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Key Features

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Essentials of Diagnosis
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  • Majority of childhood cases, especially those acquired vertically, are asymptomatic despite development of chronic hepatitis

  • Incubation period is 1–5 months, with insidious onset of symptoms

  • Flu-like prodromal symptoms and jaundice occur in < 25% of cases

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General Considerations
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  • Risk factors in adults and adolescents include

    • Injection drug use

    • Occupational or sexual exposure

    • History of transfusion of blood products prior to 1992

  • Vertical transmission occurs more commonly when mothers with HCV are coinfected with HIV

  • Approximately, 0.2% of children, 0.4% of adolescents, and 1.5% of adults in the United States have serologic evidence of infection

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Clinical Findings

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Symptoms and Signs
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  • Mild inflammation and fibrosis on liver biopsy

  • Hepatosplenomegaly may or may not be evident

  • Ascites, clubbing, palmar erythema, or spider angiomas are rare and indicate progression to cirrhosis

  • Cirrhosis may develop rapidly in rare cases

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Differential Diagnosis
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  • Hepatitis A

  • Hepatitis B

  • Wilson disease

  • α1-Antitrypsin deficiency

  • Autoimmune hepatitis

  • Primary sclerosing cholangitis

  • Drug-induced hepatitis

  • Steatohepatitis

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Diagnosis

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Laboratory Findings
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  • Anti-HCV IgG

  • Not informative until the infant is 18 months old, at which time antibody testing should be performed

  • Patients older than 18 months with positive anti-HCV IgG should have subsequent testing for serum HCV RNA in order to determine active infection

  • Serum HCV RNA

    • Can be tested prior to 18 months of age, but should not be tested before 2 months old

    • If positive in infancy, it should be rechecked when the infant is 12 months of age in order to determine presence of chronic infection

  • Fluctuating mild to moderate elevations of aminotransferases over long periods are characteristic of chronic HCV infection; however, normal aminotransferases are common in children

  • Generally cirrhosis develops in adults after 20–30 years of chronic HCV infection, but it has occasionally developed sooner in children

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Treatment

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  • Subcutaneous injections of pegylated interferon-α and oral ribavirin

  • End-stage liver disease secondary to HCV responds well to liver transplantation, although reinfection of the transplanted liver is very common

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Outcome

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Prevention
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  • At present, the only effective means of prevention is avoidance of exposure through elimination of risk-taking behaviors such as illicit use of intravenous drugs.

  • There is no effective prevention for vertical transmission, but avoidance of fetal scalp monitoring in infant of mothers with HCV has been suggested

  • Elective Caesarean section is not recommended for HCV-monoinfected women, as it confers no reduction in the rate of mother-to-infant HCV transmission

  • Breast-feeding

    • Does not promote HCV transmission from mother to infant

    • Should be avoided if the nipples are bleeding, mastitis is present, or the mother is experiencing a flare of hepatitis with jaundice

  • There is no vaccine and no benefit from using immune globulin in infants born to infected ...

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