Varicella-zoster virus hepatitis - a rare complication of primary infection in immunocompetent children?

Abstract

Aim of the study: This research aimed to investigate the incidence and course of varicella-zoster virus hepatitis in immunocompetent children.

Material and methods: Medical charts of children hospitalised between 2019 and 2022 (excluding the period of the COVID-19 pandemic) due to varicella were retrospectively analysed and compared.

Results: In total, 216 children were included in the analysis. In 24 children (11.1%) alanine aminotransferase (ALT) levels were elevated, whereas in 192 (88.9%) children, ALT levels were within the normal range. In 19 patients, ALT levels exceeded the upper limit of normal (ULN) less than twofold, in 4 patients ALT levels were elevated 2-3-fold, and in only one infant, a value 9.4× ULN was observed. None of the patients developed liver failure. The median age at the time of the diagnosis was significantly higher in the group of patients with elevated ALT - 5.5 years vs. 3 years in the group with normal ALT values (p = 0.02). The median duration of fever and hospitalization was longer by 1 day in the group with elevated ALT. Additionally, varicella lesions lasted longer in this group, 7.5 days vs. 6 days in the group with normal ALT levels (p = 0.01). Although median C-reactive protein (CRP) and procalcitonin (PCT) values did not differ, median leukocyte values were lower (p = 0.01) in the group with elevated ALT (7.3 × 10³/ml vs. 8.8 × 10³/ml).

Conclusions: Elevation of ALT during varicella is observed in 1 out of 10 immunocompetent patients. The course of this hepatitis is predominantly mild.

Keywords: VZV; alanine aminotransferase; chickenpox; hepatitis; varicella.