Aging Begins at 30

Jaundice Isn't Simple Any More

Elizabeth visited her grandchildren in Arkansas. They developed jaundice and so did she - 28 days later when she returned home. She had nausea, vomiting, fatigue, fever, cold-like symptoms, and aches all over, followed a week later, when she was beginning to feel better, by jaundice. At that time, she had dark urine and clay colored stools. She was tender under her right ribs where I could feel her liver. Five years later she is totally well without complications.

We used to say someone with yellow eyes and skin was jaundiced (from jaune, yellow) and leave it at that. Later we called it infectious hepatitis (liver inflammation) and serum- or syringe-transmitted hepatitis. Now we have five or more hepatitis types: A (epidemic or infectious, which Elizabeth had), B (serum), C (blood transfusion, needle, and community acquired, formerly called Non A, Non B), D or delta agent (piggyback infection on top of B, primarily in mainline drug addicts or hemophiliacs), and E (water borne in India, Africa, and Central America). These types of hepatitis, A through E, are caused by five different families of viruses, called HAV, HBV, etc., from picorna virus (for dwarf RNA virus) to hepadna virus (for DNA virus of the liver). There has been an explosion of knowledge in this field in the past decade, leading to improved prevention and, we hope, in the near future to carefully targeted treatment. The name hepatitis is better than jaundice as with better tests we have found that not all infected patients become jaundiced. Another form of hepatitis is chemical hepatitis caused by alcohol, some anesthetics, nitrofurantoin, isoniazid, and other drugs. Copper build up Wilson's disease is inherited. There are no viruses involved in these varieties.

Hepatitis was recorded first in the 500 to 380 B.C.E. period in the Talmud and by Hippocrates, probably type A, with 10-year cycles of increased prevalence. Since then, it has plagued the armies of Rome, Napoleon, World Wars I and II, Korea, Viet Nam, and Desert Storm. Viral hepatitis became reportable in the U.S. in 1952 and as type A or B, or non-specified, in 1965.

Hepatitis A or HAV is spread by the oral and stool route. It is acquired by exposure to another case in 40%, by day care in 20%, by travel where food handling is unsaniitary and by food (often shellfish) in 5% each. It can be prevented in contacts of patients by intramuscular injection of immune serum globulin in amounts of half to 2 milliliters, according to weight. There are rarely any complications.

Hepatitis B is a big problem and there are estimated to be several billion cases worldwide. The first breakthrough was a Nobel Prize winning discovery by Dr. Baruch Blumberg, a geneticist. He found that when serum from a hemophiliac patient containing hepatitis B was mixed with the serum of a hepatitis B carrier, a visible line was formed that could be used as a test virus. The carrier happened to be an Australian aborigine, so this antigen was called Australia Antigen or Hepatitis Associated Antigen and now is called hepatitis B surface antigen designated HbsAg. The signs and symptoms are similar to HAV infection, but time from contact case to jaundice is 2-6 months. About 10% of hepatitis B and 60% of C patients go on to chronic disease called chronic active hepatitis. They maintain a carrier state so that their blood is infectious. There are about 300 million chronic carriers worldwide. This is why, along with the risk of AIDS, we now use universal precautions using rubber or plastic gloves in hospitals and in nursing homes (where 1% of patients are hepatitis B carriers and 2% hepatitis C carriers). A single needle stick with known hepatitis B positive blood transmits the disease in about 20% because there are 10 trillion disease particles per milliliter of blood, compared to 10 to 100 bacterial particles in blood poisoning patients' blood.

People at high risk of developing HBV infection are spouses of patients, nurses, physicians, dentists, IV drug addicts, recipients of blood or blood products, hemodialysis patients, homosexuals, persons with multiple sex partners, and persons in crowded institutions such as mental hospitals and prisons.

Hepatitis B is acquired by personal contact in 15%, homosexual activity in 12%, heterosexual activity in 20%, drug use in 24%, and hemodialysis in 1%. Jaundice occurs in 50%. Less than a third need hospitalization and 2% of these die. Twenty per cent of infants from infected mothers develop hepatitis and, if untreated, 90% become chronic carriers. A special hepatitis B immune serum globulin, along with vaccination, is used to protect these children. Hepatitis B immunization is now included in universal childhood vaccination schedules.

About 20% of chronically infected patients later die of liver cirrhosis or of liver cancer.

Hepatitis D is a defective or incomplete virus which cannot exist alone and infects people who already have hepatitis B and increases its severity. It is confined to persons exposed frequently to blood and blood products, primarily drug addicts and hemophiliacs.

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See related Patient Topics Digestive System or Liver Diseases--General.

See related Provider Topics Digestive System or Liver Diseases--General.

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