Studies on 222 cases of Acute Infective Hepatitis During an Epidemic
Sinha, B.B., M.R.C.P., Chief Medical Officer, Kurzi Holy Family Hospital, Patna, Bihar, India.
Infective hepatitis is a well recognised communicable disease caused by a virus. It produces clinical, symptomatic and general effects. The liver, the largest metabolic gland in the body having diverse functions, bears the brunt of the disease. Diseases of the liver, by producing various disturbances, throw the entire system out of gear. In the diagnosis and the study of progress of this disease, evaluation of the hepatic functions is of major importance. Biochemical and histopathological studies are of great value in confirming the diagnosis and assessing the progress of the disease process.
Infective hepatitis can be mild, moderate or severe; and may cause acute or subacute hepatic necrosis, leading to the clinical condition of precoma or coma. There are inflammatory changes in the hepatic parenchyma and interstitial tissue with clinical and histopathological evidence of hepatocellular degeneration in various stages of the disease process. Yeogt in Germany was the first to demonstrate infectivity of the disease in volunteers. In U.S.A. there were 72000 cases in 1961, the highest incidence for any year since the disease was reported as a common one and also as occurring in moderate to severe epidemics.
This study was conducted on 222 cases of viral hepatitis in an epidemic when the morbidity and mortality rate was fairly high. The clinical features, their progress, laboratory findings and their weekly progress were studied. Laboratory studies routine blood and urine examination, estimation of total and direct bilirubin, thymol turbidity test, serum alkaline phosphatase tests, plasma protein estimate, blood group assessment were done in all cases and histopathological studies of the liver were carried out wherever possible. The progress of the clinical and laboratory findings was noted every week for four weeks on a previously planned and prepared proforma. 78 patients were treated with Liv.52 and 144 cases served as control, other treatment and general management being the same in both the groups. The age distribution in years is given in Table I.
Table I: Age in years, with Liv.52 and without Liv.52 — 222 cases |
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Age in years |
No. of cases |
% |
No. of cases |
% |
0 - 5 |
4 |
5.1% |
12 |
8.3% |
6 - 10 |
1 |
1.3% |
1 |
0.7% |
11 - 20 |
19 |
24.4% |
22 |
15.3% |
21 - 30 |
31 |
39.7% |
61 |
42.4% |
31 - 40 |
12 |
15.4% |
30 |
20.8% |
41 - 50 |
5 |
6.4% |
9 |
6.3% |
51 - 60 |
5 |
6.4% |
4 |
2.8% |
61 - 70 |
— |
— |
3 |
2.1% |
71 - 80 |
1 |
1.3% |
2 |
1.3% |
Total |
78 |
100% |
144 |
100% |
The highest incidence was in the age group between 21-30 years and the largest number of patients were between the ages of 11 and 40; 62 in the first group of 78 cases and 113 in the second group of 144 cases.
The patients mostly came from the low and poor socio-economic group. The intensity of the disease varied from case to case. A large number of cases were in the precoma or coma state. Clinical evaluation of symptomatology in these cases revealed the data as shown in Tables II and III.
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A study of the clinical symptomatology showed that a large number of patients were in the acute fulminating stage of the disease as this study was during the period of an epidemic as could be seen by 11 cases in confused mental state, 9 semiconsciousness and 4 in coma i.e.. 24 cases out of 78 in the Liv.52 group and 44 cases in confused mental state, 49 semiconsciousness and 43 in coma in the control group. Some of the cases might have lapsed from one stage of consciousness to another and there may be some degree of overlapping but these symptoms bring out that the group of cases were acute and severe with a fair degree of presumed hepatic damage.
Table IV: Showing signs and symptoms |
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Symptoms & signs |
Liv.52 group |
Without Liv.52 |
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No. of cases |
% |
No. of cases |
% |
|||||
Fever |
50 |
64.1% |
112 |
77.8 |
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Yellow urine |
57 |
73.1% |
121 |
84.0% |
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Jaundice |
66 |
84.6% |
123 |
85.4% |
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Pain in abdomen |
34 |
43.6% |
64 |
44.4% |
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General bodyache |
10 |
12.8% |
14 |
9.7% |
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Pruritus |
7 |
9.0% |
5 |
3.5% |
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Anorexia |
47 |
60.3% |
53 |
36.8% |
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Nausea |
28 |
35.9% |
39 |
27.1% |
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Vomiting |
33 |
42.3% |
40 |
27.8% |
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Confused mental state |
11 |
14.1% |
44 |
30.6% |
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Semiconsciousness |
9 |
11.5% |
49 |
34.0% |
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Coma |
4 |
5.1% |
43 |
29.9% |
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Concomitant pregnancy |
4 |
5.1% |
27 |
18.7% |
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Enlarged and palpable liver |
37 |
47.4% |
56 |
38.9% |
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Enlarged and palpable spleen |
5 |
6.4% |
12 |
8.3% |
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Ascites |
16 |
20.5% |
22 |
15.3% |
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Clinical discernible cirrhosis of liver |
8 |
10.2% |
17 |
11.8% |
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Portal hypertension |
3 |
3.8% |
6 |
4.2% |
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Refference: http://www.himalayahealthcare.com/pdf_files/liv215.pdf