Hepatitis C in children of the first year of life

It is quite obvious that in the first year of life the child's acquisition of hepatitis C is most likely from the mother.

[1], [2], [3], [4], [5], [6], [7], [8],

Causes Hepatitis C in children of the first year of life

Causes of hepatitis C in children of the first year of life

The probability of infection of a baby with hepatitis C virus from a mother with some form of HCV infection is high, but when the transmission of the virus occurs most naturally - in utero, in childbirth or after birth, with close contact - it is not yet clear enough. In addition, clinical variants of hepatitis C in this age group have not been studied.

In infants born to mothers with chronic hepatitis C, in a number of cases, development of hepatitis C was observed. At the same time, babies were born with the presence of anti-HCV and the absence of symptoms of hepatitis; in the future, at the 6th-12th month of life, they developed hepatitis C in an anemia with subsequent chronization of the process.

T. Kuroki et al. (1993) found a high incidence (33%) of transmission of HCV infection to infants from mothers with CHC; while researchers believe that the infection of children occurs most likely in childbirth or in the first months of life, when there is close contact between mother and child.

The incidence of perinatal infection with hepatitis C virus is 7.2%, and when combined with a mother CHC with HIV infection - increases to 14.8%.

M. Giovannnini et al. (1990), observing 25 pairs-an anti-HCV-positive mother-newborn, all babies were found to have anti-HCV in the blood serum, disappearing in the next 2-4 months of life. In 11 children aged 6-12 months, anti-HCV appeared again, which was regarded as seroconversion as a result of HCV infection. When studying the anamnesis it was found that 6 out of 11 children aged 3-12 weeks of life registered increased ALT activity, which was not given due attention.

The presented data are ambiguous, but nevertheless testify that vertical transmission of the hepatitis C virus from the mother is possible; with a high probability of formation of primary chronic hepatitis.

[9], [10], [11], [12], [13],

Symptoms Hepatitis C in children of the first year of life

Symptoms of hepatitis C in children of the first year of life

Under clinical supervision, there were 41 children aged 2 months to 1 year who entered the clinic with a diagnosis of viral hepatitis. At that, 2 patients (4.9%) had hepatitis A, 15 (36.6%) had hepatitis B, 17 (41.5%) had hepatitis C, and 3 (7.3%) had cytomegalovirus hepatitis, in 4 (9.7%) - viral hepatitis of unknown etiology. Thus, the leading place in the structure of viral liver damage in children in the first year of life was occupied by hepatitis B and C.

Among 17 patients with hepatitis C, 11 girls and 6 boys were children of the first year of life. Mothers of 3 children suffered from drug addiction, while 2 women with simultaneous examination with children in the blood showed anti-HCV without clinical and laboratory signs of liver damage, 9 more children were born from mothers with CHC, 1 child from mother who 2 weeks after childbirth, serologically confirmed hepatitis C developed. Only 4 children were from healthy mothers. All babies, except for one, were born full-blooded, with a body weight from 2800 to 4000 g.

Based on the available epidemiological data, it could be assumed that the source of HCV infection in 11 children was mothers with acute or chronic hepatitis C (9 people) and drug addicts (2 people) with latent HCV infection. All these children received no blood products. Of the remaining 6 children, 3 were most likely infected via blood products, since they were in the infant department for 2-3 months before hepatitis C, where one child was given blood and two were given plasma. In the mothers of these children, specific hepatitis C markers were not detected. Two other children (mothers refused them) were constantly treated at the hospitals from birth, received multiple parenteral manipulations, through which, apparently, they contracted the hepatitis C virus. One child from a healthy mother had an indication of a single blood sample for clinical analysis in polyclinic.

The development of acute hepatitis occurs in 2 girls aged 3 and 4.5 months. Mother of one of them fell ill with typical hepatitis C 2 weeks after childbirth. The girl fell ill 2.5 months after the onset of the disease in the mother - sharply, with a rise in body temperature to 38.3 ° C and the appearance of lethargy. The next day there was a darkening of the urine, and on the 3rd stump - jaundice, in connection with which the child was hospitalized in a hospital with a diagnosis of hepatitis C. The condition in the hospital was regarded as moderate. The girl was lethargic, regurgitating. Skin and sclera were moderately icteric. The abdomen is swollen, painless. The liver of a dense consistency, with palpation protruded from the hypochondrium by 3 cm, the spleen - by 1.5 cm. In a biochemical blood test, the level of total bilirubin was 70 μmol / l, conjugated - 50 μmol / l, ALT activity - 1520 ED, ACT - 616 ED, FSA - 970 ED, beta-lipoproteins - 63 ED, prothrombin index - 68%, indices of thymol test - 11.8 ED. In the blood test for serological markers of viral hepatitis, anti-HBc, anti-HBs, anti-HCV; HCV RNA was not detected.

With ultrasound scanning, a moderate compaction of the liver parenchyma with echoes to 1/3 of the maximal, normal gallbladder, and a sharp increase in the pancreas were revealed. The spleen is slightly enlarged.

Based on clinical and serological data, hepatitis C, mild form, pancreatitis is diagnosed.

The presence of antibodies to the hepatitis B virus is explained by transplacental transmission from the mother who had them in the anamnesis.

The course of the disease was smooth, at the end of the 2nd week after the onset of the disease, jaundice disappeared, the liver diminished, and only moderately elevated transaminase activity was detected in the biochemical blood test: ALT-414 ED and ACT-241 units. In a satisfactory condition the girl is discharged home.

Given that the mother fell ill with acute hepatitis C 2 weeks after childbirth, and the child - 2.5 months after the mother's illness, one can think of postnatal infection with close contact in the maternity hospital, but you can not exclude infection in labor (intra-natal) , since it is known that the hepatitis C virus appears in the blood for 2-4 weeks before the first clinical signs of the disease.

Another girl, 4.5 months old, mother drug addict for 1 week before childbirth was transferred to hepatitis B. The girl was given parenteral treatment from birth in connection with cerebral circulation disorder, after discharge she entered the child's home (her mother refused it), developed unsatisfactorily, poorly added to the mass, in connection with which she was repeatedly hospitalized.

The present disease began with the appearance of jaundice, about which the girl was hospitalized in our clinic in an average condition. I was restless, I ate badly. Skin and sclera were slightly icteric. The liver protruded from the hypochondrium 1.5 cm, the spleen was determined at the edge of the costal arch. Biochemical blood test: total bilirubin 58 μmol / l, conjugated 30 μmol / l, ALT activity 473 units, ACT 310, beta-lipoproteins 63 ED, prothrombin index 64%, timol assay 10 ED. Serological markers: HBsAg, anti-HCV.

During the next 3 days the condition deteriorated steadily: the excitement was replaced by lethargy, the girl periodically did not react to others, the icterism of the skin, the sclera increased to moderate. The growing pastosity of the tissues was noted. Breathing became frequent, superficial. Cardiac tones are distinct, increasing to 200 beats / min. The abdomen is moderately inflated. The liver diminished and was palpated 0.5 cm from the hypochondrium. The girl fell into a coma, and soon when the phenomena of stopping breathing and cardiac activity came a lethal outcome. On the same day, a sharp increase in the level of bilirubin was registered in the biochemical analysis - up to 236 μmol / l, half was not the conjugated fraction; the activity of ALT and ACT decreased to 160 and 190 units, respectively. In the morphological study, acute massive necrosis of the liver was diagnosed. Clinical diagnosis: combined hepatitis B and C, malignant form, hepatic coma with fatal outcome.

Given multiple episodes of hospital treatment since the neonatal period, parenteral infection with the hepatitis C virus can be suspected. With the hepatitis B virus, a girl could become infected from a mother who had acute acute hepatitis B 1 week before delivery.

The third child was enrolled at the clinic at the age of 5 months because of a maternal temperature increase up to 39 ° C for 2 weeks before, dark urine and jaundice appeared.

Biochemical blood test: total bilirubin - 113 μmol / l, conjugated - 65 μmol / l, ALT - 530 ED, ACT - 380 units. Serological markers of hepatitis: HBsAg "-", anti-HBc IgM "-", anti-HCV "+", anti-HAV IgM "+", HCV RNA "-". This gave grounds to diagnose her hepatitis A against a background of chronic hepatitis C.

From the child's anamnesis it is known that he was born full-term from the first timely birth, with a body weight of 4000 g, a length of 54 cm. At the age of 1 month, he was operated for pyloric stenosis (he did not receive blood products)

Upon admission to the clinic, the child's condition was regarded as satisfactory. Skin and sclera - normal color. On the skin in the epigastric region, a postoperative scar 4 cm long. The abdomen is soft, painless. The liver is compacted and protrudes from the hypochondrium by 2.5 cm,

Biochemical blood test: bilirubin total - 4 μmol / l, ALT - 177 ED, ACT - 123 ED, indices of thymol test - 10 units. Serological markers of hepatitis; HBsAg "-", anti-HCV "+", anti-HAVIgM "-". HCV RNA "+".

These data gave grounds to diagnose hepatitis C in a child. Infection with it, most likely, occurred in childbirth, and not during operative intervention for pyloric stenosis, since the operation was not accompanied by blood transfusion.

Another 14 children aged 3.5 months to 1 year had primary chronic hepatitis C. None of them had a clear onset of the disease. They entered the clinic due to prolonged hepatosplenomegaly. In 3 of them, neurologic symptoms (hyperexcitability, increased muscle tone, hypertensive syndrome) were noted at birth and anti-CMV IgM were detected in the serum, which allowed diagnosing congenital cytomegalovirus infection. Further neurologic manifestations decreased, but there was a lag in the psychomotor development and progressed hepatolyenal syndrome, as well as increased activity of AJTT and ACT. Progression of hepatolyenal syndrome, increased activity of transaminases with repeated biochemical studies allowed suspected viral hepatitis. At admission to the clinic, children were sluggish, had a reduced appetite; in 3 of them (with congenital cytomegalovirus infection) there was a clearly expressed lag in psychomotor development. Two infants had single telangiectasias on the limbs, in one case - a pronounced venous network on the abdomen. Everyone was palpating a dense liver that protruded from the hypochondrium to 2.5-4 cm. In 8 children the spleen protruded 1-2 cm below the rib margin.

Biochemical blood test: the activity of ALT and ACT from 75 to 200 units, an increase in the alkaline phosphatase value is 1.5-3 times higher than normal. The level of bilirubin in all patients was normal, there was practically no change in the protein spectrum of serum. At ultrasound scanning in 7 patients the heterogeneity of liver tissue with echoes from 1/3 to 1/2 maximum was revealed. All children in the serum were found to have anti-NSO in 7 children, HCV RNA was also detected.

Thus, the majority (11 of 17 children) were infected with the hepatitis C virus from mothers. In this case, the presence of acute and chronic hepatitis was found in 6 mothers, and 2 other mothers of anti-HCV appeared in a parallel examination with children.

Most likely, the transmission of HCV infection from the mother to the baby occurs in most cases during labor, as evidenced by the appearance of clinical symptoms of hepatitis C 2-3 months after birth. 5 children were infected with hepatitis C after birth (3 - as a result of transfusion of plasma and blood and 2 - with numerous parenteral manipulations).

As shown by observations, in 15 of 17 children of the first year of life, hepatitis C developed as primary chronic, with torpid current and fluctuations in increased activity of transaminases. Only in 2 infants, hepatitis C appeared in icteric form, and in one - in the fulminant variant as a result of mixed infection with hepatitis B.

Thus, hepnitis C in children of the first year of life can occur due to ante-, intra- and postnatal infection. According to the research, infection during labor can be considered as the most prevalent, while the vertical way of HCV transmission, if present, is, most likely, extremely rare.

Own observations and a few reports of other researchers show that hepatitis C in children of the first year of life proceeds as a primary chronic process. In this regard, they need a careful long-term monitoring and the appointment of interferon therapy.