Introduction
Hepatitis-A is the commonest cause (10-30%) of acute viral hepatitis. Hepatitis-A is responsible for 20-25% of clinical hepatitis in the developing countries due to improper sanitisation, limited access to clean water and poor hygienic conditions in these countries.[2]
HAV infection is highly infectious and is spread by faeco oral route. HAV belongs to the picornavirus group of enteroviruses and HAV infection has an incubation period of 15-45 days. Infected person excretes viruses in the faeces for about 2-3 weeks before the onset of the illness and for up to 2 weeks thereafter.[3]
It is characteristically an acute febrile illness, with a typical duration of 7- 14 days, presenting with an abrupt onset of anorexia, nausea, malaise, vomiting and jaundice. Acute hepatic failure is rare in HAV infection. In extrahepatic disease, the most common features are joint pain, muscle ache, and rashes.[1]
Anti HAV of IgM type is diagnostic of acute HAV infection.[3] Rise in ALT, AST, bilirubin, ALP and GGT are almost universally found in all acute viral hepatitis.[2]
Hepatitis-A is a self-limiting disease and there is no specific treatment for hepatitis-A. The treatment is usually symptomatic and supportive.[4]
Ayurveda mentions a clinical condition named Kamala. If a patient of Pitta, indulges in Pittavitiating diet and regimen, thePittaso aggravated burns theRaktaand theMamsadhatuto cause the disease Kamala.
Its clinical features[5] are हारिद्रनेत्रः स भृशं हारिद्रत्वङ्नखानन: (the eyes, skin, nails and face of the patient become exceedingly yellow), रक्तपीतशकृन्मूत्रो (stool and urine become reddish-yellow in colour), भेकवर्णो (complexion develops a colour similar to that of a frog), हतेन्द्रियः (the senses get impaired), दाह (burning sensation), विपाक (indigestion), दौर्बल्य (weakness), सदन (prostration), अरुचि (anorexia). Acharya Charak has mentioned “कामली तु विरेचनैः” as Chikitsa Sutra.[6]
Pitta Prakopa and Rakta Dushti are responsible for Kamala and timely planned Virechan along with Shamana Chikitsa helps to get rid of vitiated Pitta and Rakta.
Case Report
A 19-year-old male patient presented with low grade fever, yellowish discolouration of eyes and urine, loss of appetite, vomiting 4-5 per day, indigestion, bloating, fatigue along with itching all over the body and gradual weight loss since six days, had visited Swasthavritta OPD on 28/12/2024.
The condition was diagnosed as Hepatitis A as per his blood investigation reports dated 27/12/2024 – HAV-IgM – 6.57 s/co. Patient was on paracetamol 500mg qid prior coming for Ayurvedic management. The assessment of the patient’s conditions was done based on symptoms, supported by blood investigation reports and Ayurvedic parameters, the condition was diagnosed as Kamala.
Clinical findings
The patient’s immediate vitals revealed hemodynamic stability with heart rate of 84/min, respiratory rate of 18, temperature 99°F, axillary, blood pressure of 140/86, and oxygen saturation of 100% on room air. His physical exam revealed a well-nourished, diffusely jaundiced male in no acute distress. The patient was alert and oriented and answered all questions appropriately, albeit with short answers. Apparently scratched his body (pruritus) during the whole examination.
Further examination revealed prominent bilateral yellow discoloration of the eyes (i.e., scleral icterus) and abdominal examination demonstrated a mildly distended abdomen with mild tenderness in the right upper quadrant. There were no other indications of peritonitis and the remainder of the physical examination was within normal limits.
Further questionnaire revealed a past history of dengue 2 months back, and frequent attacks of fever once in every month that lasted for 2 days, sweats a lot, short tempered and had visible greying of hair. (revealing his Pitta Prakriti Lakshana)
Astavidha Pariska revealed Nadi of 84/min, a Vikruta Varna Mutra (Peetha Varna-yellow coloured urine), a Vikruta Varna and Katina Mala (dark and hard stools), Alpasama Jihwa (mild coated tongue), Madhyama Shabda (mild feeble voice), Ushna Sparsha (warm on touch), Peetha Varna Drik (yellow coloured sclera), and a Pravara Akriti (71 kgs).
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