Illness: this month - infectious Hepatitis
INFECTIOUS HEPATITIS was in the past often known as the 'yellow jaundice'.
It is an acute infectious disease of the liver caused by the hepatitis A virus (Hep A). This virus is usually transmitted through the fecal-oral route, usually by ingestion of contaminated food or water or through direct contact with an infectious person. The time between infection and the appearance of the symptoms (incubation period) is between two and six weeks with the average period around 28 days.
The symptoms can vary from none in some cases to the classical combination of fever, abdominal pain, tiredness, anorexia, nausea and the cardinal sign of jaundice. The latter is usually quite obvious with either yellow pigment in the eyes or in some cases the whole body. If the latter is present the urine becomes darker in colour and the faeces become paler.
In general infectious hepatitis is more commonly seen in children and younger adults but can occur at any stage of life. It has traditionally been associated with overcrowding and poorer social circumstances so often seen in the developing world.
Blood tests will usually show up elevated liver function tests, and evidence of specific antibodies against the Hepatitis A virus itself. Infectious hepatitis is usually a self limiting condition that in general the body is able to fight off and rarely end up causing chronic liver disease (unlike its more sinister colleague - Hepatitis B). However up to ten to fifteen % may experience a relapse of symptoms within six months of the first episode. Thankfully acute liver failure is also quite a rare complication as is mortality from the condition.
The most important task for the family doctor is to eliminate other more serious causes of jaundice. These causes include cancer of the pancreas particularly in older age groups and Hepatitis B infection which is more commonly spread through blood products or through sexual transmission.
Pancreatic cancer is usually eliminated by ultrasound or CAT scans of the abdomen and Hepatitis B by having blood tests.
The treatment is usually quite conservative as the illness is caused by a virus and therefore immune to antibiotics. In general rest, fluids and management of pyrexia and nausea are all that will be required.
The illness can be prevented by vaccination with the hepatitis A vaccine and this is regularly given to people travelling to countries known to be prone to this virus.