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)

2. Prepare a list of factors from the case description that you think will be relevant in solving this case. What type of epidemiology study would be useful to conduct in this case?

Answer 1

The factors influencing the Acute Viral Hepatitis;

Most patients with acute viral hepatitisA, have a favourable course,but a few of them suffer from several forms of hepatitis such as fulminant hepatitis.

Acute hepatitis is mostly self-limited acute illness and does not progress to chronic hepatitis disease.

In children,acute hepatitis virus infection is usually asymptomatic whereas symptomatic in adults.

Factors influencing on the severity of viral hepatitis consists of host and viral factors.

For the host factors, chronic liver disease, old age, heavy alcoholic drinking, HIV infection and pregnancy are being suggested.

It frequently shows critical clinical course and accompany high rate of fulminant hepatitis and mortality.

Hence, it is demonstrated that the host and environment factors affect the severity of liver disease in patients with acute hepatitis A.

Chronic hepatitis B, has significant effect on serious complications such as fulminant Hepatitis and mortality.

Nearly 153 cases of viral hepatitis is admitted to hospital during the period of 1995-97 were analyzed for various epidemiological variables or studies.

Out of it, 54 cases were found to be positive for acute hepatitis virus.

The epidemiological data was administered through the interview technique.

This data was analysed using simple statistical methods.

About 2-3 billion people of world are infected with one or more of the hepatitis virus.Viral hepatitis results around 1.4 million death's each year.