Clinical Studies of Acute Viral Hepatitis A in a Family

A family of four developed acute viral hepatitis A beginning with the father, 33 years old. He complained of general malaise, nausea, vomiting, loss of appetite, high fever and showed jaundice and elevation of transaminases level. Chemical recovery was made in 99 days. His wife, 28 yrs., showed almost the same symptoms 31 days after the onset of her husband's hepatitis. Transaminases returned in 27 days. In a 5-year-old boy, 10 days after the onset of his mother's illness he complained of anorexia, nausea and vomiting but showed no pyrexia and jaundice. He recovered in 20 days. In a 4-year-old boy, he showed loss of appetite, dark urine and slight jaundice 3 days earlier than his brother. Chemical recovery was delayed and returned in 56 days. Symptoms were more severe in adults than in children but there was no remarkable difference as to clinical course between them. Serum antibody to hepatitis A antigen was determined with radioimmunoassay (HAVAB-M kit, DAINABO'IT) and all patients showed high titers. The determination of IgM revealed: husband, 272 mg/dl; wife, 318 mg/di; elder brother, 302 mg/dl; younger one, 180 mg/dl. IgM level of children declined gradually. In all cases, examination of the blood disclosed 2-5 per cent atypical lymphocytes (type 2) in differential count and it lasted the first 20-30 days of illness.