Clinical Case 1

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Clinical Case 1

• Virus Group 6

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Patient

• male, 28 yrs of age, does not smoke or drink,
  insurance salesman by profession.
• Regular chiropractic patient has just returned
  from a thirty day humanitarian trip to west
  Africa where he assisted in the construction of
  low income housing. Three days following his
  return to the States, he visits his chiropractor.

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Signs/Symptoms

• During his health assessment, he notes that he
  has not felt good since he returned from Africa
• Generally complaining of weakness and loss of
  appetite. His physical update (checkup) does not
  indicate any obvious problems except that he has
  a low grade fever (100 F).
• He was treated based upon his listings, and was
  advised to increase his vitamin C intake.

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Progression of Condition

• Three days later, the chiropractor receives a
  call from his wife informing him that her husband
  has be hospitalized due to extremely nausea and
  vomiting.
• Their medical physician stated that he thinks
  there is some type of infection within the
  gastrointestinal system because his abdomen is
  very tender especially in the region of the liver
  i.e. right upper quadrant.

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Presumptive Diagnosis

• Hepatitis

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Laboratory Tests

• Liver Function Tests
• Serum bilirubin .6 mg/dL .1 - .3 mg/dl
• AST 50 units/L 0- 35 units/L
• ALT 70 units/L 7-56 units/L
• CBC
• slight leucopenia 4.3 x 103/uL
• 4.8 10.8 x 103/uL
• Serology
• Anti-HVA (IgM) 1640
• Anti-HVA (IgG) 1 80

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Confirmed Diagnosis

• Heptatitis
• Etiology Hepatitis Virus, type A

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Nature of the Organism

• Picornavirus
• Small RNA virus
• Positive-sense RNA
• Non-enveloped
• Hepato-Trophic ( affinity for liver hepatocytes)
• Virus Cycle
• Positive-sense RNA cycle
• Lytic

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Epidemiology

• Reservoir Humans
• Humans with infections involving HVA
• Source fecally contaminated food or water
• Mode of Transmission
• Person-to-Person, indirect, fecal-oral, food and
  water
• Endemic in most of the World
• Except developed countries where is is sporadic

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Control

• Interrupt fecal-oral transmission
• Proper disposal of human feces
• Treatment of drinking water
• Disinfection of contaminated fomites
• Immunization
• Recommended for susceptible individuals in high
  risk settings
• Inactive Vaccine formalinized
• Virus grown in tissue culture