Dengue virus infection: a major cause of acute hepatic failure in Thai children

• Published in: Annals of tropical paediatrics Vol. 26; no. 1; pp. 17 - 23
• Main Authors: Poovorawan, Yong, Hutagalung, Yanee, Chongsrisawat, Voranush, Boudville, Irving, Bock, Hans L.
• Format: Journal Article
• Language: English
• Published: Leeds Taylor & Francis 01.03.2006; Maney; Taylor & Francis Ltd
• Subjects: Acute Disease; Adolescent; Arboviroses; Biological and medical sciences; Biomarkers - blood; Child; Child, Preschool; Dengue - complications; Dengue - epidemiology; Dengue - mortality; Dengue fevers; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis - virology; Human viral diseases; Humans; Infant; Infectious diseases; Liver Failure, Acute - etiology; Liver Failure, Acute - mortality; Liver Failure, Acute - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Other diseases. Semiology; Prognosis; Prospective Studies; Thailand - epidemiology; Tropical viral diseases; Viral diseases; Thailand; Asia; Human; Infection; Pediatrics; Liver failure; Viral disease; Acute; Dengue; Arbovirus disease; Digestive diseases; Hepatic disease; Tropical medicine; Child
• ISSN: 0272-4936; 2046-9047; 1465-3281; 2046-9055
• DOI: 10.1179/146532806X90565

Background: Acute hepatic failure (AHF) can be caused by a variety of viruses, drugs, toxins and metabolic disorders. Aims: A prospective study was conducted to determine the aetiology and outcome of AHF in Thai children aged 1-15 years. Methods: All serum samples were tested for anti-HAV IgM, HBsAg, anti-HBc IgM, anti-HCV, anti-HEV IgM and anti-dengue IgG and IgM. Further individual investigations were done according to the clinical impression. Results: Forty subjects were enrolled from 14 centres during February 2000 to December 2001. Five cases were excluded owing to a lack of evidence of encephalopathy. The causes of AHF were dengue infection in 12 (34.3%), Wilson disease in 2 (5.7%), T-cell lymphoma in 2 (5.7%), ischaemic hepatitis in two (5.7%), haemophagocytic syndrome in one (2.8%), CMV in 2 (5.7%), Reye syndrome in one (2.8%) and unknown in 13 (37.1%) patients. The fatality rate was 68.6%. Eight of 24 (33.3%) deaths were caused by dengue infection. Conclusions: Improvements in sanitation and socio-economic status as well as the implementation of hepatitis B vaccine in the Extended Programme on Immunization (EPI) are likely to be the reasons for the observed absence of AHF caused by hepatitis A and B. The study showed that dengue infection, on the other hand, was a major cause of AHF in Thailand.