An Investigation on the Incidence and Clinical Importance of Atypical Complications in Children with Acute Hepatitis A Infection

Introduction: Atypical presentations in hepatitis A virus (HAV) infection are uncommonly encountered; nevertheless, they may lead to serious clinical complications. The present study reported the frequency of atypical presentations among children with acute HAV infection in south-east of Iran. Materials and Methods: This prospective (cohort) study was conducted in the gastroenterology clinic of Amir-Al-Momenin Hospital (Zabol, Sistan and Baluchestan province, Iran). A total of 294 children with positive anti-HAV IgM test were enrolled during 2015-2018. They were prospectively monitored for the incidence of any atypical presentation. Results: Out of 294 children, 152 (51.7%) were males, and the mean age was 7.3±3.5. Nausea and vomiting (41.8%) constituted the most frequent clinical presentations. Overall, atypical presentations were observed in 38 (12.8%). The atypical presentations included autoimmune hepatitis (AIH) (15, 5.1%), pancytopenia (11, 3.7%), non-immune hemolytic anemia (5, 1.7%), Wilson disease (3, 1%), prolonged cholestasis (3, 1%), and gallbladder hydrops (1, 0.3%). The mean level of alanine aminotransferase at diagnosis was significantly lower in patients with atypical presentations compared with those without such complications (801.28±986.61 vs. 1119.09±1109.98 IU/l, P=0.01). Patients with atypical manifestations also had significantly lower levels of total bilirubin (3.77±2.88 vs. 5.57±5.28 mg/dl, P=0.03) and direct bilirubin (2.03±2.06 vs. 2.91±3.20 mg/dl, P=0.04). Conclusion: Atypical manifestations are relatively common among children with acute HAV infection and should be routinely screened. With timely and appropriate interventions, clinical outcomes may not be significantly different from patients with typical presentation.