Case Report

Myths in Kala Piliya- A Nick Name of Hepatitis B & C

Parveen Malhotra*, Vani Malhotra, Yogesh Sanwariya, Senti, Harman Singh and Sandeep Kumar

Department of Medical Gastroenterology and Obstetrics & Gynaecology, PGIMS, India

Submission:January 20, 2025;Published:February 06, 2025

*Corresponding author:Parveen Malhotra, Department of Medical Gastroenterology and Obstetrics & Gynaecology, PGIMS, Rohtak, Haryana, India

How to cite this article:Pierluigi T, Davide B, Giorgia C, Nicola Z, Ezio F, et al. Antibiotic Prophylaxis has no Advantage over Surveillance alone in Terms of the Incidence of Mycobacterium Tuberculosis Infection after Liver Transplantation. Adv Res Gastroentero Hepatol, 2025; 21(2): 556063.DOI: 10.19080/ARGH.2025.21.556063.

Abstract

Haryana is one of the states in India which is having high incidence as well as prevalence of Hepatitis B & C, mainly due to unsafe needle practices and intravenous abuse of drugs. This disease is most commonly seen in poor socio-economic status who are illiterate and easily confuse hepatitis B& C with HIV, thus many patients do not come forward for treatment. Thus, for making them understand course of disease and to differentiate hepatitis B & C from hepatitis A & E, former was named as Kala Piliya, so that uneducated people can understand the need of regular follow up. The reason behind naming them as kala piliya was to understand the chronic nature of hepatitis B & C which can persist for long time, just like black colour stain on clothes which can remain for prolonged duration.

Keywords: HBV; HCV; Kala piliya; Black tongue; Black nails; Myths

Introduction

The most common cause of jaundice is viral hepatitis which predominantly is due to hepatitis A & E and followed by hepatitis B & C. Out of all of these hepatitis C is least commonly diagnosed in acute hepatitis stage. The patient becomes aware of jaundice once there is yellowing of sclera or passage of dark yellow coloured urine. There is scarcity of proper health care facilities in developing country like India, especially in rural areas. Thus, majority of patients with jaundice do not get checked causative agent for hepatitis and seek alternative remedies by local unregistered practitioners, we know in acute viral hepatitis, A & E are responsible for eighty percent of cases and remaining twenty percent are due to B & C. Majority of hepatitis A & E will recover completely within two to three months. The hepatitis B & C in significant subset of patients can progress into chronic stage and patients who have not get the causative viral factor in beginning of jaundice, remain unaware of presence of hepatitis B & C virus in their body and come to know about it when they are screened before surgery, screening camps, blood donation camps, antenatal check-up or after development of cirrhosis and its decompensation features like ascites, pedal oedema, haematemesis and melena. When we started running dedicated clinic for free treatment of hepatitis C, followed by hepatitis B in 2010, under Haryana government Jeevan Rekha project, the above fact of getting non tested for variety of viral hepatitis was found to be one of the major culprits behind many cases of hepatitis B & C [1].

Now, the challenge was how to make patients understand the importance of getting tested for viral screen at time of beginning of development of jaundice and regarding complications of chronic hepatitis B & C like cirrhosis and hepatocellular carcinoma. As, majority of patients were poor, uneducated and from village background, so they needed a term which they could easily understand and imbibe. The stain of black colour on clothes can persist for longer duration, thus on same lines they were made to understand that hepatitis B & C can persist for long time in body in comparison to hepatitis A & E which resolves in 2-3 months. Thus, Kala Piliya term was coined by us for hepatitis B & C for easy understanding of the patients [2]. It also helped in greater compliance, as patient after understanding the nature of hepatitis B & C by its nick name Kala Piliya started coming for regular follow up because they were worried for life threatening complications of these deadly viruses. It is always said that every coin has two sides. The term Kala Piliya became so popular in general population and now majority of jaundice patients started getting tested their viral screening to know whether they were suffering from hepatitis B & C i.e. Kala Piliya or Hepatitis A & E i.e. Simple Piliya. Some patients wrongly started thinking that anything black in their body can be attributed to Kala Piliya. Many patients attributed the blackening of nails, tongue, face or passage of high dark colour urine to Kala Piliya. This was over interpretation by patients, may be due to fear of complications but our dedicated treating team was able to allay fear in their mind by repeated counselling and now things are working in right direction (Figure 1).

Black nails can be seen in sudden injury to the nail, or repeated trauma over time, can cause bleeding and swelling under the nail. This is common for runners and athletes who wear ill-fitting shoes. Sometimes a blunt force like dropping a heavy object on foot, can cause blood vessels to break and pool under the nail. It can also be seen in fungal infections like Onychomycosis which can cause the nail to become thick, brittle, and discoloured. It can be more likely to occur in people with diabetes, psoriasis, or athlete's foot. Other causes can be lack of vitamin B12, drugs, such as psoralens, phenytoin, sulphonamides, and antimalarial or in melanoma, diabetes, peripheral arterial disease, lichen planus, malnutrition, thyroid disorders, smoking, and hemochromatosis. Black tongue, also known as black hairy tongue (BHT), can be caused by a number of factors like poor oral hygiene i.e. not cleaning tongue and mouth properly which leads to buildup of keratin, food particles, and debris on the papillae, or small bumps, on the tongue. Other reason is soft diet that doesn't help rub dead skin cells off the tongue, thus contributing to black tongue. Certain medications like antibiotics and antipsychotics are also responsible for BHT. Mouthwashes that contain oxidizing agents, like peroxide, can irritate mouth and affect the balance of bacteria leading to black tongue. Other causes are Smoking or chewing tobacco, drinking large amounts of alcohol, radiation therapy, dry mouth, and conditions that lower ability to fight infections, such as cancer or HIV (Figure 2).

Conclusion

New innovations are must in treatment, especially in developing country like India where many patients and general public are uneducated. Thus, for better compliance, you have to communicate in their language and terms which they can easily understand but at the same time overinterpretation has to be safeguarded. The use of term Kala Piliya has been game changer in management of hepatitis B & C in India.

References

1. Parveen M, Naveen M, Vani M, Ishita S, Ajay C, et al. (2016) Jeevan Rekha: Counter for Hepatitis C in Haryana. Adv Res Gastroenterol Hepatol 1(3): 555561.
2. Malhotra P, Malhotra V, Gupta U, Sanwariya Y, Pahuja I, et al. (2021) Myths in Liver Disease - Experience at Tertiary Care Centre of Northern India. Japanese J Gstro Hepato V6(18): 1-4.