Clinicopathological profile of acute hepatitis in children: a tertiary center experience from Bangladesh

Background: Despite immunizations, preventative measures, and hygiene, millions of children worldwide contract acute hepatitis. Objective: To observe the etiology, biochemical markers, and clinical characteristics of acute hepatitis in hospitalized children in a tertiary care facility. Method: This cross-sectional study was conducted in the Department of Pediatrics, BIHS General Hospital, Dhaka, from January 2022 to December 2024. The study included a total of 90 children under the age of 15 who presented with acute hepatitis. Results: Out of 90 children with acute hepatitis, 8 (8.9%) were in the 1-5-year age group, 51 (56.6%) were in the 5-10-year age group, and 31 (34.5%) were in the 10–15-year age group. The majority, 64 (71.1%), tested positive for anti-HAV IgM, followed by anti-HEV IgM, 6 (6.6%). Three (3.3%) tested positive for both salmonella hepatitis and combined HAV with HEV. A single case of Salmonella was linked to HAV, CMV, and Wilson's illness. We found a total of 11 (12.2%) cases with an unclear cause. Most of the children had jaundice (90, 100%); more bacterial hepatitis (83%) had abdominal pain than viral causes (50.1%); more viral hepatitis had pale stool (48.2%) and pruritus (21.3%) than bacterial kids; and more bacterial hepatitis had fevers (100%) which was higher grades than viral kids (52.1%). Hepatomegaly was present in the majority (94.3%) of cases. The maximum number of patients (100%) had elevated serum bilirubin, ALT, and AST levels. There was a significant increase in viral cases compared to bacterial cases. Alkaline phosphatase levels may increase in cases of pale stool (cholestasis). Out of 90 admitted patients, 75.6% had herbal medicines at the time of admission. Conclusion: The most common cause of acute viral hepatitis in Bangladeshi children is HAV, followed by HEV. Clinical and biochemical criteria helped distinguish viruses from bacterial and metabolic causes, but serological testing is important for etiological identification.