Pediatric Case Study: Diagnosis of Hepatitis B in an Eight-Year-Old Child

QUESTION

An eight-year child is ill for five days. He has jaundice of the skin and sclera, recurrent vomiting, the temperature rises up to 38,3⁰ C. The stool  is light-colored, the urine is dark.

The findings of the biochemical analyses of the blood are as follows:

• total bilirubin – 208,3 mcmol/l, direct bilirubin – 118,1 mcmol/l , inderect bilirubin – 90,2 mcmol/l;
• PT index – 40%;
• ALT 4,0 millimole/l, AST 2,5 millimole/l;
• Sublimate test 1,5 ml;

The findings of the EIA are as follows:

HBsAg (+)

Questions:

1. What is your diagnosis?

2. Estimate the data of the laboratory examination

ANSWER

 Pediatric Case Study: Diagnosis of Hepatitis B in an Eight-Year-Old Child

Introduction

This case involves an eight-year-old child who has been ill for five days, presenting with jaundice, recurrent vomiting, elevated temperature, light-colored stools, and dark urine. The biochemical blood analyses have revealed various abnormalities, including elevated bilirubin levels and positive HBsAg. In this essay, we will discuss the diagnosis, based on clinical and laboratory findings.

Diagnosis

The diagnosis in this case is Hepatitis B (HBV). Several key clinical and laboratory findings support this diagnosis:

Clinical Symptoms: The child’s presentation of jaundice, light-colored stools, and dark urine is characteristic of hepatitis. Additionally, recurrent vomiting and an elevated temperature are common in hepatitis cases.
Laboratory Findings: The significantly elevated levels of total bilirubin (208.3 μmol/l) and direct bilirubin (118.1 μmol/l) indicate cholestatic jaundice, which is consistent with hepatitis. The presence of indirect bilirubin (90.2 μmol/l) suggests an excess of bilirubin in the blood. The positive HBsAg (Hepatitis B surface antigen) in the EIA confirms Hepatitis B infection.

Laboratory Examination Assessment

Total Bilirubin: The markedly elevated levels of total bilirubin and direct bilirubin are indicative of impaired bilirubin metabolism, resulting in cholestatic jaundice.
HBsAg: The presence of HBsAg in the blood indicates active Hepatitis B infection. It is a specific marker for the presence of the virus in the body.
Liver Enzymes (ALT and AST): Elevated ALT (4.0 millimole/l) and AST (2.5 millimole/l) levels suggest liver inflammation, which is common in hepatitis cases.
Sublimate Test: The sublimate test is used to detect thiol groups, and a value of 1.5 ml indicates the presence of sulfur-containing compounds, which may be related to liver dysfunction.

Conclusion

Based on the clinical presentation and laboratory findings, the most likely diagnosis for this eight-year-old child is Hepatitis B (HBV). Hepatitis B is a viral infection that affects the liver and is characterized by jaundice, elevated liver enzymes, and the presence of HBsAg in the blood. Early diagnosis and appropriate management are essential in cases of Hepatitis B to prevent further complications and ensure a complete recovery.