Question

History and Physical Examination

Mary, a 25-year-old kindergarten teacher felt fatigued, had diarrhea and was running a fever. She went to see her physician when the symptoms continued after several days of rest. As part of her patient history, Mary noted that her stools had changed color. The physician noticed that the whites of Mary’s eyes were yellow. Her physician ordered a liver panel and Mary’s bilirubin and ALT levels were abnormally elevated. The physician requested an acute hepatitis panel and the results follow:

Assay and the Results

HBsAg Negative, Anti-HAV IgM positive, Anti-HBc IgM negative, Anti-HCV negative.

Questions

1.What is the most likely diagnosis for this patient?

2.How is this disease transmitted? What additional information would be helpful in determining the source of the infection?

3. What is the incubation period? What is the usual outcome of infection with this organism? Is there a chronic stage?

4. What is the usual treatment for this disease? What can be given early in the infection to minimize the clinical symptoms?

5. What tests are performed to determine immunity to this virus and what would the results show if the patient is now immune?

Answer 1

Qn

1.What is the most likely diagnosis for this patient?

Answer

The patient has hepatitis A virus infection. The presence of anti-HAV (IgG or IgM) in human serum or plasma is indicative of past or present infection with hepatitis A virus (HAV) or vaccination against HAV.

Qn

2.How is this disease transmitted? What additional information would be helpful in determining the source of the infection?

Answer

The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. The hepatitis A virus is found mostly in the stool and blood of an infected person. The virus is present about 15 to 45 days before symptoms occur and during the first week of illness.

Qn

3. What is the incubation period? What is the usual outcome of infection with this organism? Is there a chronic stage?

Answer

The incubation period of hepatitis A is approximately 28 days (range 15-50 days)

Hepatitis A virus infects liver cells and causes inflammation. The inflammation can affect the liver condition and cause other signs and symptoms of hepatitis A.

Not everyone with hepatitis A has symptoms. Adults are more likely to have symptoms than children. If symptoms develop, they usually appear 2 to 7 weeks after infection. Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months.

Almost every one gets life long immunity after the disease.

Qn

4. What is the usual treatment for this disease? What can be given early in the infection to minimize the clinical symptoms?

Answer

• There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and may take several weeks or months.
• Most important is the avoidance of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given.
• Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea.
• Rest. Many people with hepatitis A infection feel tired and sick and have less energy.
• To get enough calories, eat more high-calorie foods. For instance, drink fruit juice or milk rather than water. Drinking plenty of fluids is important to prevent dehydration if vomiting occurs.

Qn

5. What tests are performed to determine immunity to this virus and what would the results show if the patient is now immune?

Answer

• Blood tests for hepatitis A
• Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood.
• Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA and may require specialized laboratory facilities.