Organ Can Be Affected By Contaminated Food & Water, Blood Transfusions, Besides Alcohol

Besides alcohol consumption, a series of deadly infections that spread through water, food and even blood transfusion can cause hepatitis (liver infection).

The virus may be transmitted through saliva of the first eater to the second person sharing an apple, warn doctors. "Every month about 20 to 30 cases are detected in Pune in which people catch liver infection even though they do not consume alcohol. An equal number of people approach us suffering from liver problems due to consumption of alcohol and hepatitis B infection," said senior gastroenterologist Parimal Lawate of Jehangir Hospital.

Sharing the view, infectious disease specialist Mahesh Lakhe of Columbia Asia Hospital said, "The liver infection caused by a medium other than alcohol happens after the rainy season. Liver infections due to hepatitis A and hepatitis E viruses are common during this period which spreads through street food and contaminated water."

In general, there are about 30 to 40 cases of liver infection that are not caused by alcohol during this time of the year. "In the last couple of weeks, there has been an increase in the number of cases. We receive 5–6 cases of hepatitis every week," Lakhe said.

The causes of liver infection (hepatitis) can be broadly classified into infectious and non–infectious types. The infectious causes include bacteria and more commonly viruses.

The non–infectious causes are alcohol (alcoholic hepatitis), cholestatic, drugs and toxic material. Viral Hepatitis leads to a diseaselike condition which could be a non–reversible clinical condition. It causes liver damage/failure and can even lead to death. Correct diagnosis is important for prevention as well as effective treatment.

The hepatitis A virus is transmitted primarily by the faecal–oral route. This is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. The hepatitis E virus is also transmitted via the faecal–oral route, principally via contaminated water. Risk factors for hepatitis E are related to poor sanitation.

"Waterborne outbreaks, though infrequent, are usually associated with sewage–contaminated or inadequately treated water. The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus. Hepatitis A is the commonest cause of liver infection amongst children," Lawate said.

Since 1955, several epidemics of hepatitis in India have been reported where hepatitis E infection is responsible for 30%–70% of cases of acute sporadic hepatitis and is the major cause of acute liver failure (ALF). "Among children, Hepatitis A is the predominant cause of acute hepatitis, and dual infection with Hepatitis A and Hepatitis E has been more frequently reported among children with ALF," Lawate said.

The most important thing to recognise about liver disease is that up to 50% individuals with underlying liver disease show no symptoms.

"The most common symptoms are very non–specific and they include fatigue or excessive tiredness, lack of drive, occasionally itching. Signs of liver disease that are more prominent are jaundice or yellowing of the eyes and skin, dark urine, very pale or light colored stool or bowel movements, bleeding from the gastrointestinal (GI) tract, mAental confusion, and retention of fluids in the abdomen or belly," Lawate said.

Gastroenterologist Harshad Gadhikar of Deenanath Mangeshkar Hospital said, "Hepatitis is a silent killer as it rarely presents symptoms until very late. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis). The average estimated carrier rate of hepatitis B virus (HBV) in India is 4%, with a total pool of approximately 36 million carriers."

Prevalence of anti–hepatitis C virus antibody in India is around 1%. Studies carried out in different regions of India indicate genotype 3 as the most commonly identified genotype. "Transfusion and use of unsterile syringes are the dominant mode of transmission of HCV in India. 80% of post–transfusion hepatitis in India is due to HCV 3. 15%–20% of all chronic liver disease and hepatocellular cancer in India are caused by HCV," Gadhikar said.

July 28 is Hepatitis Day.

• The hepatitis A virus is transmitted primarily by the faecal–oral route. This is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person
• The hepatitis E virus is also transmitted via the faecal–oral route, principally via contaminated water. Risk factors for hepatitis E are related to poor sanitation
• Hepatitis B virus (HBV) is transmitted between people through contact with the blood or other body fluids (ie saliva, semen and vaginal fluid) of an infected person. It is very unlikely that it can be contracted through kissing or sharing cutlery
• The hepatitis C virus (HCV) is spread through direct contact with infected blood. Very rarely it may be passed on through other body fluids although this is currently unclear

• Wash hands after using the loo
• Keep utensils used by the infected person separate from other utensils
• Use household bleach to disinfect hard surfaces

• Avoid sharing personal items, such as toothbrushes and razors
• Abstain from promiscuous sexual activity, or use protection
• Handle objects contaminated with blood with special care, like wearing gloves when drawing blood if you work in a hospital
• Do not share drug needles if you use IV drugs and making sure that tattoo and piercing artists and acupuncturists use sterile needles
• Heat contaminated articles for one minute to kill the virus