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Mystery Hepatitis

Hi all - any knowledge would be appreciated.
My Father (69), on May 7th started to lose his appetite, his taste for alchohol, and began fatigue and fever (103F at peak). He developed 3 cold sores on his lower lip and had trouble speaking which was a physical disturbance in his throat.  He then complained of severe pains and couldnt sleep. These pains were in his arms and back. 3 days later jaundice started and he was hospitalised. He was in Hospital for 18 days. During this time, he couldnt blow his nose. The last 5 days in hospital saw jaundice significantly reduce, the cold sores disappear almost overnight, and his voice recovered 80%. He has been home for 5 days, and is eating small amounts, but is still completely exhausted and has extreme trouble climbing up 10 steps. He has always been  a healthy man, and never been into hospital before. He went to hong kong 2 months before and was vaccinated for    Hep A and B prior to his journey. He also ate a lot of oysters for the first time ever, about 4 weeks before he started the fever. My real worry is his continuing lethargy. He has had loads of blood tests in hospital and also a biopsy. He was discharged after the results of his biopsy came in, with no apparent damage, and no apparent diagnosis, but reduced inflammation still evident. Apart from being too tired to do anything, and a heavily reduced appetite, he appears in half decent health.
What im trying to find out is whether he is on the road to recovery, or is his apparent exhaustion a reason to seek further expert help. He has been ill for 7 weeks.
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Avatar universal
okay, cryptic how is it you know all this stuff?...have you had hep e? or have you had an occasion to study up on it? now you have me quite curious!!! you seem to know alot about it...but i really wouldn't know cause i know nothing about it...i hope you don't mind me asking you?

hope curiousity doesn't kill the cat, meow....sandi
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Avatar universal
As far as cases which are presumed to be viral related hepatitis(due to viral prodrome and exclusion of other causes)but are negative by serological and molecular testing of the known 5 virus types,the term nonA-E hepatitis is used.Various studies from various countries have suggested different numbers.According to reliable sources,10-15% of transfusion associated and 5% of sporadic cases fall in this category.

However ,in your particular scenario the history of foreign travel and the short incubation period viz. 30 days point to an orally acquired agent(Hepatitis E tops the list).

I hope your father shows speedy recovery..

Thankyou.
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Avatar universal
Sorry should have been HSV-1(typo)
Thankyou
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Avatar universal
Regarding the cold sores,viral infections may be accopainied by a degree of TRANSIENT immunosupression which may lead to reactivation of dormant HSV-2 and reactivation resulting in cold sores.
Thankyou.
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Very good questions. frank
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Avatar universal
Was the hospital staff informed about his oyster consumption and did they test for parasitic toxicity?
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Avatar universal
First of all, thankyou very much for EVERYONES comments and taking the time to answer.
I forgot to mention that i live in England, UK, where my father was under the care of the national health service - underfunded, but free healthcare.
I beleive they have not tested for HEP E as this testing is expensive in the UK, and providers are reluctant to spend $ if not absolutely necessary. However, I suspect that HEP E is what he has got. (If so thats a relief!)  

My initial thoughts were that he may have been a hep C carrier, and the seafood brought it into a severe acute stage, but no diagnosis of hep c from blood tests. It seems v unlilkely that he has caught hep c from food. Having read quite a bit about HEP, all his symptoms and recent history are typical of type E or A, except for the cold sores. I suspect these were due to his prolonged fever - fever sores.

This is my second post on the forum and i write simply, as a person concerned about their father, trying to find out as much about undiagnosed hepatitis' as I can. I am a sensible 33 year old with an open mind who welcomes any comments.  If anyone has had hep e, or had an undiagnosed hep, id love to hear from them.

My thoughts and prayers are with all hep sufferers and their families. What a fantastic forum.  


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Avatar universal
Dear swiller,
             It would be really informative if you would post the  biopsy description and liver function tests(ALT and alkaline phosphatase).
              Plus any medications/herbs your father was taking in the time frame of illness.
              Thankyou.
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Avatar universal
Last comment for a while i promise.
Thankyou, cryptic, for the sound and informed comments, and your time spent on providing them.
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Avatar universal
Just to answer a few questions: (not enough space on the previous)

Yes My father did inform, late in his hospital stay, that he had eaten oysters. After which they did more blood tests.

I will try and get the specifics on the results. What we do know is that they dont know whats wrong and they are unlikely to have tested for hep e. So it all points to hep e.

In the UK, the health service is stretched for resources. In fact my father only saw the consultant in charge of him once, for 5 minutes. After that it was junior docs rarely and a ENT doctor. Therefore getting an appointment to see the consultant and get the specific results, may take time, but i need to. Healthcare is in a bit of a mess in UK, they didnt even know he hadnt eaten for 5 days whilst in hospital ! and didnt tell him to stop drinking alchohol or anything else upon discharge!

Thanks again all.





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Avatar universal
Not having ever seen you here before, your identity--are you a patient?  a health care practitioner?--is indeed a bit cryptic.   Is your interest in Hepatitis E purely professional or based in personal experience?
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Avatar universal
Just some more insights:
Fever,anorexia and pain in large joints suggests a viral prodrome.
I am at a loss to explain loss of voice.
I am really interested if serology for hepatitis E was done,which I strongly suspect as the cause in this case.
The serology is available from certain labs e.g. Quest in US and you can ask your physicians(I hope they have ruled hepatitis E out already).
Good news is if it is hepatitis E there is no chance of chronic hepatitis as the infection is self-limited and your father should expect complete recovery.
Thankyou.
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Avatar universal
Given the history of travel,I would like to rule out hepatitis E.It would be really helpful if you can post the biopsy report since certain features on biopsy are indicative of a certain virus e.g. pseudorosettes,cholestasis and periportal neutrophilas have been described in many cases of hepatitis E.

Drugs and herbs ahould always be  considered as possible culprits given the trend of poly and self pharmacy in the middleaged/elderly population.

It would be great if you would give a summary of tests performed,especially the viral serologies,imaging results and the liver function tests.

Thankyou.
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Avatar universal
somewhere I read where individuals were infected with hep c after eating some sort of shellfish, I would have to look for that article. I hope someone has some ideas for you. could have been some sort of food poisoning also.
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