Know All About
ACUTE VIRAL HEPATITIS
Viral hepatitis is inflammation of the liver caused by viruses which are known to infect the liver (hepatotropic viruses) and multiply there. Viral hepatitis is the commonest cause of jaundice in the general population including children. Viruses from the alphabet A to G have been described, though the status of F and G viruses in causing liver damage is not yet proven.
Children can be affected by the viruses at any age.
Signs & Symptons
Symptoms vary greatly among children. Viral hepatitis classically presents in the form of loss of appetite, nausea, vomiting, fatigue and aches in muscles and joints. In older children, low grade fever and headache are common. Young infants may present with loose motions and failure to gain weight. Dark urine and jaundice (yellow discolouration of the eye whites and skin) develops a few days after the onset of these symptoms. Itching is common in those with prolonged jaundice. The liver is enlarged and tender. The spleen also may be enlarged in 20 -30 % of cases. However, a significant number of viral hepatitis infections do not cause any symptoms, or may cause only mild loss of appetite and nausea without any jaundice These are described as subclinical and anicteric attacks of jaundice. Almost all the viruses can rarely present with fulminant liver failure where the patient goes into coma and develops a bleeding tendency.
Hepatitis B and C infections can lead to chronic liver disease.
Types of Viral Hepatitis
This virus is spread by person to person contact and by eating or drinking contaminated food or water. In India, hepatitis A is the commonest cause of acute viral hepatitis in children.
It is usually a mild infection in a majority of individuals. Hepatitis A does not cause chronic liver disease and the person usually develops life long immunity after an attack of viral hepatitis A.
This virus is spread exactly the same way as AIDS that is through blood and body fluids. Hepatitis B is usually passed on through transfusion of infected blood, injections by infected needles, sharing tooth brushes. It is also spread by tattooing, ear pricking, acupuncture and body piercing where unsterilized equipment is used. The virus can be transmitted from a Hepatitis B positive pregnant mother to the new born child during the process of childbirth. The virus is also spread through sexual contact with an infected person.
Even if the person is asymptomatic, he is capable of transmitting the virus to others and also developing liver disease in the future.
After an attack of acute viral hepatitis B, although 90% of patients will clear the infection, about 10 % will develop chronic hepatitis B virus infection which can progress to cirrhosis or even liver cancer. The younger the child infected with Hepatitis B, the higher are the chances of becoming a chronic carrier of the viral infection.
Hepatitis C is mainly spread through infected blood and through contaminated needles like Hepatitis B infection. Transmission of infection via sexual contact or from mother to the child during childbirth can occur but is rare with Hepatitis C.
Acute hepatitis C infection is often free of symptoms or very mild symptoms may be present. Unlike Hepatitis B where majority of the individuals recover fully from an attack of acute hepatitis, acute Hepatitis C leads to a chronic infection in 80% of the affected individuals. Some of these patients with chronic infection can develop liver cirrhosis and liver cancer.
Hepatitis D or delta is an incomplete virus which cannot infect an individual by itself. It can infect a person only in the presence of Hepatitis B infection. The virus is spread through infected blood and contaminated needles like Hepatitis B and C. This infection is suspected in patients with Hepatitis B infection with acute deterioration.
Hepatitis E infection is not common in children though it is the commonest cause of viral hepatitis in adults. As for Hepatitis A, this infection is spread by fecal contamination of food and water
Hepatitis A and E infection can be prevented by better sanitation, boiling water and use of clean food. Person to person spread can be minimised by diligent hand washing after defecation and before handling of food. Immunoglobulin may be given soon after exposure to a person suffering from acute hepatitis A. Hepatitis A vaccine is recommended for travelers to highly endemic countries where the risk of developing Hepatitis A is high. There is no Hepatitis E vaccine available as yet.
Hepatitis B, C and D infection can be prevented by use of sterile and safe techniques while performing procedures or surgeries and correct disposal of all used needles and instruments. All pregnant women should be tested for the infection and if found to be positive, the newborn should be vaccinated at birth along with administration of Hepatitis B immune globulin. The immune globulin is also recommended for people who get accidental needle stick injuries from patients with known Hepatitis B infection. Many countries have already adopted universal vaccination at birth for Hepatitis B in their immunization programs. Individuals at high risk of contracting Hepatitis B such as medical and paramedical staff, patients requiring repeated blood transfusions for diseases such as hemophilia or thalassemia, family members of patients with Hepatitis B should be vaccinated. Screening of donor blood for Hepatitis B and C by blood banks will help prevent transmission of these viruses.
There is no vaccine available as yet for prevention of Hepatitis C infection.
Typical symptoms on history and clinical examination by a doctor are suggestive of the diagnosis.
Liver profile tests give a clue to the severity of the hepatitis. These tests should be repeated at 3 months when the child becomes asymptomatic to confirm that recovery is complete.
Tests for detection of either the virus or its components and antibodies against these viruses are available.
The childs hands should be washed scrupulously with water and soap after every bowel movement.
Isolation may be necessary in the early stages, though by the time the illness is diagnosed, the child is usually past the infective stage.
No single medication or liver tonic has had a proved role in the treatment of acute viral hepatitis. Anti-emetic medications may be needed if vomiting is severe.
The ill child usually elects to be in bed in the earlier stages of the disease. He is permitted to go to the bathroom. As he recovers from the disease, he spontaneously increases his activity. There are no hard and fast rules on bed rest and studies have shown that strictly enforced bed rest has no bearing on the rate of healing of the liver.
There are no strict restrictions on diet. The child is encouraged to eat as much as possible and whatever is appetizing. Fatty foods intensify the nausea and therefore the child learns to avoid these foods. A high carbohydrate diet is generally better tolerated.
Contact your Doctor
- You notice yellowness of your child’s eyes
- The following occurs during the course of treatment
- excessive drowsiness or confusion
- vomiting, diarrhoea or abdominal pain
- skin rash or itching
- increasing jaundice
- increased loss of appetite