Symptoms of Hepatitis B in Children

In typical cases of hepatitis B, four periods are distinguished: incubation, initial (pre-zheltushny), peak period (icteric) and convalescence.

The incubation period of hepatitis B lasts 60-180 days, usually 2-4 months, in rare cases it is shortened to 30-45 days or extended to 225 days. The duration of the incubation period depends on the infectious dose and the age of the children. With massive infection (blood or plasma transfusions), the incubation period is short - 1.5-2 months, and with parenteral manipulation (subcutaneous and intramuscular injections) and especially with domestic infection, the incubation period lasts 4-6 months. In children of the first months of life, the incubation period is usually shorter (92.8 ± 1.6 days) than in children of older age groups (117.8 ± 2.6 days).

Clinical manifestations of the disease in this period are completely absent, but, as in hepatitis A, at the end of the incubation in the blood, the constantly high activity of liver-cell enzymes and the detection of markers of actively active infection: HBsAg, HBeAg, anti-HBcIgM.

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

Initial (pre-jaundiced) period

Hepatitis B in children more often (65%) begins gradually. The increase in body temperature is not always noted (40%) and usually not on the first day of illness. The patient can note lethargy, weakness, fatigue, decreased appetite. Often, these symptoms are so mild that they are looked through, and the disease as it begins with a darkening of the urine and the appearance of discolored feces. In rare cases, the initial symptoms are pronounced: nausea, repeated vomiting, dizziness, drowsiness. Dyspeptic disorders often occur: a decrease in appetite right up to anorexia, aversion to food, nausea, vomiting, flatulence, constipation, and less frequent diarrhea. Older children complain of dull pain in the abdomen. When examined in this period, you can identify common asthenia, anorexia, enlargement, compaction and tenderness of the liver, as well as darkening of urine and often discoloration of stool.

Musculo-articular pains, often found in adult patients, are very rare in children in the pre-jaundiced period.

Rarely in the pre-zheltushnom period observed skin rashes, flatulence, upset of the chair.

Catarrhal phenomena are generally not characteristic of hepatitis B.

The most objective symptoms in the initial period are the enlargement, compaction and soreness of the liver.

Changes in peripheral blood in the initial period of hepatitis B are not characteristic. It can be noted only a small leukocytosis, a tendency to lymphocytosis; ESR is always within normal limits.

In all patients already in the pre-toothenic period in the serum, high activity of ALT, ACT and other hepatocellular enzymes is detected; at the end of this period, the content of conjugated bilirubin increases in the blood, but the parameters of sediment samples do not usually change, there is no disproteinemia. Blood circulates in a high concentration of HBsAg, HBcAg, anti-HBcIgM, often reveals the DNA of the virus.

The duration of the initial (pre-jaundiced) period can range from several hours to 2-3 weeks; an average of 5 days.

The icteric period (the height of the disease)

1-2 days before the appearance of jaundice, patients notice a darkening of the urine and in the majority - discoloration of the stool. Unlike hepatitis A in hepatitis B, the transition of the disease to the third, icteric period in most cases is not accompanied by an improvement in the general condition. On the contrary, many children have symptoms of intoxication.

Jaundice increases gradually, usually within 5-7 days, sometimes 2 weeks and longer. Yellowness can vary from slightly yellow, canary or lemon to greenish-yellow or ocher-yellow, saffron color. The severity and shade of icterus is associated with the severity of the disease and the development of cholestasis syndrome.

Having reached a peak of severity, icterus in hepatitis B usually stabilizes within 5-10 days, and only after this begins to decrease.

Rare symptoms of hepatitis B in children can be considered rashes on the skin. The rash is located symmetrically on the limbs, buttocks and trunk, is spotted-papular, red in color, up to 2 mm in diameter. When squeezing the rash takes ocher color, after a few days in the center of the papules appears weak peeling. These rashes should be interpreted as the Gianotti-Crosti syndrome, described by the Italian authors in hepatitis B.

In severe forms in the height of the disease, manifestations of hemorrhagic syndrome are possible: point or more significant hemorrhages in the skin.

In parallel with the growth of jaundice with hepatitis B, the liver is enlarged, its edge becomes denser, there is pain in palpation.

The increase in the spleen is observed less frequently than the enlargement of the liver. The spleen is often enlarged in more severe cases and with a prolonged course of the disease. The increase in the spleen is noted throughout the acute period with a slow reverse dynamics. Often, the spleen is palpable and after the disappearance of other (except for the increase in the liver) symptoms, which usually indicates a prolonged or chronic course of the disease.

In the peripheral blood at the height of jaundice, the number of erythrocytes tends to decrease. In severe forms, anemia develops. In rare cases, more severe changes are possible in the bone marrow up to the development of panmyelophthosis.

In icteric period, the number of white blood cells is normal or decreased. In the leukocyte formula at the height of toxicosis, a tendency to neutrophilia is revealed, and in the period of convalescence - to lymphocytosis. ESR is usually within normal limits. Low ESR (1-2 mm / h) with severe intoxication in a patient with severe hepatitis B is an unfavorable sign.

Reconvalescent, recovery period

The total duration of icterus during hepatitis B ranges from 7-10 days to 1.5-2 months. With the disappearance of jaundice, children no longer complain, they are active, they regain their appetite, but half of patients have hepatomegaly, and in 2/3 minor hyperfermentemia. The thymol test can be increased, the phenomena of dysproteinemia, etc. Are possible.

In the convalescent period, serum usually does not detect HBsAg and, especially, HBeAg, but they always detect anti-HBe, anti-HBc IgG and often anti-HBs.

Malignant form of hepatitis B in children

Malignant form occurs almost exclusively in children of the first year of life. Clinical manifestations of malignant forms depend on the prevalence of liver necrosis, the rate of their development, the stage of the pathological process. Distinguish the initial period of the disease, or the period of precursors, the period of development of massive necrosis of the liver, which usually corresponds to the state of precoma and the rapidly progressive decompensation of the hepatic functions clinically manifested by coma I and coma II.

The disease often begins sharply: body temperature rises to 38-39 ° C, there is lethargy, adynamia, sometimes drowsiness, followed by bouts of anxiety or motor excitement. Expressed diarrheal disorders: nausea, regurgitation. Vomiting (often repeated), sometimes diarrhea.

With the appearance of jaundice, the most constant symptoms are: psychomotor agitation, repeated vomiting with blood, tachycardia, rapid toxic breathing, bloating, severe hemorrhagic syndrome, fever and decreased diuresis. Vomiting "coffee grounds", sleep inversion, convulsive syndrome, hyperthermia, tachycardia, rapid toxic breath, liver odor from the mouth, a decrease in the liver is observed only in malignant forms of the disease. Following these symptoms, or simultaneously with them, a darkening of consciousness with clinical symptoms of the hepatic coma occurs.

Among the biochemical indicators are the most informative:

• bilirubin-protein dissociation - with a high bilirubin content in serum, the level of protein complexes is sharply reduced;
• bilirubin-enzyme dissociation - with a high bilirubin content, a decrease in the activity of liver-cell enzymes is observed, as well as a drop in the level of clotting factors.