Investigation of viral hepatitis E outbreak in a town in Haryana

An outbreak of 160 cases of viral hepatitis which occurred in Shahbad, Haryana, was investigated to ascertain the agent, cause of the outbreak and to initiate remedial measures. Out of the 30 samples tested, 26 (86.7%) were positive for IgM antibody against HEV, establishing hepatitis E virus responsible for the outbreak. Significant association of higher attack rates (4%) in ward 14 (OR = 17.9; 95% CI = 12.7-25.2) of the town along with leakage in water distribution system running co-existent with open drains containing household waste and sewage; and absence of residual chlorine in water samples tested at household level in ward 14 established fecal contamination of water as the cause of the outbreak. Remedial repair work was initiated along with superchlorination of water which contained the outbreak.

Acute drug induced hepatitis secondary to a weight loss product purchased over the internet

BACKGROUND

Many people now seek alternative methods of weight loss. The internet provides a readily available source of weight reduction products, the ingredients of which are often unclear. The authors describe a case of acute hepatitis in a 20 year old woman caused by such a product purchased over the internet.

CASE PRESENTATION

A 20-year old woman presented with a two day history of abdominal pain, vomiting and jaundice. There were no identifiable risk factors for chronic liver disease. Liver function tests demonstrated an acute hepatitis (aminoaspartate transaminase 1230 IU/L). A chronic liver disease screen was negative. The patient had started a weight loss product (Pro-Lean), purchased over the internet two weeks prior to presentation. The patient was treated conservatively, and improved. The sequence of events suggests an acute hepatitis caused by an herbal weight loss product.

CONCLUSION

This case report highlights the dangers of weight loss products available to the public over the internet, and the importance of asking specifically about alternative medicines in patients who present with an acute hepatitis.