The differential diagnosis of jaundice in the tropics includes a number of exotic causes which are seen less often in developed countries. Viruses are capable of causing acute or chronic hepatitis. Symptoms start with malaise, nausea and vomiting, fever followed by diarrhea which may lead to a phase of jaundice with dark urine and pale faeces.
Hepatitis A – Hep A infection is commonly asymptomatic throughout much of the tropics, the result of which is a long-lasting immunity in adult populations. Some countries experience less childhood exposure than that historically, which can cause epidemics in adults. Vaccines are available to provide long-lasting immunisation.
Hepatitis B – Acute Hep B patients are more likely to experience generalised arthralgia and rashes than patients infected with the other Hepatitis viruses. HBV infection causes 1 – 2 million deaths per year, mainly as a result of the sequelae of chronic liver disease and hepatocellular carcinoma. Perinatal or infant mass immunisation programmes have helped to prevent many such sequalae of chronic liver disease, thus minimising the number of deaths.
Hepatitis C – Rarely is Hep C the cause of acute disease, but Hep C is a major cause of chronic liver disease in the tropics, particularly in regions with uncontrolled reuse of needles and IV blood transfusions. Unfortunately, there is no vaccine for Hep C.
Hepatitis D – Formerly known as delta hepatitis, this virus can only infect individuals who have acute hepatitis B or chronic HBV carriers. Patients who are infected by hepatitis B and C at the same time – co-infection – how no further clinical manifestations than Hep B alone. However, when ‘superinfection’ occurs, with chronic HBV carries who later aquire acute Hep D infection, fulminant hepatitis results with a high mortality rate. It is prevented by immunisation against hepatitis B.
Hepatitis E – Spread by the faeco-oral route (as is Hep A primarily), usually by contamination of water supplies. Hep E is a common cause of acute sporadic and epidemic hepatitis with high mortality in pregnant women.
As of yet, there are no blog-posts on Viral Hepatitis but stay tuned, there soon will be!