Jaundice is a symptom, not a disease entity by itself. It is the manifestation of different clinical condition where there is accumulation of serum bilirubin in excess resulting yellow colouration of eyes and skin. However, non-medical persons want to mean by jaundice a condition which we term medically as "Acute Viral Hepatitis" (AVH) that results from involvement of different organs of body, primarily the liver, by different viruses.
In the summer, there is an increase in prevalence of "AVH" as there is availability of different tasty fruits in the market. Very often these fruits like mango, pineapple and papaya are served in the open places, even in footpath to the people. Sugarcane is crushed in the footpath to make juices for sale. These dirty fruits and foods which are usually contaminated by flies attract the walking people very easily. What is wrong with our people is their personal habits and hygiene.
In hotels, restaurants or in open food serving places we share same glasses and cups for drinking water and tea; lot of flies and cockroaches contaminate food and we mostly drink unboiled water all of which help in infection as well as spread of liver viruses, notably "Virus E" — an agent commonly found in Bangladesh, causing jaundice as water and food borne disease. Due to all these factors on the part of people, endemic nature of jaundice is remaining unchanged in Bangladesh. Those who are educated and solvent less commonly face these problems. However, even they are not free from the hazards of supplied tap water which is often contaminated. Liver "virus A" shares the similar route of transmission as of "E". However, it mainly causes a sub clinical (there is no obvious jaundice but there is infection) disease, mainly in children.
The second most common virus after "E" is "B", which causes hepatitis that becomes chronic in 5-10% cases and is difficult to treat and eradicate. Transmission mode of this type of viral infection is little different. It enters in the body through cut injury, sexual relations, after transfusion of blood, and sharing common needles for injection. Everyone should be very much cautious about sharing same razor, blades, scissors which is often practiced in many saloons. Another virus called "C" share the similar mode of transmission. However, its prevalence is quite low in our country. But once it infects, in 85% cases there will be a chronic disease and obvious damage of liver.
"AVH" may not be recognised easily in the early stages of infection which helps in spread from people to people as there is no jaundice, rather, there is a sense of unwell, loss of appetite and fever all of which are the symptoms of viral fever. Affected persons often start taking Paracetamol for fever which should be avoided altogether as it can cause much harm to liver in this clinical condition. Urine becomes yellow after a variable period, usually about one to two weeks followed by yellow colouration of eyes called jaundice. In the early stages, "AVH" can be detected by blood tests as will be appropriately advised by a skilled or specialist doctor.
Awareness about personal habits and hygiene can help avoid acute viral hepatitis (Jaundice).
The writer is an Professor of Gastroenterology of Dhaka Medical College & Hospital. E-mail: [email protected]