​​Viral hepatitis is associated with significant morbidity and mortality.

There are several types with which the pediatrician should be familiar, and they include Hepatitis A-E & G. These hepatitis viruses can be differentiated into two groups: those transmitted parentally (HBV, HCV, HDV, HGV) and those transmitted enterically (HAV and HEV).

Other viruses such as CMV, EBV and HHV6 can also cause mild, self-resolving forms of hepatitis with no sequel, although one fulminant case of hepatitis associated with HHV 6 has been described. Enteroviruses, other than hepatitis A, also occasionally cause hepatitis as part of a general infection with involvement of other organs usually more dominant.

Viral hepatitis - laboratory diagnosis

Once the clinical diagnosis of acute hepatitis has been made, a cost-effective initial approach to determining the causal viral agent is to test the patient’s serum for the presence of three viral serum markers: HBsAg, Anti-HBc IgM and anti HAV IgM. A positive HAV IgM indicates acute infection, immune globulin for contacts, or vaccine for prevention.

If a diagnosis of hepatitis B has been confirmed, the degree of infectivity and prognosis can be monitored, using four serum markers: HBsAg, HBeAg, anti HBe and HBV DNA. The disappearance of HBeAg and detection of anti HBe is considered a favourable prognosis for disease outcome.

The laboratory diagnosis of hepatitis C infection is also serum-based. A positive HCV test in conjunction with clinical symptoms and a negative hepatitis A and B serology provides support for an acute infection. However, proven HCV seroconversion during clinical disease remains necessary for the diagnosis of acute HCV infection, since a HCV IgM test is not yet available. A positive antibody test should be confirmed with RIBA or HCV RNA PCR. HCV viral load tests are helpful to prove the presence of HCV genome.

Hepatitis D also requires serological diagnosis and can occur as a coinfection or superinfection with hepatitis B. Hepatitis E is currently a significant problem in the Far East, in particular for pregnant women who may have a fatal outcome with HEV infection.