There are many infectious causes of hepatitis and most people are familiar the common ones, aptly named hepatitis A, B, C, D and E. While these are best known, there are many other viruses which can cause hepatitis and are important to be aware of as we enter summer. Almost all viruses can cause mild, transient elevations in the liver chemistries, including the virus that causes the common cold. Some viruses may even cause liver tests to become markedly elevated or cause jaundice but it is rare for these viruses to cause liver failure.
Adenoviruses are common causes of bronchitis, pneumonia, conjunctivitis and gastroenteritis. People infected with these self-limited infections usually complain of cough, fever, abdominal pain, diarrhea or eye pain. Enteroviruses are another family of virus that are common in our area and can cause hepatitis. Coxsackie viruses, common amongst children in summer camps and pools, may cause a variety of complaints ranging from stiff neck to cough to chest pain to rash to diarrhea. All of these viruses commonly cause mild liver test elevations.
Most people infected with these types of viruses never see a doctor for their complaints. Some, however, will seek medical care and routine blood tests may show abnormal liver tests. These findings do not mean that liver damage has occurred or that a further evaluation is necessary at that time. The commonsense approach would be to wait for the symptoms to get better and then repeat the blood tests.
Don’t forget, many people will also have abnormal blood tests because they took over-the-counter medications or health store products or old antibiotics that were lying around in the cabinet in the hopes of making themselves feel better. In the vast majority of people, after an appropriate wait, the liver enzymes will normalize.
Infectious mononucleosis, or “mono,” the kissing disease, is a disease of young adults. This condition, caused by the Epstein-Barr virus (EBV), typically infects teenagers and young adults 15-25 years of age. It is especially common in schools, camps, hospitals and military areas. The transmission of this virus is by close personal contact such as such the transfer of saliva during kissing.
Once infected, the duration of the disease can vary tremendously from a few days to a few weeks. This condition usually starts with fatigue, sore throat, a high evening fever and enlarged, tender lymph nodes in the neck area. Over time, an enlarged liver and/or spleen may develop associated with a rash and swelling of the areas around the eyes. Liver enzymes may be dramatically elevated but diagnosis is based solely on determining the presence of antibodies in the blood to the Epstein-Barr virus.
There is no treatment for mononucleosis other than supportive care, including drinking plenty of fluids. Liver test abnormalities quickly resolve with clearance of the virus. Classically, people with mononucleosis may become jaundiced if given antibiotics. There are no long-term deleterious effects in the liver related to this infection.
Many other viruses have been associated with hepatitis. Some other examples which are less common in our area include yellow fever, Ebola virus, German measles, herpes simplex and cytomegalovirus (CMV).
It is very important to understand that not all abnormalities of liver enzymes resulting in hepatitis are caused by the named hepatitis A-E viruses. Appropriate testing, when indicated, may help solve the case and place the patient at ease as most of the other viruses causing hepatitis are self-limited, usually benign infections.
David Bernstein, MD, is chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.
