Etiology, Epidemiology, Clinical and Biochemical Profile of Acute Viral Hepatitis at a Tertiary Care Centre

INTRODUCTION: Acute viral hepatitis is a systemic infection involving the liver predominantly. Almost 75% case of acute viral hepatitis are caused by one of five viral agents HAV, HBV, HCV, HDV, HEV. All these virus are RNA except HBV is DNA virus. The term hepatitis means inflammation of the liver. All these virus produce similar illness. These range from asymptomatic and inapparent to fulminant and fatal acute infections common to all types on one hand and from subclinical persistent infection to rapidly progressively chronic liver disease with cirrhosis and even hepatocellular carcinoma (HBV,HCV and HDV). Apart from these virus, CMV EBV and DENGUE are few relatively common viruses that cause acute hepatitis. AIM OF THE STUDY: To study the etiology, epidemiology, clinical and biochemical profile of acute viral hepatitis at a tertiary care centre, Government Stanley hospital with the objective of 1. To identify the common viral organism causing acute hepatitis. 2. The epidemiological data for risk factors includes age, sex, date of onset of illness, history of travelling in the preceding two months, any history of blood transfusion/injections, history of contacts, frequency of eating outside, sources of water and milk, history of any similar illness in the neighbourhood, history of mosquito menace, history of pre/extramarital sexual exposure etc. 3. To study the clinical features and outcome of viral hepatitis in respect to the organism. 4. To study the prevalence of acute hepatitis due to rare etilogies like CMV, EBV and Dengue virus. 5. To study the laboratory parameters like Hb, TC, PLATELET, HCT, Total BILIRUBIN, Direct BILIRUBIN, SGOT, SGPT, INR and USG. METHODS: A prospective observational study, conducted in the medical wards of Stanley medical college, during June 2018 to May 2019 with a sample size of 100. RESULTS: 82 % of the studies population were male. Dominant age group was19 to 28 years. 68% were from rural areas. Etiology of viral hepatitis was seen in hundred percent with dengue 37% being predominant, hepatitis A 25%, hepatitis E 17%, hepatitis B 12% and hepatitis C 9%. There has been a considerable ovelap of infection with CMV hepatitis. Risk factors for hepatitis were identified, of which contaminated water and food was seen in 49%. Fever, anorexia, abdominal pain and vomiting were seen in hundred percent. Most common sign seen was jaundice 96%. Total bilirubin > 3 seen in 84% of population. SGOT. SGPT > 800 seen in 56% of population. Mortality of 2% is seen among 100 patients. INR > 1.1 was seen in 79% of population. Fulminant hepatic failure was seen in 10%. CONCLUSION: High prevalence of dengue hepatitis were found on this study. Overlap infection-not due to coinfection alone. It is may be due to subclinical infection, cross reactivity or undefined and untreated previous infection. Around 90% of patients were treated symptomatically with fluids and antipyretics and outcome of patients were good. Viral hepatitis more common in rural group 68% and more common among skilled occupation. Many patients risk factors are identified. Around 98% of the patients were recovered well. Mortality were only 2%. Most of the death were due to the delayed referral. So early referral with appropriate protocol management can prevent mortality. Detailed history taking, clinical examination and relevant investigation can avoid irrational use of antibiotics, and antivirals. Clinical presentation similarity, etiological agents diversity and an inability to identify an infection, makes the complexity of diagnosis. The etiological profile of the diseases may be useful in framing the rational guidelines for communicable disease and can control the infection from primary level through proper sanitation, health education and hygiene environment