Hepatitis E

Hepatitis E is a common liver disease, especially in countries with a hot climate. According to pathogenesis and epidemiology, the strain has much in common with a virus that provokes hepatitis A. However, microbiology has found that viral hepatitis e does not have antigenicity with strain A, does not belong to the subtype and is not its variation.

The hepatitis E virus is not as resistant to environmental conditions as the hepatitis A virus. It remains viable at temperatures above 20 ° C, is killed by freezing and upon contact with chlorine and iodine.

Every year, 20 million people are infected with HBV, with only 3.3 million people with hepatitis-e symptoms. WHO published data that in 2015, VGE led to the death of 44,000 patients, which is 3.3% of all deaths due to viral liver damage. In China, in 2011, a recombinant vaccine against VGE was registered, but so far it has not received approval in most countries.

How the

virus spreads The source of the VGE is the carrier of a typical or atypical( erased or jaundiced) form of the disease. There are four types of the virus. Genotypes 1 and 2 are found in humans, and 3 and 4 virus subtypes infect animals( pigs, deer, wild boar) and do not provoke outbreaks in humans.

Pathways of transmission of the pathogen are the same as those for hepatitis A, infected with fecal-oral infection. Especially great is the risk of "eating" a virus with contaminated water or raw shellfish. To get viral hepatitis e in the body can and with household contact. Other cases of transmission of the virus( from a pregnant woman to a child, with blood transfusion) have been described, but they are very rare.

It is assumed that an infected person secretes the virus with feces a few days after infection, and spreads the virus for 3-4 weeks after the onset of symptoms.
The seasonality of hepatitis E outbreaks is revealed, it coincides with the increase in the incidence of HAV( in the autumn-winter period).

Most patients are 15-40 years old.30% of the sick children. The relatively low index is explained by the fact that they have a disease in an erased or subclinical form, and since the symptoms are not bright, the disease is not diagnosed. In Russia, viral hepatitis e is not spread everywhere, probably because it is transmitted with contaminated water and it needs to be drunk quite a lot.

The most commonly diagnosed by VGE in South and East Asia

An epidemic outbreak occurs in areas where there is a shortage of clean drinking water, from hundreds to thousands of people. Sporadic cases can also be associated with the use of contaminated water or food( they are usually caused by the virus of genotype 1) or as a result of insufficient heat treatment of meat of infected animals( virus genotype 3).

What are the symptoms of infection with

? The virus penetrates the liver through the intestinal mucosa. It is not exactly established how the virus affects the gland cells, we can only assume that the pathogenesis does not differ from that in hepatitis A.

A primitive experiment showed that 30 days after the monkeys were infected with HGV, they had ironthere were changes characteristic of acute hepatitis A, with an increase in the level of transaminases, viral-like particles appeared in the feces, and antibodies to hepatitis E appeared in the blood on the 8th-15th day afterwards.

From infection to the onset of symptoms of the disease passes from 10-70 sutoThe average incubation period is 5-6 weeks. The disease most often proceeds acutely with the gradual development of symptoms. The disease manifests itself by the appearance of lethargy, lack of appetite, weakness.

Probable abdominal pain, nausea and repeated vomiting( lasting several days), skin itching or rashes, joint pain. The liver becomes soft and increases, its edge can protrude more than 3 cm from under the ribs. Yellowing of the skin and sclera can occur immediately when the first symptoms appear, and maybe after 10 days.

With VGE, the body rarely reacts with an increase in body temperature

Jaundice manifests itself gradually and intensifies during 2-3 days. And if at a hepatitis And after a yellowing of a skin symptoms of a poisoning disappear, at a hepatitis E they are saved. The infected continue to complain of anorexia, weakness, pain in the abdomen and in the liver.

Yellow skin in an infected person can be for 15-20 days. Rarely in the icteric period, fever( up to 38 ⁰С) and itching itch. As a rule, urine becomes dark on the 3-4 day after the manifestation of the disease.

At the peak of the disease in the blood, the amount of total bilirubin increases 2-10 times, mainly due to the direct fraction. The activity of liver enzymes increases by a factor of 10.The test sample for hepatitis E is lowered. Timolovaya sample does not go beyond the limits of the norm or increases no more than twice( another difference from the CAA).

Dimensions of the liver and the activity of its enzymes come gradually back to normal.2-3 months after the disease manifested itself, in the overwhelming majority of children, the structure of the gland and its functions are restored. With a long course of the disease, the signs of hepatitis E are the same as with HAV.

In case of severe HGE, a hemolytic syndrome develops, which is accompanied by a dark color of urine due to the presence of oxyhemoglobin( a symptom is found in 80% of cases), and internal bleeding( gastric, uterine, intestinal), acute renal failure occurs.

As a rule, immunity copes with the disease on its own within 2-6 weeks, but sometimes so-called transient hepatitis can develop which can lead to death.

People with chronic viral hepatitis B have a severe course. In this case, the mortality rate is 70-80%

What are the possible complications of

Rarely hepatitis E causes fulminant( transient) hepatitis, which provokes the development of acute hepatic insufficiency. It causes a change in the liver parenchyma, because of which the function of the gland is disrupted and the organism becomes intoxicated with the products of the breakdown of proteins. Mortality from liver failure is 50-80%.

Also VGE can provoke hepatic encephalopathy, to whom, bleeding from the internal organs. In 5% of infected, hepatitis E contributes to the onset of cirrhosis. Fulminant CVE has more lethal outcomes than with hepatitis A or acute hepatitis B.

A large risk of transient hepatitis in women who have contracted the virus during pregnancy, especially if the infection occurred in the ll or lll trimester. Pregnant women deteriorate sharply before childbirth or a miscarriage occurs.

Hemorrhagic syndrome manifests itself, during labor activity, heavy bleeding is noted, liver encephalopathy or hepatic coma can develop very quickly. Mortality among pregnant women is 20-25%.

How the diagnosis is made

The hepatitis E clinic does not differ from the symptoms that occur with other types of hepatitis in the acute phase. Therefore, the assumption of an outbreak is made if there have been cases in the region( pregnant women have borne the disease heavier), there is a lack of clean drinking water and the CAA is excluded.

Diagnosis of hepatitis E is not difficult. To confirm the disease, it is necessary to check the blood for antibodies to the virus( LgM and LgG) using ELISA.PCR is used to determine the virus RNA( antigen of the HEV RNA virus).Detect the pathogen in the stool can be using the method of immune electron microscopy.

What is required for the treatment of

Today, there are no antiviral drugs that would directly affect the hepatitis E virus. Patients with weak immunity or with chronic hepatitis E receive interferon and ribavirin therapy.

Treatment of hepatitis e involves symptomatic therapy, allowing to avoid complications and reduce the severity of symptoms

Patient prescribed a gentle diet, which limits the consumption of fatty acids and contains increased amounts of fiber( table No 5P).To remove toxins is also recommended a plentiful drink( minimum 2 liters of water per day).

Antispasmodics, antihistamines, oral detoxification with glucose can be prescribed. To improve liver function, the use of hepatoprotectors, choleretic preparations, vitamins and immunomodulators is recommended.

If the disease is severe, the patient is in the intensive care unit. He is undergoing detoxification therapy, protease inhibitors are indicated, if necessary, prednisolone is administered. If there are serious internal bleeding, then a transfusion of plasma, platelet mass is done.

If the risk of developing hemorrhagic syndrome is increased, the patient receives Pentoxifylline, Etamsilate. Careful medical supervision is necessary for a pregnant woman with VGE.Often the question arises of premature delivery, often doctors are forced to resort to an urgent termination of pregnancy.

If a patient is suspected of hepatitis E, the patient is hospitalized in an infectious disease hospital for a maximum of 30 days, not more than for treatment, but rather for isolation from the team. Children's institutions visited the patient, disinfected and quarantined for 1.5 months.

Children who have been in contact with a sick child should be inspected regularly by the health care provider during the entire quarantine, those who do not suffer hepatitis E are recommended to enter an immunoglobulin containing antibodies to the virus.

If the liver is broken, it is necessary to adhere to the

diet. In order to prevent infection with hepatitis E, the state needs to monitor the quality of public water supply and create the necessary systems to remove human excrement. Each person is able to reduce the risk, following the rules of personal hygiene and subjecting the meat to sufficient heat treatment.

In most cases, with viral hepatitis e, immunity alone is able to cope, but since the causative agent of infection causes serious complications that can develop for several days, the patient should be under the supervision of a doctor.

Only after a laboratory blood test and an evaluation of the functional state of the liver by the treating physician will the therapy scheme be selected. The clinical picture in viral hepatitis e is similar to the symptoms of HAV, so an accurate diagnosis is established using a microbiological study.

The peculiarity of hepatitis e is that with the appearance of jaundice the signs of intoxication do not disappear, in contrast to hepatitis A. Since there are no direct antiviral drugs, the main attention should be paid to the prevention of hepatitis.