HEPATITIS A

jaundice, effusion of bile.

What is it?

It is an inflammation of the liver (hepatitis) caused by a virus called Virus of the Hepatitis A (HAV). By the way it is transmitted, this kind of hepatitis occurs mainly in less developed areas, with poor sanitary conditions and lack of basic sanitation. In these places, which include the majority of the areas in Brazil, the condition is prevalent among small children (from 2 to 6 years old). But also individuals who did not developed the condition during childhood can acquire it at any age.

How do we acquire it?

It occurs by fecal-oral route in most cases with the feces of the patients contaminating the water and food. It can also happen to people using swimming pools with badly treated water or sharing towels and sheets imperceptibly contaminated with feces, for example.

What are the symptoms and how does it develop?

The initial symptoms can be variable and it may include a general malaise, achiness in the body, pain in the upper right abdominal area, headache, easily tiring, lack of appetite and fever. After this, the typically yellowish tinge – the jaundice – appears on the skin and mucous membrane.

The urine becomes dark brownish, similar to strong tea or coke and, sometimes, referred to as reddish. The feces can be of a light brownish gray putty-like color.

In some cases, there can be itching all over the body (pruritus) followed by marks from the patient’s scratching and not caused by previous skin injuries.

The evolution is generally benign, with the symptoms decreasing in 2 or 3 weeks. The total resolution and cure occur in around two months. During the healing period, one or two relapses of the symptoms and of the alterations of the exams may happen, which does not hinder the full recovery of the patient.

Exceptionally, in less than 1% of the cases, a few number of people may develop a fulminant form, in which there is a quick failure of the liver function, putting the patient at a great risk of life.

Except for the few fatal cases associated with the fulminant form, there is not a chronic Hepatitis A form. The patient becomes cured, with no sequelae and immune to future virus exposures. It is worth mentioning that many people are symptom-free and only discover that they had it when having occasional blood tests.

How does the physician make the diagnosis?

By joining the complaints and the findings of the clinical investigation, the physician hints at the diagnosis, which is confirmed through blood tests where the hepatic alterations and antibodies of the acute stage of the disease by the hepatitis A virus are detected. Some results of these initial investigations and of their follow-up can reveal a trend toward an unfavorable prognosis, with the disease evolving into a fulminant form.

How is it treated?

There is no specific medication. When necessary. medication against nausea, pain and fever is used. Strict resting is not necessary, and it is the patient’s responsibility to respect his/her limits according to his/her tolerance.

Eating restrictions are not needed, and the food can be normal. Some people, because of their bad condition and the nausea, cannot maintain the minimal ingestion of water and food, needing intravenous hydration. The rare cases of fulminant Hepatitis A may demand a liver transplant as the unique way of treatment.

How to prevent it?

The A virus is eliminated through the feces during the incubation period and the first 10 days of jaundice. The feces contaminate the water, which if not treated may contaminate other individuals when used to wash food, utensils and bathing.

It is important therefore to use treated or boiled water for eating purposes, in addition to following recommendations as to not bathing in areas where the water is contaminated and the use of disinfectant in swimming pools. Individuals exposed to the Hepatitis A virus for less than 15 days and still showing no symptoms may be treated with an antibody injection (immunoglobulin), in an attempt to prevent or minimize the disease.

VACCINATIONS

The vaccination for Hepatitis A is recommended for all one-year-old children and older, as well as for anyone traveling to places where Hepatitis A is very frequent, as is the case with Northern Brazil and underdeveloped tropical countries. Higher risk groups as children and adults attending child day care centers, elder homes or prisons; homo or bisexual individuals; injectable, or non-injectable, drug users; and patients with chronic hepatic disease, those with AIDS or coagulation disorders also have to be vaccinated.

The vaccine administration is likewise useful for health care professionals because of the potential contact with infected patients or material. Food industry workers , once vaccinated, avoid virus transmission via food preparation.

Questions that you can ask your physician

What kind of hepatitis do I have?

How do we catch it?

Is there risk for people living next to me?

How long will it it take me to recover?

Essa doença tem cura ou vou ficar com hepatite crônica?

Is there a cure or will have I chronic hepatitis?

Is medicine treatment necessary?

Does medicine work for everybody?

What side-effects might the treatment have?

Is there risk of developing cirrhosis? or cancer?

Is there a vaccine for hepatitis?

Would it help me and the people next to me to take it now?

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