Some peculiarities in the abnormal course of hepatitis A in childhood

doi:10.4254/wjh.v18.i3.110217

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World Journal of Hepatology

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World J Hepatol. Mar 27, 2026; 18(3): 110217
Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.110217

Some peculiarities in the abnormal course of hepatitis A in childhood

Valeri Velev, Toma Tomov, Metodi Popov, Latchezar Tomov, Elitsa N Golkocheva-Markova, Maria Pavlova, Tsvetelina Velikova, Yordanka Mitova-Mineva

Valeri Velev, Department of Infectious Diseases, Medical University of Sofia, Sofia 1000, Sofia-Grad, Bulgaria

Toma Tomov, Department of Infectious Diseases and Parasitology, Medical University of Sofia, Sofia 1431, Sofia-Grad, Bulgaria

Toma Tomov, Clinic of Children’s Infectious Diseases, University Hospital “Prof. Iv. Kirov”, Sofia 1431, Sofia-Grad, Bulgaria

Metodi Popov, Clinic of Infectious Diseases, General Hospital “St Iv. Rilski”, Dupnitsa 2600, Kyustendil, Bulgaria

Latchezar Tomov, Department of Informatics, New Bulgarian University, Sofia 1618, Bulgaria

Latchezar Tomov, Tsvetelina Velikova, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria

Elitsa N Golkocheva-Markova, NRL of Hepatitis Viruses, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia 1504, Bulgaria

Maria Pavlova, Department of Microbiology, National Centre of Infectious and Parasitic Diseases, Sofia 1000, Bulgaria

Yordanka Mitova-Mineva, Department of Epidemiology and Hygiene, Medical University of Sofia, Sofia 1431, Bulgaria

Author contributions: Velev V research designs, manuscript revisions, writing the initial draft; Tomov T and Popov M collection and analysis of clinical material from patients, literature reviews; Tomov L statistical data processing; Golkocheva-Markova EN and Pavlova M performing and interpreting laboratory tests, editing the text; Velikova T analysis of the data, visualization, proofreading of the draft; Mitova-Mineva Y writing a preliminary manuscript, literature reviews, supervision of the author team. All authors approved the final manuscript.

Institutional review board statement: The studies were performed in accordance with the local Ethics Committee of the Hospital “Prof. Iv. Kirov” and with informed consent of the parents/legal guardians in accordance with the Helsinki Declaration.

Informed consent statement: Written informed consent was obtained from the parents or legal guardians of the participants for their participation in the study.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: The data were anonymized and cannot be publicly shared because of the GDPR.

Corresponding author: Valeri Velev, DM, MD, PhD, Associate Professor, Department of Infectious Diseases, Medical University of Sofia, Blvd. “Iv. Geshov” 17, Sofia 1000, Sofia-Grad, Bulgaria. velev_md@abv.bg

Received: June 3, 2025
Revised: July 14, 2025
Accepted: January 21, 2026
Published online: March 27, 2026
Processing time: 296 Days and 7.4 Hours

Abstract

BACKGROUND

Still, in most endemic countries, hepatitis A (HA) is a serious socio-medical problem due to high morbidity, leading to frequent hospitalizations and financial burdens on health systems.

AIM

To find out the clinical spectrum of HA infection in children, the relationship between atypical manifestations and laboratory findings and the outcome of patients with atypical HA virus (HAV) manifestations.

METHODS

A total of 115 patients aged 0-14 years (mean 5.2 ± 3.5 years) were admitted to the hospital with symptoms of HA and a positive IgM anti-HAV test result during the period from July 2018 to December 2023. Patients were followed up weekly until they had made a complete recovery.

RESULTS

Atypical features were present in 30 (26%) children; prolonged cholestasis 11 (9.56%), acute acalculous cholecystitis (AAC) 15 (13.04%), ascites 2 (1.73%), thrombocytopenia 1 (0.86%) and fulminant hepatitis 1 (0.86%) were observed. Pruritus, as well as higher serum total and direct bilirubin levels, were statistically significant in children with atypical manifestations of the disease. Moreover, this group had a prolonged mean duration of jaundice and hospital course.

CONCLUSION

Atypical manifestations such as protracted cholestasis and AAC are not uncommon in children with HA.

Keywords: Hepatitis A; Cholestatic hepatitis; Acute acalculous cholecystitis; Ascites

Core Tip: We showed that most cases of hepatitis A (HA) 30/115 (26.08%) can occur with atypical symptoms that require longer hospitalization. Most cases occur in patients with higher serum bilirubin levels, gamma-glutamyl transferase levels, and persistent icterus. High serum bilirubin levels and their prolonged retention, as well as the thickening of the gallbladder wall, can be perceived as prognostic signs of a possible transition into an atypical clinical course for the patient with HA. Atypical manifestations such as prolonged cholestasis and acute acalculous cholecystitis are not uncommon in children with HA.