COMMUNICABLE THROUGH MOSTLY BY ORAL ROUTE BUT ALSO BY BLOOD PRODUCTS & NEEDLE PRICKS.
Medical Care: For acute cases, therapy is generally supportive, with no specific treatment for acute uncomplicated illness. Locating the primary source and preventing further outbreaks are paramount. Initial therapy often consists of bed rest. The patient should probably not work during the acute phase of the illness.
" Nausea and vomiting are treated with antiemetics.
" Dehydration may require hospital admission and intravenous fluids.
" In most instances, hospitalization is unnecessary. Most children have minimal symptoms; adults are more likely to require more intensive care, including hospitalization.
" Between 3-8% of cases of fulminant hepatic failure are caused by HAV; however, only 1-2% of HAV infections in adults lead to fulminant hepatic failure.
" Tylenol may be cautiously administered but is strictly limited to a maximum dose of 3-4 g/d in adults.
" Other treatments are directed by specific complications.
Surgical Care: Consider patients with fulminant hepatic failure for referral for liver transplantation. Recurrent disease after transplantation has not been reported. Selection of patients who require transplantation may be difficult because 60% of them recover from fulminant failure without a need for transplantation (similar to acetaminophen toxicity), and predicting who needs this life-saving procedure is difficult. Late referral has ominous implications, with the accompanying comorbidities (eg, renal failure, coagulopathy, cerebral edema) and waiting times contributing to poor outcomes.
Diet: Encourage an adequate diet. Patients should avoid alcohol and medications that may accumulate in liver disease. Otherwise, no specific dietary restrictions are necessary.
Activity: Bed rest during the acute illness may be important, although data to support this practice are lacking. Restricting transmission is important, especially in the early phases of the illness. Returning to work should probably be delayed for 10 days after the onset of jaundice.
DRUG TREATMENT :
1. ANALGESIC / ANTIPYRETIC AGENTS :
- ACETAMINOPHEN
2. ANTIEMETICS :
- METOCLOPRAMIDE
3. IMMUNE GLOBULINS :
- IMMUNE GLOBULINS I.M.
Contraindications: Corticosteroids may add to morbidity/increased mortality.
PATIENT MONITORING
o Serial measurement of serum AST/ALT
o Appropriate serum viral markers useful for evaluation of recovery or progression
o Liver biopsies in acute cases if diagnosis remains in doubt
o Monitor for metabolic complications
PREVENTION/AVOIDANCE
o Good sanitation, hygiene
o Immune globulin (passive immunization): 0.02 mL/kg IM (given 1-2 weeks after exposure prevents illness in
80-90%). With prolonged exposure give q 5 months. Also use for close contacts, day care staff/children (if
case occurs), institutions with multiple cases, travelers to areas of high prevalence (with 3 week lead time, use vaccine).
o Hepatitis A vaccine (Havrix, Vaqta): 0.5 mL dose IM in children > 2 yrs; 1 mL in adults IM; 2nd dose 6-12
mo later for >8 yrs. Separate syringe site from immune globulin. Use for travelers, day-care staff/children,
custodial facility employees, sewage workers, military, homosexual men, food handlers, Native Americans,
Alaskan natives.
POSSIBLE COMPLICATIONS
o Icteric disease
o 3 rare variants: relapsing, cholestatic, fulminant
EXPECTED COURSE/PROGNOSIS
o Mild disease usual, often no jaundice
o No chronic liver disease
o Mortality < 1%
o Lifetime immunity usual with recovery