Ways of infection with hepatitis a. Causes, symptoms and treatment of hepatitis A

14.07.2020

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 the year to 10 years have endured the disease in easy form, and babies and older 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.

History. 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

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.

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

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	Reaction immune system on 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 advent of the jaundice, the temperature is normalized
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 bile bubble does not fall into 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 medical 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 In 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 of the state	Anti-inflammatory anti-allergic effects, reduce the attack of immunity cells (lymphocytes and leukocytes) on damaged liver cells	Prednisolone, methylprednisolon	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
Immunomodulators		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 Sulfat.	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.

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
beverages: Tea black, herbal, compotes, juices, umbaw, decoction of rosehip, coffee with milk, alkaline mineral water, 5% glucose solution.
preloading preparations recovery electrolyte balance Rejections 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, sparkled
beverages: Strong coffee, cocoa, carbonated drinks, alcohol

Diets must be followed during the disease and for 3-6 months after recovery. Restriction of fats I. simple carbohydrates Allows you to prevent fat degeneration of the liver. Easy to assimage dishes and fractional food 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 physical and emotional state.

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 right shoulder, occurs after eating and exercise. Bind in the mouth, nausea, vomiting, unpleasant smell of mouth.
Cholecystitis - Inflammation of the walls of the gallbladder, accompanied by stagnation of bile. Symptoms: acute pain in the right hypochondrium that gives right part Lans 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 cholecystitis after meals there are stupid many pain In the right half of the abdomen.
Chronic pancreatitis - chronic inflammation pancreas. Symptoms: Pain in the area of \u200b\u200bthe 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.

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.
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.
- Travelers serving low hygiene countries
- Servicemen, for a long time staying in field conditions
- 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
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
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.

Ways of transfer of hepatitis A is the most common issue among people of any age category and sexuality, which had contact with a contaminated person. Such a disease belongs to the group of intestinal infections than and differs from other varieties of liver damage.

Hepatitis A - HAV virus is characterized by its resistance to adverse external conditions. In the environment, subject to room temperature, it is able to maintain its viability of the weeks, in the conditions of cold - months and years during freezing below twenty degrees. You can only kill the causative agent by boiling - death occurs in about five minutes.

Source of disease

Hepatitis A refers to the group of anthroponous infections. This means that a source of infection in all cases is a person, and it does not matter, in what form it flows such pathology.

The main role in the wide prevalence of such a disease is played by patients with atypical forms of illness, which can be attributed to:

starly - the main symptoms of the disease are expressed slightly and often completely ignored by people. This means that a person himself provokes the development of complications and long-term restoration of the affected organ. Norma, with timely started therapy, the liver comes from six months to one year;
a rude - with similar course, the main clinical manifestations are pronounced, while specific, in the form of a change in skin, mucous membranes, urine and cartoons are missing. Such a situation leads to the fact that such a disease is adopted for a completely different disorder;
subclinic - characterized by the fact that symptoms is not manifested at all. In such cases, only data from laboratory studies will indicate the presence of illness, which will show changes in blood tests, as well as instrumental examinations - will indicate an increase in the liver.

It follows from this that patients, in most cases, lead an active lifestyle and contact with other people, in particular children, which makes an infected person with a hidden and powerful source of infection.

It is worth noting that it is the atypical course of the disease prevails over typical forms.

People who are at the beginning or end of the incubation period are the greatest danger, the duration of which varies from two weeks to one and a half months, but often does not exceed a three-week term.

Another important thing is that the person is equally dangerous, both with a manifest form of illness, and with a rude one.

Ways transfer

Modern medicine allocates the following main ways to transmit viral hepatitis A:

water;
contact-household;
parenteral;
food.

Such paths of how Botkin's disease can be transmitted is a general mechanism - fecal-oral.

The water path of hepatitis transmission A is considered the most common, since the virus is in contaminated water. For this type of infection typical:

active increase in the number of infected;
the massability of the disease among those living in the area near the baked reservoirs.

The implementation of the water path of infection is possible in such cases:

reception inside the water of dubious origin without preliminary filtering or boiling. This can be attributed both to the closure of the reservoir and the spring;
use of water for washing dishes;
cleaning teeth or performing other hygienic procedures oral cavity Using water.

Such a method of infection can cause an outbreak of hepatitis A in entire settlements, children's and adult groups of closed or open type.

The second way of how hepatitis A is transmitted is food. For its implementation, the following cases are dangerous:

the use of one dishes and cutlery with an infected person;
joint use of the same dishes;
reception inside the food, which has prepared the patient.

In addition, it is possible to get sick in the following cases:

when using vegetables and fruits, which were washed in contaminated water, without subsequent heat treatment;
during the preparation of fish and seafood dishes that could be caught in adverse reservoirs.

This possibility of infection is most characteristic of children's teams in pre-school and school educational institutions.

The virus can also be transmitted through the infected items to which the virus carrier told.

Contact mechanism of hepatitis transmission A can be realized on the background:

direct contact with the sick person;
use of common household items to which a razor machine, manicure scissors and a toothbrush are attributed;
non-compliance with the rules for processing the toilet both home and public.

The parenteral path is in contact of a healthy person with the blood of the patient. How can I get hepatitis and through blood:

when blood transfusion from the carrier, however, currently such an opportunity is reduced to zero, since each donor, blood test for infections is given before passing such a procedure;
subsequently transfusion of blood components, such as plasma;
through the use of a common syringe with an infected person for injection of substances.

Among the less common mechanisms of how hepatitis is transmitted and can be allocated:

unprotected sexual contact with pathogen carrier. Many patients are interested in the question - whether hepatitis is transmitted through sex? Infection with this virus sexually possibly possible only with anal-oral sexual intercourse;
visiting dental or manicure cabinets;
tattoo shocking;
through the flies - it does not exclude the possibility that these insects can act.

It is worth noting that Botkin's disease is not transmitted by air-drip, even when strong cough or sneezing. There are also no cases of transmission of virus from mother to the child during pregnancy, generic activity or breastfeeding kid.

For such a disease, characteristic seasonal outbreaks and the frequency of morbidity. So, the number of patients with hepatitis A increases in the summer-autumn time of the year.

Basic risk groups

There are several groups of people who are most infected with such a virus. The main category of risk is:

employees of medical and children's institutions - due to the fact that hepatitis A is transmitted through contact with blood or use by common cutlery;
food staff - the danger of infection lies in the fact that such people are forced to contact with products that are grown in polluted zones;
military personnel who may be in countries in Asia and Africa, where the incidence of Botkin's disease reaches high values;
drug addicts - viruses are transmitted through an infected needle who enjoyed an infected person;
persons who have direct contact with the sickness of the patient;
homosexual men;
patients suffering from other heavy liver diseases;
tourists and travelers visiting countries with a high level incidence of hepatitis A;
family members in which there is a patient with a similar diagnosis.

It is such factors that transmit the hepatitis A virus that require vaccination against such a disease that must be carried out both adults and children. Such a measure is mandatory, despite the fact that no chance has a favorable forecast and rarely leads to the development of complications.

It should be noted that the main difference between Botkin's disease from other viral lesions of the liver, is that after recovery, a lifelong immunity is formed in a patient. However, this is not a reason to abandon vaccination. In addition, today there are a large number of preventive recommendations, compliance with which minimizes the likelihood of infection with this virus.

Moscow doctors fix an unusual increase in the incidence of Muscovites with viral hepatitis A and B, although the epidemiological threshold for this disease has not yet been exceeded, writes the Moscow Komsomolets newspaper on Wednesday.

Viral hepatitis - common and dangerous infectious diseases of the liver.

Of all the forms of viral hepatitis hepatitis A is the most common. From the moment of infection until the appearance of the first signs of the disease passes from 7 to 50 days. Most often, the beginning of the disease is accompanied by a temperature lift and can resemble flu. Most cases are completed by spontaneous recovery and does not require active treatment. With severe course, droppers are prescribed, eliminating the toxic effect of the virus to the liver.

Virus hepatitis B. Transmitted by sexually, when injected by non-sterile syringes from drug addicts, from the mother - the fetus. In typical cases, the disease begins with an increase in temperature, weaknesses, pain in the joints, nausea and vomiting. Sometimes rash appear. There is an increase in the liver and spleen. There may also be a darkening of urine and bleaching feces.

Hepatitis S. - The most severe form of viral hepatitis, which is also called post-transfusion hepatitis. This means that they have fallen after blood transfusion. This is due to the fact that testing donor blood on the hepatitis C virus has become just a few years ago. Frequently often an infection occurs through the syringes from drug addicts. Possible sexual path and mothers - fruit. The greatest danger is a chronic form of this disease, which often goes into cirrhosis and liver cancer.

Chronic flow develops approximately 70-80% of patients. The combination of hepatitis C with other forms of viral hepatitis sharply takes away the disease and threatens with a fatal outcome.

Hepatitis D. - "satellite disease" complicating the course of hepatitis B.

Hepatitis E. Looks like hepatitis A, but it begins gradually and more dangerous for pregnant women.

Last in the hepatitis family hepatitis G., similar to C, but less dangerous.

Ways of infection

Hepatitis viruses fall into the human body with two main ways. The sick person can allocate a virus with feces, after which the one with water or food enters the intestines of other people. Doctors call such a mechanism for infection fecal-oral. It is characteristic of hepatitis A and E. Thus, hepatitis A and hepatitis E arise mainly due to non-compliance with personal hygiene, as well as in the imperfection of the water supply system. This explains the greatest prevalence of these viruses in low-developed countries.

The second way of infection is the contact of a person with infected blood. It is characteristic of hepatitis V viruses, C, D, G. The greatest danger, due to the prevalence and severe consequences of infection, represent the hepatitis V viruses in and S.

Situations in which most often incurs:

Transfusion of donor blood. All over the world, an average of 0.01-2% of donors are carriers of hepatitis viruses, so currently donor blood before transfusion of the recipient is investigated for the presence of hepatitis B and C viruses.

Using one needle different people Many times increases the risk of infection with hepatitis B, C, D, G. This is the most common path of infection among drug addicts;

Viruses B, C, D, G can be transmitted during sexual contact. Most often, hepatitis V. is transmitted in gepatitis. It is believed that the likelihood of infection with hepatitis with spouses is small.

The path of infection from the mother to the child (doctors call it "vertical") is observed not so often. The risk increases if the woman has an active form of a virus or in recent months of pregnancy suffered acute hepatitis. The probability of fetal infection increases sharply if the mother, in addition to the hepatitis virus, has HIV infection. With milk mother, the hepatitis virus is not transmitted. Hepatitis V viruses, with D, G are transmitted when applying a tattoo, acupuncture, piercing with ears by non-sterile needles. In 40% of cases, the source of infection remains unknown.

Symptoms

From the moment of infection until the first signs of the disease passes different time: From 2-4 weeks with hepatitis A, up to 2-4 and even 6 months with hepatitis V. After this period, during which the virus breeds and adapts in the body, the disease begins to manifest itself.

At first, before the appearance of a jaundice, hepatitis resembles flu and starts with increasing temperature, headaches, general ailment, lobs in the body, as with hepatitis A. In hepatitis B and from the beginning, as a rule, more gradual, without a sharp rise in temperature. So, the hepatitis B virus manifests itself with a minor temperature, pain in the joints, sometimes rashes.

The initial manifestations of hepatitis C can limit the weakness and decline in appetite. A few days later, the picture begins to change: the appetite disappears, pains appear in the right hypochondrium, nausea, vomiting, darkens urine and discolored feces. Doctors fix the increase in liver and less often - spleen. Changes characteristic of hepatitis are detected in the blood: specific virus markers, bilirubin increases, and hepatic samples increase 8-10 times.

Usually after the appearance of the jaundice, the patients condition improves. However, this does not occur when hepatitis C, as well as chronic alcoholics and drug addicts, regardless of the type of virus caused by the disease due to the intricaciation of the body. The remaining patients gradually, for several weeks, the reverse development of symptoms occurs. So the sharp forms of viral hepatitis proceed.

The clinical course of hepatitis can be varying severity: lightweight, medium and heavy forms. There is also a fourth, fulminant, that is, a lightning form. This is the heaviest variety of hepatitis, in which massive necrosis of the liver develops, usually ends with the death of the patient.

The greatest danger is the chronic flow of hepatitis. Chronicization is characteristic only for hepatitis B, C, D. Most characteristic features Chronic hepatitis are dismising and increasing by the end of the day increased fatigue, the inability to perform former physical exertion. At the far short stage of chronic viral hepatitis, jaundice detects, darkening urine, skin itching, bleeding, weight loss, liver and spleen, vascular stars.

Treatment

The duration of hepatitis A is on average 1 month. Special antiviral treatment is not required. Treatment includes: basic therapy, bed mode, diet observance. In the presence of indications, disintellation therapy (intravenously or orally), symptomatic therapy is prescribed. It is usually recommended to avoid alcohol use, which, as a poisonous substance, can weaken the already damaged liver.

Acute viral hepatitis In with pronounced clinical symptoms Ends in recovery in more than 80% of cases. In patients undergoing rude and subclinical forms, hepatitis in often chronized. Chronic hepatitis leads to the development of cirrhosis and liver cancer. Full cure chronic hepatitis Practically does not occur, but it is possible to achieve a favorable course of the disease, subject to certain recommendations regarding the regime and recreation, nutrition, psycho-emotional loads, as well as when receiving drugs that improve exchange processes In liver cells.

Basic therapy is required. Antiviral treatment is prescribed and is carried out under the strict control of the doctor and in cases where testimony is available. Antimiral treatment includes drugs of interferon groups. Treatment is carried out for a long time. Sometimes repeated therapy courses are needed.

Hepatitis C is the most serious type of hepatitis. The development of chronic form is observed at least every seventh diseased. These patients have a high risk of cirrhosis and liver cancer. The basis of all treatment schemes is interferon alpha. The mechanism of action of this drug is to prevent the infection of new liver cells (hepatocytes). The use of interferon cannot guarantee complete recovery, however, the treatment of them prevents the development of cirrhosis or liver cancer.

Hepatitis D proceeds only against the background of hepatitis B. Hepatitis D should be carried out in the hospital. Requires both basic and antiviral therapy.

Hepatitis E is not treated, since the human body is strong enough to get rid of the virus without the help of treatment. After a month and a half comes a complete recovery. Sometimes doctors prescribe symptomatic therapy to eliminate headaches, nausea and other unpleasant symptoms.

Complications

Complications of viral hepatitis can become functional and inflammatory diseases of the biliary tract and hepatic coma, and if the violation in the work of biliary tract is amenable to therapy, then the hepatic coma is a formidable sign of the lightning form of hepatitis, ending with the fatal outcome of almost 90% of cases. In 80% of cases, the lightning flow is due to the combined effect of hepatitis B and D viruses. The hepatic coma comes due to massive death (necrosis) of liver cells. The decay products of the liver tissue fall into the blood, causing the lesion of the central nervous system and the extinction of all life functions.

Chronic hepatitis is dangerous in that the absence of adequate treatment often leads to cirrhosis, and sometimes liver cancer.

The most serious flow of hepatitis causes a combination of two or more viruses, for example B and D or B and C. Even b + d + c. In this case, the forecast is extremely unfavorable.

Prevention

To protect yourself from infection with hepatitis, it is necessary to comply with uncomplicated rules. Do not use non-filled water, always wash fruits and vegetables, not neglect the heat treatment of products. So you can prevent infection with hepatitis A.

In general, contact with biological fluids of other people should be avoided. For protection from hepatitis B and C - first of all with blood. In microscopic quantities, blood can stay on razors, toothbrushes, nail scissors. Do not share these items with other people. It is impossible to make piercing and tattoos by non-sterile devices. It is necessary to take precautions during sex.

Material prepared on the basis of open sources information

Hepatitis A, which is often called Botkin's disease or jaundice - one of infectious diseaseswidespread. People are sick of all ages, but more often children from 2 to 14 years old, men and women are infected equally often. According to statistics, more than 1.5 million people are ill in the world, however, doctors believe that this figure is strongly understated because childhood The disease very often flows absolutely asymptomatic.

The disease is caused by a virus. The mechanism of transmission of infection fecal-oral. The sick person with carte masses highlights a huge amount of pathogens into the environment, which can fall on the item (dishes, toys, door handles, buttons in the elevator, etc.). With the disordered objects, the causative agent of the disease is most often applied to the hands, and then into the oral cavity. That is why the outbursts of hepatitis A in the collectives are often recorded, especially children, and the disease in the people is called dirty hands.

The virus can fall into water and food when preparing an infected cook. It is possible to interfere with vegetables, fruits and berries on which wastewater and sewage can enter. Bathing in contaminated water bodies and drinking from unverified sources can also lead to infection.

The probability of transmitting the virus by a parenteral manner exists, but it occurs extremely rarely.

The virus is sufficiently stable in the external environment. In room temperature, it is saved on the item at room temperature during the week, and on food in a humid environment - several months.

From the oral cavity, the virus enters the intestine, from there to blood, and further into the liver, where the inflammatory process causes. The causative agent is multiplied in the cells of the liver - hepatocytes, provoking their death. This occurs until the body has the amount of antibodies sufficient to suppress its activity.

Symptoms of disease Botkin

During the disease, several stages are distinguished: the incubation period, the pretty, jellied and recovery period.

The incubation period of the disease lasts up to 60 days, all this time the patient highlights the causative agent of the disease into the environment and can infect others.

Promotional (Pricky) period

During this period, the patients appear the first complaints, its duration usually does not exceed 7 days. Symptoms of general intoxication of the body appear: fever, weakness, headache, little runny nose, sore throat. There may be bol in abdominal pain, nausea, vomiting, diarrhea or constipation. Sometimes the symptoms of intoxication and the temperature increase are not and the disorders of the digestion are coming to the fore.

In some cases, the long period is hidden and the disease immediately manifests the jaundice.

Ripping period (jaundice)

Patients may be disturbed pain or severity in the right hypochondrium, it is caused by an increase in liver and stretching its capsules, it is also possible to increase the spleen. Nausea, vomiting, meteorism and stool disorders can persist. Jaundice comes to the fore: skin cover, mucous membranes, the sclers acquire lemon yellow painting. As a rule, with the advent of this symptom, the body temperature is normalized. Attention is drawn to the darkening of urine (dark beer color) and lightening of carts.

The duration of jaundice on average is 2-4 weeks.

Reconvocation period (recovery)

The symptoms gradually pass, restore the function of the liver, however the yellowness of the skin and the scool can be maintained for quite a long time. Complete recovery occurs after 1-12 months.

Treatment of hepatitis A.

Entryosorbents, the most famous among whom will be prescribed by hepatitis A activated carbon.

Hospitalization in the infectious department is usually not required. Specific treatment of this disease does not exist, symptomatic means apply. In addition, the diet shown in the pathologies of the liver (Table No. 5 for Pessner) is required.

Groups of drugs used in the treatment of Botkin's disease:

Disinfectants: saline and 5% glucose solution, with the addition of ascorbic acid, REOPOLIGULUKIN.
Enterosorbents: Activated coal, enterosgel, smecta, polyfepan, polysorb, etc.
Hepatoprotectors: Phosphoglie, Essence Forte, Pro Parp, Heptral, hepaben.
Enzyme preparations: Mezim Forte, Creon, Panzinorm, Festal, Poletrath, Pancreatin.
Choleretic means apply only if the patient has no gallgamed disease: Allohol, Holenzim, Hofitol, Holosas, Flamin, etc.
Vitamins: any polyvitamin complexesBut especially useful for the health of the liver Vitamins of Group V.

Consequences and prevention

In the overwhelming majority of cases, this disease does not give complications and does not lead to any consequences for the body. As a result of the treatment and observance of the diet, the liver function is restored completely. A diet must be observed for at least six months after the disappearance of symptoms, several courses of treatment for hepatoprotectors and reception of vitamins can also be recommended.

Exceptions are possible only in 2% of cases, when patients did not comply with the diet, abandoned therapy, chronically abuse alcohol or had previously any liver disease.

Prevention of hepatitis A does not represent special difficulties and is primarily reduced to compliance with the rules of personal hygiene and food culture. It is necessary to thoroughly wash your hands with soap (to wash at least 20 seconds) after each visit to the toilet and before eating. It should only drink boiled water, fruits and vegetables before use need to be washed and desirable to use boiling water.

If the team was detected in the team, the focus is needed:

wet room cleaning with disinfecting solutions;
in kindergartens and schools, disinfection of furniture and toys, quarantine is declared for 35 days from the moment of registration of the latter case;
the dishes that previously used the patient should be thoroughly washed and boiled for 15 minutes in soda solution, and during the disease he needs to highlight an individual set of dishes, which will also be carefully processed after each meal intake;
bed and underwear before washing, you need to boil in the solution of washing powder (15 minutes).

Hepatitis A vaccination

To date, designed effective vaccine To prevent this disease, it is not included in the list of mandatory vaccinations in our country. In Russia, several vaccines are used:

Havrix;
Avaksim;
Vakta;
Gep-A-in-Vak;
Hepatitis A. vaccine

travelers and people who are forced to visit countries with a high level of antisanitarian (countries of Africa and Asia);
people, for a long time stay away from full sources of clean water and sewage (servicemen on field exercises, refugee camps);
food industry workers at enterprises, catering establishments, kitchens of public institutions;
medical workers, especially contacting patients with biological fluids (Sanitary, laboratory technicians, nurses, surgeons, infectiousists).

To which doctor to turn

When the child appears, the symptoms of infection must be referred to as a pediatrician or infectious background. In the future, the consultation of the nutritionist will be useful, since proper nutrition Helps liver cells to recover faster.

Fragment of the transmission "On the most important" (TV channel "Russia 1"), the topic of release "Hepatit A":

Hepatitis A - symptoms of cause and treatment

It is such a question that occurs in a person of any age after contact with a sick person. How hepatitis A is transmitted, how great the chances are sick with this disease, what precautions should be observed - there are quite specific answers to all these issues. Observing simple and understandable rules, a person practically cannot get infected with this viral disease.

Features of the hepatitis A virus

From the properties of the pathogen, in this case of certain characteristics of the hepatitis A virus, directly depend possible paths transmission of infection. The virus multiplies predominantly in liver cells, to a lesser extent - in biliary tracts and cells of the epithelium of the digestive channel.

The hepatitis A virus is resistant to a number of external environment factors, namely to chlorine and disinfectants, low temperatures. Thus, this pathogen can penetrate the tap water and continually persist in it, and infection is transmitted despite the traditional chlorination of tap water.

Source infection

Hepatitu A refers to a group of anthroponous infections with a predominant fecal-oral transmission mechanism. This means that in any situation, the source of infection is a sick person. The selection of the virus is sufficiently long: it starts in incubation (hidden) period and ends sometimes even slightly later than the patient's clinical recovery. Thus, a person is a danger to others during the whole illness and even before the appearance of clinical symptoms.

During the viral hepatitis A, the following periods are distinguished:

incubation (i.e. hidden) - its duration is 14-30 (up to 55) days, there are no symptoms of the disease, it is during this period that the likelihood of infected with a infected person is most high;
a short-term long-term (prospital) period - only 6-7 (up to 10) days; Intensive selection of the virus continues;
the period of explicit clinical manifestations (the period of the right) can be limited to 10-14 days, and can delay for a whole month and more if exacerbations or complications are developing; The selection of the virus continues, but less active;
the selection of the virus in the reconvaluation period (recovery) varies significantly, so it is rather difficult to talk about any average duration in this period.

Another important detail: It is equally dangerous by a person with obviously yellow skin covers (the so-called manifest form of the disease) and without significant change general status (the so-called rude shape). In addition, with hepatitis, it often develops so-called hidden or abortion forms of the disease. The person does not feel the signs of the disease of his own body, while he distinguishes the causative agent of infection into the environment and infects other people.

From this point of view, for healthy people, the greatest danger represents a person with a rude illness. No anti-epidemic activities are conducted in this case, since such a state is rarely diagnosed. A man with a clear jaundice is subject to hospitalization and isolation, all the subjects surrounding it - disinfection.

What way hepatitis A

Modern medical books indicate the following possible ways of infection with hepatitis A:

water;
food;
contact-household;
parenteral.

All transmission methods suggest certain situations dangerous in terms of infection. In some cases, infection is likely to be in others - exactly the opposite.

For hepatitis, but not typical by air-drip and transmissible transmission. The air-drip transmission mechanism is infection when inhalation of air containing a droplet of mucus from the nasopharynx of the patient. Since the hepatitis virus does not multiply in respiratory tract, infection only when communicating (without direct contact) is impossible with a sick person.

The transmissive transmission path is infection with the bite of a sick person with a live carrier (loss, tick, mosquito, mosquito). When hepatitis, this option is not described in modern medical literature.

Water transfer

Most often, hepatitis A is transmitted through a contaminated (contaminated virus) water. For the so-called "water outbreaks" typical: a rapid increase in the amount of diseased, the massability of the disease among those living in a certain area or zone. The implementation of the waterway transmission is possible in the following situations:

drinking for a drink of non-filled water from any source (including from central water supply);
the most dangerous (potentially contain a greater amount of virus) wells, artesian wells, water taps of the old building (there is a possibility of mixing sewage drain and tap water);
use of water for washing dishes, vegetables and fruits without subsequent processing by disinfecting agents or high temperatures;
in an existing focus, the virus can fall into the oral cavity in the process of cleaning the teeth and when performing other hygienic procedures.

Viral hepatitis A when implementing a water path of transmission can cover the whole settlements organized by children's closed and open-type children.

Food transfer path

Viral hepatitis A is often transmitted to the food, for the implementation of which the following situations are dangerous:

use of one dishes with a sick person;
consumption of some culinary products;
the inclusion in the food diet is poorly washed and not subject to thermal processing of vegetables, fruits and other things.

Food transfer path is most typical for children's teams that feed in one catering establishment (for example, school canteen). Dissemination contribute to non-compliance with hygienic skills, lack of soap and so on.

Contact path transmission

Infecting surrounding sick man touches a variety of items through which the virus is transmitted to other people.

The contact path is implemented:

with direct contact with the sick person;
when using general items ( toothbrush, towel);
in the process of the game with common toys (solid and soft);
failure to comply with the rules of hygienic processing of the toilet (both public and home).

All methods of infection with hepatitis A can be implemented both at home and in public territory. Visiting public catering enterprises of any class, toilets common use Increases the risk of infection.

Epidemiological features of hepatitis A

Hepatitis A transmitting "through dirty hands" has a number of patterns:

the increase in morbidity is celebrated in the warm season;
predominant patients under 35 years old;
easy infection causes the possibility of the development of an epidemic flash;
after the suffering disease, life immunity remains;
careful compliance with hygienic rules makes it easy to control this infection.

Gepatitis A - the process is quite easy, but the rules for preventing this disease are also simple, understandable and accessible to a person of any age.

Materials on the topic

Hepatitis A refers to the group of anthroponous infections. This means that a source of infection in all cases is a person, and it does not matter, in what form it flows such pathology.

The main role in the wide prevalence of such a disease is played by patients with atypical forms of illness, which can be attributed to:

starly - the main symptoms of the disease are expressed slightly and often completely ignored by people. This means that a person himself provokes the development of complications and long-term restoration of the affected organ. Norma, with timely started therapy, the liver comes from six months to one year;
a rude - with similar course, the main clinical manifestations are pronounced, while specific, in the form of a change in skin, mucous membranes, urine and cartoons are missing. Such a situation leads to the fact that such a disease is adopted for a completely different disorder;
subclinic - characterized by the fact that symptoms is not manifested at all. In such cases, only data from laboratory studies will indicate the presence of illness, which will show changes in blood tests, as well as instrumental examinations - will indicate an increase in the liver.

It is worth noting that it is the atypical course of the disease prevails over typical forms.

Another important thing is that the person is equally dangerous, both with a manifest form of illness, and with a rude one.

Modern medicine allocates the following main ways to transmit viral hepatitis A:

water;
contact-household;
parenteral;
food.

Path transmission of hepatitis A

Such paths of how Botkin's disease can be transmitted is a general mechanism - fecal-oral.

The water path of hepatitis transmission A is considered the most common, since the virus is in contaminated water. For this type of infection typical:

active increase in the number of infected;
the massability of the disease among those living in the area near the baked reservoirs.

The implementation of the water path of infection is possible in such cases:

reception inside the water of dubious origin without preliminary filtering or boiling. This can be attributed both to the closure of the reservoir and the spring;
use of water for washing dishes;
cleaning the teeth or the performance of other hygienic procedures of the oral cavity using water.

Such a method of infection can cause an outbreak of hepatitis A in entire settlements, children's and adult groups of closed or open type.

The second way of how hepatitis A is transmitted is food. For its implementation, the following cases are dangerous:

the use of one dishes and cutlery with an infected person;
joint use of the same dishes;
reception inside the food, which has prepared the patient.

In addition, it is possible to get sick in the following cases:

when using vegetables and fruits, which were washed in contaminated water, without subsequent heat treatment;
during the preparation of fish and seafood dishes that could be caught in adverse reservoirs.

This possibility of infection is most characteristic of children's teams in pre-school and school educational institutions.

The virus can also be transmitted through the infected items to which the virus carrier told.

Sources of infection with hepatitis A

Contact mechanism of hepatitis transmission A can be realized on the background:

direct contact with the sick person;
use of common household items to which a razor machine, manicure scissors and a toothbrush are attributed;
non-compliance with the rules for processing the toilet both home and public.

The parenteral path is in contact of a healthy person with the blood of the patient. How can I get hepatitis and through blood:

when blood transfusion from the carrier, however, currently such an opportunity is reduced to zero, since each donor, blood test for infections is given before passing such a procedure;
subsequently transfusion of blood components, such as plasma;
through the use of a common syringe with an infected person for injection of substances.

Among the less common mechanisms of how hepatitis is transmitted and can be allocated:

unprotected sexual contact with pathogen carrier. Many patients are interested in the question - whether hepatitis is transmitted through sex? Infection with this virus sexually possibly possible only with anal-oral sexual intercourse;
visiting dental or manicure cabinets;
tattoo shocking;
through the flies - it does not exclude the possibility that these insects can act.

It is worth noting that Botkin's disease is not transmitted by air-drip, even with a strong cough or sneezing. There are also no cases of transmission of virus from mother to a child during pregnancy, generic activity or breastfeeding kid.

For such a disease, characteristic seasonal outbreaks and the frequency of morbidity. So, the number of patients with hepatitis A increases in the summer-autumn time of the year.

There are several groups of people who are most infected with such a virus. The main category of risk is:

employees of medical and children's institutions - due to the fact that hepatitis A is transmitted through contact with blood or use by common cutlery;
food staff - the danger of infection lies in the fact that such people are forced to contact with products that are grown in polluted zones;
military personnel who may be in countries in Asia and Africa, where the incidence of Botkin's disease reaches high values;
drug addicts - viruses are transmitted through an infected needle who enjoyed an infected person;
persons who have direct contact with the sickness of the patient;
homosexual men;
patients suffering from other heavy liver diseases;
tourists and travelers visiting countries with a high level incidence of hepatitis A;
family members in which there is a patient with a similar diagnosis.

Today in the world, viral hepatitis occupy the first place in the structure of liver disease. In addition, viral hepatitis more often from all diseases of the hepatobiliary system leads to the development of cirrhosis and liver cancer, which are seriously treated and in most cases they give a fatal outcome.

What is viral hepatitis?

Viral hepatitis call a group of infectious-inflammatory liver diseases, which are based on viral damage to hepatocytes with violations of their functions.

Depending on the type of pathogen, all viral hepatitis is accepted to divide on A, B, C, D, E, F and G. The last four species occur very rarely.

Viral hepatitis A is considered the most common, and the most insidious and dangerous - hepatitis C.

By duration of the disease, viral hepatitis can be divided into lightning, sharp, chronic and protracted.

Lightning, or fulminant, flow occurs during hepatitis A, B, C, D. This is a heavy version of the flow of viral hepatitis, in which hepatic insufficiency progress, intoxication of the body and violations by the central nervous system.

Fulinate viral hepatitis even with timely treatment has high mortality.

For the acute form of viral hepatitis, intoxication and disruption of liver functions are characteristic. Most cases ends with recovery, but sometimes chronic viral hepatitis can develop.

Acute viral hepatitis lasts no more than three months. This flow option is observed when hepatitis A.

The protracted viral hepatitis resembles an acute course, but with a longer jagglie period. The protracted flow takes about six months and occurs when hepatitis B and S.

Chronic viral hepatitis proceeds for a long time with periods of exacerbation and remission. The severity of the symptoms of the disease depends on the type of pathogen, the state of the immune system of the patient and the presence of concomitant pathology.

Important! The most common chronic viral hepatitis - B, C and D, which often become reasons liver failure, cirrhosis and liver cancer.

Features of viral hepatitis:

viral hepatitis belong to the group of anthroponous infections;
viral hepatitis can be transferred to parenteral, sex and alimentary paths;
hepatitis viruses are highly resistant to external environmental factors;
the causative agents of viral hepatitis are hepatotropic viruses that multiply in liver cells and damage them;
viral hepatitis is manifested by similar laboratory signs;
the principles of treatment are the same with all types of viral hepatitis.

Causes of viral hepatitis

Hepatitis A virus - This is a hepatotropic RNA virus with a weak cytopathogenic effect, which belongs to the Peikornavirus family. Hepatitis Virus A managed to highlight Finestone in 1973.

This virus has high resistance to high and low temperatures, drying, freezing. Long retains its pathogenicity in water, food, sewer waters, as well as on objects and surfaces.

Interesting! Inactivate the hepatitis A virus can be boiled for five minutes and when treating chlorine lime solutions, potassium permanganate, chlorine or formalin.

Hepatitis B virus It is a representative of the DNA viruses of the kind of orthopes of the family of hepadnovirus. The DNA of the virus has the appearance of a ring of two threads.

The surface of the protein-lipid shell contains a surface antigen - HBsag, and within a viral cell three more heart-shaped - HBXAG, HBEAG and HBcag. Antibodies are produced by HBSAG and HBCAG antigens and HBCAG in the patient's body, and lifelong immunity is formed.

The causative agent of hepatitis B, as well as the hepatitis A virus, steady to aggressive factors of the external environment. At room temperature can live for several months, and in a frozen form - several years.

At a temperature of 120 ° C, dies within 45 minutes, and at 180 ° C - in an hour. Hepatitis Virus into deuxerative deuxes based on hydrogen peroxide, chlorine and formalin.

Hepatitis C virus - This is a RNA-containing Flavovirus family virus. Due to the large number of options for a set of RNA, 6 types are known and more than 90 subtypes of the hepatitis C virus

In each region, the disease causes a certain type of virus. Crossing immunity for different types and subtypes of viruses is not formed. In addition, the hepatitis virus has the property of prolonged persistence in hepatocytes without any signs of the disease.

Hepatitis C virus retains its activity at a temperature of 50 ° C, resistant to freezing. At 25-27 ° C can live up to 4 days. Inactivation of the virus occurs during ultraviolet irradiation within 9-11 minutes and at a temperature of 100 ° C in 2-3 minutes.

Hepatitis D virus has resistance to heating and freezing, as well as to acids, nucleases and glycosides.

Mechanisms and ways of transmission of viral hepatitis

The source of the disease with all viral hepatitis is a sick person or a viroster.

The fecal-oral gear mechanism is the spread of pathogens through contaminated hands, vegetables and fruits, drinking water. In this way, you can get hepatitis A and E.

The parenteral distribution mechanism is to transmit the pathogen through blood and other biological fluids. This mechanism is characteristic of hepatitis V viruses, C, D and G.

The transmission paths of viral hepatitis may be such:

hemotransfusion - when transfusion of blood and its components;
injecting - through syringes and needles that contain residues infected with blood hepatitis virus;
sexual path - with sexual intercourse without the use of a condom;
vertical - from a sick mother to a child during childbirth or care;
when performing tattoos, acupuncture, piercing by non-sterile needles;
when manicure, pedicure, shave, epilation, permanent makeup, if the tools are not processed by dees basins.

Clinical course of viral hepatitis

Viral hepatitis can flow cyclically and acyclically.

Interesting! Asymptomatic forms of the disease are diagnosed randomly during examination of persons who have been contacted with patients with viral hepatitis, and about other pathology, as well as in the process of preoperative preparation.

This is explained by the fact that there are no signs of viral hepatitis, but the blood activity of transaminase is determined in the blood, the presence of antibodies against hepatitis viruses, their antigens and genetic material.

The cyclic form of viral hepatitis can be divided into the following steps:

incubation;
nasty, or long-term;
yellow, or stage of groove;
stage of reconciliation, or recovery.

Incubation Stage (period)

The shortest incubation period in hepatitis A - 2-4 weeks, and the longest hepatitis C - 2 months, and sometimes 5-20 years. The duration of the incubation stage depends on the amount of the virus, which fell into the body when infected, on the type of virus and the state of human immunity.

Promotional Stage (period)

Promotional period that can manifest the following syndromes and symptoms:

1. Austhenovegetive syndrome:

fast fatiguability;
low performance;
general weakness;
drowsiness or insomnia.

2. Dyspeptic syndrome:

reducing or complete absence of appetite;
heaviness in epigastrics;
flatulence;
end of chalk or constipation.

3. Artralgic syndrome:

migratory pains in the joints, without signs of their inflammation.

4. Inxication syndrome:

lubrication in the body;
pain in muscles;
fever;
chills;
increased sweating;
pain.

5. Allergic syndrome:

dry skin;
itching skin;
rash.

Period of sickness of the disease (jaundice)

The patient has the yellowed skin, scool and other mucous membranes. With the advent of the jaundice, intoxication of the body is enhanced, and the patient's condition deteriorates even more.

Also during this period darkens urine due to the large amount of urobilinogen in it. Urine resembles strong black tea or dark beer.

Cal brighten and becomes quite colorless, as it does not have Sterkobilinogen, which stains it in an orange-brown color.

Reconquencing period

The reconciliation period is the time from the beginning of the element of the symptoms of the disease until they are completely disappeared and the normalization of all blood indicators. During this period, patients have fatigue, general weakness, violated biochemical indicators blood.

Methods for diagnosing viral hepatitis

General blood analysis It is assigned to identify the inflammatory process in the body, for which it is peculiar to: an increase in the number of white blood taurus, shift leukocyte formula To the left, accelerating the speed of erythrocyte settlement.

General urine analysis Spends on the bilirubin surplus in the body - the presence of a large number of bile pigments, direct bilirubin and urobilin. Common feast analysis. Sterkobilin disappears from Cala, which gives him a natural color.

Blood chemistry It is the most informative, so indicates a violation of the functions of the liver. For viral hepatitis, it is characterized an increase in the activity of hepatic transaminases (alaninotransferase, aspartataminotracerase, alkaline phosphatase, glovedhydehydrogenase,drogenase, a decrease in the number of common protein and the imbalance of its fractions, prothrombin, fibrinogen, increasing the number of bilirubin, cholesterol.

Linked immunosorbent assay It is a specific method for identifying causative agents of viral hepatitis. With the help of this method in the blood, quantitatively and qualitatively markers of viral hepatitis - antibodies for hepatitis viruses and their antigens are determined.

Polymerase chain reaction - This is another method for determining the type of virus, which caused viral hepatitis. This method is to identify the genetic material of the virus (DNA, RNA) in the blood and feces of the patient.

Ultrasonic liver surveys and biliary tract It is used to diagnose structural changes in the liver, as well as for differential diagnosis viral hepatitis with other pathology of the hepatobiliary system.

Biopsy liver It is carried out to determine the activity, prevalence of the process and the presence of complications.

Treatment of viral hepatitis

All viral hepatitis is treated by general principles, among which are the following:

prescribed only extremely necessary medical preparationsso as not to overload the liver;
the choice of the drug depends on the period of the disease, the presence of concomitant pathology or complications;
if possible, the concomitant chronic pathology is treated after the normalization of the liver functions;
the bed regime is prescribed during acute viral hepatitis or exacerbation of chronic;
the diet is a mandatory component of the therapy of viral hepatitis.

Treatment of viral hepatitis consists of etiotropic and pathogenetic therapy.

Etiotropic therapy - This is the appointment of drugs that stop replicating viruses and kill them.

The basis of antiviral therapy during hepatitis are the interferons of the short and long actions, as well as Ribavirin, Lamivudine, Acyclovir, Retrovir, Zinovudin and others. Depending on the type of viral hepatitis, monotherapy or combined treatment circuits are used. Treatment of sharp viral hepatitis lasts on average 1 month, and chronic - 6-12 months.

Pathogenetic therapy Viral hepatitis include the following items:

hepatoprotectors to activate the processes of recovery of hepatocytes and protect them from negative factors (hepaben, heptral, essential, silib, Carsil and others);
enterosorbents to accelerate the removal of bilirubin and viruses from the body (enterosgel, lactofilm and others);
disintellation therapy (5% glucose, 0.95 sodium chloride, reosorbilact, ringer-lactate, disol, trisole, etc.);
glucocorticosteroids (prednisone, dexamethasone);
antispasmodic therapy (but-shpa, papaverine);
choleretic therapy (Ursochol, Ursosan, Cholezas);
vitamin preparations (cyanocobolmine, A nicotinic acid, Ascorbic acid other).

Complications of viral hepatitis

biliary dyskinesia;
cholecystitis, cholangitis;
hepatic coma;
cirrhosis of the liver;
hepatocellular carcinoma.

Prevention of viral hepatitis

Important! Viral hepatitis often lead to serious and dangerous complications, and their treatment is not only long, but also expensive.

Therefore, it is better to carry out simple prevention of viral hepatitis:

vaccinoprophilaxis of hepatitis A and B;
high quality use drinking water, purely washed vegetables and fruits;
all products must undergo sufficient heat treatment;
do not use other people's nail accessories, scissors, razors, toothbrushes;
making tattoos and piercing only in special salons in which appropriate anti-epidemic standards are performed;
use condoms during sexual intercourse;
do not use injection drugs.

The treatment of viral hepatitis is engaged in an infectious person in conjunction with the doctor hepatologist.

If you suspect a viral hepatitis, it is necessary to immediately consult a doctor to confirm or exclude a diagnosis.

Hepatitis A is an acute inflammatory process of the liver, which causes the hepatitis A. hepatitis virus, and differs from others in that it has a favorable outcome and never goes into a chronic form.

S. P. Botkin believed that hepatitis A was caused by infection, therefore, the disease is called Botkin's disease in the people. He also connected jaundice with liver cirrhosis. But, only in 1973, American S. Fanestone proved that hepatitis A is caused by a virus and was able to identify it.

The hepatitis A virus is often the cause of epidemics, especially in countries and regions, where bad sanitary and hygiene living conditions - Asia, Africa, Latin America. In Russia since 1996, the incidence of hepatitis A is gradually decreasing. In 2015, it amounted to 4.5 100 TIS. population.

Interesting! The highest incidence rates (13.6 per 100 TIS. Population) in Dagestan, Chelyabinsk, Transbaikalia, Krasnodar Territory and Samara region.

Hepatitisa and more often sick in childhood. Breasts do not hurt hepatitis, as they get immunity from mother with milk. Children often encounter rude-like forms of the disease. Botkin's outbreaks are observed in the hot season - summer, the beginning of autumn.

In persons who have surpassed hepatitis A, an active lifelong immunity is produced.

Hepatitis A calls the HAV virus (hepatitis A virus), which is a representative of the Picornavirus family.

The hepatitis A virus is a RNA-containing virus, a rounded form with a diameter of 27-30 nm.

HAV virus steady in external environment. It will peer dry and retains the activity of the week. In food and water, it is saved from 3 to 10 months.

Withstand heating to 60 ° C for 12 hours. At a temperature - 20 ° C and more can be stored for more than one year.

The hepatitis A virus dies when boiling for more than five minutes. Also, disinfectant solutions of chlorine lime, potassium permanganate, chlorine, formalin are affected by the virus.

How is hepatitis A virus transmit?

Hepatitis A can be infected through water, food, dishes and other household items. Such a mechanism of infection is called fecal-oral. The transmissible path of transmission (transfer of infection by flies) and parenteral (blood transfusion, intravenous injections) is not excluded.

The HAV virus to the external environment from the patient is highlighted with feces and urine.

The source of the hepatitis A virus can be the following persons:

sick people during the incubation period, when signs of hepatitis A are absent;
patients during the extended period, when the first symptoms of the disease appear;
patients during hepatitis a (jaundice stage);
patients with asymptomatic the flow of the disease or a rude form.

In other words, the patient is infectious from the beginning of the incubation period to the first days, and this is approximately a month and a half.

Hepatitis A virus can get into your body in the following situations:

Swimming in pools and open reservoirs.
Eating unwashed vegetables, fruits, berries, etc. Many owners for the fertilizer of strawberries use human feces.
Preparation of dishes from raw mollusks and mussels that are caught in water bodies polluted by feces.
Use of crude water or using it for domestic needs.
Use of domestic objects of the patient for hepatitis A, which unprocessed by a disinfectant.
Sexual relationship with patients on hepatitis A.
The use of non-sterile syringes in intravenous injections.

Who is the risk group for hepatitis E?

Persons who do not comply with personal hygiene rules.
People living in boarding schools, barracks, hostels.
Refugees, military personnel and others who live in bad sanitary and hygienic or field conditions (without water supply, without sewage).
Tourists who visit countries with a high level of morbidity without preliminary vaccination against hepatitis A;
Persons living with patients with hepatitis A.
People who are in their professional activity Faced patients with hepatitis A.
Persons living in natural disasters that have no access to clean drinking water.

Pathogenesis (mechanism of development) hepatitis A

The hepatitis A virus enters the blood through the mucosa of the digestive tract. The period from getting into the body of the hepatitis virus A before the appearance of the first signs of the disease is called the incubation period.

Interesting! The incubation period of hepatitis A can last from week to two months, an average of 2-4 weeks.

With blood, the hepatitis A virus is entered into liver cells, where it is being introduced into their ribosomes and programms them so that they begin to produce copies of the virus. "Newborn" virus cages with biliary fall back to digestive tractand are output to the external environment with feces and urine.

The liver cells in which the virus temporarily lived is dying and replaced by cells of the connective tissue. After that, the causative agent penetrates healthy hepatocyte. It could last until the liver would have turned completely into the connecting tissue.

But, a sufficient amount of antibodies to antigens of the pathogen is produced in the body, and they destroy the virus.

IN clinical flow Hepatitis A distinguish such stages (periods):

incubation stage (2-4 weeks);
promotional stage, when the first signs of the disease appear (on average week);
the jaundice stage or stage of hepatitis A (on average 2-3 weeks);
the stage of recovery or reconvalues \u200b\u200b(on average up to year).

Hepatitis A can leak typically and atypically.

A typical course depending on the severity of symptoms may be light, medium and heavy.

Atypical hepatitis A proceed in two forms - rude and subclinical.

Signs of hepatitis A with a typical course, depending on the stage of the disease, may be as follows:

1. The incubation period passes asymptomatic;

2. Promotional period:

general weakness;
fast fatiguability;
reduction or absence of appetite;
increase body temperature up to 38-39 ° C, chills, increased sweating.

3. Jaundice period:

yellowing scler, mucous membrane, skin;
skin itch;
dry skin;
urine color of dark beer;
aholic (bleached) Cal;
severity and soreness in the right hypochondrium;
nausea, vomiting, meteorism, constipation, severity in epigastrics;
pain in muscles (Malgy).

4. Reconvocation period: The patient's condition is improving, the disease retreats, and the liver operation is normalized.

Important! If your skin are wishes, urine has become dark color, and the feces discharged, then immediately refer to the infectious doctor.

A rude form of hepatitis A resembles a lightweight intestinal infection. Patients may briefly increase body temperature up to 37-38 ° C. There may also be nausea, the general weakness, a decrease in appetite, pain in the right hypochondrium and epigastrics, the liver and spleen increases. With the rudeness of the jaundice there is no.

The disease is diagnosed on the basis of laboratory blood tests, urine and feces on the basis of laboratory tests. Identifying the virus by identifying immunoglobulins M or genetic material in the patient's blood.

Subclinical form has no manifestations. The disease is revealed mainly in individuals who have been contacted with patients with hepatitis A through biochemical and serological blood tests.

The appearance of the patient, complaints about the darkening of urine and the discoloration of the feces do not make mistakes with the diagnosis. Be sure to clarify the patient if he had no contact with patients with hepatitis A, he did not attend Asia, Africa, Latin America for the last month.

In case of inspection, except for the yellowing of the skin, the increase in the liver is determined, and sometimes the spleen. Palpation sensitive liver.

With the atypical course of the disease, the complaints and the inspection do not give anything, so it is necessary to carry out an additional laboratory and instrumental examination of the patient.

Lab diagnostics:

In general blood test, there may be a minor decrease in the amount of white blood cells (leukopenia), an increase in the amount of lymphocytes (lymphocytosis) and accelerate the erythrocyte sedimentation rate (ESO). These changes are nonspecific and observed with any viral infection, so the overall blood test is not informative.
Biochemical blood test will open to the idea that the inflammatory process is localized in the liver. When hepatitis A, an increase in the number of bilirubin is observed due to the direct fraction, an increase in the activity of ALT 10 times and more, positive thymol sample.
In general, urine analysis is determined by bilirubin and urobilin.
In the coprogram there is no Sterkobilin, which gives the cali of its natural color.
Polymerase chain reaction (PCR) allows you to identify genetic material (RNA) in the blood and identify the hepatitis A. virus
An immunoassay blood test is carried out to detect antibodies to the hepatitis A. Immunoglobulins virus, reveal in patients with hepatitis A. Immunoglobulins G are in the blood from those who have sought Botkin's disease or was vaccinated.

Tool-hardware diagnostics:

Ultrasonic examination of the abdominal organs is carried out to determine the size of the liver and its structural changes.
Computer and magnetorezonance tomography are used in rare cases.

The light shape of hepatitis A can be treated at home. Patients with medium-heavy and heavy forms are hospitalized into an infectious office or hospital. Ethiotropic treatment of hepatitis A is not designed.

Basis therapy includes the following:

bed or semi-noar mode. Restriction of physical exertion;
diet nutrition. It is recommended to drink a lot of fluid - about 2-3 liters. For this purpose, strong tea with milk, roshinka decoction, fresh fruit juices, compotes, fruit, alkaline mineral waters are excellent. It is necessary to limit or eliminate the use of fried, smoked marinated dishes, pork, lamb. Prohibit alcoholic beverages. The menu of the patient with hepatitis should consist of vegetable soups, dishes from chicken, veal, rabbit, low-fat varieties of fish. The food needs to be prepared by gentle methods of heat treatment (cooking, baking, steamed);
with pronounced intoxication, detoxification therapy is prescribed - enterosorbents (enterosgel, white coal et al.), infusion of 5% glucose, Ringer's solution, etc., with severe flow - plasmferres;
hepatoprotectors - Esssential, Karsil, Hepabin, Heptral.
in case of violation of the outflow of bile and pronounced jaundice - tocopherol acetate, rrrtitinol, enterosorbents, ursodex, urmsofalk;
vitaminotherapy (vitamins B, s, etc.);
during constipation, it is necessary to normalize the stool - dofalak, the norm;
with severe liver damage, glucocorticosteroids are prescribed - prednisone, dexamethasone.

Hepatitis A. Prevention

1. The following actions are carried out in the infection focus:

the patient's utensils are boiled in a 2% solution of soda for 15-20 minutes;
bed linen and patient's clothing need to boil 2% soap solution for 15-20;
Paulic coating, furniture, door handles, toilet and washbasin faucet need to be wiped with hot 2% soap or soda mortar.

2. It is necessarily monitored:

in a group kindergarten Quarantine is introduced for 35 days from the moment the last sick child is detected;
observation of everyone who has contacted patients with hepatitis A;

3. To identify the rudeness and subclinical forms, the contact is carried out PCR or IFA;

4. In order to create artificial active immunity, hepatitis Vaccinerate is carried out. For this, human immunoglobulin or hepatitis vaccine vaccine is introduced into the body. Vaccination is carried out at will or persons from risk groups.

5. Compliance with personal hygiene rules:

wash your hands after visiting the toilet;
drink boiled or purified water;
be sure to wash vegetables, fruits, berries and greens before eating them;
avoid swimming in water bodies in which water could be caught with sewage;
print thorough heat treatment products when cooking. Events regarding contact persons.

The consequences of hepatitis A.

Complications for Botkin's disease occur very rarely. Basically, weakened patients and those who violate the regime, diet, recommendations of the doctor.

Dyskinesia can occur with gallbladder, inflammation of the gallbladder, pancreatitis.

Hepatitis, and although it is considered a disease with a favorable outcome, but still requires a serious relationship to avoid complications and a long period of recovery.

Hepatitis A virus properties

Treatment of hepatitis A.

Hepatitis Treatment A Medications

Does hospitalization need for hepatitis ah?

Diet with hepatitis A

Is it possible to treat hepatitis and at home?

Hepatitis A. Prevention

Source of disease

Ways transfer

Basic risk groups

Symptoms of disease Botkin

Promotional (Pricky) period

Ripping period (jaundice)

Reconvocation period (recovery)

Treatment of hepatitis A.

Consequences and prevention

Hepatitis A vaccination

To which doctor to turn

Features of the hepatitis A virus

Source infection

What way hepatitis A

Water transfer

Food transfer path

Contact path transmission

Epidemiological features of hepatitis A

Materials on the topic

What is viral hepatitis?

Causes of viral hepatitis

Mechanisms and ways of transmission of viral hepatitis

Clinical course of viral hepatitis

Incubation Stage (period)

Promotional Stage (period)

Period of sickness of the disease (jaundice)

Reconquencing period

Methods for diagnosing viral hepatitis

Treatment of viral hepatitis

Complications of viral hepatitis

Prevention of viral hepatitis

How is hepatitis A virus transmit?

Who is the risk group for hepatitis E?

Pathogenesis (mechanism of development) hepatitis A

Hepatitis A. Prevention

The consequences of hepatitis A.

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