Dengue virus infection: a major cause of acute hepatic failure in Thai children.
BACKGROUND
Acute hepatic failure (AHF) can be caused by a variety of viruses, drugs, toxins and metabolic disorders.


OBJECTIVE
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.
Poovorawan
Yong
Y
Center of Excellence in Viral Hepatitis Research, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and Hospital, Bangkok, Thailand. Yong.P@chula.ac.th
Hutagalung
Yanee
Y
Chongsrisawat
Voranush
V
Boudville
Irving
I
Bock
Hans L
HL
D000208:Acute Disease; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006505:Hepatitis / Q000821:virology; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000209:etiology* / Q000401:mortality / Q000821:virology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology
D015415:Biomarkers