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When a 30-year-old woman walked into Dr Rommel Tickoo’s clinic, one look at her yellowish eyes told him that she had a liver problem. Sure enough, when the internal medicine expert at Max Healthcare, Delhi, checked her liver enzymes, they were through the roof. Her enzyme levels stood at around 3,000 IU/L — the normal ranges are between 7 and 55 IU/L. She tested positive for hepatitis A, a viral infection usually transmitted through contaminated food and water.
With several gastrointestinal infections and vector-borne diseases being common during the monsoon, getting the correct diagnosis may be a challenge. “The typical symptoms, such as yellowing of skin and eyes that people associate with hepatitis, are not the first ones to appear. The yellowing happens at later stages of the disease, where there are high levels of accumulated bilirubin (a yellow pigment produced when the red blood cells break down, usually cleared out by the liver). A person should ideally go to a doctor before this happens,” says Dr Tickoo.
Why a test matters
The overlapping symptoms, which can be caused by other gastrointestinal infections, are the reason that doctors go in for tests to be sure. As Dr Suranjit Chatterjee, senior consultant of internal medicine at Indraprastha Apollo Hospital, Delhi, says, “During this season, you would either see food and water-borne infections, vector-borne infections and some respiratory infections. Usually, patients coming in with symptoms such as loose motions, vomiting, loss of appetite have gastrointestinal diseases such as hepatitis A, E, gastroenteritis or typhoid. High fever, headache and body ache would usually be the symptoms in patients with vector-borne diseases such as dengue, malaria or chikungunya.”
Dr Tickoo usually gets such patients tested for complete blood count, liver enzyme and C-reactive protein, the last indicative of the inflammation in the body. Then he prescribes tests for dengue, malaria, typhoid, and in some cases, especially concerning the women and elderly, he gets a urine culture to check for urinary tract infection.
When to see a doctor
People who get fever, nausea, vomiting or diarrhoea should go to a doctor if the symptoms seem to be worsening or do not seem to be improving after a couple of days. Dr Chatterjee advises that anyone who is immunocompromised — for example, if they are living with conditions such as heart diseases, liver disease, kidney disease, diabetes, cancers, HIV, or have undergone an organ transplantation — should go to their doctor sooner. “One should also go to a doctor immediately if their symptoms are unmanageable, say if they are vomiting or getting loose motions more than 20 times a day,” he says.
Do not pop pills at will
Importantly, people with these symptoms should only take medicines such as paracetamol and those to prevent vomiting when at home. “Other medicines such as Combiflam should be avoided. Pain medications such as diclofenac or mefenamic acid should also be avoided, especially when diseases like dengue are likely. These medicines are known to increase the risk of bleeding in patients with dengue. Antibiotics are a strict no-no. They are of no use in cases of viral infections such as hepatitis, can lead to growing antimicrobial resistance and, importantly, may also affect the results of certain tests we need to confirm our diagnosis,” says Dr Tickoo.
While most people with hepatitis A get better within four to 16 weeks, some go on to develop serious complications such as liver failure and coma. “It is, however, impossible to tell who will get the complications. So it is essential that everyone who has the hepatitis A infection takes rest and helps the body recover,” says Dr Ashwini Setya, senior consultant of gastroenterology at Medanta, Gurugram.
What to eat during recovery
While at home, patients should ensure that they drink plenty of fluids and eat healthy meals as per their appetite. “It is a myth that people need to eat bland, boiled food. They should only eat as much as they feel like. Usually, people’s appetite reduces significantly when they have a hepatitis infection. Force-feeding can lead to more nausea,” says Dr Setya.
It is better to boil water and follow hand hygiene, according to Ritika Samaddar, regional head, dietetics and nutrition, Max Healthcare. “During the recovery phase, liver cells are regenerating. So they need protein in the form of eggs, milk and paneer. They need good fat, so normal refined, olive and nut oils work, but in moderation. A teaspoon of ghee can be had too to whet the appetite. Carbs are equally important for regenerating liver cells. Have small, frequent meals,” she says.
However, she warns that the diet discipline must be adhered to strictly for at least six months. “Hepatitis A is a self-limiting infection. But sometimes there can be a relapse if you do not take care. Besides, you could be at risk of other strains of the hepatitis virus. A diet discipline is a must,” says Samaddar. She even suggests a strict preventive regime: “Please drink only filtered and boiled water, even cook with it. Wash all your fruits and vegetables thoroughly. Do not eat raw or undercooked foods. Avoid street food, cut fruits and even ice drinks from the roadside or restaurants.”
Take the preventive shot
There are five hepatitis viruses that cause liver disease in humans. Hepatitis A and E are transmitted through contaminated food and water and usually do not lead to lasting liver damage. Hepatitis B, C and D, on the other hand, are usually transmitted by blood and can lead to chronic infections.
At present, vaccines are available against hepatitis A and B. This may also reduce the risk of hepatitis D, which can only occur in people who have hepatitis B infection. While there is no vaccine for hepatitis C, there is an effective antiviral treatment.
“When it comes to water-borne hepatitis, any person who has had hepatitis A is immune for life, but hepatitis E can happen multiple times,” says Dr Setya. Hepatitis E infection in a pregnant woman can lead to abortion of a foetus and increase the risk of maternal mortality, he adds.
So, who should take the hepatitis A vaccine? Doctors recommend it for children, students living in hostels, people who eat out often or those who are immunocompromised. Others may also take it to reduce the risk of an infection, but it is not necessary for everyone.
(With inputs by Rinku Ghosh)
