Viral hepatitis E – a liver infectious nature. The infection is fecal-oral mechanism of transmission is acute, cyclic and quite dangerous for pregnant women. The incubation period of viral hepatitis E can take up to 2 months. The clinical picture of the disease has very much similar with symptoms of hepatitis A.
Differential diagnosis is carried out by detecting specific viral antigens by PCR. Parallel is a survey of the state of the liver (ultrasound, hepatic biochemical tests, MRI of the liver). Treatment of viral hepatitis E includes diet therapy, symptomatic and detoxification treatment.
Viral hepatitis E
Viral hepatitis E – a liver infectious nature. The infection is fecal-oral mechanism of transmission is acute, cyclic and quite dangerous for pregnant women. Hepatitis E is mainly distributed in tropical countries and regions where the supply of clean water is not enough (Central Asia).
Characterization of the pathogen
The hepatitis E virus belongs to the genus Calicivirus is an RNA-containing, has a lower resistance to weathering than the virus of hepatitis A. the causative agent is still viable at 20 °C and less during the freezing and subsequent thawing will be killed, well inactivated by chlorine – and iodine-containing disinfectants. Reservoir and source of hepatitis E virus are sick people and infection carriers. The period of infectiousness is not sufficiently studied, but presumably the contagiousness occurs at the same time as hepatitis A.
The hepatitis E virus is transmitted via fecal-oral mechanism mainly by water. In rare cases (when contaminated utensils, objects of everyday life virus) is realized contact-household transmission. Food infection is possible by eating raw shellfish. Mainly by the water route of infection confirms its low focality, the occurrence of epidemics in connection with seasonal rainfall, changes in groundwater levels. The most high natural susceptibility in pregnant women after 30 weeks of pregnancy. Previous infection presumably leaves a persistent lifelong immunity.
Symptoms of viral hepatitis E
Clinical course of hepatitis E is similar to that in infection with viral hepatitis A. the Incubation period ranges from 10 to 60 days, averaging 30-40 days. The onset is usually gradual. In predzheltushnogo period of the disease patients also noted weakness, malaise, decreased appetite, in a third of cases there is nausea, vomiting. Most patients complains of pain in the right hypochondrium and upper abdomen, often quite strong. In some cases, abdominal pain is the first sign of infection. The body temperature usually remains within the normal range or rises to subfebrile values. Arthralgia, rashes are usually not mentioned.
Duration predzheltushnogo period can be from one to nine days, after which there are signs of functional disorders of the liver: urine becomes dark, discolored feces, first the sclera and then the skin acquires a yellow tint (sometimes very intense). Biochemical blood analysis in this period notes the increased levels of bilirubin and liver transaminases. Unlike hepatitis A, this infection in the development of icteric syndrome regression of symptoms of intoxication were observed. Weakness, lack of appetite and abdominal pain persist, can join itching (associated with a high concentration of bile acids in the blood). There is enlargement of the liver (liver edge may protrude from under the costal arch more than 3 cm).
1-3 weeks after clinical symptoms begin to regress, there is a period of recovery, which may last 1-2 months before full normalization of a status of the organism (in lab tests). Sometimes there is a more prolonged duration of infection. For severe hepatitis E is characterized by the development of hemolytic syndrome accompanied by hemoglobinuria, hemorrhage, acute renal failure. Hemoglobinuria occurs in 80% of patients with viral hepatitis E with severe and in all cases developed hepatic encephalopathy.
Hemorrhagic symptoms can be quite pronounced, characteristic massive internal (gastric, intestinal, uterine) bleeding. The condition of patients and the severity of hepatitis depends on the concentration of plasma clotting factors. Reduction in their number, as well as reducing activity of plasma proteases, contributes to a noticeable worsening of the patient’s condition and aggravation of clinical symptoms until the threat of development of hepatic encephalopathy.
Pregnant women who contracted viral hepatitis E is usually very hard to tolerate the infection, developing mainly after 24 weeks of pregnancy. Characterized by sharp deterioration in the state immediately before delivery or spontaneous abortion. Pronounced hemorrhagic syndrome, in labor notes intense bleeding, rapidly developing hepatic encephalopathy up to hepatic coma (the progression of symptoms often occurs over 1-2 days). Frequent intrauterine fetal death, renal-hepatic syndrome.
Complications of viral hepatitis E is an acute hepatic failure, hepatic encephalopathy and coma, internal bleeding. In 5% of patients with viral hepatitis E contributes to the development of liver cirrhosis.
Diagnosis of viral hepatitis E
Specific diagnosis of viral hepatitis E is based on detection of specific antibodies (immunoglobulins M and G) using serological methods and detection of virus antigens by PCR.
Other laboratory and diagnostic procedures aimed at determining the functional state of the liver and identification of risks of complications. These include: coagulation, liver function tests, liver ultrasound, MRI, etc.
Treatment of viral hepatitis E
Treatment of mild and moderate forms in patients with viral hepatitis E produced in the infectious ward of the hospital, appointed by the diet (shown in table number 5 on Pevsner – sparing diet with reduced content of fatty acids and rich in fiber), drink plenty of liquids. Symptomatic treatment (antispasmodic, antihistamines) according to the testimony. If necessary, is oral detoxification a solution of 5% glucose.
In severe patients treated in the ICU, is infusion detoxification therapy (saline, glucose, and electrolyte blend), protease inhibitors, according to the testimony introduced prednisone. With the threat of development of hemorrhagic syndrome is assigned to pentoxifylline, etamzilat. Massive internal bleeding – transfusion with plasma, platelets.
Special attention is paid to the treatment of pregnant women. Question about premature delivery is solved individually, often taken to emergency abortion.
Prediction and prevention of viral hepatitis E
Most often viral hepatitis E ends in recovery, but severe form of the disease threatens to develop life-threatening complications: renal and hepatic failure, hepatic coma. The mortality rate among patients with viral hepatitis E is 1-5%, this rate among pregnant women reaches 10-20%. In the case of viral hepatitis E in individuals suffering from hepatitis b, the prognosis is markedly worse, death when such a combination occurs in 75-80% of cases.
General prevention of viral hepatitis E is to improve the living conditions of the population and control the condition of water sources. Individual prevention involves the observance of sanitary norms, the use of good quality water from reliable sources. Special attention to the prevention of viral hepatitis E should be given to pregnant women traveling in epidemic-prone regions (Uzbekistan, Tajikistan, North Africa, India and China, Algeria and Pakistan).