Abstract：
UNASSIGNED: Acute hepatitis due to various tropical infections can mimic the clinical picture of acute viral hepatitis(AVH), leading to increased morbidity and mortality. We aimed to identify clinical and laboratory parameters that could help to distinguish acute hepatitis due to tropical infections from AVH.
UNASSIGNED: We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared.
UNASSIGNED: Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group (p < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all p < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections.
UNASSIGNED: High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia.SUMMARYAcute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.
UNASSIGNED: We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared.
UNASSIGNED: Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group (p < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all p < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections.
UNASSIGNED: High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia.SUMMARYAcute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.
摘要：
■由于各种热带感染引起的急性肝炎可以模仿急性病毒性肝炎（AVH）的临床表现，导致发病率和死亡率增加。我们旨在确定临床和实验室参数，以帮助区分热带感染与AVH引起的急性肝炎。
■我们回顾性分析了我们在2013年1月至2023年3月期间150名患有AVH的儿童（107名男孩）和50名患有急性肝炎的儿童（34名男孩）的数据库。临床特征,调查,比较并发症和结局.
■甲型肝炎（75％）是最常见的病因AVH，而肠热（34％），登革热(26%)，斑疹伤寒（20％）和钩端螺旋体病（16％）构成了大多数热带感染。在热带感染组中分别有88％和16％的患者发现持续发热和皮疹，在AVH组中没有发现（p<0.001）。在单变量分析中，前驱症状,临床可检测的黄疸，胆汁淤积型,总胆红素和直接胆红素和肝酶明显高于AVH，而头痛，肌痛，白细胞减少症,血小板减少症,热带感染组低钠血症明显高于对照组(P均<0.05)。多因素分析将血小板减少症（比值比[OR]4.237）确定为独立的阳性预测因素，并且总胆红素明显升高（OR0.575），直接胆红素（OR0.498），天冬氨酸转氨酶（OR0.841）和丙氨酸转氨酶（OR0.863）是热带感染引起的急性肝炎的独立阴性预测因素。
对于黄疸发作后持续发热的患者，有必要对热带感染的高怀疑指数，尤其是在存在皮疹和血小板减少症的情况下。摘要由于热带感染引起的急性病毒性肝炎和急性肝炎可以具有相似的临床和生化参数。黄疸程度较轻，较低的血清转氨酶升高和血小板减少可能是热带感染引起的急性肝炎的有用预测因子.
■我们回顾性分析了我们在2013年1月至2023年3月期间150名患有AVH的儿童（107名男孩）和50名患有急性肝炎的儿童（34名男孩）的数据库。临床特征,调查,比较并发症和结局.
■甲型肝炎（75％）是最常见的病因AVH，而肠热（34％），登革热(26%)，斑疹伤寒（20％）和钩端螺旋体病（16％）构成了大多数热带感染。在热带感染组中分别有88％和16％的患者发现持续发热和皮疹，在AVH组中没有发现（p<0.001）。在单变量分析中，前驱症状,临床可检测的黄疸，胆汁淤积型,总胆红素和直接胆红素和肝酶明显高于AVH，而头痛，肌痛，白细胞减少症,血小板减少症,热带感染组低钠血症明显高于对照组(P均<0.05)。多因素分析将血小板减少症（比值比[OR]4.237）确定为独立的阳性预测因素，并且总胆红素明显升高（OR0.575），直接胆红素（OR0.498），天冬氨酸转氨酶（OR0.841）和丙氨酸转氨酶（OR0.863）是热带感染引起的急性肝炎的独立阴性预测因素。
对于黄疸发作后持续发热的患者，有必要对热带感染的高怀疑指数，尤其是在存在皮疹和血小板减少症的情况下。摘要由于热带感染引起的急性病毒性肝炎和急性肝炎可以具有相似的临床和生化参数。黄疸程度较轻，较低的血清转氨酶升高和血小板减少可能是热带感染引起的急性肝炎的有用预测因子.
