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Lethargy and Hepatitis A
Q: Our son just had hepatitis A. He had classic symptoms of being ill. He is improved and doing well. My question is, for a few months now he appears to be lethargic, very unmotivated, and he is in an honors program. We considered taking him for a physical, but then the hepatitis came along and we mentioned it to the doctor, but got no real response from him. He is almost 13 years old, and has grown quite a bit. Could this be his hormones kicking in or something else? He does seem to be getting headaches often, and he never has had much in the way of appetite his whole life. Both my wife and I are in the health profession, but sometimes when it's your own child, you can't be objective. We want to rule out something disastrous, i.e. a brain tumor, etc. His lab work showed high liver enzymes due to hepatitis, but nothing else. Any suggestions, or should we quit worrying?
A: As I'm sure you are aware, hepatitis A is an acute, self-limited illness with fever, tiredness, jaundice (yellow skin), poor appetite, and nausea. It is transmitted person-to-person, resulting from contact with contaminated stool and then ingestion by mouth. The incubation period (how long it takes to show signs of the disease from the time of exposure) is anywhere from2 to 6 weeks. Once someone has the disease, the virus can be shed for up to 1 to 3 weeks, making them contagious to others for the same period of time. The illness usually lasts several weeks, but prolonged or relapsing disease can last as long as 6 months. Chronic infection does not occur.
What you have described with your son sounds like it may all be related. In general, doctors like to give signs and symptoms a single cause. However, you have added headaches into the mix along with concern for disasters like a brain tumor. I don't share your concerns about a brain tumor at this time. A complete physical exam by his doctor along with a more detailed history may help put your minds at ease.
Have you tried talking with him to help figure out what he thinks is going on? Adolescence can be a difficult time for both kids and their parents. Teens often have many things on their minds, accounting for a lack of activity and motivation. Overall, I would "quit worrying" at this point. I would still keep an open mind for further evaluation if, in fact, you do notice a continued significant change in his school performance, his personality, or if any symptoms persist longer than you're comfortable with.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.
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