Specific diseases Infectious		There are many infectious agents that can cause hepatitis. A clear association between urinary tract infection and elevated bilirubin, indirect and direct, is well-known. Sepsis, sepsis, sepsis, of course, is always on the differential diagnostic list. In particular, E. coli sepsis may be the presenting manifestation of classic galactosemia. Hepatitis with increased conjugated bilirubin is part of the initial presentation with TORCH infections. Clues to this diagnosis are hemolytic anemia, thrombocytopenia, symmetrical SGA, chorioretinitis, hepatosplenomegaly and a variety of rashes. CMV, HSV and rubella virus can be cultured. Serologic testing is required for the other agents. Treatment of HSV with acyclovir is well tolerated by the newborn and outcome is generally good. Treatment is less than satisfactory for the other agents and outcome is poor, owing to the intrauterine nature of those infections. Transplacental transmission of hepatitis B virus (HBV) from an infected mother (vertical transmission) is an important route of infection in neonates. Diagnosis is by identification of HBV DNA by PCR or presence of hepatitis B surface antigen (HBsAg) or e antigen (HBeAg) or anti-hepatitis B core antibody. Universal immunization has reduced the frequency of HBV infections. In Taiwan, an endemic area, HBsAg rates in children decreased from 10% to < 1% with universal immunization. However, even with this success, 2-3% of infants of HBeAg-positive mothers have HBsAg at birth and become chronic carriers. HBV infections can be acute, fulminant or chronic. Progression to cirrhosis or even hepatocellular carcinoma can occur. Hepatitis C virus (HCV), originally called non-A, non-B hepatitis, is an RNA virus. It is less common than HBV. Since blood bank screening for HCV began, vertical transmission has become the predominant cause of pediatric HCV infections. Diagnosis is by detection of HCV RNA or HCV antigens. The course is generally benign. Fulminant hepatitis is rare, as is progression to cirrhosis and liver failure. Almost 90% of pediatric HIV infections are acquired by vertical transmission. Liver disease in an HIV-infected patient can be due to a number of different agents. Cholestasis can also occur in patient with HIV, although the exact pathogenesis of this is not known. Adenovirus, parvovirus B19 and human herpesvirus 6 have all been implicated in cases of fulminant neonatal hepatitis but the association is unclear and the incidence unknown. Already mentioned too is the presumed association between reovirus and/or rotavirus hepatitis in certain patients and the development of BA. Return to top of page