Management of Rospotrebnadzor on EAO

About Hepatitis A: Causes, Symptoms, Treatment, Prevention

Hepatitis A (Botkin's disease, jaundice) is an acute viral liver disease, which is caused by the hepatitis A virus (HAV). The main symptoms of viral hepatitis A are increased fatigue, nausea, vomiting, bitter extinguishing, pain in the right hypochondrium, jaundice, urine darkening, etc. Diagnosis of hepatitis A is carried out on the basis of the serological analysis of blood, which reveals the presence of antibodies against the hepatitis virus A. Treatment of hepatitis A It is the appointment of diet and symptomatic treatment. In most cases, hepatitis A ends with complete recovery.

How is hepatitis A virus transmit?

Hepatitis A virus is transmitted by a person a fecal-oral way. This means that the sick hepatitis A is distinguished by viruses with a fellow, which, with insufficient hygiene compliance, can fall into food or water and lead to infection of another person. Hepatitis A often called dirty hand disease.

Factors Enhancing the risk getting sick with hepatitis A.

The risk of hepatitis and above:

  • children attending children's preschool institutions,
  • persons who do not comply with the rules of personal hygiene or living in overpopulated areas,
  • People often attend the countries of Central Asia and Africa,
  • In people in contact with patients with hepatitis A.

How does the hepatitis A virus act on the liver?

The hepatitis A virus is transmitted by the fecal-oral way, that is, it enters the human body through the mouth with contaminated food or water containing viruses. Finding into the intestines, the virus is absorbed into the blood and penetrates the liver. In liver cells (hepatocytes), the virus multiplies, and changes their structure and destroys them. Next, the virus falls into bile, which is thrown into the intestines. Together with biliary, viruses are derived from the body with wheel masses. In the development of hepatitis A, the immune system of man takes place. The fact is that during the reproduction (replication) of the virus in hepatocyte, the structure of special markers (identification) of liver cells and the immune system begins to consider them as alien ones. The organism begin to produce antibodies - substances that cause the death of hepatocytes that enhance the destructive effect of the virus on the liver tissue.

After what time after the infection of hepatitis, will it begin to manifest?

The incubation period of viral hepatitis A (time from the moment of infection before the appearance of symptoms) is an average of 30 days, but it may vary from two weeks to one and a half.

What are the symptoms and signs of viral hepatitis E?

Often viral hepatitis A proceeds asymptomatic, or under a mask of another disease (for example, gastroenteritis, flu, cold), but, as a rule, some of the following symptoms may indicate the presence of hepatitis:

  • Weakness, increased fatigue, drowsiness, in children is a fiscalness and irritability.

  • Reducing or absence of appetite, nausea, vomiting, burrowing.

  • Discolored feces

  • Increase temperatures up to 39 ° C, chills, sweating.

  • Pain, feeling of gravity, discomfort in the right hypochondrium

  • The darkening of urine - comes a few days after the first signs of hepatitis.

  • Jaundice (the appearance of yellow painting the scool of the eyes, the skin of the body, the mucous membrane of the mouth), as a rule, appears a week after the start of the disease, bringing some facilitating the state of the patient. Often there are no signs of jaundice at hepatitis.

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In children hepatitis A rather often proceeds asymptomatic or under the guise of acute gastroenteritis (inflammation of the gastric and intestine mucosa). Also, the development of hepatitis A in the child can resemble flu or colds. In such cases, the darkening of urine and / or discoloration of feces, as well as the appearance of jaundice indicate that the child is sick with hepatitis. The above symptoms are characteristic of any type of viral hepatitis, so only on the basis of symptoms cannot be diagnosed with acute viral hepatitis A.

What to do with suspected viral hepatitis e?

When symptoms characteristic of viral hepatitis appear, it is necessary to immediately consult a doctor. To identify viral hepatitis A (HAV), it is necessary to carry out a serological analysis of blood for the presence of antibodies to the hepatitis A - ANTI-HAV IGM virus. If the hepatitis in the blood gets into the blood, the body immediately begins to fight the virus, producing antibodies against it. The presence of antibodies Anti-HAV IgM can indicate with high accuracy to acute viral hepatitis A.

What is the danger of hepatitis e?

Of all the known types of viral hepatitis (B, C, D, E), viral hepatitis A is the most gentle for the liver. Acute viral hepatitis A, as a rule, lasts about 6 weeks and is independently resolved by complete recovery. Cases of transition of acute viral hepatitis A in fulminant (lightning) shape with a subsequent fatal outcome are extremely rare. Such a development of the disease is more likely in persons already ill hepatitis in or S.

How to treat acute viral hepatitis e?

The basic principles of treatment of hepatitis A are observance of diet and supporting therapy (symptomatic treatment). Treatment of hepatitis A is carried out under the control of doctors of infectiousists. Independent treatment of hepatitis A is unacceptable. During the entire period of the disease, the patient with hepatitis A isolate from the collective (especially important in the case of children). Sick hepatitis A ceases to be contagious about after 3 weeks of the disease.

Diet with hepatitis A

Sick hepatitis A recommend to exclude fatty meat, liver, fried dishes, alcohol, chocolate, carbonated drinks from the diet. The diet includes milk and dairy cereals, kefir, boiled vegetables, low-fat varieties of meat and fish, fruit juices, honey.

Symptomatic treatment of hepatitis A

For the treatment of hepatitis and special antiviral drugs are not needed. Our body is able to overcome infection itself. Treatment of hepatitis A is to maintain some functions of the liver suffering during the disease. So, the body needs detoxification - removing the toxins that the patient liver is not yet able to neutralize itself. Detoxification is carried out with the help of special solutions that dilute blood and reduce the concentration of toxic substances (hemodez). In addition to detoxification for the treatment of hepatitis A, hepatoprotectors are used - these are medicines that protect liver cells. Among other things, for a speedy recovery, it is necessary to fill the stock of vitamins that help the body to recover after the disease.

Hepatitis A. Prevention

Hepatitis and often referred to the disease of dirty hands, as non-compliance with the rules of hygiene significantly increases the risk of Hepatitis A. To avoid infection, it is necessary to thoroughly wash your hands with soap in front of meal, wash the fruit and vegetables under running water, to eat products subject to proper heat treatment Drinking water from proven sources, or boil water before use.

Immunity and vaccination from hepatitis A

A man who has suffered hepatitis and most likely will never get sick them again. The fact is that after recovery in the blood of a person, antibodies against the hepatitis A virus remain forever, which, when re-hitting the virus, immediately attack it, not allowing the disease. Immunity against hepatitis A can also be purchased using vaccination (vaccinations). Vaccine against hepatitis A consists of dead hepatitis viruses that are not able to cause disease, but can cause immunity production. Immunity, developed after vaccination, is maintained for 5-10 years, protecting a person from infection with hepatitis A.

Who is the vaccination against hepatitis E?

Put the vaccination from hepatitis A can anyone who has not suffered hepatitis and earlier. To find out, hepatitis ah no, it is enough to make a serological analysis of blood for the presence of antibodies against the virus. If they are missing - it means the body has never met with the hepatitis A virus and is susceptible to high risk of the disease. In this case, the vaccination is shown.

Hepatitis A or Botkin's disease - acute viral liver disease, which causes damage to organ cells. It manifests itself with general intoxication and jaundice. Hepatitis A is transmitted by the fecal-oral way, so it is also called the "dirty hand disease." Compared to other hepatitis (B, C, E), this disease is considered the most benign. In contrast, hepatitis A does not cause chronic lesions and has a low mortality rate - less than 0.4%. With the uncomplicated flow, the symptoms of the disease disappear in 2 weeks, while the liver functions are restored over a period of one and a half months. Diseases are equally susceptible to men and women of all ages. Children from year to 10 years tolerate disease in light shape, and babies and elderly people in heavy. After the suffered disease, persistent immunity remains, so hepatitis A is sick once. Incidence statistics Hepatitis A. According to WHO, the disease annually transfer 1.5 million people. In fact, the number of illness is more different. The fact is that 90% of children and 25% of adults suffer a hidden asymptomatic form of the disease. Viral hepatitis A is distributed in developing countries with low sanitation ^ Egypt, Tunisia, India, the countries of Southeast Asia, South America and the Caribbean. It is worth remembering to tourists departing for rest in hot countries. In some states, the disease is so common that all children are overgamed to the ten-year-old age. The territory of the CIS refers to countries with an average risk of infection - 20-50 of those ill per 100 thousand population. Here the seasonal rise in incidence is celebrated in August - early September. Story . Hepatitis A is known since the time of antiquity called "Justice Disease". Large epidemics broke out during the war, when the masses of people turned out to be in the conditions of antisanitarian, so hepatitis was also called the "troop jaundice." Doctors linked the disease for a long time only with blocking of biliary tract. In 1888, Botkin put forward a hypothesis that the disease has an infectious nature, so subsequently it was named after him. The hepatitis virus was detected only in the 70s of the twentieth century. At the same time, it was possible to create a vaccine that protects against infection.

Hepatitis A virus properties

Virus properties hepatitis A

Hepatitis A or HAV virus belongs to the Picornavirus family (from the Italian "small"). It really is different from other pathogens very small size - 27-30 nm. Structure. The virus has a rounded spherical shape and is one chain of RNA enclosed in a protein shell - capsid. HAV has 1 serotype (variety). Therefore, after a transferred disease in the blood, antibodies to it are preserved and the disease is no longer developing during re-infect. Sustainability in the external environment. Despite the fact that the virus does not have a shell, it remains for quite a long time in the external environment:

  • when drying on household item - up to 7 days;
  • in a humid environment and on food products for 3-10 months;
  • When warming up to 60 ° C withstands up to 12 hours;
  • When freezing below - 20 ° C is saved for years.

Disposal with a boiling virus over 5 minutes or solutions of disinfectants: chlorine lime, potassium permanganate, chlorine T, formalin. Given the stability of the virus, disinfection in the premises where the patient was needed especially carefully. HAV Life Cycle . With food, the virus falls on the mucous membrane of the mouth and intestines. From there he penetrates into the bloodstream and in the liver. Since the virus falling into the body before the occasion of the disease, it takes from 7 days to 7 weeks. In most cases, the incubation period lasts 14-28 days. Next, the virus penetrates inside the cells of the liver - hepatocytes. How he manages it still has not been established. There it comes out of the shell and embedded in the ribosome of cells. He rebuilds the work of these organelles in such a way that they create new copies of the virus - Virion. New bile viruses fall into the intestines and are outlined with the feces. The affected liver cells wear out and dying, and the virus moves to neighboring hepatocytes. This process continues while the body does not produce enough antibodies that destroy viruses.

Causes of hepatitis A.

Causes of hepatitis A.

The transmission mechanism is fecal-oral. The sick person allocates a huge number of viruses with the creation of the environment. They can get into the water, for food, household items. If the pathogen falls into his mouth with a healthy susceptible to the infection to a person, hepatitis will develop. Infected hepatitis A can be infected in such situations

  • Swimming in polluted pools and water bodies. The virus enters mouth with fresh and sea water.
  • Eating contaminated products. Often it is berries, for the fertilizer of which used human feces.
  • Eating raw mollusks and mussels from contaminated reservoirs where the causative agent of the disease can continue.
  • When using poorly purified water. Infected water is dangerous not only to drink, but also use it for washing hands and dishes.
  • With a joint accommodation with a sick, infection occurs through household items (door handles, towels, toys).
  • With sex with patients. This transmission path is especially common in the Homosexual environment.
  • With intravenous drug administration, the non-sterile syringe. The virus circulates in the blood and through the needle is transmitted from one person to another.

Risk factors for hepatitis A

  • Non-compliance with personal hygiene rules
  • Stay in the places of large cluster of people: boarding rooms, barracks
  • Stay under conditions where there is no water supply and sewage: refugee camps, military camps of military personnel
  • Trips to areas with high levels of morbidity without preliminary vaccination
  • Accommodation with man, sick hepatitis A
  • lack of access to safe drinking water

Symptoms of hepatitis A.

Symptoms of hepatitis A.

Symptom Development mechanism How externally or when diagnosing manifests itself
Prickful period lasts 3-7 days
Signs of general intoxication appear at the end of the incubation period Liver cell decay products poison the patient's body, including the nervous system Havigation, increased fatigue, lethargy, loss of appetite
Temperature increase. In the first days of illness in 50% of patients The reaction of the immune system to the presence of blood virus Chills, fever, temperature rise to 38-39
The jaundice period lasts 2-4 weeks
Jaundice appears on the 5-10th day since the beginning of the disease A bile pigment is accumulated in the blood - bilirubin. This is a product of the decay of erythrocytes in the liver. Normally, the pigment binds to blood proteins. But when the function of the liver is broken, it can not "send" it in bile, and bilirubin returns to blood First yellow the mucous membrane under the tongue and eye sclera, then the skin becomes yellow, saffron. This happens when the bilirubin concentration in the blood exceeds 200-400 mg / l with the appearance of a jaundice temperature normalizes
Damage urine In the surplus bilirubin and urobilin from the blood output through the kidneys with urine Urine acquires dark beer color, foams
Decorating Cala When hepatitis, the arrival of sterkobilo with bile in the intestines is reduced. This is a pigment from destroyed red blood cells, which stains cals In the pre-sutual period of the feces decollected gradually - becomes spotted, then it becomes completely colorless
Pain in the right hypochondrium Viruses affect liver cells and cause their death, edema develops. The liver increases in size and stretches the sensitive capsule The feeling of rubbing, pain and severity in the right hypochondrium. The liver is enlarged, when tugs, the patient feels pain
Increased spleen Associated with an immune response to infection and reinforced neutralization of toxins When tugs, the spleen is increased
Dyspeptic phenomena Digestive problems are associated with impaired liver function. Bile is stood in the gallbladder misses the intestines in sufficient quantities Nausea, vomiting, gravity in the stomach, belching, bloating, constipation
Pain in muscles and joints Pains are associated with accumulation of toxins caused by the death of virus and liver cells Lomotation in body pain in muscles
Skin itch Increasing the level of bile acids in the blood leads to their accumulation in the skin and allergic reaction. Dry skin that is accompanied by itching
The period of recovery lasts from 1 week to six months
Symptoms gradually weaken, liver functions are restored.

Treatment of hepatitis A.

Hepatitis Treatment A Medications

Specific medication treatment of hepatitis A does not exist. Therapy is aimed at eliminating symptoms, removal of intoxication and speedy restoration of normal liver operation.

Group of drugs Mechanism of therapeutic action Representatives How to apply
Vitamins Reduce the permeability of vessels, reduce the edema of the liver tissue, increase the body's resistance to the virus Askorutin, Askorutin, Undevit, Aevit 1 tablet 3 times a day
Hepatoprotectors Accelerate the restoration and division of damaged liver cells. Supply structural elements necessary for the construction of cell shells of hepatocytes Esssential, Carsil, Hepatofalc 1-2 capsules 3 times a day
Enterosorbents To remove toxins from the intestine and eliminate the bloating Smekt, polyfepan. 2 hours after each meal
Enzyme preparations with medium and heavy forms Contribute to the splitting of proteins, fats and carbohydrates and early suction of food in the intestine Creon, Mezim-Forte, Pancreatin, Festal, Enzystal, Panzinorm During each meal of 1-2 tablets
Glucocorticoids with a sharp deterioration Anti-inflammatory anti-allergic effects, reduce the attack of immunity cells (lymphocytes and leukocytes) on damaged liver cells Prednisolone, methylprednisolone 60 mg / day orally or 120 mg / day intramuscularly for 3 days
Immunomodulators Improve the work of immunity. Stimulate the production of antibodies to combat hepatitis A virus Timalin, Timogen Introduced intramuscularly at 5-20 mg per day for 3-10 days
T-activin Enter subcutaneously 1 ml 0.01% solution for 5-14 days
Disinfect solutions Bind toxins circulating in blood and contribute to their rapid excavation with urine Gemodez, Geopolyglyukin Intravenously drip 300-500 ml per day
Choleretic means Eliminate bile stars in the liver, contribute to its cleansing and improving digestion Sorbitol magnesium sulfate 1 tsp dilute in a glass of warm boiled water and drink overnight

Currently, doctors try to abandon unnecessary drugs, assigning only the necessary minimum to eliminate symptoms.

Does hospitalization need for hepatitis ah?

When hepatitis, I need hospitalization into an infectious office in such cases:

  • with complicated forms of hepatitis A
  • With the joint occasion of the disease of Botkin and other hepatitis
  • with alcohol liver damage
  • Elderly patients and children under the 1st year
  • In weakened patients with severe concomitant diseases

Diet with hepatitis A

In the treatment of hepatitis A recommended diet 5 . In the fight against infection, therapeutic nutrition plays a big role. It reduces the load on the liver and protects its cells. It is recommended to eat in small portions 4-6 times a day. Recommended products for hepatitis A:

  • dairy products : low-fat cottage cheese, kefir, yogurt, low-fat sour cream for refueling
  • Non-fat meat : beef, chicken, rabbit
  • Meat products: Steam beds, meatballs, meatballs, sausages and boiled sausages from beef
  • Non-fat fish : Sudak, Pike, Carp, Heck, Mintai
  • vegetables : Potatoes, zucchini, cauliflower, cucumbers, beets, carrots, cabbage, tomatoes
  • Garniirs : Cruses (except legumes and pearl), pasta
  • Soups low-fat vegetables, milk with the addition of croup
  • bread Yesterday, SUKHARI
  • Eggs : Omelet from proteins, 1 egg skeyka per day
  • desserts : mousses, jelly, kislets, marshmallow, marmalade, grazing, protracted cookies, honey, homemade dried fruit jam
  • Fats: Creamy oil 5-10 g, vegetable oils up to 30-40 g
  • the drinks : Tea black, herbal, compotes, juices, umbar, decoction of rosehip, coffee with milk, alkaline mineral waters, 5% glucose solution.
  • Preloading preparations To restore the electrolyte balance, reciprons are recommended, Human electrolyte, hydraulic forte.

Exclude from the diet:

  • Fried smoked dishes
  • Cannedize Fish, meat, vegetable
  • Meat of fatty varieties : Pork, goose, duck
  • Fat fish : sturgeon, bulls, spicy herring, caviar
  • Fat. : Saletz, Salo, Margarine
  • bakery products Fresh bread and puff pastry
  • Fatty dairy products : whole milk, cream, bold cottage cheese, salted cheese
  • Soups on concentrated meat, fish broth, sour soup
  • vegetables : radish, radish, sauerkraut, sorrel, onions, parsley, pickled vegetables, mushrooms
  • desserts : ice cream, chocolate, products with cream, candy, sparkling
  • the drinks : Strong coffee, cocoa, carbonated drinks, alcohol

Diets must be followed during the disease and for 3-6 months after recovery. The limitation of fat and simple carbohydrates allows preventing fat degeneration of the liver. Lightweight dishes and fractional nutrition contribute to the best outflow of the bile and normalization of digestion. It is very important to stick to the drinking mode. To remove toxins, it is necessary to use at least 2 liters of pure water without gas.

Is it possible to treat hepatitis and at home?

With the easiest course of the disease, hepatitis can be treated at home. For this you need several conditions:

  • The patient passed the survey, passed the tests, and will regularly visit the doctor
  • The disease occurs in a light uncomplicated form
  • It is possible to isolate a patient in a separate room
  • Compliance with diet and semi-state regime

By the time of the appearance of jaundice, the patient becomes practically not dangerous for others. It can eat at one table with family, use a shared toilet and bathroom. Restrictions . It is not desirable to attract a patient for cooking. All family members must strictly follow the rules of personal hygiene and thoroughly wash their hands after visiting the toilet. Mode. Prickful period - bedding needed. The patient is experiencing strong weakness and excess energy costs can lead to an additional liver load. And in a horizontal position, the sick organ gets more blood, which contributes to a speedy recovery. Justice period - The semi-noar mode is allowed. After the symptoms of the disease weakened, you can gradually increase activity. This contributes to the restoration of the physical and emotional state.

The consequences of hepatitis A.

The consequences of hepatitis A.

Complications are not characteristic of hepatitis A. The consequences arise only 2% of cases. In the risk group, people who disturb the diet, not respecting the appointment of a doctor who abuse alcohol suffering from the pathology of the liver. The most common complications of hepatitis A

  • Biliary dyskinesia - Violation of the motorbish of biliary tract, as a result of which the stagnation of bile arises. Symptoms: pain in the right hypochondrium, giving up the right shoulder, occurs after eating and physical exertion. Bind in the mouth, nausea, vomiting, unpleasant smell of mouth.
  • Cholecystitis - Inflammation of the walls of the gallbladder, accompanied by stagnation of bile. Symptoms: sharp pain in the right hypochondrium, giving up the right side of the lower back and neck. Strengthen when moving, cough, changing body position. The right half of the abdominal wall is tense. Joy, skin itching, nausea, vomiting. In chronic fine-free cholecystitis after a meal there are stupid bastards in the right half of the abdomen.
  • Chronic pancreatitis - chronic inflammation of the pancreas. Symptoms: Pain in the area of ​​the stomach and left hypochondrium, pains can be permanent or periodic, are given in the back, heart, often have a sinking character. The disease is accompanied by diarrhea, nausea and can cause diabetes mellitus.

Hepatitis A. Prevention

Hepatitis prevention A includes several directions.

  1. Disinfection in hepatitis and hepatitis Disinfection is carried out in the apartment of the disease. Medical staff teaches family members how to handle items with which the patient contacted.
    • Bed linen and clothing boil in soap 2% solution (20g any washing powder per liter of water) 15 minutes, and then erased as usual.
    • Dishes after meals are boiled 15 minutes in 2% soda solution
    • Carpeted coatings are cleaned with a brush moistened in a 1% solution of chlorine.
    • The floors and other surfaces wash with hot 2% soap or soda solution. In the same way handle the door handles of the toilet and wash tank.
  2. Hepatitis A vaccination Vaccination is aimed at reducing susceptibility to the virus.
    • Human immunoglobulin is normal. The drug is administered intravenously drip people living in the same apartment with sick. The drug contains ready-made donor antibodies against hepatitis A and other infections. Its use several times reduces the risk of getting sick.
    • Vaccine against hepatitis A - a mixture of neutralized cleaned viruses. In response to the introduction of vaccine, the body produces specific antibodies. Therefore, if infection occurs, the disease does not develop - antibodies quickly neutralize viruses.
    The vaccine is not included in the list of mandatory vaccinations due to its expensive value. Her introduction is recommended People in the risk group and:
    • Travelers serving low hygiene countries
    • Servicemen, long time staying in the field
    • People in refugee camps and other places where it is impossible to comply with the rules of hygiene due to the lack of water supply and sewage
    • Medical personnel
    • Employees of food industry enterprises
  3. Hygiene rules
    • Thoroughly wash your hands after visiting the toilet
    • drink only boiled water
    • Wash vegetables, fruits and greens
    • do not swim in the reservoirs in which the wastewater could get
    • carefully serving and deliver products when cooking
  4. Activities for contact persons To prevent the spread of infection, the health workers are watching people who were in contact with the patient:
    • Quarantine in groups and children's teams for a period of 35 days from the moment of insulation of the last diseased disease
    • Observation of all contacting. Check whether there is no yellowness on the mucous membranes and the gluers, whether the liver is not increased. When influenate symptoms appear, they need to be isolated
    • Blood test for the presence of specific antibodies to hepatitis A virus (IgG)

Hepatitis A is considered a relatively benign disease, but requires a serious relationship and treatment. Otherwise, its consequences can be felt for months and years.

Publication date October 16, 2018. Updated October 14, 2020.

Definition of the disease. Causes of the disease

Viral Hepatitis A. (Hepatitis a viruses, HAV) - acute infectious disease caused by the hepatitis A virus, clinically characterized by syndrome of general infectious intoxication, pigment exchange syndrome, enteritis syndromes, cholestasis, increased liver and in some cases, accompanied by violation of the liver function, mainly benign flow .

Liver damage to the hepatitis A virus

Etiology

Kingdom - Viruses

Promotion - RNA-containing

Rod - Enterovirus

Family - Picornaviridae (Picornaviridae)

Subclass - Hepatovirus

View - Hepatitis A virus (HAV)

The structure of the hepatitis A virus

The diameter of the virion is 28-30 nm. It is a RNA virus. Contains specific capsid proteins, protease P2, P3 and RNA polymerase. Doesn't have a shell. There is a single serotype and several virus genotypes (currently known 7).

In the external environment, it is very stable: at ambient temperature, about 4 ° C is stored for several months, at 2 ° C - several years, during freezing is very long, at room temperature - several weeks. In the solution of chlorine-containing means (0.5-1 mg / l), dies within an hour, at 2.0-2.5 mg / l - for 15 minutes, ultraviolet irradiation leads to death for a minute, while boiling is saved to 5 minutes. In the acidic area of ​​the stomach does not die.

The most significant marker of viral hepatitis A is class M antibodies (anti-HAV IgM), which are formed in the initial period of the disease and are detected up to 5 months. The appearance of anti-HAV IgG (marker transferred earlier than infection) begins with 3-4 weeks of the disease. The antigen of the virus is revealed in the wheel masses 7-10 days before the start of manifestic (clearly pronounced) manifestations of the disease. [one] [2] [four]

Epidemiology

Infection of hepatitis A occurs when contacting the source of infection - a living person (patient with various forms of the disease and a virus monitor). Patients with typical forms are the main source of virus spread (from the end of the hidden and all the jagglie).

Every year, approximately 1.5 million cases of disease are registered in the world (the number of subclinical and asymptomatic forms is difficult to even submit). Mortality in the world in 2016, according to WHO, amounted to 7134 people [ten] .

Conditionally exist Territorial distribution According to the levels of infection of the population: high, medium and low.

High infection areas This is predominantly Southeast Asia, Central Asia, Africa, Central America (bad sanitary conditions and low income) - the majority of the population by the period of growing up and have immunity, outbreaks of disease are rarely found.

Middle Infection Areas - Countries with transitional economies, developing, having differences in sanitary and hygienic conditions on the territory of one region, for example, Russia (most of the population by the period of maturity did not sore and does not have immunity to the virus, large outbursts are possible).

Low infection areas - developed countries with high income and good sanitary and hygienic conditions, such as USA, Canada, Europe, Australia. Most people have no immunity and did not sore, outbreaks happen rarely and more often among risk groups. [7] .

In the environment, the virus is highlighted mainly with feces.

Transmission mechanism: Fecal-oral (Ways - water, contact-household, food), parenteral (rare when blood transfusion), sexual (oral anal contact).

The susceptibility of the population is high.

Risk factors infection:

  • High crowdness of the population;
  • non-compliance with the rules of personal hygiene and the rules for storage, processing and preparation of food;
  • unsatisfactory condition of water supply facilities;
  • Household hearth disease.

Who is in the risk group

  • travelers (especially in roast climate countries and with bad social conditions);
  • homosexuals;
  • people who use drugs (any), alcoholics;
  • Health workers (unknown and not painful);
  • homeless;
  • People who have permanent contacts (due to profession or other reasons) with migrants from disadvantaged hepatitis and regions.

Characterized autumn-spring seasonality, increased attachment to the hot southern regions.

Immunity after transferred disease persistent, lifelong, that is, it is impossible to re-get sick [one] [3] [four] [7] [ten] .

Warning

When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of hepatitis A.

The disease begins gradually. The incubation period of hepatitis A flows 7-50 days.

Viral hepatitis A syndromes

  • general infectious intoxication;
  • impairment of pigment exchange (jaundice);
  • enteritis (inflammation of the mucosa of the small intestine);
  • cholestasis (reducing the amount of bile coming into the duodenum);
  • hepatolyenal (increase in liver and spleen);
  • hydropic;
  • Violations of the liver function.

Typical course of illness - This is the jaundice form of medium severity disease (obsolete title - jaundice or Botkin's disease).

Initial period of the disease (barbecue) It has a duration from 2 to 15 days and can proceed in several options:

  1. Influencing - rapid body temperature up to 38-39 ° C, weakness, breakdown, chills, headache diffuse (spilled) localization, Malgia and arthralgia (pain in muscles and joints), runny nose, dry cough, loss of desire to smoke;
  2. Disps - loss of appetite, the occurrence of pain, severity and discomfort in the right hypochondrium, urge to nausea, vomiting, unstable stool;
  3. Austhenovegetive - gradually developing weakness, irritability, drowsiness, headaches of fuzzy localization and dizziness, the temperature reaction is poorly expressed;
  4. Mixed version.

When inspection, an increase in liver is found and, to a lesser extent, spleen, the sensitivity of the edge of the liver, an increase in heart rate (pulse), nasal bleeding. At the end of the period, the urine is darker, and the feces becomes lighter.

Next period (jaundice) The duration of about 7-15 days is characterized by a decrease in the severity of the preceding period symptoms ( That is, with the advent of jaundice, well-being improved ). The jaundice staining of the scler, the skin and the oral mucosa is enhanced. Urine acquires the color of the dark beer, Cal Beleet. There is a general weakness, malaise, bad appetite, a feeling of gravity and overcrowding in the right hypochondrium, the patient is calculated due to the skin of the skin (liquidification), petechies appear (small hemorrhages) on the skin.

Signs of the jaggptious hepatitis A period

In a medical examination, an increase in the liver and spleen is revealed, a symptom of the orthnera (soreness when the edge of the palm of the palm of the palm of the palm of the palm), hypotension (may be normal), toxic bradycardia (decrease in heart rate), peripheral edema appear, pain in the joints (arthralgia ).

Further, with a favorable course of the disease (which is observed in most cases), clinical symptoms are regulated, urine lightening and fence darling, a slower flourishness of the skin, scler and mucous membranes.

In a typical cyclic flow - after the jaundice period (disease rapid) - comes Reconvocation period (recovery) : The general condition is normalized, signs of pigment exchange disruption are erased, "pigment crisis" arises - a decrease in the jaundice of the skin and mucous membranes, urine clarification and fence darkening. A clear tendency to the normalization of pathologically changed laboratory indicators is revealed, mainly livenish aminotransferase, bilirubin and prothrombin.

Under atypical flow Diseases implies light risk-free forms of hepatitis A (lack of symptoms or light weakness without jaundice, heaviness in the right hypochondrium), fulminant forms.

With rare fulinate (in a few hours or day) acute liver encephalopathy (acute liver syndrome - reduction of liver size, liver smell of mouth, inadequate behavior, positive letters and score, vomiting "coffee grounding", sharp increase in the level of Alt and AST), quickly Coma and death develops. [one] [2] [four]

Factors increasing the risk of severe hepatitis A:

Consequences for pregnant women

In pregnant women hepatitis A is generally somewhat heavier than that of non-empty. In about 36% of cases, the development of generic activity, premature childbirth (31-37 weeks) and postpartum bleeding are possible. The virus does not penetrate the placenta, that is, there is no specific effect on the fruit. In breast milk, the virus is not contained [one] [2] [four] [7] .

Pathogenesis of Hepatitis A.

The gate for the penetration of the virus is the mucous membrane of the organs of the gastrointestinal tract, where its primary reproduction occurs in the endothelial liner of the small intestine and mesenterical lymph nodes.

The path of propagation of hepatitis A in the human body

Next occurs the hematogenous propagation of virus particles and penetrate them into the liver, where they are localized in the rope and hepatocytes reticulogistic cells. As a result, cell damage occurs:

  • penetration of the virus into the cage;
  • capture lysosome;
  • destruction of the protein shell of the virus;
  • Assembling proteins according to a viral RNA program;
  • embedding these proteins in the cell cytolym;
  • the formation of pathological pores in the cage shell;
  • admission inside the cell of sodium and water ions;
  • Balloon dystrophy (the destruction of the ultrastructures of the cell and the formation of large vacuoles) followed by necrosis (its volume is usually limited);
  • The death of the cell and the lymphocytic immune response leading to the main volume of the lesion.
Changes in liver cells when hepatitis A

In the future, the virus falls into bile, with it he penetrates into the intestines and is displayed in the environment with feces. Due to the competent immune protection reactions, the breeding of the virus ends, and he leaves the patient's body. [2] [3] [four]

Classification and stage of the development of hepatitis A

According to the degree of diversity of manifestations, two forms of hepatitis A are distinguished:

  • clinically pronounced (jaundice, rude, erased);
  • Subclinic (Inapparantant).

The duration of the flow also highlight two forms of hepatitis A:

  • acute cyclic (up to three months);
  • Acute prolonged (more than three months).

Severity of hepatitis A:

  • lung;
  • medigated;
  • heavy;
  • Fulinate (lightning room).

According to the ICD-10 (international classification of diseases of the tenth revision), the disease is divided into three types:

  • B15. Acute hepatitis A;
  • B15.0. Hepatitis A with a liver room;
  • B15.9. Hepatitis A without a liver coma. [2] [four]

Complications of hepatitis A.

The disease can lead to the following complications:

  • The liver coma (dysfunction of the central nervous system associated with severe liver damage - is extremely rare);
  • cholecystocholangitis (severe pain in the right hypochondrium, the rise of jaundice and skin itch);
  • hemolytic-uremic syndrome, mainly in children (hemolytic anemia, thrombocytopenia, acute renal failure);
  • The development of the autoimmune hepatitis I type.

Hepatitis A does not lead to the formation of chronic forms, however, due to the pronounced inflammatory process, long-term residual (residual) phenomena is possible:

  • Dyskinesia (violation of motility) biliary tract;
  • postgepatitite hepatomegaly (increase in liver size due to the growth of connective tissue);
Residual phenomenon in the form of a liver
  • Postgepatite syndrome (increased fatigue, asno-neurotic manifestations, nausea, discomfort in the right hypochondrium). [one] [five]

Diagnosis of hepatitis A.

Laboratory diagnostic methods:

  • Clinical analysis of blood - normocytosis or leukopenia, lymph and monocytosis, neutropenia, ESO is normal or reduced.
  • Biochemical blood test - an increase in the total bilirubin and to a greater degree of its associated fraction (reaction of Erlich), an increase in the alanine substransferase and aspartataminotransferase, a decrease in the prothrombin index, an increase in the thymol sample (decrease in albumin and the increase in gamma globulin), an increase in gamma-glutamlitranspendase, alkaline phosphatase and other indicators.
  • Biochemical analysis of urine is the appearance of urobilin and biliary pigments due to direct bilirubin. Earlier, especially in the armed forces, to identify patients at the initial stage, the use of sample sample was practiced: in the morning the indicator strip is lowered in the urine (with urobilin, it changes color), and the soldier with a suspected disease was hospitalized for in-depth examination. A urobilin test becomes positive at the very beginning of the disease - at the end of the incubation period due to the disease of the liver cell.
  • Serological tests - detecting anti-HAV IgM and anti-HAV IgG by the IFA method (immuno-immunimal analysis) in different periods of the disease and HAV RNA with the help of PCR diagnostics (polyamic chain reaction) in a sharp period.
  • Ultrasound examination of the abdominal organs is an increase in the liver and sometimes spleen, reactive changes in the structure of the liver tissue, lymphadenopathy of the gate of the liver.

Survey of persons who are in contact with patients

Persons contacting with patients with viral hepatitis A are subject to inspection by a infectious disease physician, followed by observation up to 35 days from the date of disagreement with patients. The observation includes thermometry, inspection of the skin, determining the size of the liver and spleen, as well as a laboratory examination (ALT, total bilirubin, antibodies of the C classes M and G to the hepatitis virus at first and three weeks from the primary survey).

Differential diagnosis is carried out with the following major diseases:

  1. In the initial period:
  2. flu;
  3. gastritis, gastroenterocolite;
  4. polyarthritis;
  5. Enterovirus infection;
  6. In the jaundice period:
  7. leptospirosis;
  8. pseudotuberculosis;
  9. Infectious mononucleosis;
  10. jaundice other etiology (hemolytic disease, toxic lesions, tumors of the tract and other diseases);
  11. Hepatitis of other etiology (viral hepatitis B, C, D, E and other, autoimmune hepatitis, Wilson's disease - Konovalova, etc.) [one] [2] [3] [four] [9] .

Treatment of hepatitis A.

Ethiotropic therapy (aimed at eliminating the cause of the disease) has not been developed.

Medications

Depending on the degree of severity and specific manifestations, infusion therapy with glucose-saline solutions enriched with vitamins is prescribed. It is shown the appointment of sorbents, drugs to increase energy resources, if necessary, hepatoprotectors are appointed, in heavy cases - hormonal drugs, blood preparations, hyperbaric oxygenation and plasmapheresis.

Plasmapheresis mechanism in the treatment of hepatitis A

Does hospitalization need

In the case of light hepatitis forms, treatment can be carried out at home (if there are conditions). Hospitalization will be required, starting with medium-stage forms, persons of risk groups in severe flow, patients with complicated forms, pregnant women and children. Any features for further treatment of viral hepatitis A in children not.

The mode is bed or semicessive. In hepatitis, the processes of energy formation in mitochondria are violated, therefore a long rest is preferable.

Hospital treatment and extract

Treatment of hepatitis A. It takes place in the infectious department of the hospital. Patient extract occurs after the appearance of a persistent and pronounced tendency to clinical improvement, as well as improved laboratory indicators.

Criteria of patient extracts:

  • persistent and pronounced tendency to clinical improvement (no intoxication, reduction of liver size, jaundice regress);
  • Stable improvement in laboratory indicators (normalization of the level of bilirubin, a significant decrease in the level of Alt and AST).

With uncomplicated forms, reconvalues ​​(recovering patients) are subject to observation during three months with inspection and examination at least once a month. [2] [3] [6]

Physiotherapy

In the reconnaissance phase, especially with the protracted forms of the disease, the use of physiotherapy treatment methods is possible:

  • mud applications to the area of ​​the right hypochondrium;
  • acupuncture;
  • Massage of the projection of the region of the liver, gallbladder, biliary ducts.

Diet

Diet No. 5 is shown on the pessner - mechanically and chemically gentle, the use of increased fluid and vitamins, the prohibition of alcohol. The sharp, roasted, smoked, is limited to acidic and salt. All dishes are prepared for a couple, stew, drunk and served only in warm form.

Forecast. Prevention

The forecast of the disease is usually favorable. Patients are recovered 1-3 months after discharge from the hospital. In rare cases, the disease acquires a protracted character.

Criteria criteria:

  • lack of intoxication;
  • complete normalization of the level of bilirubin, alt and asthma;
  • Normalization of the size of the liver and spleen;
  • The appearance of antibodies to the hepatitis A class G (anti-HAV-IgG) appearance.

Nonspecific measures to reduce the number of infection cases:

  • ensuring the conditions and factors of consumption of safe drinking water (water supply);
  • ensuring and control over the observance of wastewater disposal (sewage farm);
  • monitoring the quality of the survey of personnel associated with the food industry;
  • Control and compliance with the technology of storage, preparation and transportation of food and water.

To personal preventive measures There is a thorough wash of hands after visiting the toilet, changing diapers, as well as before cooking or having food.

Vaccination

A specific prophylactic event is to conduct immunization against hepatitis A: almost 100% of vaccinated twice people are developed persistent immunity, preventing the development of the disease. Vaccination is the best way to prevent infection.

Hepatitis A vaccination

Groups of persons who are shown vaccination against hepatitis A:

  • persons, persistent drugs;
  • Travelers in hot countries;
  • homosexuals;
  • people having liver diseases (including viral hepatitis B and C);
  • Employees of decreated services and industries (educators, teachers, employees of the system of water supply economy and the food industry);
  • Children under 18;
  • homeless;
  • HIV-infected;
  • pregnant women with a risk of infection or a serious course of the disease;
  • all wishing to make vaccinations [one] [3] [6] [7] .

A, B, C, D, E, F, G ... This is not an English alphabet, it is a "hepatitis" alphabet: letters denote 7 types of disease. It is so much known today with viral hepatitis, according to many sources on the Internet. And almost all, saying gently, brew. How is it really?

Tells Alexey Buovers, a liver disease specialist, doctor of medical sciences, professor of the first MIMU. I. M. SECHENOVA (Sechenovsky University) :

- Already forgotten hepatitis F and G, once they were allocated, but it turned out to be a mistake. Viruses who were attributed to these variants of the disease turned out to be neither. In science it happens. Now there are five viral hepatitis: a, b, c, d and e. There are also several viruses that live in the liver, but do not cause diseases. Our immune system of them seems to notice: does not produce antibodies against them and does not attack, as a result they do not apply the visible liver damage. Their role is still unclear.

Ate and infected

In principle, all hepatitis can be divided into two groups depending on the method of infection. Hepatitis A and E are infected orally: through the mouth. The patient highlights viruses, and with contaminated products, water or hands they fall to a person. Both infections proceed with a jaundice, although not always. Hepatitis and long known and well studied, but with hepatitis E is more and more difficult. It is known that it is transmitted through a pork (there is evidence that the virus can multiply in the body of piglets) and many other infected products. But the infection itself is studied not enough, its prevalence in Russia is poorly known, and the methods of survey on hepatitis E into the number of routine are not included: the study that determines whether the causative agent of this form of hepatitis accurately causes an infection. And this means that such a disease can often receive hepatitis A. But hepatitis E is much more dangerous. If it develops in a person who has already chronic liver disease, the infection can proceed very hard and even with systemic effects: lesions of the joints and nervous system. This is a dangerous course. In the risk zone, there are also women in the second half of pregnancy, the third of them have very hard lesions with liver failure. In addition, there are suspicions that hepatitis E, unlike A, may become chronic, and in some cases it is capable of cirrhosis of the liver.

Hepatitis e must be engaged in seriously, especially since our country is a priority in the opening of this disease. She was taken for hepatitis A for a long time, and in the eighties, the Soviet scientist Mikhail Balayan proved that this is a separate infection. He was the first to highlight the virus, causing it. To do this, he had to be exposed to self-use, and the virus then he allocated. This discovery is recognized in the whole world.

Vampire viruses

Infection with the other variants of viral hepatitis occurs otherwise: the pathogen must be hit directly into the blood. Often talking about the sexual transmission of the virus during sex. In fact, the probability of such an infection is not the highest: the penetration of the virus through healthy mucous membranes is impossible, for this you need at least microcracks through which the pathogen can get directly into the blood. The possibility of such a transmission rises with anal sex, as it is more traumatic. Much more often, infection occurs when using non-disconnect or poorly processed medical instruments, with cosmetology procedures, applying tattoos, piercing, as well as drug addicts, and not only with intravenous drug administration, but also when inhalation of cocaine. Hepatitis viruses are sufficiently alive and retain activity for several days.

Hepatitis V virus does not always cause a disease, people can simply be with its carriers without any symptoms of infection. If they are present, it is necessary to be treated, since hepatitis can lead to cirrhosis and liver cancer. Alpha interferon and drugs from the nucleotide group are used.

Hepatitis D causes a viroid, unlike the classic virus, he cannot multiply. To do this, he needs a hepatitis B virus, only when interacting with which it is capable of replicated (multiply). And therefore, hepatitis D is only in those who are already sick with hepatitis V. Such a combination makes a more aggressive disease, it is heavier to be treated, cirrhosis develops much faster, and, as a rule, the patient needs a liver transplant. Liver cancer can develop. The only drug against this virus is alpha interferon, but it is effective for no more than 20-25% of patients. New drugs are at the stage of clinical trials.

But in the treatment of hepatitis with the revolution occurred. More recently, it was considered healing only about half of the patients, but now several drugs acting directly on the virus appeared, and patients are successfully cured. And, of course, it helps to avoid complications: cirrhosis and liver cancer. But with hepatitis C there are two problems. Its treatment is quite expensive (although it pays off), and there are many undiagnosed cases: people live with hepatitis C virus, not suspecting it. A lot of them and with us. For example, we recently conducted a study in the eight district centers of the Moscow region. Anonymously tested in saliva, the antibodies were determined to the virus. The true prevalence of the disease was 8-9 times higher than registered. Speaking easier, 80-90% of hepatitis virus media do not know about it. It is dangerous for them (they do not receive treatment) and for society (they can easily infect other people, expanding the scale of the disease). If they knew that hepatitis C virus was infected with, they could be effectively treated and behaved in such a way that the risk of infection from them was minimized. This is a huge social and medical problem.

reference

Than hepatitis differ from each other

Hepatitis A . The virus is transmitted mainly through water, products, and sometimes through household items. The causative agent enters the body through the mouth. The disease does not become chronic. Often, such hepatitis takes place secretly, without jaundice, and at this time from the patient it is very easy to get infected. After the disease, immunity is formed, and a person is repeated with such hepatitis. Against hepatitis A eating a vaccine, it is done in those cases when high risk of infection.

Hepatitis B . The virus is transmitted with blood and through all the secrets of the body (saliva, sperm, etc.). It is very easy to infect. This may be with any manipulations with blood: blood transfusion, injections and intravenous infusion by non-sterile needles, any operations, including dental manipulations, drawing tattoos, piercing. You can get infected with sexual contacts, kisses, using a common syringe with the introduction of drugs. Sick mother can infect the fruit.

5-10% of infectious disease becomes chronic. Approximately every fourth with the active current of the disease over time develops cirrhosis of the liver, and some are even liver cancer.

There is a vaccine that protects against hepatitis B (and therefore, from hepatitis D)

Hepatitis S.

. The main way of transmission - through blood. But it is less common that other ways to transfer the hepatitis C virus, typical for hepatitis V. But hepatitis itself is more seriously acute hepatitis with most often flows unnoticed, but chronic disease becomes every 6-8 people out of ten. Cirrhosis develops in every second or third patient with hepatitis C, very many often on the background of cirrhosis (and sometimes before) there is a liver cancer. No vaccines, but succumb to effective treatment.

Hepatitis D. . The causative agent of this disease cannot cause hepatitis independently: the disease is developing only in those who are already sick hepatitis V. Therefore, it makes sense to talk about mixed hepatitis B and D. Path of transmission in both of these diseases is the same, but when they combine, the forecast is sharply deteriorating: chronic disease It becomes 8-9 people out of ten, the course of the disease is severe.

Hepatitis E. . The causative agent is transmitted in the same way as hepatitis A, but this form is more severe. The disease is especially dangerous for pregnant women: it often leads to the death of the mother, and especially the fetus. There are no vaccines against such hepatitis.

Hepatitis A.

Viral hepatitis A. (Botkin's disease) - acute infectious lesion of the liver, characterized by a benign course, accompanied by necrosis of hepatocytes. Viral hepatitis A is included in the group of intestinal infections, since it has a fecal-oral infection mechanism. In the clinical course of viral hepatitis A, wailing and jaundice periods are distinguished, as well as reconvaluescence. Diagnostics is carried out according to the data of biochemical analysis of blood, the results of RIA and IFA. Hospitalization of patients with viral hepatitis A is needed only in severe cases. An outpatient treatment includes a diet and symptomatic therapy.

General

Viral hepatitis A. (Botkin's disease) - acute infectious lesion of the liver, characterized by a benign course, accompanied by necrosis of hepatocytes. Botkin's disease belongs to viral hepatitis transmitted by the fecal-oral mechanism, and is one of the most common intestinal infections.

Characteristic pathogen

Hepatitis A virus belongs to the genus Hepatovirus, its genome is represented by RNA. The virus is quite resistant to the environment, is maintained for several months at 4 ° C and years - at -20 ° C. In room temperature, saves viability for several weeks, dies when boiling after 5 minutes. Ultraviolet rays inactivate the virus of a turn of one minute. The causative agent can keep the vitality in chlorinated water from the water pipeline.

Hepatitis A is transmitted using a fecal-oral mechanism mainly aqueous and alimentary way. In some cases, it is possible to infect contact-domestic weather when using item item, dishes. Outbreaks of viral hepatitis A when implementing the water path of infection, it is usually arising when a virus in the waterproof tanks, the food path of infection is possible both when eating contaminated vegetables and fruits and raw mollusks living in infected reservoirs. The implementation of the contact-household path is characteristic of children's teams, where there is not enough attention to the sanitary and hygienic regime.

Natural susceptibility to hepatitis virus and people are high, the greatest - in children of appropriate age, post-infectious immunity is stressful (somewhat smaller tension is characteristic after subclinically flowing infection) and long. Infection with viral hepatitis and most often occurs in children's teams. Among adults in the risk group includes staff of preschool and school children's food, as well as medical and preventive and spa institutions, nutrition facilities. Currently, collective outbursts of infection among drug addicts and homosexuals are increasingly marked.

Symptoms of viral hepatitis A

The incubation period of viral hepatitis A is 3-4 weeks, the beginning of the disease is usually acute, the flow is characterized by a sequential change of periods: no fighters, yellow and reconvaluedness. The expell (long-term) period occurs in various clinical versions: feverish, dyspeptic, asthenovegetative.

Fevering (flu) variant of the flow is characterized by sharply developed fever and intoxication symptoms (the degree of severity of the general-cycration syndrome depends on the severity of the flow). Patients complain of general weakness, Malgia, headache, dry curves, throat, rhinitis. Catarial signs are expressed moderate, the redness of the rise is usually not observed, they may be combined with dyspepsia (nausea, degradation of appetite, belching).

The dyspeptic version of the flow is not accompanied by catarrhal symptoms, intoxication is expressed little. Patients complain mainly on digestive disorders, nausea, vomiting, bitterness in the mouth, belching. Often there is a stupid moderate pain in the right hypochondrium, epigastrics. It is possible a disorder of defecation (diarrhea, constipation, their alternation).

The expensive period flowing through the asthenovogetative version is little specific. Patients of sluggish, apathetic, complain about general weakness, suffer from sleep disorders. In some cases, the long-standing features are not observed (latent version of the waves), the disease begins immediately from jaundice. In case there are signs of several clinical syndromes, they talk about a mixed version of the expensive period. The duration of this phase of infection can be from two to ten days, on average, usually the long period takes a week, gradually moving to the next phase - jaundice.

In the jaundice period of viral hepatitis A characteristic of the disappearance of signs of intoxication, the falling of fever, improving the overall condition of the patients. However, dyspeptic symptoms, as a rule, persists and aggravated. Jaundice is developing gradually. At first, the darkening of urine, the yellowish shade is acquired by sclers, mucous membranes of the bridle of the tongue and soft nose. In the future, yellowing the skin, acquiring an intense saffron tint (hepatic jaundice). The severity of the disease can be correlated with the intensity of skin staining, but it is preferable to navigate for dyspeptic and intoxication symptoms.

With severe hepatitis, signs of hemorrhagic syndrome (petechia, hemorrhage on mucous membranes and skin, nose bleeding) can be noted. With a physical examination, a yellowish flare in the tongue, teeth noted. The liver is enlarged, during palpation moderately painful, in a third of cases there is an increase in the spleen. The pulse is several regenerated (bradycardia), blood pressure is lowered. Cal brightens up to complete discoloration in the midst of the disease. In addition to dyspeptic disorders, patients may complain about asthenovegetative symptoms.

The duration of the jaundice period usually does not exceed the month, it is 2 weeks., After which the reconstruction period begins: there is a gradual regression of clinical and laboratory signs of jaundice, intoxication, the size of the liver is normalized. This phase can be quite long, the duration of the reconnaissance period usually reaches 3-6 months. The course of viral hepatitis A is predominantly easy or medium-free, but in rare cases there are seriously occurring forms of the disease. The chronization of the process and the virons is not characteristic for this infection.

Complications of viral hepatitis A

Diagnosis of viral hepatitis A

In general blood test, there is a reduced concentration of leukocytes, lymphocytosis, EDA elevated. Biochemical analysis shows a sharp increase in the activity of aminotransferase, bilirubinemia (mainly due to the associated bilirubin), reduced albumin content, low prothrombin index, an increase in the sulea and reduction of thymol samples.

Specific diagnosis is carried out on the basis of serological methods (antibodies are detected using ELISA and RIA). In the jaggie period there is an increase in IG M, and in reconvalled - IgG. The most accurate and specific diagnosis is to identify the RNA of the virus in the blood using PCR. The discharge of the pathogen and the virological study is possible, but in view of the complexity to the general clinical practice inexpediently.

Treatment of viral hepatitis A

Botkin's disease can be treated with an outpatientness, hospitalization is produced in severe forms, as well as on epidemiological indications. In the period of pronounced intoxication, the patients are registered, diet No. 5 (in the variant for acute hepatitis flow), vitaminotherapy. Food fractional, fatty food is excluded, products that stimulate bile production are encouraged by dairy and vegetable components of the diet.

It is necessary to completely exclude alcohol. Ethiotropic therapy for this disease is not developed, a complex of medical measures is aimed at reliefing symptoms and pathogenetic correction. For the purpose of disintellation, abundant drink is prescribed, if necessary, the infusion of crystalloid solutions. In order to normalize the digestion and maintenance of the normobiocenosis of the intestine, lactulose preparations are prescribed. Antispasmodics are used to prevent cholestasis. If necessary, the preparations of UDCC (URSO-Osodoxycholic acid) are prescribed. After clinical recovery, patients are on the dispensary observation of the gastroenterologist for another 3-6 months.

In the overwhelming majority of cases, the prognosis is favorable. In complications from the biliary tract, the cure is delayed, but with false therapy, the forecast is not exacerbated.

Prevention of viral hepatitis A

General preventive measures are aimed at ensuring the qualitative purification of drinking water sources, controlling wastewater discharge, sanitary and hygienic requirements for catering at catering establishments in food and medical institutions. Epidemiological monitoring of production, storage, food transportation, with flashes of viral hepatitis A in organized groups (both children's and adults), carry out relevant quarantine events. Patients are isolated for 2 weeks, contagious after the first week of the jaundice period comes down. Admission to study and work are carried out by the onset of clinical recovery. Contact persons are monitored for 35 days from the moment of contact. In children's teams, quarantine is appointed at this time. In the focus of infection, the necessary disinfective measures are manufactured.

Vaccination against hepatitis A is recommended for children from age 1 year and adults departing in zones dangerous on viral hepatitis A.

Ways of infection with hepatitis A

Hepatitis A is a disease of Botkin or jaundice, which is known to many, because the disease occurs among patients of the most different age.

Scientists were able to establish that approximately 1.5 million infected people were recorded annually in hospitals, but this is not a final number.

It is known that the disease is able to flow without explicit signs and complications for the patient, because some people do not even know what caused infection and do not seek help for help.

A common audience for hepatitis A is children aged three to ten years. It is necessary to carefully react to the disease to avoid complications.

In the article you will find information about who is most susceptible to infection, the likelihood and ppnet transmission of infection, as well as ways to protect ourselves from hepatitis A.

Who is subject to infection?

The disease is often transmitted through unwashed hands.

Hepatitis A is called children's infection. In most cases, this concerns countries that develop and have a reduced level of social, as well as economic development. Many children suffer from a disease for even 10 years and have a lifelong strong immunity to him.

Studies have shown that the number of patients who have been manifested by hepatitis symptoms and much less than the number of people having antibodies to this virus. This fact suggests that the disease often does not show itself and does not have adamable signs.

In well-developed and stable countries, "diseases of dirty hands" are not so common, because personal hygiene is observed at a high level, and utilities perfectly cope with their tasks.

What is the risk of getting infection?

To find out the likelihood of the risk of infection itself, conduct a special study of blood to the slightest presence in the body of antibodies to hepatitis A of the class of the designated immunoglobulin of the group G. When these particles are detected in the blood, we can talk about the presence of strong immunity to infection, that is, the possibility of infection is neurophered, and vaccination It is not required to protect the body. If there is no antibody, the risk increases, and therefore you need to go to the hospital vaccination.

Experts allocate several groups of people who need vaccination due to the high risk of infection:

  1. Households who live with a man, having hepatitis.
  2. Persons who have sex contacts with sick.
  3. Children who live in a terrain with a common virus.
  4. People who are sent for a certain period into the country with an increased incidence of hepatitis A.
  5. Men who have the practice of homosexual relationships.
  6. Drug addicts.

You can contact with patients with hepatitis A if you comply with the usual hygiene rules. Children are better to be isolated from infected. If you consider all the simple rules, you can easily live on one territory with a family member who has already received an infection.

Path transmission infection

Fecal-oral infection

This transmission method is the most famous and common. Hepatitis type A virus is highlighted in a sufficiently large quantity together with feces during the period of the asymptomatic period of the course of the disease, and sometimes in the early stages of the ailment, when there are primary clinical manifestations. An infected patient may not be suspected that the body is already actively developing a disease. A huge role in all this is also played by personal hygiene, which many simply do not observe.

Do not drink water from unknown sources, use clean

Contacts with people

The transfer of hepatitis viral infection can occur after close contact with a previously infected person. This is possible if the patient care is performed, which suffers from incontinence or urine. Sometimes you have to care for people who cannot independently apply personal hygiene measures, which contributes to infection with the hepatitis of type A.

Hepatitis outbreaks are often fixed in kindergartens, schools, hospitals, nursing homes. In these premises, the staff is constantly in close contacts with people, followed by. At home, contacts also bear the threat of infection, which is simply impossible to avoid.

With sexual contacts, especially in the case of its oral-anal form, it is often a frequent infection with hepatitis of type A, therefore it is recommended to use condoms.

Speaker

Parenteral path infection

During the period of primary development, there is no donation, because the risk of plasma infection increases. The virus of this type has no shell, therefore it cannot be stopped by using solvents and detergents.

Common blood products that were not properly processed in advance can quickly lead to an active flash of hepatitis A in patients with hemophilia. But still the frequency of infection is dangerous to health virus in the case of blood transfusion is not as high as with other methods of transmission of viral infection.

How to avoid infection

Not sick with this hepatitis after the virus cells occurred can only be possible when special vaccination was previously carried out from this infection and the body formed an immunity to it.

If there is no bodies for protection, and the virus has already fallen into the blood, then hepatitis itself can not be avoided. There is a specialized drug - Immunoglobulin which is introduced into the body immediately before possible infection or in the near future after the resulting infection. This makes it possible for a certain period to protect yourself from infection or the active development of the disease when infected.

Remember that the re-infection of the hepatitis of the type A does not occur.

If your family already has a patient, you need to examine absolutely all members of the family on the spread of antibodies that are working against hepatitis. When there are no antibodies in the body, vaccination is recommended. It is held in the direction of the doctor who checked your health.

Compliance with the rules of hygiene will avoid infection with hepatitis A

Always follow the Hygiene rules marked everywhere, which will help to avoid illness at contact with the illness:

  • After another visit to the toilet room and even the use of the bathroom should be washed your hands.
  • Wash your hands carefully and after everyday care of a newborn or more adult child and to any actions that concern him.
  • Before taking food and its preparation is also recommended to wash your hands.

It is worth paying attention to what you eat, never take food with dirty hands, on which there may be not only hepatitis A, but also other dangerous ailments.

It is necessary from early childhood to teach children to wash your hands after the street, animal contacts. Food is to betray heat treatment so that there is no dangerous virus infections and their pathogens that bring tremendous harm to the body.

Conclusion

Hepatitis infections fall into the body are quite different and require attention among adults, parents and children. Always pay attention to the fact that you want to contact with dirty food or dishes that did not have proper heat treatment before filing on the table.

For timely treatment, it is necessary immediately after contact with the patient or an increased risk of infection to contact a specialist who can diagnose your infection by carrying out the necessary detailed analyzes and examination of the patient. If the family already has an infected with hepatitis of type A, it is also necessary to seek medical help in the form of vaccination.

Proper compliance with ordinary tips will help avoid jaundice and infection of family members. It is also recommended in countries with a reduced level of development to improve the informs of people about the disease, its distribution and methods of struggle. The information will help people not be afraid of this ailment, and be able to stop it and secure yourself from hepatitis A, as well as their family and children.

Many diseases begin only for the reason that people are not informed about them and do not know the right methods of struggle. If this nuance take into account, the outbreaks of hepatitis A and its consequences can be avoided.

If the infection has happened, it is necessary to seek qualified help to the attending physician, which will conduct an accurate diagnosis with the final diagnosis and treatment with effective modern methods. Timely appeal to the doctor will help to avoid unwanted and dangerous consequences of the disease, as well as infection of other people with which subsequent contacts occur.

Minov Alexey Leonidovich

Hepatologist, gastroenterologist, proctologist

Alexey is engaged in medical activities since 1996. Conducts the therapy of all diseases of the liver, gallbladder and the gastrointestinal tract in general. Among them: hepatitis, pancreatitis, duodenal ulcer, colitis.

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