Hepatitis - Viral (Pediatric)

Definition

Viral hepatitis in children is an inflammation of the liver caused by hepatotropic viruses (hepatitis A, B, C, D, E), leading to jaundice, malaise, anorexia, and liver enzyme elevation.

Epidemiology

• Hepatitis A and E are more common in children in developing countries due to fecal-oral transmission
• Hepatitis B and C can be acquired perinatally or via blood exposure
• Incidence varies by region and vaccination coverage
• Hepatitis A is often asymptomatic in children under 5 years
• Hepatitis B and C can lead to chronic infection in a significant proportion of pediatric cases

Etiology

• Hepatitis A virus (HAV): fecal-oral route, contaminated food/water
• Hepatitis B virus (HBV): vertical transmission, blood, body fluids
• Hepatitis C virus (HCV): vertical transmission, blood transfusion
• Hepatitis D virus (HDV): occurs only with HBV co-infection
• Hepatitis E virus (HEV): fecal-oral route, contaminated water
• Rarely, other viruses (CMV, EBV, HSV) can cause hepatitis in children

Pathophysiology

• Viral entry into hepatocytes and replication
• Immune-mediated hepatocyte injury causes inflammation and necrosis
• Cholestasis may occur due to hepatocellular dysfunction
• In acute hepatitis, liver enzymes rise (ALT, AST), bilirubin increases
• Chronic HBV/HCV can lead to fibrosis, cirrhosis, or hepatocellular carcinoma
• Host immune response determines severity and clearance of virus