Hepatitis A( Botkin's disease)

Contents of

Hepatitis A( Botkin's disease) is an acute inflammation of the liverinfectious origin, is accompanied by death of hepatocytes. Included in the group of intestinal pathologies, which is due to the mechanism of infection: the disease is transmitted by the fecal-oral route. Transmission by airborne droplets is not possible.

Characteristics of the causative agent

The hepatitis A virus belongs to the Hepatovirus group, the genome is represented by RNA.Stable outside the body of the carrier. At room temperature, dies in a few weeks, with +4 able to survive a few months, at -20 remains active for years.

The causative agent perishes by boiling after 5 minutes, may remain active for a short time in chlorinated tap water. It is transmitted by the fecal-oral method mainly by alimentary and waterways. It is not impossible to contaminate by contact-household means: the transfer is through the use of common utensils or household items.

Causes of development of

The source of infection is a sick person. It becomes contagious from the last few days of the incubation period and continues to be the carrier of the disease throughout the illness. The most dangerous for others is the first week and the prodromal period( the time interval from the end of the incubation phase and the appearance of the first symptoms of the disease).

You can get the virus when you are in contact with a sick person. Infection is carried out through food and contact-household way. The virus from the hands of the patient gets the working surfaces. Hepatitis A is commonly called "sickness of dirty hands".This explains the outbreak of the disease in kindergartens, schools, pioneer camps and other organized collectives.

Symptoms of viral hepatitis

The duration of the incubation period is three to four weeks, after which the first signs of hepatitis A appear. For the disease, a typically acute onset. The pathology passes through several consecutive periods:

• is aneolous or prodromal - it can take place in febrile, dyspeptic and asthenovegetative form;
• is icteric;
• convalescence.

. The symptoms of the febrile period are as follows:

• a sudden increase in body temperature;
• signs of intoxication appear - general weakness, muscle and headaches;
• dry cough;
• runny nose;
• redness of the throat.

In some cases dyspeptic symptoms - eructations, attacks of nausea, worsening of appetite. For the dyspeptic variant, the symptoms will be somewhat different - catarrhal symptoms and intoxication are not very pronounced. As the main complaints are:

• indigestion;
• attacks of nausea, resulting in vomiting;
• bitter taste in the mouth;
• belching;
• violation of defecation - constipation, replacing diarrhea.

The pre-egg period, which takes place in the asthenovegetative format, has no specific symptomatology. Complaints are standard: apathetic condition, general weakness, sleep disorders - problems with falling asleep. In rare cases, the prodromal period is asymptomatic and the disease immediately begins with jaundice.

The duration of the jaundice period is 2-10 days, but most often this is a week. The transition to the next phase of hepatitis A occurs gradually. In the icterus period, the symptoms of hepatitis A in adults change. For him typical: complete disappearance of signs of intoxication, normalization of body temperature, improvement of general health.

Symptoms of dyspepsia persist and even increase. The formation of jaundice is slow. Initially, the patient notes a change in the color of urine: it gets a dark color. Then the sclera of the eyes become yellowish. Next, the mucous membranes of the mouth turn yellow, the soft palate. The last color changes the skin: it becomes an intense yellow-saffron shade.

Severely leaking hepatitis A is characterized by the following symptoms:

• formation of petechiae, chiseled hemorrhage on the mucous membranes and the surface of the skin;
• formation on the surface of the tongue and teeth of a characteristic yellowish plaque;
• enlargement of the liver and spleen;
• small pain syndrome with her palpation;
• bradycardia;
• decreased blood pressure;
• discoloration of stool.

The duration of icteric period is not more than a month. Most often it is limited to 2 weeks. Then follows the period of convalescence( recovery).The condition is normalized, signs of jaundice disappear. The phase takes 3-6 months.

In most of the diagnosed cases, hepatitis A is mild to moderate. Severe course is rare. The patient after complete recovery from the virus carrier is not.

Forms of hepatitis A

Depending on the course, hepatitis A passes in three forms - mild, moderate and severe. Signs of a mild form of pathology become almost complete absence of jaundice. Its maximum duration does not exceed two to three days. On the state of health of the patient it is not reflected in any way.

Sometimes Botkin's disease is completely asymptomatic. Diagnosis in this case is based on the determination of the activity of a specific aldolase enzyme. At an average severity level, the patient has the following symptoms:

• drowsiness;
• the retardation;
• severe jaundice;
• on the skin surface formed petechiae( pinpoint hemorrhage);
• heart expanded;Myocardial tone weak
• ;
• tachycardia.

Malignant hepatitis A( hepatic dystrophy) accompanies mass death of hepatocytes. For the condition is typical: the development of severe jaundice, a rapid decrease in liver size as a result of parenchyma death, bleeding, febrile condition, liver failure, symptomatology of the CNS.

Possible complications of

Exacerbations for viral hepatitis A are not typical. Sometimes the infection is able to cause the development of cholangitis, cholecystitis, violation of bile flow, inflammation of the gallbladder. It is not excluded that secondary infection is attached. Severe consequences from the liver, in particular, acute hepatic encephalopathy, are extremely rare.

Diagnosis of pathology

Diagnosis is based on characteristic symptoms, as well as physical examinations and laboratory tests. The patients must donate blood. Biochemistry shows the following changes:

• elevated bilirubin content( bilirubinemia);
• increase in activity of hepatic enzymes - AST, ALT;
• decrease in prothrombin index;
• decrease in albumin;
• drop of thymol and growth of the sulphure assay.

Changes are recorded in the general blood test. There is an increase in the rate of erythrocyte sedimentation, as well as leukopenia and lymphocytosis. There is also a specific diagnosis, based on the definition of antibodies. The technique of ELISA and RIA is used. A more accurate method is serodiagnostics, which makes it possible to detect viral RNA in the blood.

Treatment of hepatitis A in children and adults

Treatment of hepatitis A is possible at home. Hospitalization of the patient is necessary only in case of severe illness, and also if the patient needs to be "put" in quarantine. How long does a person stay in a hospital? The length of stay in the infectious department is not less than 4 weeks.

When expressed signs of intoxication patient recommended compliance with bed rest. The patient is assigned a diet number 5, completely eliminating fatty foods, meals that stimulate the production of bile, alcohol. The diet should include dairy products and vegetable products.

. Specific therapy of hepatitis A does not exist. The development of a clinical protocol is aimed at eliminating and alleviating the current symptomatology. To remove signs of intoxication, the patient is recommended to drink abundantly. If there is a need, then intravenous administration of crystalloid solutions is prescribed.

To prevent the development of cholestasis - stagnation of bile - drugs from the group of antispasmodics may be prescribed. After recovery the patient should be observed at the gastroenterologist within three to six months.

Treatment of hepatitis in childhood

Disease in children is diagnosed when the first symptoms are already missed, i.e. at the stage of jaundice development. The child in this period of danger to the surrounding people does not represent and does not need quarantine. Passage of therapy in a hospital is stress for the child.

In addition, a weakened immunity enhances its susceptibility to various hospital infections. If hepatitis A is mild, then home treatment is the best option.

Therapy of pathology includes the following activities:

• Compliance with strict bed rest for the first 10 days from the development of jaundice.
• Following the principles of dietary nutrition - a complete rejection of fatty / spicy / fried foods. Allowed sour-milk products, lean meat and fish, cereals, pasta, potatoes, compotes, salads with dressing from vegetable oil, jelly. The child is recommended a plentiful drink.
• Reception of cholagogue drinks on a plant basis.
• Vitaminotherapy.

A hepatoprotector on a plant basis can be assigned to a child. A good result shows decoctions of cholagogue grasses, in particular, knotweed. After clinical recovery, follow-up care should be performed for three to six months.

Treatment at home

The mild form of hepatitis A is successfully treated at home. To exclude infection of family members, you must follow certain recommendations: you need to take tests and visit a doctor regularly, the course of the disease is not complicated, the sick person should be in a separate room, adherence to the principles of dietary nutrition and a semi-fast treatment.

After jaundice formation, the patient does not present a danger to others, so he can eat at a common table and use sanitary facilities. The patient must be protected from cooking. Family members are recommended strict adherence to the rules of personal hygiene, in particular, each time to wash their hands with soap after going to the toilet.

During the pre-zheltushnogo period, the patient recommended strict compliance with bed rest. A typical symptom is severe weakness, additional stress on the body will be superfluous and may adversely affect the liver. During the icteric period from strict compliance with bed rest, you can be.

Prevention

Specific prevention of infection is absent. Common measures to prevent infection become:

• qualitatively performed purification of sources of drinking water supply;
• compliance with sanitary and hygienic requirements;
• epidemiological control at the enterprises engaged in the production, storage and transportation of food products.

In case of an outbreak of hepatitis A in organized groups mandatory anti-epidemic quarantine measures are implemented. Ill people are isolated for a period of 2 weeks. Patients cease to pose a danger to surrounding people after the onset of icteric period.

To work and study are allowed only after clinical recovery, i.e. when the test results are normalized. Persons who come into direct contact with infected people need to monitor the condition for 35 days. In kindergartens and schools for this period, quarantine is declared. The room is thoroughly sanitized all surfaces.

Vaccination

Vaccination against hepatitis A in Russia is not included in the mandatory vaccination schedule, although in other countries it is actively practiced and is mandatory. The "Havriks 720" vaccine from a Belgian manufacturer proved to be very successful. It is a suspended formalin-inactivated virus.

Vaccination is carried out in advance: approximately 10-14 days before potential contact with the virus carrier. It is advisable to vaccinate before going to a children's camp, to another country where frequent outbreaks of Botkin's disease are fixed.

The introduction of a vaccine is justified after direct contact of a person with an infected person. Term is the first week after communication. Children tolerate the vaccine quite well. In rare cases, a slight deterioration in overall well-being is possible. This is considered an acceptable physiological norm.

The drug is administered twice with an interval of 6-12 months, which provides a stable immunity to the disease for at least 6 years. The prognosis for viral hepatitis A is favorable. The disease is characterized by a successful recovery in 3-6 months after infection. The virus-carrying and transition of a disease to a chronic form is atypical.