinoma
- those with anti-HCV, have a 25x higher risk than the
normal population of developing hepatocellular cancer
INVESTIGATIONS:
- striking rise in level after the incubation period and
levels fluctuate over a prolonged period of time
2. Bilirubin
- transient elevation associated with the peak in ALT levels
lasting up to 2 months
3. Serology
- the mean interval from onset of hepatitis to detection of
anti-HCV may be as long as 15 weeks (range 4-32 weeks) which
then disappears in those with acute disease or persists in
those with chronic disease
4. Viremia
- HCV-RNA can be detected 2 weeks after a transfusion of HCV-contaminated
blood and will persist in those with chronic hepatitis
MANAGEMENT:
2. Medical
- alpha-interferon (6th month course) is effective in 5-25% of
patients
3. Prognosis
- can result in chronic hepatitis, liver disease, and/or a
carrier state (yet there is a very low risk of perinatal
infections)
- there is a relatively high incidence (about 50%) of chronic
liver diseae
- mortality from fulminant hepatitis is:
- 1-2% in uncomplicated cases
- 2% in complicated cases
|
Pediatric Database - HEPATITIS C
Pediatric Organization - Pedbase [at] Gmail.com