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Clinical Focus
12 DECEMBER 2025 ausdoc. com. au
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Source: AusDoc website; 15 Oct to 30 Nov.
A child’ s post-holiday illness highlights the importance of a pre-travel checkup and vaccines before heading to endemic areas of risk.
Dr Nabeel Makmahi GP practising in Melbourne, Victoria.
MAYA, a previously well six-yearold girl, was brought in by her mother, Nat, for review because the whites of her eyes have become yellow over the past two days. They, along with Maya’ s father, Sam, had returned from a family holiday in Bali five days earlier. Nat reports Maya has had a slightly reduced appetite and lethargy but no fever, vomiting, diarrhoea, or abdominal pain. They are a family of three and no-one else at home is unwell.
Maya has no significant medical history, takes no regular medications, and has no known allergies. She is fully immunised per the Australian national immunisation schedule but has not received any additional or travel-specific vaccinations.
Assessment
Maya is alert, apyrexial and haemodynamically stable. Physical examination reveals scleral icterus but no hepatosplenomegaly, abdominal tenderness, or stigmata of chronic liver disease. Neurological assessment is normal. Urinalysis is positive for bilirubin, suggesting conjugated hyperbilirubinaemia and thus hepatocellular injury.
The GP calls the local hospital on-call paediatric registrar to discuss appropriate workup and management. The registrar recommends performing FBC, LFTs, coagulation profile, hepatitis and CMV serologies, along with close clinical follow-up. The rationale for deferring a haemolysis workup is that the bilirubinuria, thus conjugated hyperbilirubinaemia, points to hepatocellular or cholestatic pathology rather than haemolysis. The bloods are marked urgent, and review is arranged for the next day.
Maya’ s significant laboratory testing results are shown in table 1. All other requested tests are normal. At follow-up, Maya’ s clinical status remains stable and unchanged.
A diagnosis of hepatitis A is made. Nat is advised regarding symptomatic management at home with fluids, and avoidance of potential hepatotoxins( including paracetamol, where practicable). Nat is also given safety netting instructions in case of deterioration. The diagnosis is reported to the local public health unit, who recommend offering post-exposure prophylaxis with hepatitis A vaccine to unvaccinated household contacts,
Table 1. Maya’ s blood test results Test Result Normal range ALT 240 5-35 U / L AST 177 5-30 U / L Total bilirubin 72 1-20 µ mol / L
Gamma-glutamyl transferase
60 5-35 U / L
CRP 12 < 5mg / L
Hepatitis A immunoglobulin M
Positive
as it is less than 14 days since her exposure. Nat confirms both she and Sam have previously completed a course of hepatitis A vaccination. Nat is also advised that Maya should
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