Question

Alarmingly high number of people describing similar acute symptoms. An investigation team composed of medical professionals and scientists was assigned to determine the root of the problem. 30 patients from different parts of the town exhibited similar symptoms at various hospitals in town. Symptoms include vomiting, liver damage, abdominal pain and edema. Aside from the symptoms reported, patients appear intact, that is no cuts or skin bruises. Thorough analysis of blood, urine and stool for microbial pathogens did not identify any known pathogens. All patients do not recall specific trauma leading to these symptoms, nor visiting an exotic place in the months before the outbreak. Patient’s ages range from 10-55 with a clear trend of increased severity of the symptoms amongst young patients (under 16). Patient’s ethnicity is diverse. Below is an initial list of questions to guide you in solving the case. Note, it is an initial list and you are expected to come up with further ideas at the workshop.

Already Answered**

1. What body system is affected? (Digestive system is affected.)

2. What may cause the signs and symptoms? (Acute Hepatitis virus, commonly caused by Type A followed by type B. A is often transmitted by consuming food or water contaminated by feces of a infected person)

3. What may be the causative agent? (Acute Hepatitis A via contaminated food/drink)

4. How does this agent cause the disease? (The pathogn attacked on liver causing inflammation [edema] to liver and the result may be vomiting pain and swelling on the body [edema].)

5. What tests could be carried out? What would these tests show? (1.Bilirubin test for jaundice. 2.TLC - DLC test for observing level of WBCs especially eosinophil count. 3.Hb test to indicate level of damage. 4.Heptitus blood test. 5. Liver biposy but only if absolutly necessary.)

6. What other information you may need from the patients to identify the source of the problem? (i. patient ALT, AST, ALP and sGPT levels. ii. Signs of dark urine or juandiuce)

Early preparation (before you arrive at the Workshop)

1. Prepare a list of the disease signs and symptoms

Answer 1

2.The period of time between exposure to hepatitis and the onset of the illness is called incubation period. The incubation period varies depending on the specific hepatitis virus. Hepatitis A virus has an incubation period of about 15 to 45 days; Hepatitis B virus from 45 to 160 days. Many patients infected with HAV, HBV, and HCV have few no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flue like symptoms including:

• Loss of appetite
• Nausea
• vomiting
• Fever
• Weakness
• Tiredness
• Aching in the abdomen

Less common symptoms include:

• Dark urine
• Light colored stools
• Jaundice

3.Hepatits A virus (HAV), a hepatovirus from the Picornaviridae family, is the causative agent, primarily through the faecal-oral route.The hepatitis A virus is one of the most frequent causes of foodborne infection. It is a viral infection of the liver that is spread person to person and via contaminated food and water.