HEPATITIS A (Health Tips)

1. This is the most common type of viral hepatitis, highly infectious and is caused by hepatitis A virus. This disease commonly affects children and young adults.
2. Spread of infection is mainly by the oro-fecal route and arises from the ingestion of contaminated water and food (e.g milk). Overcrowding and poor sanitation facilitate the spread. Infected person excretes virus in the feces for about 2 weeks before the onset of clinical illness and for up to 7 days after.
3. Hepatitis A is maximally infectious just before the onset of jaundice. Blood and stools are infectious during the incubation period (2-6 weeks) and during early illness.
4. Clinical illness is more severe in adults than in children.
5. No carrier state, complete recovery, does not lead to chronic hepatitis.
6. Mortality is low and fulminant hepatitis is uncommon except in cases where hepatitis A occurs in a patient with chronic hepatitis C.
7. incubation period 2-6 weeks.

 DIAGNOSIS

Antibody to hepatitis A (anti-HAV) appears early in the course of the illness. Detection of 1gM anti-HAV is and excellent test for diagnosis of acute hepatitis A. Peak titers of 1gM occur during the first week of clinical disease and usually disappear within 3-6 months. Titers of 1 gG peak after one month of the disease and may persist for years.

CLINICAL FEATURES

Pre-icteric or prodromal phase

This phase of constitutional symptoms precedes the onset of jaundice by 1-2 weeks. Onset may be abrupt or insidious.

• Initially there is flue-like illness such as malaise, easy fatigability, headache, arthralgia, myalgia and upper respiratory symptoms e.g. nasal discharge, cough and pharyngitis.
• Anorexia: Out of proportion to the degree of illness.
• Nausea, vomiting are frequent, diarrhea or constipation may occur.
• Mild fever (100-102-F) with chills is usually present.
• Abdominal pain: mild and constant pain in right upper quadrant or epigastrium due to stretching of capsule of enlarged liver.
• Dark-colored urine (due to bilirubinuria) may be noticed

 Icteric phase

After 1-2 weeks patient develops jaundice. This phase is called icteric phase. With the onset of jaundice there is often improvement of the prodromal symptoms. Features of this phase are:

• Jaundice occurs in most (70-85%) adults with acute HAV infection. Jaundice is less likely in children and is uncommon in infants. The degree of icterus also increases with age.
• Liver becomes enlarged and tender with pain in right hypochondrium due to stretching of liver capsule.
• Splenomegaly and cerical lymphadenopathy are present in 10-20% of patients particularly in children.
• Dark colored urine, pale stool due to intrahepatic cholestasis

.Convalescent phase

This recovery phase comes within 3-6 weeks of illness and is characterized by increasing sense of well being, return of appetite and disappearance of jaundice, abdominal pain and tenderness.

COURSE OF HEPATITIS A

The acute illness subsides over 2-3 weeks with complete clinical and laboratory recovery by 9 weeks. Less than 1% develop acute fulminant hepatic failure. Relapse may occur in hepatitis A but ultimate recovery is the rule.

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