The infectious disease, historically the author, who first described the pathology, called viral (epidemic) hepatitis A in children. Although ill they can be any person who does not have immunity, but for this infection of the liver is typically primarily lose children from 5 years old up to 15-16 years, which is associated with features of children’s behavior, their compliance with the rules of hygiene and frequent stay in organized groups. The infection referred to as a “disease of dirty hands” in connection with the peculiarities of its transfer in the population
Overview of pathology in children
Hepatitis a refers to an acute infection with stage cyclical flow. Provoked by the infectious disease virus, belonging to the group of RNA, resistant to vneshnetorgovy conditions. The main characteristic of the infection is a transient formation of symptoms of intoxication, the liver with the development of acute inflammatory process and relatively quickly corrected impaired functioning of the liver.
For infection in childhood is typically benign.
This kind of hepatitis are referred to children’s pathologies, they are ill preschoolers, school children and Teens. This is due to the active study of the world, close contacts among themselves and often neglect elementary rules of hygiene (unwashed hands, fruit, drink the water of their common bottle). Viral hepatitis a develops quite quickly in children period from infection to manifestation of symptoms is relatively shorter in the adult.
It is important
Often, although the symptoms are unpleasant and pronounced, ending the inflammatory process safely, without complications and consequences. Severe and unfavorable course possible for some groups of the child population – newborns, kids with immune deficiencies and those who have liver disease, concomitant severe somatic and infectious pathology.
The disease lasts up to six months, but the period of anatomical and functional recovery of the liver, as the main affected organ, can last up to six months. At this time it is recommended compliance gentle treatment and a special diet in order not to cause the overload has not yet fully recovered to the liver.
As the child may get infected by virus?
For children and is characterized by its own peculiarities in the ways of penetration of the virus into the body. The route of transmission – fecal-oral, that is, the infection enters the body through the digestive system – if it is infected food or water, and dirty hands, which the children eat, not washing them after streets, visiting the toilet, or communicating with animals. The probable outbreak of hepatitis in the children’s groups, where there is centralized power supply, if the children ate the same food and drinks. Nominated version of the infection by droplet infection (like a cold), and vertical (mother to fetus) and parenteral (via injection) in the clinical practice of physicians such cases were registered, but they’re usually exceptions, rather than the main transmission path.
The main source of viruses to others – infected adult or child, it viruses detected in faeces, blood and urine even before the emergence of jaundice, the maximum transmittable be sick in predzheltushnogo period, when the typical General, non-specific, similar to the common cold and other symptoms of the disease. As the coloration of the whites of the eyes and skin a yellowish color, the isolation of the virus into the environment progressively decreases.
It is important
The maximum contagious child with hepatitis becomes in the first three days of illness, after two weeks from the end of the incubation period a child can be considered non-contagious, it is not dangerous in terms of infection of others.
According to physicians for hepatitis A is characterized by seasonality of the disease, the greatest number of cases observed during the autumn and winter season. In case of successful overcoming of the infection the child develops a persistent and lifelong immunity, the second time the infectious disease no longer hurt.
The main cause of the infection
Children are almost 100% susceptible to hepatitis A virus, but the disease is considered relatively easy among all the hepatitis, and it has a favourable prognosis and outcomes. The main causative agent of Botkin’s disease is considered to be a hepatitis A virus having a high activity and stability in the external environment. It belongs to the genus of Enteroviruses, the family of Picornaviruses, it contains a molecule of RNA and proteins, ensuring its properties. Has common for all genotipov virus antigen (HAAg), which was used for the tests can detect it doctors. It is up to 90% cases detected in the faeces, called faecal antigen.
High infectivity of the virus contribute to its special properties – it is resistant to adverse environmental factors, including gastric acid and enzymes of the intestine. In dry areas and on the surface of food, it can survive up to several months in faeces up to 30 days in ponds with fresh water up to six months. It is sensitive to boiling water, steam processing and ultraviolet radiation.
Cause diseases becomes jaundice in children penetration of the pathogen into the digestive system. He calmly passes the mucous membranes of the mouth, stomach and intestines, soaked in blood, enters liver cells and reproduces inside them. The incubation period from penetration of the virus into the body until the first symptoms lasts about 30 days, less extended to 45-50 days, and during this period the liver cells are destroyed actively reproducing viruses.
With the onset of jaundice is formed by the gradual recovery of the liver tissue and the process turns to recovery, which is explained by the activation of the immune system in fighting viral particles. By this time the immune system learns to recognize the antigen HAAg on the surface of viruses and destroys them. The stronger the immune system of the child, the greater and faster are removed from the body of the virus, and together with them destroyed the damaged hepatocytes. This causes the brightness of jaundice because of the disease.
It is important
The faster removed all the damaged hepatic cells, the sooner the child recovers. The liver has strong regenerative capacity, in place of the destroyed cells immediately formed a new functional hepatocytes. This explains the favorable prognosis of the disease.
Stage Botkin’s disease in childhood
All the symptoms of hepatitis a in children will depend on the degree of inflammation, as the severely damaged liver cells and what is the main form of pathology. Classification stand out:
- Acute icteric infection
- Busselton subacute form of the disease
- Atypical (subclinical) hepatitis with virtually no external symptoms.
Speaking of classically occurring in children of Botkin’s disease, it sequentially (in cycles) is followed by several phases of the disease. In each of these phases will be typical of your set of symptoms and signs, laboratory changes and morphological changes of the liver tissue. Doctors identify the following phases of pathology:
- The incubation period (latent period, since the introduction of the virus into the body until the first signs)
- the prodrome (initial symptoms, usually those of a General nature)
- predzheltushnogo stage, when changes in the liver have already expressed and symptoms of the distinct
- stage jaundice
- postgestosis period
- the period of convalescence (this is the beginning of recovery and the final completion of the disease).
In each of the stages with Botkin’s disease in children has its own particular symptoms and characteristics in comparison with those of adults.
The symptoms of Botkin’s disease in children
The incubation period averages about two weeks, and no symptoms at this time are not available, the child looks quite healthy. But if the conduct of laboratory studies, can be allocated specific antigen HAAg, as well as increasing the activity of enzymes ALT and AST.
In pricelessly period can be formed, the first signs of infection, her symptoms of hepatitis And in children the symptoms appear quite abruptly, but no specific manifestations, they are common. Are formed symptoms of intoxication and a high temperature, headaches and nausea, sudden decrease in appetite. Can also be formed digestive disorders – vomiting, which occurs after a meal, bringing relative relief, but the nausea is back again, and can be a pain on the right side of the abdomen, usually in the upper quadrant.
Also formed bloating with flatulence, can be both diarrhea and constipation, symptoms of dyspepsia (disturbed digestion). Symptoms mistaken for poisoning, especially given some relief after a couple of days when the temperature is declining but remain indications of digestive disorders, fatigue with weakness.
It is important
Against these manifestations of the parents note the change of colour of faeces and urine, and stool is light and urine is much darker, acquiring the color of dark beer. This symptom is most typical for hepatitis, and it is necessary to pay attention of a doctor.
This is important because hepatitis in children may have atypical course, without the pains in my side and febrile reactions, and thus only due to changes in color of urine and stool can detect the presence of Botkin’s disease.
The most striking manifestation of Botkin’s disease is the development of jaundice, in which the painting forms the protein shell of the eyes and skin of the face, neck and body in a yellow tint typical of hepatitis. The more pronounced liver damage, the more the immune system suppresses the virus and destroys the affected cells, respectively, and the yellow is the skin. While the General condition of the children are relatively normal, although the liver is enlarged in size, and again change the color of stool and urine. Are sharply inclined from the normal parameters of bilirubin, protein fractions and levels of transaminases.
At the end of the period of jaundice is much improved condition and General wellbeing of children, they have a restored appetite, normal sleep and activity, a sign of the end of the period of jaundice is the restoration of normal color of stool and urine.
The period of convalescence (clinical and laboratory recovery) appears in the restore as functionality, and anatomy of the liver, so this time is important to limit the load.
Under normal appearance and General state of the typical fatigue, occasional discomfort and pain in the right hypochondrium. On average, this period lasts 2-6 months, it depends on how hard and long was struck by the liver.
The methods of detection of hepatitis A in children
The main diagnostic criteria that help to identify viral infection, are getting symptoms that you need to pay attention to parents. So, it is important in the diagnosis of Botkin’s disease indication of contact with patients with similar symptoms, as well as being in the focus of hepatitis. In addition, it is important to collect all details of the complaint, which occurred earlier at toddler or an older child. Especially important are instructions in the period when there is no jaundice, but the health is severely disrupted.
The basis of diagnosis of hepatitis is laboratory analysis of the General profile and specific research. An important General analysis of blood and urine, biochemical their study, blood clotting, liver function tests and determination of the fractions of bilirubin, transaminases, feces analysis.
Complementary methods of detection of virus antigens and to him – PCR of blood, definition of HAAg in the stool, and a study of instrumental methods liver ultrasonography.
The basics of treatment of hepatitis A in children
Hospitalization of children with infectious disease today is practiced infrequently, the diagnosis is usually revealed in the period of jaundice, when the child is no longer contagious to others and his condition is stable enough and satisfactory. Plus being in the hospital, provided that the child is normal feeling is stress, which leads to reduced immunity and reduces the ability of body to fight infection. Plus there is always the risk of secondary nosocomial infection already. Therefore, when a fairly stable and satisfactory condition of children treated at home.
The complex assignments for hepatitis includes a number of activities symptomatic plan:
- lightweight motor mode, with strict bed rest in the first 8-10 days of illness, when the condition of the most severe, and after the ending jaundice, is necessary to limit outdoor games and activities, leading to fatigue.
Excludes sports and physical education in school for six months.
- special diet number 5 or 5A by Pevsner, which involves unloading the liver. From food to eliminate all heavy and spicy, fatty dishes, fried foods and all those that burden the liver. Shown taking dairy foods that undergo heat treatment, lean meat and fish, steam or baked. Shows the use of cereals and grains, pasta, vegetables, salads with vegetable oil and beverages, not irritating the liver. It is important to keep the ratio of protein, fat and carbohydrate components, apply a generous alkalizing drink.
- apply cholagogue vegetable infusions and decoctions, pills with herbal ingredients that stimulate the flow of bile.
- replenish reserves of vitamins, especially group b, ascorbic acid, vitamin E, are antioxidants.
- reception hepatoprotectors of plant-based, which helps to restore the liver.
Throughout the treatment until complete recovery, the child must be on the account at the doctor, who strictly monitors his condition, power mode and periodically assigns the control tests. They go through 40 days since the onset of the disease, then after 3 months. After six months, the child is removed from the dispensary, it is considered to be healthy (assuming full normalization of blood counts).
Prevention methods Botkin’s disease in children
The basis of preventive measures that prevent the epidemic of hepatitis A is strict compliance with all sanitary rules, especially regarding personal hygiene of children. This they should teach the parents, monitoring the adherence to all activities. Plays a significant role and compliance with sanitary norms and rules in catering, to prevent the spread of infection from food and water, an important quality control products and drinking water, as well as the kitchens and the health of employees. For children also developed for preventive vaccination against hepatitis A, although it is not included in the list of mandatory vaccinations according to the calendar, it is strongly recommend that children.
When and how is the vaccine
In many European countries it refers to the compulsory, in our country it is carried out by epidotization or at the request of parents, the advice of a doctor, especially when going on holiday to countries where the infection is widespread.
Doctors give recommendations to implement the vaccine before starting kindergarten or school, as the risk of infection in organized groups above, including full-time or extended stay within the walls of institutions.
To carry out vaccination in advance, to have time to develop immunity to the disease, it is at least two to three weeks before the release of the team. The vaccine will be useful for kids who plan on staying in school camps, sanatoriums or in countries where wet and hot climate. Vaccination of those children whose parents are ill with hepatitis, and this measure will be most effective in the first week after contact with a sick person. The vaccine is well tolerated, possible lung ailments that are valid on the background of vaccination. On average, immunity lasts up to 6 years, but there are medications that can create a protection of up to 10 years or more.
Parezca Allen, pediatrician, medical columnist