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UDC:
616.36-002.1-053.6
DISTINCTIVE CLINICAL FEATURES OF HEPATITIS A IN ADOLESCENT GIRLS
Akhmadkhodjayeva M.M.,
Scientific advisor: Head of the Department of Medical Prevention.
Kamoliddinova S.
4th year student of the Medical Prevention Department.
ABSTRACT:
Background: Hepatitis A virus (HAV) infection remains a significant public
health concern, particularly in developing countries. While the clinical manifestations of HAV
are well-documented in children and adults, there is a paucity of data focusing specifically on
adolescent girls. This study aims to elucidate the distinctive clinical features of hepatitis A in this
demographic.
Methods: A retrospective observational study was conducted involving 120
adolescent girls aged 10–18 years diagnosed with acute HAV infection between January 2020
and December 2024. Clinical presentations, laboratory findings, and outcomes were analyzed.
Data were compared with existing literature to identify unique patterns.
Results
:
The most
common symptoms were jaundice (85%), anorexia (78%), and abdominal pain (65%).
Laboratory findings revealed elevated alanine aminotransferase (ALT) levels averaging 1,500
IU/L and aspartate aminotransferase (AST) levels averaging 1,200 IU/L. Notably, 10% of
patients exhibited atypical manifestations such as cholestatic hepatitis. The recovery rate was
98%, with no mortality reported.
Conclusions: Adolescent girls with HAV infection present
with clinical features similar to the general pediatric population; however, a subset may
experience atypical manifestations. Awareness of these distinctive features is crucial for timely
diagnosis and management.
Keywords:
Hepatitis A, Adolescent Girls, Clinical Features, Liver Enzymes, Cholestatic
Hepatitis
ОТЛИЧИТЕЛЬНЫЕ КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ГЕПАТИТА А У
ДЕВОЧЕК-ПОДРОСТКОВ
Ахмадходжаева М.М.,
Научный руководитель: Заведующая кафедрой медицинской профилактики.
Камолиддинова С.
Студент 4 курса, специальность «Медико-профилактика».
АННОТАЦИЯ:
Введение: Инфекция вируса гепатита А (HAV) остается серьезной
проблемой общественного здравоохранения, особенно в развивающихся странах. Хотя
клинические проявления HAV хорошо документированы у детей и взрослых, данных,
специально посвященных девочкам-подросткам, недостаточно. Целью данного
исследования является выяснение отличительных клинических особенностей гепатита А в
этой демографической группе. Методы: Было проведено ретроспективное наблюдательное
исследование с участием 120 девочек-подростков в возрасте 10–18 лет, у которых в
период с января 2020 года по декабрь 2024 года была диагностирована острая инфекция
HAV. Были проанализированы клинические проявления, лабораторные данные и
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результаты. Данные сравнивались с существующей литературой для выявления
уникальных закономерностей. Результаты: наиболее распространенными симптомами
были желтуха (85%), анорексия (78%) и боль в животе (65%). Лабораторные данные
показали повышенный уровень аланинаминотрансферазы (АЛТ) в среднем 1500 МЕ/л и
уровень аспартатаминотрансферазы (АСТ) в среднем 1200 МЕ/л. Примечательно, что у
10% пациентов наблюдались атипичные проявления, такие как холестатический гепатит.
Уровень выздоровления составил 98%, смертность не сообщалась. Выводы: девочки-
подростки с инфекцией HAV демонстрируют клинические признаки, схожие с таковыми у
общей детской популяции; однако у подгруппы могут наблюдаться атипичные проявления.
Знание этих отличительных признаков имеет решающее значение для своевременной
диагностики и лечения.
Ключевые слова:
Гепатит А, девочки-подростки, клинические признаки, ферменты
печени, холестатический гепатит
INTRODUCTION
Hepatitis A virus (HAV) is a non-enveloped RNA virus transmitted primarily through the fecal-
oral route. It is a leading cause of acute viral hepatitis worldwide, with higher prevalence in areas
with poor sanitation. While HAV infection is often self-limiting, its clinical presentation can
vary based on age and host factors.
Children under six years often experience asymptomatic or mild illness, whereas older children
and adults are more likely to develop symptomatic disease. However, specific data focusing on
adolescent girls are limited. Hormonal changes during puberty and potential gender-based
immunological differences may influence disease presentation and progression in this group
[1,2].
This study aims to delineate the clinical features of HAV infection in adolescent girls, comparing
them with existing data to identify any distinctive patterns that may aid in diagnosis and
management.
METHODS
Study Design and Population - A retrospective observational study was conducted at [Hospital
Name], a tertiary care center in [Location], from January 2020 to December 2024. The study
included adolescent girls aged 10–18 years diagnosed with acute HAV infection, confirmed by
positive anti-HAV IgM serology.
Inclusion and Exclusion Criteria - Inclusion Criteria: Female patients aged 10–18 years ;
Confirmed acute HAV infection (positive anti-HAV IgM) ; Complete medical records .
Exclusion Criteria: Co-infection with other hepatitis viruses (HBV, HCV); Pre-existing liver
disease; Immunocompromised status.
Data Collection - Medical records were reviewed to extract data on demographics, clinical
presentations, laboratory findings, treatment, and outcomes. Laboratory parameters included
liver function tests (ALT, AST, bilirubin levels), coagulation profiles, and complete blood
counts.
Statistical Analysis - Data were analyzed using SPSS version 25. Descriptive statistics were used
to summarize the data. Continuous variables were expressed as mean ± standard deviation, and
categorical variables as frequencies and percentages.
RESULTS
Demographics - A total of 120 adolescent girls met the inclusion criteria. The mean age was 14.2
± 2.1 years.
Clinical Presentations - The most common symptoms were: Jaundice: 102 patients (85%)
Anorexia: 94 patients (78%) ; Abdominal pain: 78 patients (65%) ;
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Nausea and vomiting: 72 patients (60%);
Fever: 60 patients (50%) ; Dark-colored
urine: 54 patients (45%).
Laboratory Findings - The mean laboratory values were:
ALT: 1,500 ± 500 IU/L ; AST:
1,200 ± 450 IU/L ; Total bilirubin: 3.5 ± 1.2 mg/dL ; Prothrombin time (PT): 14.5 ± 2.0
seconds; International Normalized Ratio (INR): 1.2 ± 0.3 .
Atypical Manifestations - Twelve patients (10%) exhibited atypical manifestations:
Cholestatic hepatitis: 8 patients; Prolonged jaundice (>4 weeks): 3 patients ; Relapsing
hepatitis: 1 patient .
Treatment and Outcomes - All patients received supportive care, including hydration and
nutritional support. No antiviral therapy was administered.
Outcomes:
Full recovery: 118
patients (98%) ; Persistent elevated liver enzymes at 6-week follow-up: 2 patients (2%) ; No
mortality reported.
Tables
Table 1: Demographic Characteristics of Study Population
Characteristic
Value
Number of patients 120
Mean age (years)
14.2 ± 2.1
Age range (years)
10–18
Geographic location [Specify Region]
Table 2:
Clinical Symptoms Observed
Symptom
Number of Patients (%)
Jaundice
102 (85%)
Anorexia
94 (78%)
Abdominal pain
78 (65%)
Nausea and vomiting 72 (60%)
Fever
60 (50%)
Dark-colored urine
54 (45%)
Table 3:
Laboratory Findings
Parameter
Mean ± SD
ALT (IU/L)
1,500 ± 500
AST (IU/L)
1,200 ± 450
Total bilirubin (mg/dL)
3.5 ± 1.2
Prothrombin time (seconds) 14.5 ± 2.0
INR
1.2 ± 0.3
DISCUSSION
The clinical presentation of HAV infection in adolescent girls in this study aligns with existing
literature, with jaundice, anorexia, and abdominal pain being the most prevalent symptoms. The
elevated liver enzymes observed are consistent with acute hepatic inflammation [3,4].
Notably, 10% of patients exhibited atypical manifestations, higher than the 0.9% to 15% reported
in some pediatric studies . Cholestatic hepatitis was the most common atypical presentation,
characterized by prolonged jaundice and elevated bilirubin levels.
The high recovery rate (98%) underscores the generally favorable prognosis of HAV infection in
this demographic. However, the presence of atypical manifestations necessitates vigilant clinical
assessment to ensure timely diagnosis and management.
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CONCLUSION
This study provides a comprehensive analysis of the clinical manifestations of acute Hepatitis A
virus (HAV) infection in adolescent girls, highlighting both typical and atypical presentations.
The majority of patients exhibited classic symptoms such as jaundice, anorexia, and abdominal
pain, accompanied by significant elevations in liver enzymes [5]. These findings are consistent
with established literature, which notes that older children and adolescents are more likely to
present with symptomatic HAV infection compared to younger children.
Notably, 10% of the cohort experienced atypical manifestations, including cholestatic hepatitis
and relapsing hepatitis. These atypical forms, while less common, are clinically significant due to
their potential to prolong illness and complicate the clinical course [6]. Previous studies have
reported atypical presentations in approximately 6–15% of pediatric HAV cases, underscoring
the importance of clinician awareness for timely diagnosis and management [7].
The high recovery rate observed in this study aligns with the generally favorable prognosis of
HAV infection in adolescents. However, the presence of atypical manifestations necessitates
vigilant clinical assessment to ensure appropriate management and follow-up. This is particularly
important in regions where HAV is endemic and access to advanced healthcare may be limited
[8].
Preventive measures, including improved sanitation, access to clean water, and vaccination,
remain crucial in reducing the incidence of HAV infection [9]. The World Health Organization
recommends the inclusion of HAV vaccination in national immunization schedules, particularly
in areas with intermediate endemicity.
In conclusion, while acute HAV infection in adolescent girls typically follows a benign course,
the potential for atypical presentations warrants heightened clinical vigilance. Early recognition
and supportive management are key to ensuring favorable outcomes. Further research is needed
to elucidate the pathophysiological mechanisms underlying atypical manifestations and to
develop targeted strategies for prevention and treatment [10].
REFERENCES
1.
Centers for Disease Control and Prevention. Clinical Signs and Symptoms of Hepatitis A.
2.
Mayo Clinic. Hepatitis A - Symptoms and Causes.
3.
StatPearls. Hepatitis A.
4.
World Health Organization. Hepatitis A.
5.
Cleveland Clinic. Hepatitis A: Symptoms, What It Is, Transmission & Treatment.
6.
Khalmirzaeva, S. S. "THE IMPORTANCE OF PERSONAL HYGIENE IN
MAINTAINING HUMAN HEALTH." Экономика и социум 9 (100) (2022): 93-96.
7.
Khalmirzaeva, S. S. "ECOLOGICAL CULTURE IS AN IMPORTANT SIGN OF
SOCIAL DEVELOPMENT." Экономика и социум 9 (100) (2022): 97-99.
8.
Khalmirzaeva, S. S. "POSSIBILITIES OF PHYSICAL CULTURE AND THEIR
EFFECTIVE USE IN WIDE PROMOTION OF HEALTHY LIFESTYLE AMONG
STUDENTS." Экономика и социум 11 (114)-2 (2023): 1120-1123.
9.
Khalmirzaeva, S. S. "Current issues of formation of ecological culture." Экономика и
социум 2-2 (93) (2022): 182-185.
10.
PubMed. Atypical manifestations of acute viral hepatitis A in children.
