ACUTE VIRAL-HEPATITIS TYPE-E, TYPE-A, AND TYPE-B SINGLY AND IN COMBINATION IN ACUTE LIVER-FAILURE IN CHILDREN IN NORTH-INDIA

The aetiological agents responsible for, and the outcome of, acute liv er failure were investigated prospectively in 44 children (29 males, 1 5 females) attending a tertiary health care facility in India. The chi ldren were between the ages of 2 months and 13 years. Studies for vira l infections and other etiologies could be carried out in 40 patients. Specific aetiological labels were possible in 35 (87.5%) patients. Th irty (75%) had evidence of acute viral hepatitis. Acute hepatitis E vi rus (HEV) infection was found in a total of 18 children, with hepatiti s A (HAV) in 16, hepatitis B in 5, and C in 1. Seven had isolated infe ction with hepatitis E, five with A, and four with B. Nine had both E and A infection. Superinfection of HEV was observed in a child with In dian childhood cirrhosis (ICC). Acute HEV infection was confirmed by i mmunoblot assay in all the patients and in eight of these, HEV-RNA was also detected in the serum. HAV was involved in 37.5% of cases with i solated infection in 10% (4 of 40). The aetiological factors associate d with acute liver failure, apart from HAV and HEV, were other hepatot ropic viruses (22.5%), Wilson's disease (5%), ICC (5%), and hepatotoxi c drugs (7.5%). In five patients, no serological evidence of acute vir al hepatitis could be found, neither did the metabolic screen yield an y result. It was observed that enterically transmitted hepatitis virus es (HAV and HEV) were associated with 60% of acute hepatic failure in children. Mixed infection of HAV and HEV formed the single largest aet iological subgroup. In developing countries, where hepatitis A and E i nfections are endemic, severe complications can arise in the case of m ixed infection. This may contribute to most of the mortality from acut e liver failure during childhood. (C) 1996 Wiley-Liss, Inc.