Hepatitis C In Children - Causes, Symptoms, Diagnosis And Treatment

Hepatitis C in children

Hepatitis C is an infectious and inflammatory disease that affects the liver when infected with the hepatitis C virus (HCV).

In children, hepatitis C in 80-90% of cases immediately begins to develop as a chronic disease. Its share among acute viral hepatitis in children under the age of 14 is 1%, in the structure of chronic viral hepatitis - 41%.

HCV differs from other types of viruses in that it is present in serum in small quantities, so the immune system gives a weak and delayed response when infected.

According to statistics from the USA and Western Europe, hepatitis C accounts for 95% of cases of viral hepatitis, including post-transfusion (caused by transfusion of infected blood).

The hepatitis C virus is very dangerous; it can exist in the body for a long time in a dormant state and genetically change. HCV infects hepatocytes (liver cells), which leads to proliferation of connective tissue (fibrosis) and liver necrosis. Complications of hepatitis C can be vasculitis, encephalopathy, arthritis, since this virus can penetrate into the tissues of the brain, heart, etc.

Content:

• Reasons for the development of hepatitis C in children
• Types of hepatitis C
• Symptoms of hepatitis C in children
• Diagnosis of hepatitis C in children
• Treatment of hepatitis C in children
• Forecast and prevention

Reasons for the development of hepatitis C in children

The hepatitis C virus is transmitted through blood. There are two main routes of transmission - parenteral and vertical (from mother to child during labor). The incidence of perinatal transmission to a child from an infected mother is about 5%. In the presence of a combination of hepatitis C virus and HIV infection, this indicator increases by 3-4 times.

Parenteral modes of transmission:

• Various medical procedures: the use of non-sterile instruments for dental treatment, various kinds of injections; there is a high risk of infection with blood transfusions, hemodialysis, plasmapheresis, if the blood was poorly checked and infected, with various surgical interventions and organ transplantation;
• Failure to comply with the rules of personal hygiene: the use of someone else's razors, manicure supplies; the hepatitis C virus is transmitted through the household in the presence of microtraumas, through abrasions and cuts;
• Procedures related to damage to the skin: tattoos, piercings made in questionable establishments;
• Repeated use of syringes for intravenous drug administration;
• Unprotected sex, especially during menstruation.

Types of hepatitis C

The duration of the flow is distinguished:

• Acute hepatitis (up to 3-6 months);
• Chronic hepatitis (more than 6 months). The chronic form can be a consequence of an acute illness, but in most cases the chronic process is primary. The disease is characterized by a long progressive course and causes serious liver damage: cirrhosis, liver failure, malignant tumors.

Depending on the clinical symptoms, there are:

• A typical acute form, accompanied by signs of jaundice;
• Atypical (anicteric form), which is much more common in children.

Symptoms of hepatitis C in children

The incubation period is on average 5-8 weeks. The disease develops gradually, its first signs may appear even 6-12 months after infection. In acute hepatitis C, there is an asthenic-vegetative syndrome, pain in the abdomen and joints, an increase in temperature for a long time up to 37-38 ° C; the urine becomes dark and frothy, the stool becomes discolored. Intoxication of the body is accompanied by nausea, vomiting.

Signs of jaundice (yellowing of the skin, sclera of the eyes and oral mucosa) in children do not always appear, but only in 20-40% of cases, and last for 2-3 weeks. Jaundice in hepatitis C is milder than in other types of hepatitis. The acute course of the disease is observed in 10-20% of cases, and then usually becomes chronic. In this case, the child's well-being comes to a normal state, the liver can be slightly enlarged and hardened.

Chronic hepatitis C is usually asymptomatic, sometimes for many years. Against the background of a relatively satisfactory state of health of the child, hepatomegaly (an increase in the size of the liver) is diagnosed, in 60% of cases - also splenomegaly (an increase in the spleen). 35% of children with chronic hepatitis C have increased fatigue, asthenia, weakness, gastrointestinal upset, telangiectasia (“spider veins” on the body).

Despite the mild severity of symptoms, there is a persistent tendency to fibrosis of liver tissue. In 50% of cases, this occurs a year after infection, in 87% - within 5 years. Even with a slight fibrosis, hepatitis C in children more often than in adults leads to such serious consequences as cirrhosis of the liver, hepatic and renal failure, and bleeding.

The chronic form of the disease is cyclical, when phases of exacerbation are replaced by phases of remission, and is often discovered by chance.

Diagnosis of hepatitis C in children

HCV is diagnosed based on biochemical and serological test results. In the blood with HCV, there is always an increased level of ALT and ACT enzymes, sometimes - an increase in bilirubin. A serological study (ELISA) confirms the presence of antibodies in the blood, helps to determine the activity of the virus, the stage of the disease, and the period of infection.

Read more: The norm of bilirubin in the blood

PCR studies can detect HCV RNA in the blood 3-4 days after infection, when antibodies have not yet formed. The PCR method determines the genotype and concentration of the virus in the blood. The more concentration, the worse the prognosis. Most often children have HCV genotype 1b, which is characterized by 90% transition to the chronic stage and a rather severe course.

Hepatitis C in children should be differentiated from other viral hepatitis (primarily from hepatitis B), hemolytic disease, obstructive (mechanical) jaundice.

Additionally, an abdominal ultrasound can be performed. In some cases, a liver biopsy is required.

Treatment of hepatitis C in children

Hepatitis C in children is treated in the same way as other types of viral hepatitis. Treatment includes taking antiviral drugs, immunomodulators, symptomatic therapy (elimination of clinical manifestations of the disease). It is recommended to stay in bed and follow a diet.

In the chronic form of hepatitis (and in order to prevent the transition of the disease to the chronic stage), interferon preparations are used: viferon, roferon A, intron A, as well as ribavirin and interferon inducers (cycloferon). Children aged 3-17 years, in the absence of contraindications, are prescribed recombinant interferon-alpha (IFN-a) in combination with ribavirin or separately.

The treatment regimen is determined individually, depending on the severity of the process and other factors. The duration of treatment is on average 6 months to a year. For malignant forms, corticosteroid hormones are prescribed.

Also, in chronic hepatitis, ursosan can be used - a drug with an immunomodulatory, anticholestatic, antioxidant effect. It is taken in parallel with interferon or as monotherapy.

Side effects of antiviral therapy can be changes in blood composition, minor gastrointestinal disorders, headaches and muscle pains, fever, general weakness, dry skin, and hair loss. But as the body gets used to drugs, the patients' well-being improves.

To alleviate the condition and relieve the toxic load from the liver, auxiliary therapy can be prescribed, including the use of hepatoprotectors (Essentiale forte, Karsil, Silymar) and sorbents (Enterosgel, activated carbon).

Read More: List of Best Hepatoprotectors for Liver Repair

Forecast and prevention

The prognosis of the disease varies widely. The acute form of hepatitis C with adequate therapy can be completely cured within a year. The chronic process can take decades and lead to cirrhosis. In severe, complicated forms of the course of the disease and the development of a malignant process, there is a risk of death.

Prevention measures include:

• Use of sterile or disposable medical instruments (syringes, dental instruments, catheters);
• Scrupulous examination and testing of blood for transfusion and its preparations;
• Following the rules of personal hygiene;
• Fight against child drug addiction.

Author of the article: Kletkin Maxim Evgenievich | Hepatologist

Education: Diploma in the specialty "General Medicine" received at the Military Medical Academy. S. M. Kirov (2007). At the Voronezh Medical Academy. NN Burdenko graduated from residency in the specialty "Hepatologist" (2012).