الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hepatitis C virus (HCV) infection is responsible for considerable morbidity and mortality worldwide. Egypt is considered to have the highest prevalence of HCV infection in the world, averaging 12%- 24% in the general population. Infection with HCV occurs in children as in adults throughout the world; however, there are differences in modes of acquisition, natural history, clinical presentations and complications between both groups.
The aim of this work was to study the various clinical presentations of HCV infection in children. The files of 164 patients with HCV infection attending the hepatology outpatient clinic of Alexandria University Children’s Hospital during the period from 1/7/2004 to 31/3/2010 were retrospectively analyzed for demographic data, risk factors for HCV infection, medical history, physical examination and periodic laboratory investigations.
In the present study, there was a definite male predominance among patients with HCV infection with male: female ratio of 1.56:1. Age ranged from 3 to 17 years (8.8±3.0 years). The age group with higher prevalence of HCV affection was from 8 years to less than 12 years and the least prevalence was in age group less than 4 years. There was almost equal incidence in urban and rural areas.
Out of the study sample, only 9.9% of patients have no associated diseases. The remaining had associated diseases arranged in a descending pattern of frequency: renal diseases in 38.9% of patients, oncologic diseases in 23.2%, hematological diseases in 18.3%, congenital heart diseases in 6.7%, and miscellaneous diseases in 3%.
Risk factors for HCV infection in this study include use of community barber, blood transfusion, albumin infusion, parental affection, dental care, dialysis and circumcision in informal places. There was a history of blood transfusion in 50% of patients and blood transfusion was the only detectable risk factor for HCV transmission in 9.8% of studied patients.
The majority of patients included in this study were asymptomatic and presented by elevated liver enzymes (42.1% of cases) or discovered accidentally during check up for other diseases (24.3% of cases). Other modes of presentation include non-specific manifestations like fever, anorexia, malaise and abdominal pain in 22.6 % of cases and jaundice in 11 %.
Clinical examination in patients with HCV infection showed no abnormalities in 65.3% of patients, hepatomegaly in 18.9%, splenomegaly in 0.6%, hepatosplenomegaly in12.2% and hepatosplenomegaly and ascites in 3%.
Initial measurement of serum ALT and AST in the study sample showed normal levels of both enzymes in 24.4% of patients, elevated only ALT levels in 2.4%, elevated only AST levels in 25.6% and elevated levels of both enzymes in 47.6%. Out of the 82 patients with elevated ALT 75.6% had mild elevation and 24.4% had moderate elevation. Out of the 120 patients with elevated AST 76.7% had mild elevation and 22.5% had moderate elevation and only 0.8% had severe elevation. Follow up liver function tests showed persistently elevated ALT levels in 23.8% of patients and persistently elevated AST levels in 36.0% of patients