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Abstract
Hepatitis C virus infection is a major cause of chronic liver disease world-wide (Alter et al., 1989). The variable clinical presentation and genetic heterogeneity of HCV suggested that HCV have different genotypes HCV has been classified into six genotypes and a series of subtypes. The geographic epidemiology of HCV genotypes may provide information about transmission and even clues to the viral origin. If different HCV types have different clinical pathological implication, knowledge of the HCV genotypes may have preventive and therapeutic implication. The aim of this work was to study the current distribution of HCV genotypes among Egyptian children with chronic liver disease and the possible relation between these HCV genotypes and the severity of liver disease. This study was carried out on 83 children suffering from chronic liver disease, 49 of them were males and 34 were females with age ranged from 1.5 months to 15 years. They were selected from the pediatric outpatient clinic and inpatient department of Liver Institute, Menoufiya University. Diagnosis of chronic liver disease was based on clinical, biochemical and abdominal ultrasound data and confirmed by liver biopsy in 51 cases. The patients are classified into 3 groups according to the possible etiology of chronic liver disease: ¥ Group I: Chronic hepatitis group. It includes 43 with chronic hepatitis of different etiology. ¥ Group II: Bilharzial liver disease group. It includes 20 children with manifestation of bilharzial liver disease. ¥ Group III: Congenital and metabolic liver disease group. Includes 20 children. All patients were subjected to the following: I. Full history and thorough clinical examination. II. Laboratory investigations: 1- Urine and stools examination for bilharziasis. 2- Rectal snips for bilharziasis. 3- Complete blood count. 4- Liver function test (total and direct bilirubin, AST, ALT, ALP, gGT, total protein, serum albumin and prothrombin time). 5- Blood urea and serum creatinine. 6- Hepatitis markers: a- HBsAg. b- HBcAb. c- Anti-HCV. d- HCV RNA by PCR. e- Hepatitis C genotypes which done in two steps: i- HCV amplification procedure. ii- INNO LipA HCV (Line Probe Assay). III. Abdominal ultrasonography. IV. Liver biopsy after consent from parents. The data of this study were collected and tabulated and analyzed statistically. The result obtained from this work can be summarized as the following: 1- The distribution of chronic liver diseases among the studied patient shows: (a) chronic hepatitis represent 43 patients out of 83 patients (51.8%), (b) twenty patients (24.1%) were due to pure bilharzial liver disease, (c) twenty patients (24.1%) were due to congenital and metabolic liver disease. 2- Jaundice, abdominal pain, passage of dark urine is more frequent in chronic hepatitis group than other studied group and this difference was significant (P<0.001). 3- Clinical examination of the studied patients shows: jaundice, palmer erythema, liver span and the size of spleen were frequent significantly in chronic hepatitis patients. 4- Regarding to the liver function tests of the studied groups, total and direct bilirubin, AST, ALT, GGT showed statistically significant difference among the studied groups. 5- Schistosoma mansoni infestation was detected in 30 cases (36%) out of 83 cases studied. Twenty cases of them were pure bilharzial liver disease diagnosed clinically, laboratory, abdominal ultrasonography finding of periportal fibrosis and liver biopsy confirm the diagnosis of most of cases. The other ten cases had mixed etiology. Schistosoma haematobium was detected in 3 cases (3.6%). 6- Mixed HCV infection and bilharzial infestation was found in 16 patients (53%) out of 30 patients with positive bilharzial testing. Those patients were anti-HCV seropositive. On using PCR assay their number decreased to thirteen (43%) only had HCV-RNA. 7) Hepatitis B surface antigen (HBsAg) was detected in thirteen cases (15.7%) of all studied cases while HBcAb was detected in twenty cases (24.1%) of the studied groups. 8) Mixed HBV and HCV infection was found in 5 cases (38.%) out of 13 cases with positive HBsAg testing, and in 5 cases (25%) out of 20 cases with positive HBcAb testing by using ELISA technique for detection of anti-HCV antibodies. HCV-RNA was detected in 4 cases (30.8%) out of 13 cases with positive HBsAg and in 4 cases (20%) with positive HBcAb. 9) Hepatitis C virus antibodies was detected in 38 cases (45.8%) out of 83 cases studied using ELISA Third Generation Assay, while HCV RNA using PCR assay was detected in 20 cases (52.6%) out of 38 cases with positive anti-HCV antibodies. 10) Hepatitis C genotype assay using Line Probe Assay (INNO LipA HCV) was done to those 20 patients with positive HCV-RNA, eighteen cases (90%) had genotype (4), one case (5%) had genotype 3 and one case (5%) had genotype 5. 11) Out of the 18 cases with genotype 4, ten cases were biopsied, 2 cases of them (20%) had chronic hepatitis minimal activity, 3 cases (30%) had chronic hepatitis mild to moderate activity, 2 cases (20%) had chronic hepatitis severe activity and 3 cases (30%) had liver cirrhosis. The only case with type 5 had chronic hepatitis minimal activity and that had type 3 had chronic hepatitis mild to moderate activity.