Viral hepatitis a (Botkin’s disease) – an acute infectious liver disease, is characterized by benign course, accompanied by necrosis of hepatocytes. Viral hepatitis a is in the group of intestinal infections, because it has a fecal-oral mechanism of infection. The clinical course of viral hepatitis
And allocate Doulton and icteric periods, as well as convalescence. Diagnosis is carried out according to biochemical blood test results of RIA and ELISA. Hospitalization of patients with hepatitis a only required in severe cases. Outpatient treatment includes diet and symptomatic therapy.
Viral hepatitis a
Viral hepatitis a (Botkin’s disease) – an acute infectious liver disease, is characterized by benign course, accompanied by necrosis of hepatocytes. The infectious disease relates to viral hepatitis transmitted via the fecal-oral mechanism, and is one of the most common intestinal infections.
Characterization of the pathogen
The hepatitis a virus belongs to the genus Hepatovirus, its genome represented by RNA. The virus is quite resistant in the environment is stored for several months at 4 °C and years at -20 °C. To room temperature preserves the viability of a few weeks, killed by boiling after 5 minutes. The UV rays inactivate the virus turn for one minute. The causative agent may temporarily survive in chlorinated water.
Hepatitis a is transmitted via fecal-oral mechanism mainly water and nutritional way. In some cases, it could be infected by contact-household when using the household items, kitchenware. Outbreak of viral hepatitis in the implementation of the water route of infection usually occurs by ingestion of the virus in reservoirs of water for public use, food route of infection is possible by eating contaminated fruit and vegetables and raw shellfish that live in infected water bodies. Implementation of contact-household way characteristic of children’s groups, where insufficient attention is paid to sanitary-hygienic regime.
Natural susceptibility to hepatitis b virus And people high, the highest in children goubernator age, post-infectious immunity stressful (somewhat less tension characteristic occurring after subclinical infection) and long-term. Viral hepatitis And most often occurs in children’s groups. Among adults at risk include employees of the kitchens of preschool and school children, as well as treatment-and-prophylactic and sanatorium-and-Spa institutions, food plants. Currently, there is a growing collective of outbreaks of infection among drug users and homosexuals.
Symptoms of viral hepatitis A
The incubation period of hepatitis A is 3-4 weeks, the onset is usually acute, the course is characterized by a succession of periods: dialtosave, icteric and convalescence. Doulton (prodromal) period occurs in different clinical variants: fever, dyspeptic, and asthenovegetative.
Feverish (flu-like) variant of the flow is characterized by a sharply developed fever and intoxication symptoms (severity obscheintoksikatsionnogo syndrome depends on the severity). Patients complain of General weakness, myalgia, headache, dry cough, sore throat, rhinitis. Catarrhal symptoms are mild redness of the throat are not usually observed, it may be combined with dyspepsia (nausea, poor appetite, belching).
Dyspeptic variant of the flow is not accompanied by catarrhal symptoms, intoxication expressed little. Patients complain mostly for digestive disorders, nausea, vomiting, bitter taste in the mouth, belching. There is often a dull mild pain in the right hypochondrium, the epigastrium. Maybe an upset bowel movements (diarrhea, constipation, alternating).
Dozatory period that runs through asthenovegetative version of little specific. Patients sluggish, apathetic, complain of weakness, suffer from sleep disorders. In some cases prodromal symptoms are not observed (latent option djelturanga period), the disease begins immediately with jaundice. If there are signs of several clinical syndromes, talk about a mixed option, the current djelturanga period. The duration of this phase of the infection can range from two to ten days, in the middle is usually a prodromal period lasts a week, gradually moving into the next phase – jaundice.
In icteric period of viral hepatitis And is characterized by the disappearance of signs of intoxication wears off the fever, improvement of General condition of patients. However, dyspeptic symptoms, as a rule, persists and is getting worse. Jaundice develops gradually. First, note dark urine, yellowish acquire the sclera, mucous membranes of the frenulum of the tongue and soft palate. In the future, yellow skin, acquiring an intense saffron shade (hepatic jaundice). The severity of the disease may correlate with the intensity of staining of the skin, but it is preferable to focus on diarrheal and intoxication symptoms.
In severe hepatitis may experience symptoms of hemorrhagic syndrome (petechiae, bleeding in the mucous membranes and skin, nosebleeds). The physical examination noted a yellowish coating on the tongue, the teeth. The liver is enlarged, moderately painful on palpation, in a third of cases there is enlargement of the spleen. Pulse several Urien (bradycardia), blood pressure is lowered. Cal brightens until the complete discoloration in the midst of disease. In addition to dyspeptic disorders, patients may complain of asthenovegetative symptoms.
Duration of the icteric period, usually not more than a month, the average is 2 weeks., then begins the period of convalescence: gradual regression of clinical and laboratory signs of jaundice, intoxication, normal size of the liver. This phase can be quite lengthy, the duration of the convalescence period usually amounts to 3-6 months. For viral hepatitis And mostly easy or moderate, but in rare cases there are severe forms of the disease. The chronic process and a virus for infection is not typical.
Complications viral hepatitis A
Viral hepatitis A is usually not prone to exacerbations. In rare cases the infection can provoke inflammatory processes in the biliary system (cholangitis, cholecystitis, biliary dyskinesia and gall bladder). Sometimes hepatitis a complicated by the accession of secondary infection. Severe complications from the liver (acute hepatic encephalopathy) are rare.
Diagnosis of viral hepatitis A
In the General analysis of blood, there is a very low concentration of leukocytes, lymphocytosis, elevated erythrocyte sedimentation rate. Biochemical analysis shows a sharp increase in transaminases, bilirubinemia (mainly due to bilirubin), reduced levels of albumin, low prothrombin index, raising and lowering sublimate thymol samples.
Specific diagnosis is based on serological techniques (antibodies are detected using ELISA and RIA). In icteric period marks an increase of Ig M and reconvalescence – IgG. The most accurate and specific diagnosis – identification of virus RNA in blood by PCR. Abjection and virological study possible, but due to the complexity to the common clinical practice is impractical.
Treatment of viral hepatitis A
The infectious disease can be treated as outpatients, hospitalization is performed in severe forms, and on epidemiological indications. In the period of severe intoxication patients prescribed bed regime, diet №5 (in the acute course of hepatitis b), vitamin. Power fractional, eliminated fatty foods, foods that stimulate the production of bile, encouraged dairy and vegetable components of the diet.
It is necessary full exception of alcohol. Etiotropic therapy of this disease are not developed, the complex of therapeutic measures aimed at relief of symptoms and pathogenetic correction. For the purpose of detoxification is appointed plentiful drink, if necessary, the infusion of crystalloid solutions. To normalize digestion and maintain intestinal normalizes prescribe drugs lactulose. Antispasmodics are used for the prevention of cholestasis. If necessary, prescribe drugs UDCH (ursodesoxycholic acid). After clinical recovery patients are at the dispensary supervision by a gastroenterologist for another 3-6 months.
In the vast majority of cases the prognosis is favorable. When complications in the biliary tract cure is prolonged, but about therapy the prognosis is not worse.
Prevention of viral hepatitis A
General preventive measures aimed at ensuring high-quality purification of drinking water, control of wastewater discharge, sanitary and hygienic requirements to the regime in the catering, kitchens and children’s hospitals. Carried out epidemiological control over the production, storage, transportation of food products, outbreaks of viral hepatitis in organized groups (both children and adults) carry out appropriate quarantine measures. Patients are isolated for 2 weeks, their contagious after the first week of jaundice period is winding down. Admission to the studies and work carried out at the onset of clinical recovery. Contact persons for the monitor for 35 days from the moment of contact. In the children’s groups at this time is assigned to the quarantine. The source of infection produces the necessary disinfection measures.
Vaccination against hepatitis A is recommended for children from the age of 1 year and adults, departing in the zones dangerous viral hepatitis A.