can i travel to europe if my daughter is showing signs of jaundice
Person's Gender: Female
only an spasmodic
Hi I can talk with you. Does she have diarrhea? Jaundice is yellowing of the skin, why do her doctors feel she is jaundiced? From Hepatitis A infection?
no her skin is not yellow but her bilirubin is high in urine
What about in her blood level? What are her symptoms right now?
i didn't get the results of blood yet n she seems fine except for little pain in her stomach
Is this why she had the urine taken to rule out a urine infection?
ya coz of stomach pain
Does she also have diarrhea?
even the stool was tested
What was stool tested for?
is it safe to travel with her
I'm sorry I'll ask in a better way, what organisms did they look for in the stool, parasites, or bacteria do you know?
So bilirubin is not supposed to be in the urine. When levels in the blood are high however this is where the body will excrete in as well as in the stool.
color, mucous, pus cells,ova,cyst
Thanks. Did she have a urine "dip test" only or was this test that was showing bilirubin done in a lab. Most dips are done directly in the doctors office as it is quick and easy to do.
no it was done in lab
Probably it was urobilinogen that was high correct? ( which is a byproduct of bilirubin)
So with no symptoms besides the tummy pain you have only basically the elevated bilirubin products in the urine that is concerning. Do you know if she was vaccinated against Hep A?
Has she had any blood in her urine or a dark color to it?
ya she was vaccinated n there is no blood but the urine is slightly dark yellow in color
She had the 2 shots in the series?
i didn't get u
The dark yellow color may just be more concentrated urine due to a change in how she is drinking. Sorry Hep A is a series of 2 shots, separated by at least 6 months. She got both shots from what you know?
ya she was given both the shots
How long and where are you going to in Europe?
we r taking a europe tour for 15 days which covers around 8-9 countries
Wow, when is it scheduled for?
but now its not wow its scheduled on 26th of july that is just one day from today
So the most common cause for acute or quick onset jaundice in kids is really Hepatitis A infection (which may give just mild infection or make someone quite sick, usually stomach symptoms and jaundice). If she were to have this infection it would not be a good idea to travel at all as she may be contagious and infect others. It is possible but much less so, to get it after receiving both shots in the series.
Her symptoms are not at all exciting or serious and from what you say it sounds like she would be able to physically feel good enough to tolerate the trip....but
so shall i wait for the blood test reports
she is not at all tired or weak but m scared n the worst part is we have paid fully for the tour
I would probably wait yes for the blood results. The reason being (they may have sent for Hep A antibodies to test for it particularly), but if it is not Hep A then what is it? All other reasons are somewhat more involved medically and really would be helpful to know sooner rather than later. You may find however (and I am so sorry about the vacation!!!) (maybe I could go instead just joking!) that the blood test is totally normal.
so is it a no for the tour
If this were the case the urine may have not been accurate. I have found many small elevations in the amount of urobilinogen in kids (especially in the dipsticks!) that are not clinically real. She is not clinically jaundiced thus maybe the blood level is not elevated then no scare for Hep A. Without knowing though it wouldn't be a good idea to take her no.
Call the lab that did the testing today (7/25) as I am in Spain and we have 1/2 hr more of 7/24...and push them to have a result for you.
the doc has done liver function test today n m waiting for the results any moment now
Basically the time it takes to do the test is minimal, just the processing time is more. Did the doctor tell you her liver was enlarged at all?
no the doc didn't talk of any such thing
This is good. I am wondering whether the blood level will be normal!
can u wait for sometime
got the results will tell u now
total bilirubin 43.32
Do you have the reference levels of normal for the lab, or at least the units?
pls suggest me something
ya i hav
43 is not normal regardless of units though!
first one is 10-35
second is 10- 35
ya i know bilirubin is high as d normal range is under 17
So the first two are levels of enzymes produced in the liver and when elevated they point to a problem here although ast can be from something else but all together these point to the liver.
Do you have a GGT?
i don't know
So the next step for me would be to test for hepatitis serologies (A,B,C) as an infection with Hep A with her symptoms would be the most common.
ggt 106 n the normal range iw 5-36
ya n they say it will take two weeks to get the results
But to answer your question as your heart is sinking no I would not take her on this beautiful European tour tomorrow! If she has Hep A she morally can't go as she may infect others, and she may get sicker herself and not enjoy it. If the reason the levels are high is something else (much more rare) then she needs to be closer to home. The results for the viral serologies you mean?
With levels like this she probably does have a liver that is enlarged but not all physicians are that good at feeling for one! Is she thin/heavy in terms of body habitus?
she is bit on the heavier side
If it is Hep A then you need to relax and realize that the large large majority of people do not have permanent severe liver damage and clear the virus. So this may make it hard to feel for a liver edge. There is also an epidemic of fatty liver (due to overweight), that can cause hepatitis in kids these days but I have never seen liver enzyme levels this high with a fatty liver.
I'm surprised her eye whites are not yellow to you with this level of bilirubin.
actually she does not have yellowish skin at all
What about her eyes or inside of her mouth?
not even in eyes or mouth
i wanted to tell u that she is on weekly dose of Rifampicin
Amazing, tells you how poor our eyes are at seeing it, (In babies as well!) For TB?
noo for influenza
Influenza is viral and doesn't respond to Rifampin or antibiotics. How long has she been on it for?
for last 3 weeks just once a week n that too 15ml dose
We use Rifampin for severe infections or with other drugs for TB (in a "cocktail") which makes it more liver toxic, but it can affect the liver. There can also be immune response attacking the liver but I would expect her to physically be more sick with this if it was from this. This degree of elevation I haven't seen either with just drug.
so it may not be because of this drug
Really I would keep this in mind, but look to other causes (Hep A) as more likely. I have had many patients on Tb cocktails including Rifampin and what we see is gradual increase in enzymes and again not to this level.
If she is better from her cold symptoms you may ask your doctor if you can stop it as her liver needs kind of minimal work right now. Here is a link to the US National institute of health patient info site for hep A http://www.nlm.nih.gov/medlineplus/ency/article/000278.htm
so what do u say
i plan to stop this medicine for now
I would not recommend you take her on the trip no. Remember that vacations can always be repeated and although it will be financially painful to part with it! (and not to mention the spectacularness of the trip itself) but health is not to be played with. What you all want is to be healthy to enjoy many many more trips like this one!! I agree with you that it would be a good idea to stop it and her doctor should know.
ok thank you so much for ur guidance
You are so welcome. I hope that all turns out well with her! Feel free to write back and keep me updated as these question feeds stay open to additions for many days. Good luck to you and to her. You can always try to get your $ back from the travel company as frequently for medical purposes they will do this. You may qualify based on this!
thanx for the suggestion :)
All the best to you!
US Pediatrician licensed in California living abroad
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