Which kind of hepatitis is the worst kind?

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DEAR DR. DONOHUE: I am very interested in knowing which type of hepatitis is the worst – A, B or C? I have heard that infected fluids (blood and semen) are the primary source for transmitting these illnesses. Can saliva transmit any of the three, through kissing? – C.J.

ANSWER:
I have never heard that hepatitis A, B or C can be transmitted through kissing.

Hepatitis A is usually transmitted by food or drink contaminated with the hepatitis A virus. It can produce an acute illness that makes a person very sick and, on occasion, even can lead to death. Most infected people recover completely. It doesn’t cause chronic liver disease, cirrhosis or liver cancer, as the other two can do.

Hepatitis B is passed through unsterile needles, most often in the setting of injecting illicit drugs. It can also be caught through sexual relations, and infected mothers can give it to their infants. Even though the B virus is found in many body fluids – blood, semen and saliva – I am not aware of any saliva-connected infections. Hepatitis B, in addition to making many people acutely ill, produces a chronic (forever) infection of the liver in 5 percent of those who contract it. The chronic infection can evolve into liver cirrhosis or liver cancer. In the United States, hepatitis B is responsible for 100,000 new infections every year and around 6,000 deaths.

Hepatitis C, like B, can be caught through sharing dirty injection needles, and infected mothers can give it to their babies. It might be transmitted through sex, although this is not the usual way of acquiring the infection. In 9 percent of infected people, the source of infection is never found. It leads to chronic liver infection in 90 percent of its victims, and they can develop cirrhosis or liver cancer after 20 years of being infected with the virus. It causes up to 10,000 deaths yearly in the United States, and it is the No. 1 reason for liver transplantation.

Which is worst? It’s a tossup between B and C. There are vaccines for hepatitis A and B.

DEAR DR. DONOHUE: Please explain the difference between cataracts and glaucoma. Is there any relationship between glaucoma and ethnic background? – R.B.

ANSWER:
A cataract is a smudge on the eye’s lens. The lens of the eye, located about a half-inch behind the pupil, focuses incoming light onto the retina to produce for the brain a visual image. With age, proteins of the lens degenerate to form the smudge, which obscures the visual image. It’s like looking through glasses with a dense, greasy thumbprint in the middle of their lenses. Clear, man-made lenses can replace the smudged lenses.

Glaucoma is a rise in fluid pressure in the front part of the eye. Fluid brings nourishment to structures located there. It’s made constantly, and it constantly drains out of the eye. If drainage is sluggish, fluid pressure builds and compresses the optic nerve, the nerve of sight. If the pressure isn’t lowered, sight is lost. Eyedrops, oral medicines and laser treatments can restore normal fluid dynamics and save sight. (The rise in pressure has nothing to do with blood pressure.)

Black Americans over the age of 40 are at a greater risk of developing the more prevalent kind of glaucoma than are other ethnic groups. Asian-Americans are more prone to get a rarer glaucoma variety – angle-closure glaucoma – than are people of other races.

DEAR DR. DONOHUE: Forty years ago, when I was 6, I had meningitis. I spent two weeks in the hospital. I’d be most grateful if you explained what meningitis is. This past year, I have had several headaches, and I don’t have the energy I used to. Could that be a consequence of my meningitis? – C.G.

ANSWER:
Meningitis is an infection of the meninges (men-IN-jeez), three membranes that cover the brain and spinal cord. Bacteria are responsible for most meningeal infections. Viruses can also cause them, but, in the majority of cases, viral meningeal infections are not as dangerous as bacterial infections.

One of the first symptoms is severe headache. The neck becomes stiff, and that’s a valuable sign, showing that the meninges are infected. A high fever is to be expected. Bright light hurts the infected person’s eyes. Vomiting is common. Without prompt treatment, lethargy sets in. If treatment is delayed for a long period of time, coma can follow. Death is possible, but it should seldom happen in this day of powerful antibiotics.

One important test for diagnosing meningitis is obtaining spinal fluid through a lumbar puncture. A needle is inserted into the spinal canal in the lower back, and fluid is withdrawn. If the fluid is filled with white blood cells, that’s a very strong indication that the meninges are infected. The bacterium that’s causing the infection can be isolated from the fluid and tested for its susceptibility to antibiotics so that the appropriate one can be given.

Cure is expected when the infection is treated promptly with the right antibiotic. A few people suffer complications after this infection. Some might have seizures, or a memory deficit, or hearing loss or dizziness. It’s not likely that meningitis in childhood would cause symptoms 40 years later. You’ll have to get your doctor involved in looking for other causes of your current symptoms.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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