Pediatric emergency medicine trisk 2094 2094
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No specific treatment of acute viral hepatitis is available. Most patients can
be managed at home. No restrictions in diet or ambulation are necessary. The
traditional recommendations of a low-fat, high carbohydrate diet, and bed rest
are now recognized to have no effect on the symptoms or duration of the
disease. Parents should be told that anorexia and fatigue are common
symptoms. Small, frequent feedings may be helpful. Hepatotoxic drugs should
be strictly avoided. The key for both the patient and other household contacts
is personal hygiene. Infants and children should avoid contact with the patient
even after they have received immunoprophylaxis. In HAV, shedding of the
virus may occur for up to 2 weeks after the onset of jaundice. Patients should
be kept at home during this time. After this, they may return to school.
Indications for hospitalization of a patient who has acute hepatitis include (i)
dehydration secondary to anorexia and vomiting, (ii) bilirubin levels more
than 20 mg/dL, (iii) abnormal PT, (iv) WBC count more than 25,000 per
mm3, or (v) levels of transaminases more than 3,000 units/L. Newer therapies
are evolving for the treatment of chronic HCV using direct-acting antiviral
agents.
Patients who have acute hepatitis and who are hospitalized should be
isolated. Follow-up studies of all patients with acute hepatitis should be
performed to document biochemical resolution. Follow-up serology may also
establish a specific cause in cases of apparent non-A, non-B hepatitis (fourfold
increase in CMV serology, development of anti-HCV). Reevaluation of
patients with HBV is especially important either to ensure clearance of HB
surface antigen or to recognize the development of the HB surface antigen
carrier state.
POSTEXPOSURE PROPHYLAXIS
Hepatitis A
The mean incubation period for HAV infection is about 4 weeks (range, 15 to
50 days). Conventional immune serum globulin (ISG; 0.02 mL/kg IM) confers
passive protection against clinical HAV infection if given within 2 weeks of
exposure and protects for up to 3 months. Seventy-five percent of this group
will develop detectable levels of anti-HAV IgM, suggesting passive–active
immunity. Postexposure immunoprophylaxis is suggested for household and
close personal contacts, institutionalized contacts, newborns of HAV-infected
mothers, those exposed to an infected food handler and contacts within a day
