Hepatitis A in acute form. Treatment of hepatitis B

Hepatitis A, also called Botkin's disease, is a viral disease of liver cells, manifested by jaundice and intoxication. Unlike other forms of hepatitis, hepatitis A does not contribute to the chronicity of liver cell damage and very rarely causes death in people. You can overcome the symptoms of the disease in just 2 weeks, and it will also take about one to two months to normalize the structure and function of the liver after the disease.

Not among the population certain group persons who would be more susceptible to the disease than others, absolutely everyone, in equal conditions are at risk of the disease: children, men, women of different social status and age. Moreover, children aged from one year to 10 years have a particularly easy tolerance to the symptoms of the disease, while old people and babies in their first year of life suffer from a complicated form.

What it is?

Hepatitis A is an RNA virus that belongs to the family Picornoviridae, genus Enteroviruses. Its size is 27-30 nm. The virus does not have an envelope. Typing was carried out in 1973. Further, four more genotypes of the human virus and three genotypes of monkeys were identified.

It has been established that, regardless of genotypes, all type A viruses have similar antigenic, immunogenic and protective properties. That is, one serotype of a virus is determined by the same standard sets of reagents and can be prevented by the same vaccines.

Kinds

The following forms of viral hepatitis A are known:

icteric;
with erased jaundice;
anicteric.

A separate subclinical (inapparent) form is distinguished, which is diagnosed only on the basis of laboratory test results.

The course of the disease can be acute, protracted, subacute and chronic (extremely rare). Spicy infectious hepatitis by severity clinical manifestations can be light, medium and heavy.

How is hepatitis A transmitted?

The source of infection are sick people at the stages of subclinical course and initial manifestations of the disease, including those with anicteric form. After staining the sclera and skin, contagiousness is significantly reduced. In the third week of pathogenesis, dangerous virus is isolated only in 5% of patients.

The period of infectivity, taking into account the incubation period, lasts about a month, less often up to one and a half months.

Proven sources of spread of the virus, in descending order:

Contaminated food. This method transmission is of great epidemic importance. However, it is almost impossible to determine the type of dangerous food due to the long incubation period.
Direct contact with the patient. Characteristic of people with undeveloped hygienic skills and people in professional contact with them. This is how the pathogen is transmitted in preschool and school groups, boarding schools for people with disabilities.
Feces, urine, nasopharyngeal discharge. This method of transmission is called fecal-oral. The main proven factors of transmission of the hepatitis A virus include direct contact between a healthy person and a sick person. The virus can also be transmitted through food, water, airborne droplets (some authors exclude), when sexual contacts, for non-sterile intravenous injections, through flies - mechanical carriers of the virus.

Meanwhile, products that are more often factors in transmitting the virus have been identified:

Garden berries in fresh and frozen (after thawing) form, especially if mollusks and slugs are found in the beds, next to the berry plants, which can accumulate the virus if the beds are watered with fertilizer made from human feces.
Products prepared without heat treatment or consumed after storage (salads, vinaigrettes, cold appetizers, dried fruits and berries, especially from Kazakhstan and Central Asia);
Aerosol. Hypothetically possible in children's groups when outbreaks are layered respiratory diseases in groups with reduced resistance. The virus is transmitted by coughing, sneezing and secretions from the nasopharynx of a sick person.
Water. Typical for areas with undeveloped communal infrastructure, poor organization of water supply, sewerage and Wastewater. The risk of infection increases significantly during accidents and natural disasters.
Parenteral. Transmission of the virus through blood transfusions and intravenous administration of solutions cannot be ruled out, especially in an environment where sterility is not maintained (drug addicts).
Transmissible (transmission of the virus through flies). Researchers do not exclude the possibility of transmission of infection through flies, but the prevalence of this factor has not been studied.
Sexual. In the literature it is indicated as possible factor transmission in homosexuals, but the causal relationship between homosexuality and hepatitis A is not deciphered.

Stages of development

There are several variants of the course of hepatitis A. The disease can occur with a typical clinical picture and asymptomatic. In the case of manifest (proceeding with vivid symptoms) forms, several stages are distinguished in the development of the disease.

Incubation period	Lasts 35-55 days, with no symptoms.
Prodromal period	Lasts 3 – 10 days. Manifested by symptoms of general intoxication: weakness, fatigue, lack of appetite, moderate fever. Often, patients develop dyspeptic symptoms in the form of nausea, vomiting, stool upset, and a feeling of heaviness in the right hypochondrium.
Jaundice period	It has varying degrees of severity and lasts 15–20 days. In mild cases, yellowing of the visible mucous membranes occurs; in severe jaundice, the color of the skin changes. With the development of jaundice, most patients feel better. The urine darkens, its color is compared to dark beer or tea leaves. Some patients experience discolored stool.
Recovery period	It occurs after the disappearance of jaundice and lasts 2-4 weeks. At this time normalization occurs functional indicators liver, the liver itself shrinks to normal size.

After infection, persistent lifelong immunity is formed. Is it possible to get hepatitis A again? This is impossible; after suffering from the disease, the body produces cells that protect against re-infection.

Symptoms of hepatitis A

Viral hepatitis A usually begins acutely. The prodromal period can occur in different clinical variants: dyspeptic, febrile or asthenovegetative.

The febrile (flu-like) form of the prodromal period is characterized by:

increased body temperature;
general weakness;
headache and muscle pain;
sore throat, dry cough;
rhinitis.

In the dyspeptic variant of the pre-icteric period, the manifestations of intoxication are mild. Patients usually complain about various disorders digestion (belching, bitterness in the mouth, bloating), pain in the epigastrium or right hypochondrium, defecation disorders (constipation, diarrhea or their alternation).

The asthenovegetative form of the prodromal period in viral hepatitis A is not specific. Manifested by weakness, lethargy, adynamism and sleep disorders.

The transition of the disease to the icteric stage is characterized by an improvement in general condition, normalization of body temperature against the background of the gradual development of jaundice. However, the severity of dyspeptic manifestations in the icteric period not only does not weaken, but, on the contrary, intensifies.
In severe cases of viral hepatitis A, patients may develop hemorrhagic syndrome (spontaneous nosebleeds, hemorrhages on the skin and mucous membranes, petechial rash).

Palpation reveals a moderately painful liver protruding from the hypochondrium. In approximately 30% of cases, there is an enlarged spleen. As jaundice increases, stool becomes lighter and urine becomes darker. After some time, the urine acquires a rich dark color, and the feces become light gray in color (acholic stool).

The icteric period gives way to the stage of convalescence. Gradual normalization is taking place laboratory parameters and improvement of the general condition of patients. Last recovery period maybe up to six months.

Diagnostics

Diagnosis of hepatitis A is based on clinical signs of the disease: liver enlargement, jaundice and other symptoms. The doctor also takes into account epidemiological factors, that is, how the infection is contracted (consumption of unboiled water, products of unknown purity, and so on).

Laboratory tests are crucial. Disease-specific tests:

polymerase chain reaction to detect viral genetic material;
enzyme immunoassay for detecting antibodies to pathogens of the IgM class.

If only antibodies are detected in the body IgG class- this indicates a previous disease or immunity to it. The chronic form of the disease does not occur, but there are cases of healthy virus carriers.

Nonspecific laboratory signs of the disease in women and other groups of patients are necessary to assess the severity of the infectious process and the effectiveness of prescribed drugs:

ALT and AST;
bilirubin and its fractions (direct, indirect);
serum protein level, fibrinogen.

Ultrasound is used to determine the size of the liver.

Complications

Hepatitis A rarely causes complications; usually the disease ends in complete recovery. The most severe complication of Botkin's disease is liver failure. After recovery from hepatitis A, strong immunity usually remains and re-infection is not possible. However, if treatment is not completed and complete recovery has not occurred, a second wave of the disease may occur - a relapse. This happens in 15% of people with Botkin's disease and can occur repeatedly.

Liver failure is a rare and potentially life-threatening complication of hepatitis in which the liver may stop functioning normally. The following groups of people are usually affected by it:

people with weakened immune system(as a result of a chronic disease such as diabetes or a side effect of certain treatments such as chemotherapy).
people with existing liver disease such as cirrhosis or hepatitis C (a more severe type of hepatitis);

Some symptoms liver failure Symptoms are similar to hepatitis A and include jaundice, nausea and vomiting.

Treatment of hepatitis A

Patients diagnosed with Hepatitis A are subject to immediate hospitalization infectious diseases department. The duration of isolation of patients is at least four weeks.

During periods of development and height of the disease, bed rest is mandatory. Patients are prescribed a diet consisting of easily digestible foods enriched with vitamins. For hemorrhagic phenomena, Vikasol is prescribed intramuscularly, and vitamin K orally. In case of prolonged severe disease, as well as in the presence of itching, corticosteroids are prescribed (most often prednisolone), and glucose solution is administered subcutaneously and intravenously. In complicated cases, as well as in the presence concomitant diseases, antibiotics are prescribed (terramycin, penicillin, etc.). To improve the flow of bile, repeat duodenal intubation is performed.

Treatment of patients with toxic dystrophy is complex, including glutamic acid, corticosteroid hormones, neomycin, low-protein diet with plenty of fluids.

In the majority of recorded cases, Hepatitis A ends in complete recovery, and this also applies to severe cases. However, there are patients in whom this disease acquires chronic course, characterized by periodic exacerbations with disruption of adequate liver functioning.

Hepatitis A can become chronic due to late hospitalization, various violations dietary and hygienic regimes, mental and physical stress, consumption of alcoholic beverages, as well as in the case of associated diseases (gastroenterocolitis, influenza, etc.). These forms can result in death for patients with symptoms of liver failure.

Vaccination

Fortunately, there is a vaccine that can reduce people's sensitivity to the hepatitis A virus, but it is not included in the mandatory vaccination schedule due to its high cost. There are two types of preventive vaccines:

a solution based on a neutralized virus that provokes the disease;
immunoglobulin containing antibodies to hepatitis and other diseases (infections) derived from donated blood. It is administered by dropper to people living in the same area as the patient, in urgently the first days of discovery of the disease. This procedure significantly reduces the risk of infection.

Immunoglobulin is administered most at risk infection to population groups:

military personnel;
refugees;
medical workers;
people working on mass food production;
traveling to third world countries where many cases of the disease are reported.

Diet

The basis for the treatment of all diseases of the digestive system is balanced diet. The diet for hepatitis A begins during the development of the disease and continues after recovery for several more months.

How do patients eat?

You cannot reduce the amount of proteins, fats and carbohydrates; their ratio must be correct. Only some hard-to-digest animal fats are limited: beef, pork and lamb.
You cannot reduce the calorie content of food; calories must correspond to the physiological norm.
You need to drink the optimal amount of fluid - 2–3 liters of water per day.
Five small meals a day are recommended for patients with hepatitis A.

This dietary regimen must be followed for another six months after recovery. We must not forget that all harmful and spicy foods are prohibited so as not to put a strain on the liver.

Disease Prevention

The risk of hepatitis A infection can be prevented or significantly reduced through vaccination. A vaccine is a preparation containing non-viable viruses, the introduction of which into the body causes the production of antibodies and activation of the immune system. A single vaccination is sufficient to provide protection for several years.

To achieve longer-lasting immunity, the vaccine must be administered twice every 1-1.5 years over a period of 20-25 years.

Viral hepatitis – group viral diseases humans, affecting the liver and manifested by enlarged liver, spleen, jaundice and intoxication. Chronic hepatitis (diffuse inflammatory processes in the liver that last more than six months) are also of a non-viral nature.

Among infectious diseases Viral hepatitis ranks second in number of people affected, after influenza.

Pathogens viral hepatitis:

hepatitis A virus;
hepatitis B virus;
hepatitis C virus;
hepatitis D virus;
hepatitis E virus;
hepatitis F virus;
hepatitis G virus.

Signs that unite viral hepatitis into a single group:

All viral hepatitis is transmitted from person to person.
The main routes of infection are through the blood and the gastrointestinal tract.
All pathogens are viruses that are quite stable in the environment.
The main target organ for all viruses is the liver.
The basis of the disease is the destruction of liver cells - hepatocytes.
For all viral hepatitis, changes in many biochemical parameters and their dynamics are similar.
The principles of treatment are similar for all viral hepatitis.

Classification of viral hepatitis

According to the duration of the process, viral hepatitis is:

acute – up to 3 months (hepatitis A);
protracted – up to 6 months (hepatitis B, C);
chronic – over 6 months (hepatitis B, C, D).

Based on the severity of clinical manifestations, the following are distinguished:

Asymptomatic forms (carriage of the virus is typical for hepatitis B, C, subclinical form can occur with any hepatitis).
Manifest forms (may be icteric or anicteric).

The course and symptoms of viral hepatitis of various forms

Viral hepatitis is characterized by a cyclic and acyclic (with exacerbations) course.

Subclinical forms are detected by chance - during examination of donors, persons in contact with patients with viral hepatitis, and during medical examination. Such patients have no complaints or jaundice. However, the examination reveals an enlargement of the liver and spleen, and an increase in the activity of liver enzymes. The diagnosis can be confirmed using markers of viral hepatitis. The danger of subclinical forms is the possibility of the process transitioning into a chronic form.

The main periods of the disease with a cyclic course:

incubation;
preicteric;
icteric;
recovery.

The length of the incubation period depends on the specific virus, the infecting dose and the reactivity of the body.

Options for the course of the pre-icteric period:

The asthenovegetative variant is characteristic of all viral hepatitis. He appears increased fatigue, decreased performance, weakness, and sometimes sleep disturbances.
The dyspeptic (abdominal) variant occurs in all viral hepatitis. Its main symptoms are loss of appetite, a feeling of heaviness in the epigastric region, bloating, constipation or diarrhea.
The arthralgic variant occurs with viral hepatitis B, C, D. It manifests itself as pain in large joints, but the configuration of the joints and the color of the skin over them remain unchanged.
The pseudo-influenza variant is characteristic of viral hepatitis A and E. Catarrhal syndrome is absent in most cases, but aches throughout the body, increased body temperature, headache.
The allergic variant most often occurs with viral hepatitis B, C, D. It is accompanied by skin rashes, itching and fever.

In most cases, a mixed version of the course of the pre-icteric period occurs.

In the icteric period there are:

The period of increase in clinical manifestations (intoxication, jaundice).
The height of the disease; this period ends with a urinary crisis - at the height of jaundice, the amount of urine increases, it becomes light, and the jaundice decreases.
The period of subsidence of jaundice.

Jaundice appears when the bilirubin level is 1.5 times or more higher than normal. First the urine darkens. Then a slight yellowness of the sclera appears. And the skin is the last to acquire a yellow tint.

The more intense the jaundice, the more serious condition patient, more pronounced intoxication.

The recovery period is the time from the beginning of recovery, the elimination of all clinical symptoms and until all biochemical parameters are completely normalized.

Diagnosis of viral hepatitis

A general blood test indicates the presence of an inflammatory process: the number of leukocytes may increase, a shift may appear leukocyte formula to the left, accelerate ESR.

IN general analysis urine in the pre-icteric period is determined by an increase in the level of bile pigments and urobilin. With the development of jaundice, urine becomes dark in color due to direct bilirubin, and urobilin disappears.

At the height of the disease, stool becomes grayish in color, since it lacks stercobilin, which turns stool brown.

When assessing cytolytic syndrome (liver destruction), the activity of the enzymes alanine aminotransferase (ALAT), aspartate aminotransferase (AST), glutamyl dehydrogenase (GlDH) and lactate dehydrogenase (LDH) is determined.

A violation of the synthetic function of the liver is indicated by a decrease in the level of total protein, levels of prothrombin, fibrinogen, prolongation of prothrombin time.

An increase in cholesterol levels indicates the presence of cholestasis (stagnation of bile).

With viral hepatitis, the level of bilirubin increases, mainly due to direct (bound) bilirubin.

From instrumental methods research for differential diagnosis viral hepatitis with other clinically similar diseases of the liver, pancreas, and biliary tract, ultrasound is widely used.

Specific diagnosis of viral hepatitis consists in identifying antibodies and virus particles that cause specific viral hepatitis.

(Botkin's disease) – acute infectious lesion liver, characterized by a benign course, accompanied by necrosis of hepatocytes. Viral hepatitis A is part of the group intestinal infections, since it has a fecal-oral mechanism of infection. The clinical course of viral hepatitis A is divided into pre-icteric and icteric periods, as well as convalescence. Diagnosis is carried out according to biochemical blood tests, RIA and ELISA results. Hospitalization of patients with viral hepatitis A is necessary only in severe cases. Outpatient treatment includes diet and symptomatic therapy.

General information

(Botkin's disease) is an acute infectious liver injury characterized by a benign course, accompanied by necrosis of hepatocytes. Botkin's disease is a viral hepatitis transmitted by the fecal-oral mechanism, and is one of the most common intestinal infections.

Characteristics of the pathogen

The hepatitis A virus belongs to the genus Hepatovirus, its genome is represented by RNA. The virus is quite stable in the environment, persisting for several months at 4 °C and for years at -20 °C. IN room temperature remains viable for several weeks, dies when boiled after 5 minutes. Ultraviolet rays inactivate the virus in one minute. The pathogen can remain viable for some time in chlorinated tap water.

Hepatitis A is transmitted via the fecal-oral mechanism, predominantly through water and nutritional routes. In some cases, infection through contact and household contact is possible when using household items and utensils. Outbreaks of viral hepatitis A through waterborne infection usually occur when the virus enters public water reservoirs; foodborne infection is possible through consumption of contaminated vegetables and fruits, as well as raw shellfish living in infected water bodies. Implementation contact and household path typical for children's groups, where insufficient attention is paid to the sanitary and hygienic regime.

Natural susceptibility to the hepatitis A virus in people is high, the highest in pre-pubescent children, post-infectious immunity is intense (somewhat less tension is typical after a subclinical infection) and long-lasting. Infection with viral hepatitis A most often occurs in children's groups. Among adults, the risk group includes employees of preschool and school children's catering departments, as well as medical and preventive institutions and sanatorium-resort institutions, and food factories. Currently, collective outbreaks of infection among drug addicts and homosexuals are increasingly observed.

Symptoms of viral hepatitis A

The incubation period of viral hepatitis A is 3-4 weeks, the onset of the disease is usually acute, the course is characterized by a successive change of periods: pre-icteric, icteric and convalescence. The pre-icteric (prodromal) period occurs in various clinical variants: febrile, dyspeptic, asthenovegetative.

The febrile (flu-like) variant of the course is characterized by a sharply developed fever and intoxication symptoms (the severity of the general intoxication syndrome depends on the severity of the course). Patients complain of general weakness, myalgia, headache, dry cough, sore throat, rhinitis. Catarrhal symptoms are moderately expressed, redness of the pharynx is usually not observed, they may be combined with dyspepsia (nausea, loss of appetite, belching).

The dyspeptic variant of the course is not accompanied by catarrhal symptoms, intoxication is mild. Patients complain mainly of digestive disorders, nausea, vomiting, bitterness in the mouth, and belching. Dull moderate pain in the right hypochondrium and epigastrium is often noted. Possible defecation disorder (diarrhea, constipation, their alternation).

The pre-icteric period, which proceeds according to the asthenovegetative variant, is not very specific. Patients are lethargic, apathetic, complain of general weakness, and suffer from sleep disorders. In some cases, prodromal signs are not observed (latent variant of the pre-icteric period), the disease begins immediately with jaundice. If there are signs of several clinical syndromes, they speak of a mixed variant of the course of the pre-icteric period. The duration of this phase of infection can range from two to ten days, on average usually prodromal period takes a week, gradually moving into the next phase - jaundice.

The icteric period of viral hepatitis A is characterized by the disappearance of signs of intoxication, subsidence of fever, and improvement in the general condition of patients. However, dyspeptic symptoms, as a rule, persist and worsen. Jaundice develops gradually. First, darkening of the urine is noted, the sclera, mucous membranes of the frenulum of the tongue and soft palate. Subsequently, the skin turns yellow, acquiring an intense saffron hue (hepatic jaundice). The severity of the disease may correlate with the intensity of skin coloring, but it is preferable to focus on dyspeptic and intoxication symptoms.

In severe cases of hepatitis, there may be signs hemorrhagic syndrome(petechiae, hemorrhages on the mucous membranes and skin, nosebleeds). On physical examination, a yellowish coating is noted on the tongue and teeth. The liver is enlarged, moderately painful on palpation, and in a third of cases there is an enlarged spleen. The pulse is somewhat slow (bradycardia), arterial pressure downgraded The feces lighten up to complete discoloration at the height of the disease. Besides dyspeptic disorders, patients may complain of asthenovegetative symptoms.

The duration of the jaundice period usually does not exceed a month, on average it is 2 weeks, after which the period of convalescence begins: there is a gradual regression of clinical and laboratory signs of jaundice, intoxication, and the size of the liver normalizes. This phase can be quite long, the duration of the convalescence period usually reaches 3-6 months. The course of viral hepatitis A is predominantly mild or moderate, but in rare cases severe forms of the disease are observed. Chronicity of the process and virus carriage are not typical for this infection.

Complications of viral hepatitis A

Viral hepatitis A is usually not prone to exacerbations. In rare cases, infection can provoke inflammatory processes in the biliary system (cholangitis, cholecystitis, biliary dyskinesia and gallbladder). Sometimes hepatitis A is complicated by a secondary infection. Severe complications from the liver (acute hepatic encephalopathy) are extremely rare.

Diagnosis of viral hepatitis A

A general blood test reveals a decreased concentration of leukocytes, lymphocytosis, and an increased ESR. Biochemical analysis shows a sharp increase in aminotransferase activity, bilirubinemia (mainly due to conjugated bilirubin), reduced content albumin, low prothrombin index, increased sublimate and decreased thymol samples.

Specific diagnosis is carried out on the basis of serological methods (antibodies are detected using ELISA and RIA). In the icteric period there is an increase in Ig M, and in the convalescent period - IgG. The most accurate and specific diagnosis is detection of viral RNA in the blood using PCR. Isolation of the pathogen and virological study possible, but due to the complexity of the overall clinical practice inappropriate.

Treatment of viral hepatitis A

Botkin's disease can be treated on an outpatient basis, hospitalization is carried out when severe forms oh, and also - for epidemiological reasons. During the period of severe intoxication, patients are prescribed bed rest, diet No. 5 (in the version for acute course hepatitis), vitamin therapy. Meals are fractional, excluded fatty food, products that stimulate bile production, dairy and plant components of the diet are encouraged.

A complete exclusion of alcohol is necessary. Etiotropic therapy for of this disease not developed, complex therapeutic measures aimed at alleviating symptoms and pathogenetic correction. For the purpose of detoxification it is prescribed drinking plenty of fluids, if necessary, infusion of crystalloid solutions. In order to normalize digestion and maintain normal intestinal biocenosis, lactulose preparations are prescribed. Antispasmodics are used to prevent cholestasis. If necessary, UDCA (ursodeoxycholic acid) drugs are prescribed. After clinical recovery patients are on dispensary observation see a gastroenterologist for another 3-6 months.

In the vast majority of cases, the prognosis is favorable. In case of complications from the biliary tract, the cure is delayed, but with false therapy the prognosis does not worsen.

Prevention of viral hepatitis A

Are common preventive actions aimed at ensuring high-quality purification of sources drinking water, control over wastewater discharge, sanitary and hygienic requirements for the regime at enterprises Catering, in the catering units for children and medical institutions. Epidemiological control is carried out over the production, storage, and transportation of food products; in case of outbreaks of viral hepatitis A in organized groups (both children and adults), appropriate quarantine measures are carried out. Patients are isolated for 2 weeks, their infectiousness disappears after the first week of the icteric period. Admission to study and work is carried out upon the onset of clinical recovery. Behind contact persons carry out observation for 35 days from the moment of contact. In children's groups, quarantine is prescribed for this time. The necessary disinfection measures are taken at the source of infection.

Hepatitis A is a liver disease caused by the hepatitis A virus. The hepatitis A virus is distinguished by record resistance to external influences: boiling - inactivation of the virus occurs only after 5 minutes. Chlorine – 30 min. Formalin – 72 hours. 20% ethanol– is not inactivated. Acidic environment(pH 3.0) – does not inactivate, survival in water (temperature 20 o C) – 3 days.

The hepatitis A virus is spread primarily when an uninfected (or unvaccinated) person consumes food or water contaminated with feces from an infected person. The virus can also be transmitted through close physical contact with an infected person, but hepatitis is not transmitted through casual contact between people. The disease is closely linked to a lack of safe water, inadequate sanitation and poor personal hygiene. The sources of the virus are sick people.

The disease can cause significant economic and social consequences in individual communities. To restore people's health so they can return to work, school and Everyday life may take weeks or months.

Chance of getting sick

Anyone who has not been vaccinated or previously infected can become infected with hepatitis A. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur among children early age. Risk factors include the following:

poor sanitation;
lack of safe water;
injection drug use;
living together with an infected person;
sexual relations with a person who has acute infection hepatitis A;
travel to areas with high hepatitis A endemicity without prior immunization.

In developing countries with very poor sanitation and hygiene practices, most children (90%) acquire viral infection hepatitis A before they reach 10 years of age.

In cities where it is easier to comply with hygienic requirements, a person remains susceptible longer, which, paradoxically, leads to a higher incidence of icteric and sometimes severe forms of hepatitis A in city residents. Thus, city residents traveling to countryside, are also a risk group.

Symptoms

The incubation period for hepatitis A usually lasts from two to six weeks, with an average of 28 days. Symptoms of the disease can be mild or severe. These may include elevated temperature, malaise, loss of appetite, diarrhea, vomiting, discomfort in the abdomen, dark urine and jaundice (yellowing of the skin and whites of the eyes). Not everyone infected people all these symptoms appear.

Signs and symptoms of hepatitis A are more common in adults than in children, and the risk of severe disease and death is higher in older adults. Infected children under six years of age usually do not show any noticeable symptoms, and only 10% develop jaundice. Among older children and adults, hepatitis A occurs with more severe symptoms, and jaundice develops in more than 70% of cases.

Unlike hepatitis B and C, hepatitis A does not cause chronic form diseases.

Complications after an illness

Recurrent hepatitis A, observed 4-15 weeks after the onset of symptoms, cholestatic hepatitis A, characterized by jaundice and itching, fulminant hepatitis A (characterized by high fever, severe pain in the abdomen, vomiting, jaundice in combination with convulsions).

The most severe clinical forms viral hepatitis A are cholestatic (cholestasis - literally “stagnation of bile”) and fulminant (fulminant). In the first case, the dominant symptoms are severe jaundice, significant enlargement of the liver and severe itchy skin, the cause of which is irritation of the nerve receptors of the skin by bile components. Stagnation of bile in this form of viral hepatitis A is caused by significant inflammation of the walls bile ducts and the liver in general. Despite the more severe course, the prognosis for the cholestatic form of hepatitis A remains favorable. This cannot be said about the fulminant, fulminant form of the disease, which, fortunately, is quite rare among children and young adults (frequency is a fraction of a percent), but not uncommon in elderly patients (several percent of cases). Death occurs within a few days due to acute liver failure.

Mortality

Mortality from hepatitis A ranges from 1% to 30%, with a clear increase in mortality with age, which is associated with an increase in the likelihood of infection layering on chronic illness liver. Substantial part deaths is registered in patients who are chronic carriers of the hepatitis B virus.

Features of treatment

There is no specific treatment for hepatitis A. Recovery from symptoms caused by the infection may be slow and take several weeks or months. Therapy is aimed at maintaining comfort and proper combination nutrients, including replacement of fluid lost due to vomiting and diarrhea.

Vaccination effectiveness

After vaccination, immunity against the hepatitis A virus is formed in 95% of people within 2 weeks after the first injection and in 100% after the second dose of the vaccine. Even if exposed to the virus, one dose of the vaccine has a protective effect for two weeks after exposure to the virus. However, manufacturers recommend two doses of the vaccine to provide longer-lasting protection—for approximately 5 to 8 years after vaccination.

Vaccines

There are several hepatitis A vaccines available on the international market. They are all similar in terms of how well they protect people from the virus and side effects. There are no licensed vaccines for children under one year of age. All inactivated vaccines are formalin- and heat-inactivated hepatitis A viruses and are the most widely used in the world, and live attenuated vaccines, which are produced in China and used in several other countries.

Many countries use a two-dose vaccination regimen using inactivated vaccine hepatitis A vaccine, but other countries may require one dose of inactivated hepatitis A vaccine to be included in immunization schedules.

Latest epidemics

Hepatitis A virus is one of the most common reasons infections food origin. Epidemics associated with polluted food products or water, can be explosive, such as the Shanghai epidemic in 1988, during which 300,000 people were infected.

Historical information and interesting facts

Epidemic jaundice was first described in ancient times, but the hypothesis about infectious nature Botkin formulated it for the first time only in 1888. Further research led in the 1960s to the distinction between fecal-oral viral hepatitis (A) and serum hepatitis (B). Later, other viral hepatitis were identified - C, D, E, etc. Outbreaks of hepatitis A were first described in the 17th-18th centuries.

The fecal-oral mechanism of spread of the virus was discovered only during the Second World War. In 1941-42 Jaundice became a problem for British troops during the war in the Middle East, when the virus put out about 10% of the personnel. From that moment on, in 1943, in-depth research into the problem began in Great Britain and the USA.

The fact of lifelong immunity to infection in those who have once recovered from it has led researchers to the idea that the serum of those who have recovered from hepatitis A can be used for prevention. Efficiency of use human immunoglobulin(it is believed that the serum of all adults contains antibodies to the hepatitis A virus) was demonstrated already in 1945, when the result of immunization of 2.7 thousand American soldiers was an 86% reduction in incidence.

Hepatitis – inflammatory disease liver. According to the nature of the course, acute and chronic hepatitis are distinguished. Acute cases occur with severe symptoms and have two possible outcomes: complete cure, or transition to a chronic form.

Different types of hepatitis differ from each other different ways infection, rate of progression, severity of clinical manifestations, treatment methods and prognosis for the patient. Hepatitis is characterized by a specific set of symptoms, which, depending on the type of disease, may be more severe than others.

What is hepatitis?

Hepatitis is an acute or chronic inflammatory disease of the liver that occurs due to infection with specific viruses or an effect on the parenchyma of the organ. toxic substances(e.g. alcohol, medications, drugs, poisons).

Viral hepatitis is a group of common and dangerous infectious diseases for humans, which differ quite significantly from each other, are caused by different viruses, but still have common feature is a disease that primarily affects the human liver and causes its inflammation.

The main signs of hepatitis are– abdominal pain, loss of appetite with frequent nausea and vomiting, headache, general weakness and increased body temperature up to 38.8 ° C, and in severe cases - yellowing of the skin and eyes.

Types of viral hepatitis

Hepatitis is classified:

due to development - viral, alcoholic, medicinal, autoimmune hepatitis, specific (tuberculosis, echinococcal, etc.), secondary hepatitis (as complications of other pathologies), cryptogenic (of unclear etiology);
along the course (acute, chronic);
according to clinical signs (icteric, anicteric, subclinical forms).

According to the mechanism and routes of infection, they are divided into two groups:

Having an oral-fecal transmission mechanism (A and E);
Hepatitis, for which blood contact (hemopercutaneous), or, more simply, the path through the blood, is the main one (B, C, D, G - group of parenteral hepatitis).

Depending on the form of hepatitis, the disease may long time disturb the patient, while in 45–55% of cases complete recovery occurs. The chronic (permanent) form of viral hepatitis can bother the patient throughout his life.

Hepatitis A or Botkin's disease is the most common form of viral hepatitis. His incubation period(from the moment of infection to the appearance of the first signs of the disease) ranges from 7 to 50 days.

During this period, a person can infect others. Most symptoms usually disappear after a few days or weeks, but the feeling of fatigue may last for months as the liver returns to normal. It takes several months to fully recover.

Viral hepatitis B

Jaundice occurs as a result of a disorder in the metabolism of bilirubin, which is toxic to the body. When liver function is impaired, it accumulates in the blood, spreads throughout the body, depositing in the skin and mucous membranes and giving them a yellowish color.

Most often, as a result of a violation of the outflow of bile from the liver, part of which enters the blood and spreads throughout the body, itching appears: bile acids, deposited in the skin, greatly irritate it.

In some cases, patients develop so-called lightning acute hepatitis. This is an extremely severe form of the disease, in which there is massive tissue death and extremely rapid development of symptoms. If left untreated, such acute hepatitis ends in death.

Forms of development

During viral hepatitis, 4 forms are distinguished:

Mild, often characteristic of hepatitis C: jaundice is often absent, low-grade or normal temperature, heaviness in the right hypochondrium, loss of appetite;
Moderate severity: the above symptoms are more pronounced, joint pain, nausea and vomiting appear, there is practically no appetite;
Heavy. All symptoms are present in a pronounced form;
Fulminant (fulminant), not found in hepatitis C, but very characteristic of hepatitis B, especially in the case of coinfection (HDV/HBV), that is, a combination of two viruses B and D that cause superinfection.

Complications and consequences for the body

Both spicy and chronic hepatitis can lead to very serious consequences. Among them it is worth especially noting:

inflammatory diseases of the biliary tract;
hepatic coma (ends in death in 90% of cases);
Liver cirrhosis – occurs in 20% of patients with viral hepatitis. Hepatitis B and its derivatives most often lead to cirrhosis;
liver cancer;
extension blood vessels and subsequent internal bleeding;
accumulation of fluid in abdominal cavity– ascites.

Treatment of hepatitis

Treatment of hepatitis depends on the etiological factor that caused inflammatory process in the liver. Of course, hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment.

Standard treatment tactics for hepatitis include:

eliminating the cause of the disease by destroying the virus and detoxifying the body;
treatment of concomitant diseases;
restoration of liver function;
maintaining normal functioning of the organ;
compliance special diet and certain sanitary and hygienic protection measures.

Treatment of acute hepatitis

Treatment must be carried out in a hospital. Besides:

diet No. 5A is prescribed, semi-bed rest (in severe cases - bed rest);
for all forms of hepatitis, alcohol and hepatotoxic drugs are contraindicated;
intensive detoxification infusion therapy is performed to compensate for this
liver function;
prescribe hepatoprotective drugs (essential phospholipids, silymarin, milk thistle extract);
prescribe a daily high enema;
carry out metabolic correction - potassium, calcium and manganese preparations, vitamin complexes.

Diet

Except drug therapy, the patient must follow a diet. Nutrition should be based on the following rules:

complete exclusion of alcohol (including beer);
ban on marinades, smoked meats, spicy and fatty foods;
lean meat and fish are recommended;
You can consume low-fat dairy products.

Antiviral therapy in tandem with diet and bed rest may lead to complete recovery. However, it should be noted that compliance dietary nutrition and therapy is also required after recovery. Otherwise, relapse and transition of the disease to chronic viral hepatitis are practically not excluded.

What to eat:

various teas based on herbs and berries, juices and compotes with a small sugar content;
ground, well-cooked porridge;
various soups and vegetable purees;
low-fat dairy products;
meat and fish must be low-fat varieties steamed;
steam omelette;
bran bread, rye bread, biscuits.

For sweets, you can eat dried fruits, not too sweet jam, honey. Baked apples, bananas and berries in small quantities are useful.

What not to do:

very strong tea, chocolate, coffee;
legumes, mushrooms;
sour, salty, too sweet;
baked goods, puff pastry products, pancakes, pies;
sausages and canned meats;
pork;
hard-boiled and fried eggs.

Prevention

Prevention is necessary so that viral hepatitis does not return, and in case chronic manifestation- did not worsen, did not become complicated. Prevention consists of observing the following rules:

exclusion of alcohol from the diet (completely);
compliance with all doctor’s recommendations (do not skip appointments, take prescribed medications correctly);
diet (exclude fried and fatty, salty and spicy foods, canned food and preserves);
exercise caution when in contact with contaminated biomaterials (applies to healthcare workers), namely, use PPE (protective equipment).

How to protect yourself from hepatitis?

Viral hepatitis often leads to serious and dangerous complications, and their treatment is not only long-term, but also expensive.

Prevention is as follows:

Wash your hands before eating
Boil water before drinking
Always wash fruits and vegetables and heat-treat food
Avoid contact with biological fluids other people, including those with blood
Protect yourself during sexual intercourse (including oral)
Do piercings and tattoos only with sterile instruments in trusted centers
Get vaccinated against hepatitis.