title: Does co-infection with multiple viruses adversely influence the course and outcome of sporadic acute viral hepatitis in children?
abstract: BACKGROUND
  This study looked at the frequency of co-infection with multiple hepatotropic viruses and the effect of such infection on the course and outcome of acute sporadic viral hepatitis (AVH) and fulminant hepatic failure (FHF) in children.
  
  
  METHODS
  Consecutive children up to 15 years of age presenting with AVH or FHF between January 1998 and July 2002 were evaluated prospectively. The following viral markers were assessed in all children: immunoglobulin M (IgM) anti-hepatitis A virus (HAV), IgM anti-hepatitis E virus (HEV), hepatitis B surface antigen (HBsAg), IgM anti-hepatitis B core (HBc), and anti-hepatitis C virus (HCV).
  
  
  RESULTS
  A total of 149 children were included in the study, 122 with AVH and 27 with FHF. Co-infection with multiple viruses was detected in 30 (24.6%) AVH patients (A+E in 24, A+B in three, and E+B, A+C and A+E+B in one each) and seven (26%) FHF patients (A+E in five, and A+B and E+B in one each). The majority of single infections were due to HAV (AVH 70/92, FHF 14/20) followed by HEV (AVH 9/92, and FHF 5/20). HEV infection was associated with infection with another agent in 88% of patients with AVH (odds ratio 53, 95% confidence interval 15-186, P<0.0001). Frequency of anicteric state, prolonged cholestasis, relapsing hepatitis, ascites, hemolysis and mortality rates were similar in the single and multiple infection groups for both AVH and FHF patients.
  
  
  CONCLUSIONS
  Co-infection with multiple viruses is observed in one-quarter of patients with sporadic AVH in childhood. Such infection does not produce a more severe disease. HEV positivity is a strong marker for multiple infections.
authors.affiliation: Department of Gastroenterology (Pediatric Gastroenterology), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Kumar
authors.forename: Surender Kumar
authors.initials: SK
authors.lastname: Yachha
authors.forename: Ujjal
authors.initials: U
authors.lastname: Poddar
authors.forename: Uttam
authors.initials: U
authors.lastname: Singh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006518:Hepatitis Viruses / Q000276:immunology*; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000914:Antibodies, Viral