CHRONIC HEPATITIS C IN CHILDREN: A CLINICOPATHOLOGICAL, LABORATORY
AND IMMUNOHISTOCHEMICAL STUDY
Abdel-Latif M.A, Gaafar. I. M*, EL-Sayed K.
A*, Moemen M. H** and Enas A M***
Departments f Pediatrics*, Pathology** and
Microbiology and Immunology***, Faculty of Medicine, Assiut
University, Egypt
Objective:
The aim of this work is to assess the pattern of chronic HCV infection in
children of our locality as regards, clinical, laboratory and pathological
aspects of this disease. We will also evaluate the importance of
immunohistochemical diagnosis of chronic HCV infection.
Methods: This
study included 15 patients with chronic hepatitis C virus (HCV) disease,
Their ages ranged from 5 to 13 years. All included patients were positive
for HCV antibodies with persistently high or fluctuant alanine
aminotrasferase (ALT) for at least 6 mo.
On admission all patients were subjected to full
history and thorough clinical examination, abdominal ultrasound and
laboratory investigations including CBC and liver function tests. Liver
biopsy specimens were taken from all included patients for
histopathological grading and staging. Liver specimens were subjected to
immunohistochemical studies by use of monoclonal antibody TORDJI-22.
Results:
Risk factors were encountered in 60% of our patients. Blood transfusion and
exposure to injuries were the most important risk factors. Fatigue or
generally unwell was a common complaint (53.3%), while 26.67% of patients
were asymptotic. Most of our patients (60%) had mild elevation of ALT
enzyme and were classified as having mild liver disease while 33.33% of
patients had moderate disease.
Histopathological grading and staging were done and most of our
patients were classified as having grade 1 and stage 1`. Liver cirrhosis
was not encountered in any patient. Significantly higher levels of ALT were
found in patients with grade 2 (185.75±68.16) than those with grade 1 (69.75±29.07) (p∠0.05). Again,
patients with grade 3 had significantly higher levels of ALT than those
with grade 1 (255.67±160.02 and 69.75±29.07 respectively)(p<0.05). TORDJI-22 immunopositivity was detected in
53.3% of studied liver specimens.
Conclusions: In conclusion, chronic HCV infection in
children is an important health problem. Histopathological grading and
staging are important for these children to assess the severity of
infection. Immunohistochemistry by the use of TORDJI-22 is an important
diagnostic tool of HCV infected hepatocytes in anti- HCV positive patients.
It may reflect the cytotoxicity of HCV secondary to high levels of virus
replication or prolonged infection. However, Further studies on a large
number of patients is recommended to confirm the sensitivity of this
antibody and follow up studies to clarify its prognostic value.