The main route of transmission of hepatitis A. Causes, symptoms and treatment of hepatitis a

Content

Dirty hands, unwashed food, injection with a non-sterile syringe, ignorance of personal hygiene rules, promiscuous sex are the main causes of hepatitis. A complication of this disease is liver cancer and cirrhosis, so it is extremely dangerous. Mortality from hepatitis is comparable to that of tuberculosis, malaria, HIV - these are the conclusions of scientists based on the analysis of a large international study conducted in 2016.

What is hepatitis

Inflammatory liver disease is known as hepatitis. Pathological processes destroy the cells of the organ, the main task of which is to neutralize poisons. The inability of the liver to cope with its functions leads to intoxication of the body, the replacement of liver cells with connective tissue, the development of cirrhosis, and a malignant tumor. Depending on the cause of the lesion, it is customary to distinguish the following types of hepatitis:

Who is at risk

Hepatitis affects alcoholics and drug addicts. Often people who lead a promiscuous sex life, who prefer unprotected sex with different partners, and homosexuals catch the infection. You can get infected by getting a tattoo, piercing, ear piercing in places that do not meet sanitary standards. The risk is increased if the tool is not properly handled by the craftsman.

You can become infected during medical procedures involving damage to the skin, if the medical staff ignored the safety rules. For example, the tools were not well processed. Transmission of the virus through blood transfusion is possible, but this risk is minimized, since it undergoes serious processing and testing before it reaches the recipient.

It is not uncommon for the transmission of the virus to the child to occur in the womb. The risk is increased if a woman has an active form of the virus or if she has hepatitis at the end of pregnancy. The infection is not transmitted through breast milk. However, the risk remains. Everyone who lives or is in constant contact with a person who has a viral form of the disease is at risk of getting sick.

How is it transmitted

You can only get infected with an infectious form. Methods of transmission of hepatitis - blood, water, fecal-oral method, contact-household route. The infection can lurk for years, does not manifest itself in anything, turning an unsuspecting carrier into a source of infection. This is one of the reasons why many infected people are unable to pinpoint the exact route of transmission of the disease.

Hepatitis A

Botkin's disease, known as hepatitis A, is caused by an RNA-containing organism from the picornavirus family. The disease manifests itself as fever, muscle pain, vomiting, diarrhea, pain in the right hypochondrium, dark urine, discolored feces. There are three types of disease:

• acute (icteric) form, in which the skin and mucous membranes turn yellow due to increased breakdown of erythrocytes;
• subacute (anicteric) variety;
• subclinical form - almost no symptoms.

The main source of infection is patients with anicteric or subclinical form. During the incubation period and at the onset of the disease, the virus is excreted along with the feces. The routes of infection with hepatitis A are as follows:

• Food and waterborne transmission of the disease. The pathogen enters the body through contaminated food and water. It has an acid-resistant membrane, so it is unable to neutralize acidic gastric juice.
• The contact and household route of transmission of hepatitis is through household items.
• Parenteral route of infection. Penetrates directly into the human blood (when injected with a non-sterile syringe, damage to the skin).

Hepatitis B

The cause of hepatitis B is a DNA-containing organism from the hepadnavirus family. Symptoms are similar to Botkin's disease, the disease can occur in both acute and chronic forms. It can be transmitted through household items, as well as parenterally. The routes of transmission of hepatitis B through blood are as follows:

• Natural route of infection. Transmission of the pathogen occurs during intercourse and even with a simple kiss, if there are small scratches on the oral mucosa. The baby may become infected during pregnancy or when passing through the birth canal.
• Artificial path. Transmission of infection occurs during manipulations during which damage to the skin has occurred. Among them - transfusion of low-quality blood or its components, cosmetic procedures, shaving, the use of non-sterile dental or surgical instruments during surgery, injection with a non-sterile syringe.

The virus in the bloodstream enters the liver and invades hepatocytes (organ cells). Then it begins to multiply, causing a response from the immune system, which directs antibodies to fight the pathogen, which destroy pathogens introduced into hepatocyte cells, and with them - liver tissue. The incubation period, during which the patient is an unsuspecting carrier of the virus, lasts from 2 months to six months.

The symptoms of hepatitis B are similar to Botkin's disease, but the disease is more severe. The icteric form is common. The disease is accompanied by indigestion, impaired bile formation, joint pain, weakness, and sometimes itching. Complications up to hepatic coma are possible. The acute form of the disease often turns into a chronic phase, it can provoke the development of cirrhosis. With a successful cure, stable immunity develops, therefore, doctors recommend a vaccine to prevent the disease.

Hepatitis C

Hepatitis C is caused by viruses from the flaviviridae family, of which eleven species are distinguished. The pathogen contains RNA, which encodes three structural and five non-structural proteins, to each of which the immune system produces separate antibodies. The hepatitis virus is extremely persistent and tolerates high and low temperatures well.

The source of infection is patients and carriers of the pathogen. The microorganism is an infection characterized by a parenteral mechanism of damage. The virus is transmitted in a hematogenous way, after contact with infected blood. Ways of transmission of hepatitis C:

• non-sterile instruments used for surgery, acupuncture, piercing, tattoos;
• sharing syringes;
• intercourse, if there are skin injuries, occasionally through semen or vaginal discharge (the likelihood of transmission of infection through sexual contact is low).

If pathogens only get on the skin, pathology rarely develops. For this reason, the probability of transmission of infection through household items, shaving accessories, nail scissors, toothbrushes, and epilators is low. Such methods of infection with hepatitis C are possible with concomitant bacterial or viral infections (primarily HIV), damage to the skin. The risk of transmission of the disease from mother to child during pregnancy is assessed as low: the woman's antibodies protect the fetus, are present in the newborn's blood and disappear at the age of 2-3 years.

The disease is difficult. Weakness, fatigue, sleep disturbances, and indigestion are observed. The skin rarely turns yellow. The mortality rate for this disease is 5%, and it is self-cured - 20%. In 25% of cases, the pathology goes into a chronic stage, which ends with cirrhosis or liver cancer. Vaccination against hepatitis C is not available as developments are under study.

Hepatitis D

Form D is caused by the delta virus. This microorganism does not multiply independently in the human body. To do this, he needs the causative agent of hepatitis B: delta uses the proteins produced by this microorganism for reproduction. The disease is characterized by symptoms similar to form B, but more severe along the course. The disease can go into a chronic stage, which will lead to liver failure, cirrhosis, and cancer. In this case, liver damage is not so much due to the action of the virus as the response of the immune system.

The route of transmission of the disease is the patient or the carrier of the delta virus. Infection occurs parenterally after the virus enters the bloodstream. At the same time, it can be transmitted both simultaneously with the B form, and enter the body already infected with hepatitis B. The most common transmission routes are:

• donated blood transfusion;
• infection during surgery, various medical procedures, for example, dental, acupuncture;
• tattoos, piercings, ear piercing, contaminated instruments;
• genital tract;
• from mother to fetus;
• contact and household way.

Hepatitis E

Hepatitis E is caused by an RNA virus. Symptoms of the disease are similar to those of form A, but the disease can develop fulminant (fulminant), especially in pregnant women, causing death. The pathogen is vulnerable, quickly dies in the external environment, when boiled, under the influence of antiseptic agents, but is able to stay in cold water for a long time. The disease occurs in countries with hot climates and low compliance with sanitary standards. The route of transmission of the virus is blood and oral-fecal method (through dirty hands, contaminated water, food).

Prevention

Compliance with the rules of personal hygiene, the use of protective equipment in contact with blood (gloves, condom), can stop the infection and prevent infection. To prevent viral hepatitis, you must adhere to the following measures:

• wash vegetables and fruits with warm water;
• to boil water;
• wash your hands before eating;
• get rid of the habit of touching your mouth with your fingers;
• to do tattoos and piercings in specially designated institutions, whose employees use modern methods of sterilizing instruments;
• refuse promiscuous sexual intercourse;
• use a condom during intercourse if one of the partners has genital trauma or a woman has periods;
• avoid contact with feces, urine, blood, other body fluids of other people;
• get vaccinated against hepatitis A and B;
• do not share syringes when administering medications.

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Hepatitis A, which is often called Botkin's disease or jaundice, is one of the most common infectious diseases. People of all ages get sick with it, but more often children from 2 to 14 years old, men and women get infected equally often. According to statistics, more than 1.5 million people fall ill every year in the world, but doctors believe that this figure is greatly underestimated, since in childhood the disease is very often completely asymptomatic.

Causes and mechanism of infection with hepatitis A

Through the oral cavity, the hepatitis A virus enters the intestines, from where it is absorbed into the blood and transferred to the liver.

The disease is caused by a virus. The mechanism of transmission of infection is fecal-oral. A sick person with feces releases into the environment a huge number of pathogens that can get on household items (dishes, toys, doorknobs, buttons in the elevator, etc.). From contaminated objects, the causative agent of the disease most often spreads to the hands, and then to the oral cavity. That is why outbreaks of hepatitis A are so often recorded in collectives, especially children, and the disease is popularly called the disease of dirty hands.

The virus can enter food and water when cooked by an infected cook. Possible contamination of vegetables, fruits and berries, which could get sewage and sewage. Swimming in polluted bodies of water and drinking from unverified sources can also lead to infection.

There is a potential for parenteral transmission of the virus, but this is extremely rare.

The virus is quite stable in the external environment. On household items at room temperature, it lasts for a week, and on food in a humid environment - several months.

From the oral cavity, the virus enters the intestines, from there into the blood, and then into the liver, where it causes an inflammatory process. The pathogen multiplies in liver cells - hepatocytes, provoking their death. This happens until the body produces enough antibodies to suppress its activity.

Symptoms of Botkin's disease

During the course of the disease, several stages are distinguished: the incubation period, preicteric, icteric and the recovery period.

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

Prodromal (preicteric) period

During this period, patients have the first complaints, its duration usually does not exceed 7 days. Symptoms of general intoxication of the body appear: fever, weakness, a slight runny nose, sore throat. May be disturbed by abdominal pain, nausea, vomiting, or. Sometimes there are no symptoms of intoxication and fever, and digestive disorders come to the fore.

In some cases, the prodromal period is latent and the disease immediately manifests itself with jaundice.

High period (icteric)

Patients may be bothered by pain or heaviness in the right hypochondrium, this is caused by an enlargement of the liver and stretching of its capsule, an enlargement of the spleen is also possible. Nausea, vomiting, flatulence, and stool disturbances may persist. Jaundice comes to the fore: the skin, mucous membranes, sclera acquire a lemon-yellow color. As a rule, with the onset of this symptom, the body temperature returns to normal. Darkening of urine (the color of dark beer) and lightening of feces are noteworthy.

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

The period of convalescence (recovery)

Symptoms gradually disappear, liver function is restored, however, yellowness of the skin and sclera can persist for quite a long time. Full recovery occurs in 1-12 months.

Hepatitis A treatment

A patient with hepatitis A will be prescribed enterosorbents, the most famous of which is activated carbon.

Hospitalization in the infectious diseases ward is usually not required. There is no specific treatment for this disease, symptomatic remedies are used. In addition, adherence to the diet shown for liver pathologies is required (table number 5 according to Pevzner).

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

1. Detoxification agents: saline and 5% glucose solution, with the addition of ascorbic acid, Reopolyglucin.
2. : activated carbon, Enterosgel, Smecta, Polyphepan, Polysorb, etc.
3. Hepatoprotectors: Phosphogliv, Essentiale Forte, Prohepar, Heptral, Hepabene.
4. Enzyme preparations: Mezim forte, Creon, Panzinorm, Festal, Pancitrat, Pancreatin.
5. Choleretic agents are used only if the patient does not have: Allochol, Holenzim, Hofitol, Holosas, Flamin, etc.
6. Vitamins: any multivitamin complexes, but vitamins of group B are especially useful for liver health.

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 treatment and adherence to a diet, liver function is restored completely. The diet must be followed for at least six months after the symptoms disappear; several courses of treatment with hepatoprotectors and taking vitamins can also be recommended.

Exceptions are possible only in 2% of cases when patients did not follow a diet, refuse therapy, chronically abuse alcohol, or have had any previous liver disease.

Prevention of hepatitis A is not particularly difficult and primarily comes down to adherence to the rules of personal hygiene and food culture. Hands should be thoroughly washed with soap (soap for at least 20 seconds) after each visit to the toilet and before eating. You should drink only boiled water, fruits and vegetables should be washed before use and preferably doused with boiling water.

If a sick person is identified in the team, then rehabilitation of the focus is necessary:

• wet cleaning of the premises with disinfectant solutions;
• disinfection of furniture and toys in kindergartens and schools, quarantine is declared for 35 days from the date of registration of the last case of the disease;
• the dishes that the patient previously used must be thoroughly washed and boiled for 15 minutes in a soda solution, and for the period of illness he needs to allocate an individual set of dishes, which will also be carefully processed after each meal;
• bed and underwear must be boiled in a solution of detergent before washing (15 minutes).

Vaccination against hepatitis A

To date, an effective vaccine has been developed to prevent this disease, but it is not included in the list of mandatory vaccinations in our country. Several vaccines are used in Russia:

• Hawrix;
• Avaxim;
• Vakta;
• GEP-A-in-VAK;
• Hepatitis A vaccine.

• travelers and people who are forced to visit countries with a high level of unsanitary conditions (countries of Africa and Asia);
• people staying for a long time away from full-fledged sources of clean water and sewage (military personnel in field exercises, refugee camps);
• food industry workers at enterprises, catering establishments, kitchens of state institutions;
• medical workers, especially those in contact with the biological fluids of patients (orderlies, laboratory assistants, nurses, surgeons, infectious disease specialists).

Which doctor to contact

If a child develops symptoms of infection, it is necessary to contact a pediatrician or infectious disease specialist. In the future, it will be useful to consult a nutritionist, since proper nutrition helps liver cells to recover faster.

Hepatitis A - what is it and how is it transmitted? Hepatitis A is the very "jaundice" that parents warn every child about. The disease is often considered a "dirty hands disease" because the main route of its spread is fecal-oral. The disease is often severe, and in some cases can be fatal. Therefore, everyone should know well what hepatitis A is, what it is and how it is transmitted, the symptoms, the causes of the disease.

What is Hepatitis A

The disease has been known since ancient times, but earlier doctors did not know what hepatitis A was, what kind of disease it was. It was thought to be caused by a blockage in the bile ducts. Only at the end of 19, the famous Russian doctor S.P. Botkin suggested the infectious nature of the disease. In his honor, hepatitis A is also sometimes called Botkin's disease. Currently, medicine has accumulated a lot of data about hepatitis A, what it is and how it is transmitted, how to treat it, and how to avoid the disease.

The causative agent of the disease was discovered only in the 1960s of the 20th century. It turned out to be a virus of the picornavirus family. "Pico" - translated from Latin means "small", which is the main characteristic of this infectious agent. It is really very small, its diameter is only 30 nm. Outwardly, the virus is a protein ball, inside which is an RNA molecule. It is still not known exactly how the virus enters the liver cells, once in the body. Nevertheless, he does a similar thing without much difficulty and, having transferred his genetic code to the ribosomes of hepatocytes, makes them produce new viruses. The result is the death of the liver tissue. And the viruses produced by hepatocytes enter the bile and from there into the human intestine.

The virus is highly resistant to adverse conditions. It does not die in an acidic environment (for example, in the stomach), it can persist for years in sea or lake water, when frozen to –20 ° C. It is stored on food for up to 10 months, on household items - for a week, when heated to +60 ° С - within 12 hours.

Powerless against the virus and many antiseptics, such as ethyl alcohol. The virus can be deactivated by:

• formalin,
• bleaching powder,
• potassium permanganate,
• boil for 5 minutes.

Hepatitis A accounts for approximately 40% of all cases of viral hepatitis. The disease is mainly typical for hot developing countries, where there are no clean sources of drinking water, and the hygienic culture of the population leaves much to be desired. The large number of cases is due to the illiteracy of the local population. People do not know anything about hepatitis A, what kind of disease it is, what disease has symptoms. It is believed that 90% of the population in third world countries have had this disease in childhood.

In developed countries, people have a lot of information about hepatitis A, what it is and how the disease is transmitted. This is largely why incidence rates in Europe and North America are relatively low. What makes this circumstance dangerous enough for an individual. After all, there is a great risk that the disease will affect a person in old age, when the likelihood of a severe course of pathology is much higher.

In Russia and the CIS countries, 20-50 cases of the disease are recorded annually per 100,000 people. The peak incidence occurs in August-late September.

The disease has only an acute form, the chronic form is absent. This is due to the fact that the immune system neutralizes the virus, and it disappears from the body. At the same time, a person who has had hepatitis retains lifelong immunity.

With proper treatment and patient care, mortality from hepatitis is low. It is 0.5% in children and 1.5% in people over 60. In older people, the disease is generally more severe. Most of the deaths from the disease are associated with the presence of other viral hepatitis (B or C), severe somatic diseases, and immunodeficiency states in the patient. Death is also possible due to improper treatment or the patient's lifestyle (for example, drinking alcohol).

How hepatitis A is transmitted: transmission factors and routes of infection

The cause of the disease is the ingestion of a virus. Anyone who has not previously suffered from this disease and has not been vaccinated against it can become infected with the hepatitis A virus.

The virus is transmitted, as a rule, by the oral-fecal route. Since the virus can persist for a long time in adverse conditions, it is found in huge quantities in various water bodies. Therefore, the main reason for contracting the disease is the use of unboiled water contaminated with the virus. Moreover, not only drinking, but also water used for other procedures, for example, brushing teeth, washing hands, dishes, vegetables and fruits. Infection is also possible after swimming in polluted water bodies.

If uninfected people are in the same room with a sick person, then the transmission of the virus through household items (doorknobs, dishes, towels) is possible.

Hematogenous infection is also possible, but such cases are rare. This method of distribution is more typical for developed countries. In particular, people who inject drugs are exposed to it. It is also possible to get infected during anal sex.

Duration of the disease

The disease is usually treated for a period from 1 week to 1.5-2 months. The duration of the illness depends on many factors:

• the patient's age;
• the amount of the virus that has entered the body;
• state of immunity;
• treatment methods;
• the presence of concomitant diseases in the patient, primarily of the liver.

Gradually, the symptoms of the disease subside, and the patient recovers. However, in rare cases, relapses may also occur, when an externally recovered person may again have one or two episodes of exacerbation.

Incubation period

The period starting from the moment of infection and ending with the appearance of the first clinical signs is called incubation. The incubation period of the disease can last from 7 to 50 days, most often 14-28 days. It should be noted that during the incubation period, the patient is a virus carrier and poses a danger to others, as a source of infection.

Forms of hepatitis A

The disease can be both icteric and anicteric forms. In the anicteric form, the disease is much more difficult to identify by its manifestations than in the icteric form. The anicteric form is more typical for children under 6 years old, about 90% of them suffer the disease in a similar form. In adults, the anicteric form is observed only in 30% of cases.

Also, in addition to the acute form of hepatitis A, there is also a fulminant form of the disease. It is extremely rare in children and young people, but in old age it accounts for a few percent of all cases of the disease. As already mentioned, in the acute form, mortality is relatively low, which cannot be said for the lightning-fast form. With a fulminant form, acute liver failure develops rapidly and death is very likely.

How does it manifest

After the incubation period, during which there are no signs of the disease, the prodromal period begins, when the first clinical symptoms appear.

Unfortunately, many people know little about the disease - what it is, how it is transmitted, the symptoms of the disease. According to a common misconception, the very first manifestation of Botkin's disease is jaundice. But in fact, the signs of hepatitis A initially resemble those of the flu - high fever, headaches. The temperature usually rises to values \u200b\u200bof + 38-39 ° С. However, in many cases, this symptom is absent.

Then there are signs of an upset stomach - nausea, vomiting, stool disturbances, pain in the abdomen. Bitterness appears in the mouth, the color of urine and feces changes. Due to the presence of bile pigment in the urine - bilirubin, urine becomes dark in color. What can not be said about feces, since, on the contrary, it becomes discolored due to a lack of stercobilin pigment supplied with bile, which is normally responsible for the dark color of excrement. Discomfort may appear in the right hypochondrium - heaviness or dull pain, as well as pain in muscles and joints, itching.

The next stage in the development of signs of the disease is the appearance of jaundice, which occurs only on the 5-10th day. Due to an excess of bilirubin in the blood, the skin, mucous membranes and eyeballs of the patient acquire a yellow color. A similar phenomenon is observed with an increase in the concentration of bilirubin in the blood to 200-400 mg / ml. After the onset of jaundice, the temperature usually subsides. This syndrome will soon disappear.

By the time jaundice appears, the patient ceases to secrete viruses and be infectious to others. Therefore, bed rest for the patient can be changed to half-bed. The icteric period lasts from 5 to 30 days and ends with a recovery period.

In a severe course of the disease, nosebleeds, hemorrhages on the skin may occur, which should be feared, as they are evidence of a hemorrhagic syndrome.

Also, with hepatitis A, an enlarged liver is usually observed, and in 30% of cases, an enlarged spleen. The latter is associated with an increased load on the immune system, an important component of which is the spleen.

Diagnostics

When diagnosing, it is important to separate other infectious diseases from hepatitis A due to its increased infectivity. Diagnosis is complicated by the fact that the disease has symptoms similar to those of other types of hepatitis. And it is not always possible to say with confidence that such symptoms appear precisely with hepatitis A, and not, say, with the serum form of the disease. Examination of the patient is usually not enough to identify disease. Although many characteristic signs (yellowness, enlargement of the liver) indicate an inflammatory process in the liver, nevertheless, they may not always accompany the disease.

Various methods are used to determine the type of hepatitis, such as a blood test for antibodies. There is also a more reliable PCR method, but it requires expensive equipment and cannot be carried out everywhere.

Biochemical and general blood tests are also performed. An increased level of liver enzymes - bilirubin, AST and ALT - indicates pathological processes in the liver. With the disease, an increase in the prothrombin index, an increase in ESR, and leukocytosis are also observed. Ultrasound, X-ray, CT, and MRI methods allow you to assess the physical condition of the liver and adjacent organs.

Hepatitis A - how to treat it and how to avoid it

The treatment of the disease and its prevention are the issues that are most important from a practical point of view. How to treat and how to avoid the disease? Treatment is usually carried out at home, except in cases aggravated by severe liver failure. Children under one year old and elderly patients are also hospitalized. The disease is usually treated by an infectious disease doctor. Sometimes self-medication is practiced, which should be avoided, since only an experienced specialist knows everything about hepatitis A, what kind of disease it is and how to treat it.

There are no specific antiviral drugs directed against the hepatitis A virus. However, in severe cases, the patient may receive interferon injections. In general, in most cases, the body copes with the disease on its own. It is important to provide the patient with bed rest. He also needs an abundant drink - to detoxify the body. Medicines are prescribed to the patient only by a doctor. A large number of drugs can create problems for the patient's diseased liver. In particular, according to the WHO recommendations for hepatitis A, paracetamol should not be used to lower the temperature.

To restore liver function impaired due to hepatitis, vitamin complexes, hepatoprotectors can be prescribed. Enterosorbents are used to remove toxins from the intestines, enzyme preparations are used to improve digestion, and choleretic agents and antispasmodics are used to accelerate the withdrawal of bile.

Diet for hepatitis

Diet is also an important part of treatment. From the patient's diet, it is necessary to exclude fried, salty and spicy foods, canned food, indigestible dishes, mushrooms, animal fats (fatty meats and fish), fresh bread, pastries, coffee and chocolate, carbonated drinks.

Food should be taken in small portions, but often (5-6 times a day).

The diet should be followed not only during hepatitis, but also during the recovery period (about six months).

Prevention

In order to avoid the disease, all people should be well aware of the disease, know what it is, how the symptoms of the disease are transmitted.

Measures to provide the population with clean drinking water, as well as the disposal of wastewater and food waste, control over the observance of sanitary and hygienic standards by workers in catering establishments and medical personnel contribute to a decrease in the incidence of hepatitis across countries and regions.

The family of a hepatitis A patient must be careful in dealing with him to avoid infection. The patient should be allocated a separate room. The patient's bed linen must undergo a disinfection procedure before washing (boiling in soapy water 2% for 15 minutes). The dishes from which the patient ate must also be boiled in a 2% soda solution for 15 minutes. Floors, doorknobs and other surfaces should be cleaned with a warm 2% solution of soap or soda.

In general, measures to prevent hepatitis A are simple. These include:

• refusal to use raw unboiled water, not only for drinking, but also for washing dishes or brushing teeth;
• regular hand washing, especially after using the toilet;
• washing vegetables and fruits.

Particular caution should be exercised by those who visit southern countries and sample local exotic food. In particular, the hepatitis A virus can inhabit some shellfish caught in contaminated water. Therefore, you should take it as a rule in such conditions not to eat any food that has not undergone sufficient heat treatment.

If there is no access to clean, disinfected water, then water from unsafe sources must be boiled for at least 10 minutes.

Vaccination against hepatitis A

Also, for preventive purposes, it is possible to vaccinate against hepatitis A. The vaccine contains neutralized viruses. There are several categories of citizens who are subject to mandatory vaccination - doctors, workers in the food industry and catering establishments, the military, who spend a lot of time in field camps. Vaccinations are also recommended for people traveling to hot countries.

Immunity after vaccination against hepatitis A does not form immediately, but after 3-4 weeks. Re-vaccination is required to enhance the effect. It is done 6 months after the first one. A series of two vaccinations, however, does not provide lifelong immunity. It is usually valid for 8 years.

Forecast and consequences

The prognosis for hepatitis is good. However, a complete recovery from the consequences of the disease can take a long time.

The recovery period after an active period of hepatitis can last up to 6 months. During this period, the patient must follow a sparing diet.

After the disease, the patient retains a stable immunity for life, so a second hepatitis infection is unlikely. Nevertheless, an active disease can cause some damage to the liver and the person who has suffered from hepatitis can feel the consequences of hepatitis all his life.

Possible complications of hepatitis A include:

• dyskinesia of the biliary tract,
• cholecystitis,
• chronic,
• cholangitis.

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

Features of the hepatitis A virus

Possible transmission routes directly depend on the properties of the pathogen, in this case, certain characteristics of the hepatitis A virus. The virus multiplies mainly in liver cells, to a lesser extent in the biliary tract and epithelial cells of the alimentary canal.

The hepatitis A virus is resistant to a number of environmental factors, namely chlorine and disinfectants, and low temperatures. Thus, this pathogen can penetrate into tap water and remain well in it, and the infection can be transmitted despite the traditional chlorination of tap water.

Source of infection

Hepatitis A belongs to the group of anthroponous infections with a predominantly fecal-oral transmission mechanism. This means that in any situation, the source of infection is a sick person. Isolation of the virus is quite long: it begins in the incubation (latent) period and sometimes ends even somewhat later than the patient's clinical recovery. Thus, a person poses a danger to others during the entire illness and even before the onset of clinical symptoms.

During viral hepatitis A, the following periods are distinguished:

incubation (that is, hidden) - its duration is 14-30 (up to 55) days, there are no symptoms of the disease, it is during this period that the probability of becoming infected from an infected person is most likely; short-term prodromal (preicteric) period - only 6-7 (up to 10) days; intensive virus shedding continues; the period of obvious clinical manifestations (the peak period) can be limited to 10-14 days, and it can drag on for a whole month or more if exacerbations or complications develop; virus isolation continues, but less active; the isolation of the virus during the period of convalescence (recovery) varies significantly, so it is rather difficult to talk about any average duration in this period.

Another important detail: a person with clearly yellow skin (the so-called manifest form of the disease) and without a significant change in the general condition (the so-called anicteric form) is equally dangerous. In addition, with hepatitis A, the so-called latent or abortive forms of the disease often develop. A person does not feel the signs of illness in his own body, while he releases the pathogen into the environment and is infectious to other people.

From this point of view, for healthy people, the greatest danger is a person with anicteric form of the disease. No anti-epidemic measures are taken in this case, since such a condition is rarely diagnosed. A person with obvious jaundice is subject to hospitalization and isolation, all objects around him - disinfection.

How is hepatitis A transmitted?

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

water; food; contact and household; parenteral.

All modes of transmission involve certain situations that are dangerous in terms of infection. In some cases, infection is unlikely, in others - exactly the opposite.

For hepatitis A, transmission by airborne droplets and transmissible is not typical. The airborne transmission mechanism is an infection by inhalation of air containing droplets of mucus from the patient's nasopharynx. Since the hepatitis virus does not multiply in the respiratory tract, infection only through communication (without direct contact) with a sick person is impossible.

The transmissible route of transmission is infection when a sick person is bitten by a live carrier (louse, tick, mosquito, mosquito). In hepatitis A, this option is not described in the modern medical literature.

Waterway transmission

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

drinking unboiled water from any source (including from the central water supply); the most dangerous (potentially containing a larger amount of the virus) are wells, artesian wells, old-built water supply networks (there is a possibility of mixing sewage and tap water); use of water for washing dishes, vegetables and fruits without subsequent treatment with disinfectants or high temperatures; in an existing lesion, the virus can enter the oral cavity during toothbrushing and other hygiene procedures.

Viral hepatitis A during the implementation of the waterway of transmission can cover whole settlements, organized children's groups of closed and open types.

Food transmission route

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

using the same dishes with a sick person; the use of some culinary products; inclusion in the food ration of poorly washed and not subject to heat treatment vegetables, fruits and other things.

The food route of transmission is most typical for children's groups that eat in one catering establishment (for example, a school cafeteria). The spread is facilitated by non-observance of hygiene skills, lack of soap, and so on.

Contact transmission path

A sick person infecting others touches many objects through which the virus is transmitted to other people.

The contact transmission path is implemented:

with direct contact with a sick person; when using common household items (toothbrush, towel); in the process of playing with common toys (hard and soft); non-compliance with the rules of hygienic treatment of the toilet (both public and home).

All methods of hepatitis A infection can be carried out both at home and in public areas. Visiting catering establishments of any class, public toilets increases the risk of infection.

Epidemiological features of hepatitis A

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

an increase in the incidence is noted in the warm season; the predominant age of patients up to 35 years; simplicity of infection determines the possibility of an epidemic outbreak; after the transferred disease, lifelong immunity remains; careful adherence to hygiene rules makes it easy to control this infection.

The transmission of hepatitis A is a fairly easy process, but the rules for preventing this disease are also simple, understandable and accessible to a person of any age.

Related materials

Hepatitis C - inflammation of the liver of viral genesis, the clinical manifestations of which in most cases are significantly delayed in time or so little expressed that the patient himself may not notice that a “tender” killer virus has settled in his body, as hepatitis C virus (HCV) is called.

Once, and this lasted until the end of the 80s of the last century, doctors knew about the existence of a special form of hepatitis, which does not fit into the concept of "Botkin's disease" or jaundice, but it was obvious that this hepatitis, which affects the liver no less than their own " brothers ”(A and B). The unfamiliar species was called neither A nor B hepatitis, since its own markers were not yet known, and the closeness of pathogenic factors was obvious. It was similar to hepatitis A in that it was transmitted not only parenterally, but also assumed other transmission routes. The similarity to hepatitis B, called serum hepatitis, was that it could also be contracted by receiving someone else's blood.

Nowadays everyone knows that hepatitis, called neither A nor B, is open and well studied. This is hepatitis C, which in its prevalence is not only equal to the notorious HIV infection, but also far exceeds it.

Similarities and differences

Botkin's disease was previously called any inflammatory liver disease associated with a certain pathogen. The understanding that Botkin's disease can represent an independent group of polyetiological pathological conditions, each of which has its own pathogen and the main route of transmission, came later.

Now these diseases are called hepatitis, but a capital letter of the Latin alphabet is added to the name according to the sequence of opening of the pathogen (A, B, C, D, E, G). Patients often translate everything into Russian and indicate hepatitis C or hepatitis D. At the same time, the diseases attributed to this group are very similar in the sense that the viruses caused by them have hepatotropic properties and, when ingested, affect the hepatobiliary system , each in its own way disrupting its functional abilities.

Different types of hepatitis are not equally prone to chronicity of the process, which indicates different behavior of viruses in the body.

The most interesting in this regard is considered hepatitis C, which for a long time remained a mystery, but even now, being widely known, it leaves secrets and intrigues, since it does not provide an opportunity to make an accurate forecast (it can only be assumed).

Inflammatory processes of the liver caused by various pathogens do not differ in relation to sex, therefore, they affect both men and women equally. There was no difference in the course of the disease, but it should be noted that in women during pregnancy, hepatitis can be more severe. In addition, the penetration of the virus in recent months or the active course of the process can negatively affect the health of the newborn.

Since liver diseases of viral origin still have a clear similarity, then considering hepatitis C, it is advisable to touch on other types of hepatitis, otherwise the reader will think that only the "hero" of our article should be afraid. But during sexual intercourse, you can become infected with almost any of the species, although this ability is attributed more to hepatitis B and C, and therefore they are often referred to as sexually transmitted diseases. In this regard, other pathological conditions of the liver of viral origin are usually kept silent, since their consequences are not as significant as the consequences of hepatitis B and C, which are recognized as the most dangerous.

In addition, there are non-viral hepatitis (autoimmune, alcoholic, toxic), which should also be touched upon, because one way or another, they are all interconnected and significantly aggravate each other's course.

How is the virus transmitted?

Depending on how the virus could “run across” to the person and what things it will start “doing” in the body of the new “host”, different types of hepatitis are distinguished. Some are transmitted in everyday life (through dirty hands, food, toys, etc.), appear quickly and pass, basically, without any consequences. Others, called parenteral, with the potential for chronicity, often remain in the body for life, destroying the liver to cirrhosis, and in some cases to primary liver cancer (hepatocarcinoma).

In this way, hepatitis by the mechanism and routes of infection are divided into two groups:

Having an oral-fecal transmission mechanism (A and E); Hepatitis, for which blood-contact (hemopercutaneous), or simply put through the blood path, is the main one (B, C, D, G - a group of parenteral hepatitis).

In addition to the transfusion of infected blood or flagrant non-compliance with the rules for medical manipulations associated with damage to the skin (the use of insufficiently processed instruments, for example, for acupuncture), common spread of hepatitis C, B, D, G and in other cases:

Various fashionable procedures (tattoos, piercings, ear piercing) performed by a non-professional at home or in any other conditions that do not meet the requirements of the sanitary and epidemiological regime; By using one needle for several people, this method is practiced by syringe addicts; Transmission of the virus through sexual intercourse, which is most likely for hepatitis B, C-hepatitis in such situations is transmitted much less frequently; There are known cases of infection in the "vertical" way (from mother to fetus). An active form of the disease, an acute infection in the last trimester, or being infected with HIV significantly increases the risk of hepatitis. Unfortunately, up to 40% of patients still cannot remember the source that "gifted" the hepatitis B, C, D, G.

The hepatitis virus is not transmitted through breast milk, so women who are carriers of hepatitis B and C can safely feed the baby without fear of infecting him.

It can be agreed that the fecal-oral mechanism, water, contact-household, being so interconnected, cannot exclude the likelihood of transmission of the virus and sexually, just like other types of hepatitis transmitted through the blood, they have the ability to penetrate into another organism during sex.

Signs of an unhealthy liver

After infection, the first clinical signs of different forms of the disease appear at different times. For example, the hepatitis A virus manifests itself in two weeks (up to 4), the causative agent of hepatitis B (HBV) is somewhat delayed and manifests itself in the interval from two months to six months. As for hepatitis C, its the pathogen (HCV) can reveal itself after 2 weeks, after 6 months, or it can "hide" for years, turning a healthy person into a carrier and source of infection of a rather serious disease.

The fact that something is wrong with the liver can be guessed from the clinical manifestations of hepatitis:

Temperature.Hepatitis A (headache, pain in bones and muscles) usually begins with it and the phenomena of influenza infection. The onset of HBV activation in the body is accompanied by a low-grade fever, and with C-hepatitis it may not rise at all; Jaundice varying degrees of severity. This symptom appears a few days after the onset of the disease, and if its intensity does not increase, then the patient's condition usually improves. This phenomenon is most characteristic of hepatitis A, which cannot be said about hepatitis C, as well as toxic and alcoholic hepatitis. Here, a more saturated color is not attributed to signs of a coming recovery, rather, on the contrary: with a mild form of liver inflammation, jaundice may be absent altogether; Rash and itching more typical for cholestatic forms of inflammatory processes in the liver, they are caused by the accumulation of bile acids in the tissues due to obstructive lesions of the hepatic parenchyma and injury to the bile ducts; Decreased appetite; Heaviness in the right hypochondrium,possibly an increase in the liver and spleen; Nausea and vomiting.These symptoms are more typical for severe forms; Weakness, malaise; Joint pain; Dark urine similar to dark beer, discolored feces are typical signs of any viral hepatitis; Laboratory indicators: liver function tests (ALT, AST, bilirubin), depending on the severity of the course, can increase several times, the number of platelets decreases.

During viral hepatitis, 4 forms are distinguished:

Mild, often characteristic of hepatitis C: jaundice is often absent, temperature is low-grade or normal, heaviness in the right hypochondrium, loss of appetite; Moderate severity: the above symptoms are more pronounced, there is pain in the joints, nausea and vomiting, there is practically no appetite; Heavy. All symptoms are present in a pronounced form; Fulminant (fulminant), not found in hepatitis C, but very characteristic of hepatitis B, especially in the case of coinfection (HDV / HBV), that is, a combination of two viruses B and D, which cause superinfection. The fulminant form is the most dangerous, since as a result of the rapid development of massive necrosis of the hepatic parenchyma, the patient dies.

Hepatitis, dangerous in everyday life (A, E)

In everyday life, in the first place, liver diseases can lie in wait, which have a predominantly fecal-oral route of transmission, and this, as you know, hepatitis A and E, therefore, one should dwell a little on their characteristic features:

Hepatitis A

Hepatitis A is a highly contagious infection. Previously, it was called simply infectious hepatitis (when B was serum, and the others were not yet known). The causative agent of the disease is a small but incredibly resistant virus containing RNA. Although epidemiologists note the susceptibility to the pathogen as general, it is mainly children who are sick who have crossed the age of one. Infectious hepatitis, triggering inflammatory and necrobiotic processes in the hepatic parenchyma, giving symptoms of intoxication (weakness, fever, jaundice, etc.), as a rule, ends with recovery with the development of active immunity. The transition of infectious hepatitis into a chronic form practically does not occur.

Video: Hepatitis A in the Healthy Living!

Hepatitis E

Its virus also refers to RNA-containing, it “feels” well in the aquatic environment. Transmitted from a sick person or carrier (in the latency period), there is a high probability of infection through food that has not undergone heat treatment. Mostly young people (15-30 years old) living in the countries of Central Asia and the Middle East are ill. In Russia, the disease is extremely rare. Contact-household transmission is not excluded. Cases of chronicity or chronic carriage have not yet been established or described.

Hepatitis B and the dependent hepatitis D virus

Hepatitis B virus (HBV), or serum hepatitis, is a DNA-containing pathogen with a complex structure, which prefers liver tissue for its replication. To transmit the virus, a meager dose of infected biological material is enough, why this form is so easily transferred not only during medical manipulations, but also during intercourse or in a vertical way.

The course of this viral infection is multivariate. She may limit herself to:

Carrier; Give acute hepatic failure with the development of a fulminant (fulminant) form, often taking the life of the patient; With the chronicity of the process - lead to the development of cirrhosis or hepatocarcinoma.

unfavorable development of hepatitis B

The incubation period of this form of the disease lasts from 2 months to six months, and the acute period in most cases has symptoms characteristic of hepatitis:

Fever, headache; Decreased performance, general weakness, malaise; Joint pain; Disorder of the digestive system (nausea, vomiting); Sometimes rashes and itching; Heaviness in the right hypochondrium; Enlarged liver, sometimes spleen; Jaundice; A typical sign of liver inflammation is dark urine and discolored stool.

Highly dangerous and unpredictable combinations of HBV with the causative agent of hepatitis D (HDV), which was previously called delta infection, is a unique virus that is necessarily dependent on HBV.

Transmission of two viruses can be simultaneous, which leads to the development of coinfection. If the D-pathogen later joined the HBV-infected liver cells (hepatocytes), then we will talk about superinfection. A serious condition, which was the result of such a combination of viruses and the clinical manifestation of the most dangerous type of hepatitis (fulminant form), often threatens to end in death within a short time.

Video: Hepatitis B

The most significant parenteral hepatitis (C)

viruses of various hepatitis

The "famous" C-hepatitis virus (HCV, HCV) is a microorganism with unprecedented heterogeneity. The causative agent contains a single-stranded positively charged RNA encoding 8 proteins (3 structural + 5 non-structural), to each of which corresponding antibodies are produced during the disease.

The hepatitis C virus is quite stable in the external environment, tolerates freezing and drying well, but is not transmitted in negligible doses, which explains the low risk of infection through the vertical route and during intercourse. A low concentration of an infectious agent in secretions secreted during sex does not provide conditions for the transmission of the disease, unless other factors "help" the virus to "migrate" are present. These factors include concomitant bacterial or viral infections (HIV in the first place), which reduce immunity, and a violation of the integrity of the skin.

HCV behavior in the body is difficult to predict. Penetrating into the blood, it can circulate for a long time at a minimum concentration, forming in 80% of cases a chronic process that, over time, can lead to severe liver damage: cirrhosis and primary hepatocellular carcinoma (cancer).

scheme of development of hepatitis C

The absence of symptoms or a slight manifestation of signs of hepatitis is the main feature of this form of inflammatory liver disease, which remains unrecognized for a long time.

However, if the causative agent nevertheless "decided" to immediately start a damaging effect on the liver tissue, then the first symptoms may already appear in 2-24 weeks and last 14-20 days.

The acute period often proceeds in a mild anicteric form, accompanied by:

Weakness; Joint pain; Indigestion; Slight fluctuations in laboratory parameters (liver enzymes, bilirubin).

The patient feels some heaviness on the side of the liver, sees a change in the color of urine and feces, however, pronounced signs of hepatitis, even in the acute phase, are generally not typical for this species and rarely occur. It becomes possible to diagnose C-hepatitis when the corresponding antibodies are detected by enzyme-linked immunosorbent assay (ELISA) and the pathogen RNA by PCR (polymerase chain reaction).

Video: film about hepatitis C

What is hepatitis G

Hepatitis G is considered the most mysterious today. It is caused by a virus containing single-stranded RNA. The microorganism (HGV) has 5 genotypes and is structurally very similar to the causative agent of C-hepatitis. One (first) of the genotypes chose the west of the African continent for their habitation and is not found anywhere else, the second has spread throughout the globe, the third and fourth “liked” Southeast Asia, and the fifth settled in southern Africa. Therefore, residents of the Russian Federation and the entire post-Soviet space have "chances" to meet with a representative of the second type.

For comparison: map of the distribution of hepatitis C

Epidemiologically (sources of infection and routes of transmission) G-hepatitis resembles other parenteral hepatitis. As for the role of HGV in the development of inflammatory liver diseases of an infectious genesis, it is not defined, the opinions of scientists differ, the data of the medical literature remain contradictory. Many researchers associate the presence of the pathogen with the fulminant form of the disease, and also tend to believe that the virus plays a role in the development of autoimmune hepatitis. In addition, a frequent combination of HGV with hepatitis C (HCV) and B (HBV) viruses has been noticed, that is, the presence of coinfection, which, however, does not aggravate the course of monoinfection and does not affect the immune response during interferon treatment.

HGV monoinfection usually proceeds in subclinical, anicteric forms, however, as the researchers note, in some cases it does not pass without a trace, that is, even in a latent state it can lead to morphological and functional changes in the hepatic parenchyma. There is an opinion that the virus, like HCV, can harbor and then strike no less, that is, transform into cancer or hepatocellular carcinoma.

When does hepatitis become chronic?

Chronic hepatitis is understood as a diffuse-dystrophic inflammatory process localized in the hepatobiliary system and caused by various etiological factors (viral or other origin).

The classification of inflammatory processes is difficult, however, like other diseases, moreover, there is still no universal methodology, therefore, in order not to burden the reader with incomprehensible words, we will try to say about the main thing.

Considering that in the liver, for certain reasons, a mechanism is triggered that causes dystrophy of hepatocytes (liver cells), fibrosis, necrosis of the hepatic parenchyma and other morphological changes leading to a violation of the functional abilities of the organ, they began to allocate:

Autoimmune hepatitis, characterized by extensive liver damage, and, therefore, an abundance of symptoms; Cholestatic hepatitis, caused by a violation of the outflow of bile and its stagnation as a result of the inflammatory process affecting the bile ducts; Chronic hepatitis B, C, D; Hepatitis caused by the toxic effects of drugs; Chronic hepatitis of unexplained origin.

Obviously, the classified etiological factors, associations of infections (coinfection, superinfection), phases of the chronic course, do not fully provide a complete picture of inflammatory diseases of the main organ of detoxification. There is no information on the liver's reaction to the damaging effects of adverse factors, toxic substances and new viruses, that is, nothing is said about very significant forms:

Chronic alcoholic hepatitis, which is the source of alcoholic cirrhosis; Non-specific reactive form of chronic hepatitis; Toxic hepatitis; Chronic hepatitis G, discovered later than others.

In this regard, the 3 forms of chronic hepatitis based on morphological features:

Chronic persistent hepatitis (CPH), which is usually inactive, manifests itself clinically for a long time, infiltration is observed only in the portal tracts, and only the penetration of inflammation into the lobule will indicate its transition to the active phase; Chronic active hepatitis (CAH) is characterized by the transition of the inflammatory infiltrate from the portal tracts into the lobule, which is clinically manifested by varying degrees of activity: insignificant, moderate, pronounced, sharply expressed; Chronic lobular hepatitis due to the predominance of the inflammatory process in the lobules. The defeat of several lobules with multibular necrosis indicates a high degree of activity of the pathological process (necrotizing form).

Given the etiological factor

Inflammatory process in the liver refers to polyetiologic diseases, since it is caused by a number of reasons:

The classification of hepatitis has been revised many times, but experts have not come to a consensus. Currently, only five types of liver damage associated with alcohol have been identified, so it hardly makes sense to list all the options, because viruses have not yet been discovered and studied, and not all forms of hepatitis have been described. Nevertheless, it may be worth acquainting the reader with the most understandable and accessible division of chronic inflammatory liver diseases by etiological principle:

Viral hepatitiscaused by certain microorganisms (B, C, D, G) and uncertain - poorly studied, unconfirmed by clinical data, new forms - F, TiTi; Autoimmune hepatitis (types 1, 2, 3); Liver inflammation (drug-induced), often detected in "chronicles", associated with long-term use of a large number of drugs or the use of drugs showing pronounced aggression towards hepatocytes for a short time; Toxic hepatitiscaused by the influence of hepatotropic toxic substances, ionizing radiation, alcohol surrogates and other factors; Alcoholic hepatitis, which, together with drug-induced, is classified as a toxic form, but in other cases it is considered separately, as a social problem; Metabolic, which occurs with congenital pathology - Konovalov-Wilson disease. Its cause lies in a hereditary (autosomal recessive type) disorder of copper metabolism. The disease is extremely aggressive, quickly ends with cirrhosis and death of the patient in childhood or young age; Cryptogenic hepatitis, the cause of which, even after a thorough examination, remains unknown. The disease is progressive and requires monitoring and control, as it often leads to severe liver damage (cirrhosis, cancer); Non-specific reactive hepatitis (secondary). It is often a companion of various pathological conditions: tuberculosis, renal pathology, pancreatitis, Crohn's disease, ulcerative processes in the gastrointestinal tract and other diseases.

Given that some types of hepatitis are very related, widespread and quite aggressive, it makes sense to provide a few examples that are likely to be of interest to readers.

Chronic hepatitis C

An important question regarding hepatitis C is about how to live with it and how many years they have lived with this disease. Having learned about their diagnosis, people often rush into panic, especially if they receive information from unverified sources. However, this is not necessary. With C-hepatitis, they live a normal life, but they mean it in terms of some adherence to a diet (you should not load the liver with alcohol, fatty foods and substances toxic to the organ), increase the body's defenses, that is, immunity, being careful in everyday life and with sexual intercourse. You just need to remember that human blood is contagious.

As for life expectancy, there are many cases when hepatitis, even among those who like to eat and drink well, has not shown itself in anything for 20 years, so you should not bury yourself prematurely. In the literature, both cases of recovery are described, and the reactivation phase, which begins after 25 years, and, of course, the sad outcome is cirrhosis and cancer. Which of the three groups you can get into sometimes depends on the patient, given that there is currently a drug - synthetic interferon.

Hepatitis Related to Genetics and Immune Response

Autoimmune hepatitis, which occurs in women 8 times more often than in men, is characterized by rapid progression with the transition to portal hypertension, renal failure, cirrhosis and ends with the death of the patient. According to the international classification, autoimmune hepatitis can occur in the absence of blood transfusions, liver damage by alcohol, toxic poisons, and drugs.

The cause of autoimmune liver damage is believed to be a genetic factor.Positive associative relationships of the disease with antigens of the major histocompatibility complex (leukocyte system HLA), in particular, HLA-B8, which is recognized as an antigen of hyperimmunoreactivity, were revealed. However, many may have a predisposition, but not all get sick. Certain drugs (for example, interferon), as well as viruses, can provoke autoimmune damage to the hepatic parenchyma:

Epstein-Barr; Corey; Herpes 1 and 6 types; Hepatitov A, B, C.

It should be noted that about 35% of patients who were overtaken by AIH already had other autoimmune diseases.

The vast majority of cases of autoimmune hepatitis begin as an acute inflammatory process (weakness, loss of appetite, severe jaundice, dark urine). After a few months, signs of an autoimmune nature begin to form.

Sometimes AIT develops gradually with a predominance of symptoms of asthenovegetative disorders, malaise, heaviness in the liver, slight yellowness, rarely the onset is manifested by a significant increase in temperature and signs of another (extrahepatic) pathology.

The following manifestations may indicate a detailed clinical picture of AIH:

Severe malaise, loss of performance; Heaviness and pain on the side of the liver; Nausea; Skin reactions (capillaritis, telangiectasia, purpura, etc.) Itching of the skin; Lymphadenopathy; Jaundice (intermittent); Hepatomegaly (enlarged liver); Splenomegaly (enlarged spleen); In women, the absence of menstruation (amenorrhea); In men, breast enlargement (gynecomastia); Systemic manifestations (polyarthritis),

Often, AIH is a companion of other diseases: diabetes mellitus, diseases of the blood, heart and kidneys, pathological processes localized in the organs of the digestive system. In a word, autoimmune - it is autoimmune and can manifest itself in any, far from hepatic pathology.

Any liver "doesn't like" alcohol ...

Alcoholic hepatitis (AH) can be considered as one of the forms of toxic hepatitis, because they have one reason - the negative effect on the liver of irritating substances that have a detrimental effect on hepatocytes. For hepatitis of alcoholic origin, all the typical signs of liver inflammation are characteristic, which, however, can pass in a sharply progressive acute form or have a persistent chronic course.

Most often, the onset of an acute process is accompanied by signs:

Intoxication: nausea, vomiting, diarrhea, aversion to food; Weight loss; Jaundice without itching or with itching due to accumulation of bile acids in cholestatic form; A significant increase in the liver with its induration and soreness in the right hypochondrium; Tremor; Hemorrhagic syndrome, renal failure, hepatic encephalopathy with fulminant form. Hepatorenal syndrome and hepatic coma can cause death of the patient.

Sometimes in the acute course of alcoholic hepatitis, a significant increase in body temperature is observed, bleeding and the addition of bacterial infections are possible, causing inflammatory processes of the respiratory and urinary tract, gastrointestinal tract, etc.

Chronic persistence of hypertension is malosymptomatic and often reversible if a person is able to stop in time. Otherwise, the chronic form turns into a progressive one with transformation into cirrhosis.

... And other toxic substances

For the development of acute toxic hepatitis a single dose of a small dose of a toxic substrate is enough, with hepatotropic properties, or a large amount of substances less aggressive to the liver, for example, alcohol. Acute toxic inflammation of the liver manifests itself as a significant increase and soreness in the right hypochondrium. Many people mistakenly believe that the organ itself hurts, but this is not the case. Pain is caused by stretching of the liver capsule due to an increase in its size.

With toxic liver damage, symptoms of alcoholic hepatitis are characteristic, however, depending on the type of poisonous substance, they can be more pronounced, for example:

Feverish condition; Progressive jaundice; Vomiting mixed with blood; Nose and gingival bleeding, hemorrhages on the skin due to damage to the vascular walls by toxins; Mental disorders (agitation, lethargy, disorientation in space and time).

Chronic toxic hepatitis develops over a long time when small, but constant, doses of toxic substances are ingested. If the cause of the toxic effect is not eliminated, then after years (or only months) complications can be obtained in the form of liver cirrhosis and liver failure.

Markers for early diagnosis. How to understand them?

Viral hepatitis markers

Many have heard that the first step in diagnosing inflammatory liver disease is a marker test. Having received a piece of paper with the answer to the analysis for hepatitis, the patient is unable to understand the abbreviation if he does not have a special education.

Markers of viral hepatitis are determined using enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), inflammatory processes of non-viral origin are diagnosed by other methods, not excluding ELISA. In addition to these methods, biochemical tests, histological analysis (based on liver biopsy material) and instrumental studies are performed.

However, you should go back to markers:

Infectious hepatitis A antigencan be determined only during the incubation period and only in feces. In the phase of clinical manifestations, antibodies begin to be produced and immunoglobulins of class M (IgM) appear in the blood. The HAV-IgG synthesized a little later indicate recovery and the formation of lifelong immunity, which these immunoglobulins will provide; The presence or absence of the causative agent of viral hepatitis Bdetermined from time immemorial (though not modern methods) "Australian antigen" - HBsAg (surface antigen) and inner membrane antigens - HBcAg and HBeAg, which became possible to identify only with the arrival of ELISA and PCR in laboratory diagnostics. HBcAg is not detected in blood serum, it is determined using antibodies (anti-HBc). To confirm the diagnosis of HBV and monitor the course of the chronic process and the effectiveness of treatment, it is advisable to use PCR diagnostics (detection of HBV DNA). The patient's recovery is evidenced by the circulation of specific antibodies (anti-HBs, total anti-HBs, anti-HBe) in his blood serum in the absence of the HBsAg antigen itself; Diagnostics of the C-hepatitiswithout viral RNA detection (PCR) is difficult. IgG antibodies, having appeared at the initial stage, continue to circulate throughout life. The acute period and the reactivation phase are indicated by class M immunoglobulins (IgM), the titer of which increases. The most reliable criterion for the diagnosis, monitoring and control over the treatment of hepatitis C is the determination of the virus RNA by PCR. The main diagnostic marker for hepatitis D(delta infection) immunoglobulins of class G (anti-HDV-IgG) are considered, which persist throughout life. In addition, to clarify monoinfection, super (association with HBV) or coinfection, an analysis is carried out, detected by class M immunoglobulins, which, with superinfection, remain forever, and with coinfection, go away after about six months; The main laboratory test for hepatitis G is the determination of viral RNA using PCR. In Russia, specially designed ELISA kits, capable of finding immunoglobulins to the E2 envelope protein, which is a component of the pathogen (anti-HGV E2), help to identify antibodies to HGV.

Markers of hepatitis of non-viral etiology

The diagnosis of AIH is based on the identification of serological markers (antibodies):

SMA (Tissue to Smooth Muscle); ANA (antinuclears); Class G immunoglobulins; Anti-LKM-1 (microsomal antibody).

In addition, the diagnosis uses the determination of biochemical parameters: protein fractions (hypergammaglobulinemia), liver enzymes (significant activity of transaminases), as well as the study of histological material of the liver (biopsy).

Depending on the type and ratio of markers, the types of AIH are distinguished:

The first manifests itself more often in adolescents or in adolescence, or "waits" up to 50; The second most often affects childhood, has a high activity and resistance to immunosuppressants, quickly transforms into cirrhosis; The third type used to stand out in a separate form, but now it is no longer considered from this angle; Atypical AIH representing overlapping hepatic syndromes (primary biliary cirrhosis, primary sclerosing cholangitis, chronic hepatitis of viral origin).

There is no direct evidence of an alcoholic origin of liver damage, therefore, there is no specific analysis for hepatitis associated with the use of ethanol, however, certain factors that are very characteristic of this pathology have been noticed. For example, ethyl alcohol acting on the hepatic parenchyma promotes the release of alcoholic hyaline, called Mallory bodies, which leads to the appearance of ultrastructural changes in hepatocytes and stellate reticuloepithelial cells, indicating the degree of negative effect of alcohol on the "long-suffering" organ.

In addition, some biochemical parameters (bilirubin, liver enzymes, gamma fraction) indicate alkagolic hepatitis, but their significant increase is characteristic of many pathological conditions of the liver when exposed to other toxic poisons.

Clarification of the anamnesis, identification of a poisonous substance that affected the liver, biochemical tests and instrumental examination are the main criteria for the diagnosis of toxic hepatitis.

Can Hepatitis Be Cured?

Treatment of hepatitis depends on the etiological factor that caused the inflammatory process in the liver. Of course, hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment.

Viral hepatitis A and E, although of infectious origin, are acute and, as a rule, do not give chronicity. The human body in most cases is able to resist them, therefore it is not accepted to treat them, except that sometimes symptomatic therapy is used to eliminate headaches, nausea, vomiting, and diarrhea.

The situation is more complicated with liver inflammation caused by viruses B, C, D. However, given that delta infection practically does not occur on its own, but obligatory follows HBV, B-hepatitis has to be treated first of all, but with increased doses and prolonged course.

It is not always possible to cure hepatitis C, although the chances of a cure still appeared with the use of interferon-alpha (a component of the immune defense against viruses). In addition, at present, to enhance the effect of the main drug, combined regimens are used, involving the combination of prolonged interferons with antiviral drugs, for example, ribavirin or lamivudine.

It should be noted that not every immune system adequately responds to interference in its work by immunomodulators introduced from the outside, therefore interferon, with all its advantages, can produce undesirable effects. In this regard, interferon therapy is carried out under the close supervision of a physician with regular laboratory monitoring of the behavior of the virus in the body. If it is possible to completely eliminate the virus, then it can be considered a victory over it. Incomplete elimination, but the termination of the replication of the pathogen is also a good result, allowing "to lull the enemy's vigilance" and delay the likelihood of the transition of hepatitis to cirrhosis or hepatocellular carcinoma for many years.

How can hepatitis be prevented?

The expression "A disease is easier to prevent than to cure" has long become hackneyed, but not forgotten, since many troubles can really be circumvented if preventive measures are not neglected. As for viral hepatitis, special care will not be superfluous here. Compliance with the rules of personal hygiene, the use of specific protective equipment for contact with blood (gloves, fingertips, condoms), in other cases, are quite capable of becoming an obstacle to the transmission of infection.

Health workers in the fight against hepatitis specifically develop action plans and follow them to each item. Thus, in order to prevent the incidence of hepatitis and the transmission of HIV infection, as well as reduce the risk of occupational infection, the sanitary epidemiological service recommends adhering to certain prevention rules:

Prevent "syringe hepatitis" common among drug users. To this end, organize points of free distribution of syringes; Prevent any possibility of transmission of viruses during blood transfusions (organization of PCR laboratories at transfusion stations and quarantine storage of drugs and components obtained from donated blood under ultra-low temperatures); Reduce to the maximum the likelihood of occupational infection, using all available personal protective equipment and complying with the requirements of sanitary surveillance authorities Pay special attention to departments with an increased risk of infection (hemodialysis, for example).

Do not forget about the precautions for intercourse with an infected person. The likelihood of sexually transmitted hepatitis C virus is negligible, but for HBV it increases significantly, especially in cases associated with the presence of blood, for example, menstruation in women or genital trauma in one of the partners. If you really can't do without sex, then at least at least you shouldn't forget about a condom.

The likelihood of becoming infected is also higher in the acute phase of the disease, when the concentration of the virus is especially high, so for such a period it would be better to abstain from sexual relations altogether. Otherwise, people-carriers live a normal life, give birth to children, remembering their peculiarities, and be sure to warn doctors (ambulance, dentist, when registering with a antenatal clinic and in other situations requiring increased attention) that risk group for hepatitis.

Increased resistance to hepatitis

Vaccination against a viral infection is also referred to the prevention of hepatitis. Unfortunately, a vaccine against hepatitis C has not yet been developed, but the available vaccines against hepatitis A and B have significantly reduced the incidence of these types.

The hepatitis A vaccine is given to children 6-7 years of age (usually before going to school). Single use provides immunity for a year and a half, revaccination (re-vaccination) lengthens the protection period to 20 years or more.

The vaccine against HBV is administered to newborn babies while still in the hospital on a mandatory basis, for children who, for whatever reason, have not been vaccinated, or for adults there are no age restrictions. To ensure a full-fledged immune response, the vaccine is administered three times over several months. The vaccine is developed on the basis of the surface ("Australian") HBs antigen.

The liver is a delicate organ

To treat hepatitis on your own means to take full responsibility for the outcome of the inflammatory process in such an important organ, therefore, in the acute period or in the chronic course, it is better to coordinate any of your actions with a doctor. After all, anyone understands: if the residual effects of alcoholic or toxic hepatitis can neutralize folk remedies, then they are unlikely to cope with the rampant virus in the acute phase (meaning HBV and HCV). The liver is a delicate organ, albeit patient, so treatment at home should be deliberate and reasonable.

Hepatitis A, for example, does not require anything other than adherence to a diet, which is necessary, in general, in the acute phase of any inflammatory process. Nutrition should be as gentle as possible, since the liver passes everything through itself. In the hospital, the diet is called the fifth table (No. 5), which is observed at home up to six months after the acute period.

In chronic hepatitis, of course, it is not advisable to offer strict adherence to the diet for years, but it would be right to remind the patient that one should not irritate the organ again. It is advisable to try to eat cooked foods, exclude fried, fatty, pickled foods, limit salty and sweet foods. The liver also does not accept strong broths, strong and weak alcoholic and carbonated drinks.

Can folk remedies save?

Folk remedies in other cases help the liver to cope with the load that has piled on it, to raise natural immunity, and to strengthen the body. but they cannot cure hepatitis, therefore, to engage in amateur performances, to treat inflammation of the liver without a doctor is unlikely to be correct, because each of the species has its own characteristics that must be taken into account in the fight against it.

"Blind" sounding

Often, the attending physician himself, when prescribing a convalescent from the hospital, recommends simple home procedures for him. For example - "blind" probing, which is done on an empty stomach in the morning. The patient drinks 2 chicken yolks, throwing out the proteins or using them for other purposes, after 5 minutes all this is washed down with a glass of mineral water without gas (or clean from the tap) and placed on the right barrel, placing a warm heating pad under it. The procedure takes an hour. You should not be surprised if after her a person runs to the toilet to give away everything unnecessary. Some people use magnesia sulfate instead of yolks, however, it is a saline laxative that does not always give the intestines such comfort as, say, eggs.

Horseradish?

Yes, some people use finely grated horseradish (4 tablespoons) as a treatment, diluting it with a glass of milk. It is not recommended to drink the mixture right away, so it is first heated (almost to a boil, but not boiled), left for 15 minutes for a reaction to occur in the solution. They take the medicine several times a day. It is clear that such a tool will have to be prepared every day if a person tolerates a product such as horseradish well.

Soda with lemon

They say that in the same way, some lose weight. But still, we have a different goal - to treat the disease. Squeeze the juice of one lemon and pour it a teaspoon of baking soda. After five minutes, the soda will go out and the medicine is ready. Drink 3 days three times a day, then rest for 3 days and repeat the treatment again. We do not undertake to judge the mechanism of action of the medicine, but the people do it.

Herbs: sage, mint, milk thistle

Some say that the milk thistle known in such cases, which helps not only with hepatitis, but also with cirrhosis, is absolutely ineffective against hepatitis C, but instead people offer other recipes:

1 tablespoon peppermint Half a liter of boiling water; It is infused for a day; Is filtered; It is consumed throughout the day.

Or another recipe:

Sage - a tablespoon; 200 - 250 grams of boiling water; A tablespoon of natural honey; Dissolve honey in sage with water and infuse for an hour; Drink the mixture on an empty stomach.

However, not everyone adheres to a similar point of view regarding milk thistle and offers a recipe that helps with all inflammatory liver diseases, including C-hepatitis:

A fresh plant (root, stem, leaves, flowers) is crushed; Put in the oven for a quarter of an hour to dry; Remove from the oven, lay out on paper and place in a dark place to complete the drying process; Take 2 tablespoons of dry product; Add half a liter of boiling water; Insist 8-12 hours (preferably at night); Drink 3 times a day, 50 ml for 40 days; Take a break for two weeks and repeat the treatment.

Video: viral hepatitis in the "School of Doctor Komarovsky"

Hepatitis B infection can occur when the virus enters the bloodstream. Also, any fluid that is secreted from the body of an infected person and contains a virus can cause the onset of illness. In order not to get infected, you need to know the main routes of transmission and be sure to get vaccinated against this disease. What are the symptoms that indicate hepatitis infection has occurred?

What are the signs you can learn about the disease

Symptoms of hepatitis usually do not appear immediately, but when a period of 2-6 months has passed. At this time, a person is a carrier of the virus, but does not feel a deterioration in health, therefore, he does not know about his condition.

Depending on the form of the disease, various symptoms are distinguished.

Acute viral hepatitis B in its initial manifestations resembles the flu, the body temperature rises, aches and weakness appear. When the patient's skin begins to turn yellow, this is an exact symptom of hepatitis.

In addition, a person develops the following symptoms:

joint pain; an allergic skin reaction; loss of appetite; pain in the abdomen; nausea and vomiting.

According to clinical manifestations, darkening of urine and lightening of feces are noted. The patient's liver is enlarged. After taking blood tests, a more complete picture emerges: the level of bilirubin and liver enzymes is increased. If the disease does not acquire a chronic form, two weeks after the yellowing of the skin, the patient feels an improvement, because all the symptoms subside.

Important! With a poorly developed response of the immune system to the virus, the disease can be asymptomatic and become chronic.

Chronic viral hepatitis B is the most dangerous for humans, because it not only responds poorly to treatment, but also has severe symptoms and leads to complications. A person constantly experiences weakness and general malaise. These are primary symptoms that are often overlooked. The patient may experience nausea and vomiting, upset stools, pain in the abdomen, muscles and joints.

In advanced cases of the disease, jaundice, venous reticulum, skin itching, exhaustion appear, the liver and spleen increase in size.

Transmission routes

Viral hepatitis B is the type that is transmitted only through direct contact of a healthy person with the blood, saliva or semen of a sick person.

This virus is not transmitted by the fecal-oral route.

You can get infected from a patient with chronic or acute hepatitis. In newborns, the main mechanism of transmission of the virus is blood during childbirth. Children can also get viral hepatitis from their sick brothers or sisters.

Important! Viral hepatitis is 50 times more infectious than HIV, but it is not transmitted through breast milk.

There are such routes of infection:

Through the blood. In this way, you can get infected when using one syringe, for example, when injecting drugs or using non-sterile instruments that have had blood, for example, in tattoo parlors or operating rooms. Infection is possible with the infusion of donor blood, of course, such a mechanism of transmission of the virus is quite rare, about 2% of cases have been registered. The risk of infection increases with repeated transfusions of blood or blood components. Sexually. The likelihood of infection through sexual contact is very high and reaches 30%, because the virus is in the semen and secretions from the genital tract of women. A person may not even know about his illness, so unprotected sex should be avoided. The path of transmission from mother to child. It is worth noting that intrauterine infection of the fetus cannot occur (if the placenta retains its integrity), the risk of infection increases during the birth itself. Children born to mothers with hepatitis are immediately vaccinated against hepatitis B at the hospital, which reduces the risk of developing a chronic form of this disease. In a household way. There is minimal risk of getting infected in this way. The thing is that the mechanism of transmission of the virus is not only hematogenous, but also with the help of saliva, urine or sweat. If this biological fluid gets even on the damaged skin of a healthy person in a small amount, then infection will not occur. If the concentration of the virus in the fluid is high, then infection cannot be avoided.

Important! In the absence of damage to the skin, it is impossible to get infected by household means.

Factors such as the integrity of the skin and the concentration of the virus in the biological fluid affect the likelihood of household infection.

In 30% of cases, the transmission mechanism of the virus cannot be determined. After all, the disease can be asymptomatic for a long time, especially in a chronic form.

It is worth noting that the disease can be transmitted only if the patient's blood, saliva or sweat enters the blood of a healthy person, unless, of course, he has immunity from this disease.

After infection, a patient becomes a carrier of the virus long before the first symptoms of the disease appear. In this case, there is a risk of infecting loved ones.

What is the most common form of transmission?

Most likely, you can catch the virus through accidental sexual intercourse, less often from mother to child during childbirth. Since the transmission mechanism is not only through blood, but also through saliva, you can get hepatitis B through a kiss. You should also not use a patient's toothbrush, washcloth or towel, because they may contain biological fluid, such as sweat or saliva, which is a source of infection.

The likelihood of getting infected with an infusion of donated blood is small, because recently all blood is tested for the presence of various viruses before infusion.

In rare cases, infection can occur germline when a healthy egg is infected with an infected sperm, in which case the child is born with congenital hepatitis B.

What to do if there was contact with an infected person. How do you know if there is a risk of contracting hepatitis B?

How to determine the likelihood of infection?

Everyone can know their risk of contracting viral hepatitis. He needs to be tested for the presence of the antigen of the virus and antibodies to it. If the result is negative, then such a person must be vaccinated. Otherwise, upon contact with an infected person, there is a 100% chance of becoming infected.

If the HBsAg virus is found in the blood after the tests are taken, then this indicates that the infection has already occurred and the person can infect others. Antibodies to the virus in the blood are a good sign; in this case, you can not get vaccinated, because hepatitis B is not terrible in this case.

How to find out if there was contact with the virus?

Antibodies to the virus can be detected in people who have had viral hepatitis, so re-infection is impossible.

Many are worried about whether it is possible not to get infected after contact with a patient. What factors influence this process? Infection can be avoided only after being vaccinated, and communication with a sick person is not scary for people who have previously suffered from viral hepatitis, because antibodies are produced in their blood. Also, children born to infected mothers have protection against infection for life, because at birth they are injected with immunoglobulin against hepatitis B.

If an unprotected person, for example, a health worker, had direct contact with sick people, then in order to reduce the risk of infection, an immunoglobulin can be administered to him, which will protect against illness.

The following groups can be distinguished with a high probability of contracting hepatitis:

injection drug addicts; persons of unconventional orientation; people with many sexual partners; sexual partners of patients; family members where there are infected; people who are on hemodialysis or need frequent blood transfusions;

health workers; people with hemophilia or organ transplants; children born to infected mothers.

There are certain factors that contribute to an increased risk of infection, namely:

contact with the patient's blood or its components; intravenous administration of drugs or drugs with reusable syringes; acupuncture; the use of non-sterile instruments for various manipulations on the body (ear piercing, piercings or tattoos).

Those who are at risk should take steps towards prevention. First of all, you need to get vaccinated and adhere to the rules of personal hygiene.

Family members where there is a patient with chronic hepatitis should be tested for the virus and antibodies to it and, if necessary, get vaccinated.

Knowing how the hepatitis virus is transmitted, you can protect yourself from a serious illness. To be 100% safe, you need to take a vaccination course.

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

Features of the hepatitis A virus

Possible transmission routes directly depend on the properties of the pathogen, in this case, certain characteristics of the hepatitis A virus. The virus multiplies mainly in liver cells, to a lesser extent in the biliary tract and epithelial cells of the alimentary canal.

The hepatitis A virus is resistant to a number of environmental factors, namely chlorine and disinfectants, and low temperatures. Thus, this pathogen can penetrate into tap water and remain well in it, and the infection can be transmitted despite the traditional chlorination of tap water.

Source of infection

Hepatitis A belongs to the group of anthroponous infections with a predominantly fecal-oral transmission mechanism. This means that in any situation, the source of infection is a sick person. Isolation of the virus is quite long: it begins in the incubation (latent) period and sometimes ends even somewhat later than the patient's clinical recovery. Thus, a person poses a danger to others during the entire illness and even before the onset of clinical symptoms.

During viral hepatitis A, the following periods are distinguished:

• incubation (that is, hidden) - its duration is 14-30 (up to 55) days, there are no symptoms of the disease, it is during this period that the probability of becoming infected from an infected person is most likely;
• short-term prodromal (preicteric) period - only 6-7 (up to 10) days; intensive virus shedding continues;
• the period of obvious clinical manifestations (the peak period) can be limited to 10-14 days, and it can drag on for a whole month or more if exacerbations or complications develop; virus isolation continues, but less active;
• the isolation of the virus during the period of convalescence (recovery) varies significantly, so it is rather difficult to talk about any average duration in this period.

Another important detail: a person with clearly yellow skin (the so-called manifest form of the disease) and without a significant change in the general condition (the so-called anicteric form) is equally dangerous. In addition, with hepatitis A, the so-called latent or abortive forms of the disease often develop. A person does not feel the signs of illness in his own body, while he releases the pathogen into the environment and is infectious to other people.

From this point of view, for healthy people, the greatest danger is a person with anicteric form of the disease. No anti-epidemic measures are taken in this case, since such a condition is rarely diagnosed. A person with obvious jaundice is subject to hospitalization and isolation, all objects around him - disinfection.

How is hepatitis A transmitted?

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

• water;
• food;
• contact and household;
• parenteral.

All modes of transmission involve certain situations that are dangerous in terms of infection. In some cases, infection is unlikely, in others - exactly the opposite.

For hepatitis A, transmission by airborne droplets and transmissible is not typical. The airborne transmission mechanism is an infection by inhalation of air containing droplets of mucus from the patient's nasopharynx. Since the hepatitis virus does not multiply in the respiratory tract, infection only through communication (without direct contact) with a sick person is impossible.

The transmissible route of transmission is infection when a sick person is bitten by a live carrier (louse, tick, mosquito, mosquito). In hepatitis A, this option is not described in the modern medical literature.

Waterway transmission

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

• drinking unboiled water from any source (including from the central water supply);
• the most dangerous (potentially containing a larger amount of the virus) are wells, artesian wells, old-built water supply networks (there is a possibility of mixing sewage and tap water);
• use of water for washing dishes, vegetables and fruits without subsequent treatment with disinfectants or high temperatures;
• in an existing lesion, the virus can enter the oral cavity during toothbrushing and other hygiene procedures.

Viral hepatitis A during the implementation of the waterway of transmission can cover whole settlements, organized children's groups of closed and open types.

Food transmission route

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

• using the same dishes with a sick person;
• the use of some culinary products;
• inclusion in the food ration of poorly washed and not subject to heat treatment vegetables, fruits and other things.

The food route of transmission is most typical for children's groups that eat in one catering establishment (for example, a school cafeteria). The spread is facilitated by non-observance of hygiene skills, lack of soap, and so on.

Contact transmission path

A sick person infecting others touches many objects through which the virus is transmitted to other people.

The contact transmission path is implemented:

• with direct contact with a sick person;
• when using common household items (toothbrush, towel);
• in the process of playing with common toys (hard and soft);
• non-compliance with the rules of hygienic treatment of the toilet (both public and home).

All methods of hepatitis A infection can be carried out both at home and in public areas. Visiting catering establishments of any class, public toilets increases the risk of infection.

Epidemiological features of hepatitis A

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

• an increase in the incidence is noted in the warm season;
• the predominant age of patients up to 35 years;
• simplicity of infection determines the possibility of an epidemic outbreak;
• after the transferred disease, lifelong immunity remains;
• careful adherence to hygiene rules makes it easy to control this infection.

The transmission of hepatitis A is a fairly easy process, but the rules for preventing this disease are also simple, understandable and accessible to a person of any age.

Related materials

infectium.ru

Hepatitis A, which is often called Botkin's disease or jaundice, is one of the most common infectious diseases. People of all ages get sick with it, but more often children from 2 to 14 years old, men and women get infected equally often. According to statistics, more than 1.5 million people fall ill every year in the world, but doctors believe that this figure is greatly underestimated, since in childhood the disease is very often completely asymptomatic.

Causes and mechanism of infection with hepatitis A

Through the mouth, the hepatitis A virus enters the intestines, from where it is absorbed into the bloodstream and transported to the liver.

The disease is caused by a virus. The mechanism of transmission of infection is fecal-oral. A sick person with feces releases into the environment a huge number of pathogens that can get on household items (dishes, toys, doorknobs, buttons in the elevator, etc.). From contaminated objects, the causative agent of the disease most often spreads to the hands, and then to the oral cavity. That is why outbreaks of hepatitis A are so often recorded in collectives, especially children, and the disease is popularly called the disease of dirty hands.

The virus can enter food and water when cooked by an infected cook. Possible contamination of vegetables, fruits and berries, which could get sewage and sewage. Swimming in polluted bodies of water and drinking from unverified sources can also lead to infection.

There is a potential for parenteral transmission of the virus, but this is extremely rare.

The virus is quite stable in the external environment. On household items at room temperature, it lasts for a week, and on food in a humid environment - several months.

From the oral cavity, the virus enters the intestines, from there into the blood, and then into the liver, where it causes an inflammatory process. The pathogen multiplies in liver cells - hepatocytes, provoking their death. This happens until the body produces enough antibodies to suppress its activity.

Symptoms of Botkin's disease

During the course of the disease, several stages are distinguished: the incubation period, preicteric, icteric and the recovery period.

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

Prodromal (preicteric) period

During this period, patients have the first complaints, its duration usually does not exceed 7 days. Symptoms of general intoxication of the body appear: fever, weakness, headache, a slight runny nose, sore throat. May be concerned about abdominal pain, nausea, vomiting, diarrhea, or constipation. Sometimes there are no symptoms of intoxication and fever, and digestive disorders come to the fore.

In some cases, the prodromal period is latent and the disease immediately manifests itself with jaundice.

High period (icteric)

Patients may be bothered by pain or heaviness in the right hypochondrium, this is caused by an enlargement of the liver and stretching of its capsule, an enlargement of the spleen is also possible. Nausea, vomiting, flatulence, and stool disturbances may persist. Jaundice comes to the fore: the skin, mucous membranes, sclera acquire a lemon-yellow color. As a rule, with the onset of this symptom, the body temperature returns to normal. Darkening of urine (the color of dark beer) and lightening of feces are noteworthy.

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

The period of convalescence (recovery)

Symptoms gradually disappear, liver function is restored, however, yellowness of the skin and sclera can persist for quite a long time. Full recovery occurs in 1-12 months.

Hepatitis A treatment

A patient with hepatitis A will be prescribed enterosorbents, the most famous of which is activated carbon.

Hospitalization in the infectious diseases ward is usually not required. There is no specific treatment for this disease, symptomatic remedies are used. In addition, adherence to the diet shown for liver pathologies is required (table number 5 according to Pevzner).

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

1. Detoxification agents: saline and 5% glucose solution, with the addition of ascorbic acid, Reopolyglucin.
2. Enterosorbents: activated carbon, Enterosgel, Smecta, Polyphepan, Polysorb, etc.
3. Hepatoprotectors: Phosphogliv, Essentiale Forte, Prohepar, Heptral, Hepabene.
4. Enzyme preparations: Mezim forte, Creon, Panzinorm, Festal, Pancitrat, Pancreatin.
5. Choleretic agents are used only if the patient does not have cholelithiasis: Allochol, Holenzim, Hofitol, Holosas, Flamin, etc.
6. Vitamins: any multivitamin complexes, but vitamins of group B are especially useful for liver health.

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 treatment and adherence to a diet, liver function is restored completely. The diet must be followed for at least six months after the symptoms disappear; several courses of treatment with hepatoprotectors and taking vitamins can also be recommended.

Exceptions are possible only in 2% of cases when patients did not follow a diet, refuse therapy, chronically abuse alcohol, or have had any previous liver disease.

Prevention of hepatitis A is not particularly difficult and primarily comes down to adherence to the rules of personal hygiene and food culture. Hands should be thoroughly washed with soap (soap for at least 20 seconds) after each visit to the toilet and before eating. You should drink only boiled water, fruits and vegetables should be washed before use and preferably doused with boiling water.

If a sick person is identified in the team, then rehabilitation of the focus is necessary:

• wet cleaning of the premises with disinfectant solutions;
• disinfection of furniture and toys in kindergartens and schools, quarantine is declared for 35 days from the date of registration of the last case of the disease;
• the dishes that the patient previously used must be thoroughly washed and boiled for 15 minutes in a soda solution, and for the period of illness he needs to allocate an individual set of dishes, which will also be carefully processed after each meal;
• bed and underwear must be boiled in a solution of detergent before washing (15 minutes).

Vaccination against hepatitis A

To date, an effective vaccine has been developed to prevent this disease, but it is not included in the list of mandatory vaccinations in our country. Several vaccines are used in Russia:

• Hawrix;
• Avaxim;
• Vakta;
• GEP-A-in-VAK;
• Hepatitis A vaccine.

• travelers and people who are forced to visit countries with a high level of unsanitary conditions (countries of Africa and Asia);
• people staying for a long time away from full-fledged sources of clean water and sewage (military personnel in field exercises, refugee camps);
• food industry workers at enterprises, catering establishments, kitchens of state institutions;
• medical workers, especially those in contact with the biological fluids of patients (orderlies, laboratory assistants, nurses, surgeons, infectious disease specialists).

Which doctor to contact

If a child develops symptoms of infection, it is necessary to contact a pediatrician or infectious disease specialist. In the future, it will be useful to consult a nutritionist, since proper nutrition helps liver cells to recover faster.

Fragment of the program "On the Most Important" (TV channel "Russia 1"), the topic of the issue "Hepatitis A":

Hepatitis A - symptoms, causes and treatment

myfamilydoctor.ru

Many people have a question: what is dirty hands disease, or jaundice, or hepatitis A, how is it transmitted, what is the treatment and how to prevent infection? There is nothing surprising and difficult in the process of acquiring this disease, it is enough just to eat food or drink water with this infection to trigger the mechanism of rapid infection. Hepatitis A causes serious complications that can result in the death of the patient.

Hepatitis A is an acute bacterial infection caused by the hepatitis A virus (HAV). It is responsible for inflammation processes and damage to liver cells.

Globally, about 1.2-1.4 million cases of the disease are recorded annually, 20% of patients require absolute hospitalization. The mortality rate is low and amounts to 0.6-2.1%.

Source of entry into the body

How can you get hepatitis? In 95% of cases, infection occurs through consumption:

• products, for example, washed in infected water - vegetables, fruits, fish, seafood;
• water contaminated with infected feces.

In rare cases, HAV infection can be transmitted:

• through unprotected sex;
• with close contact with infected people (a person can become infected with hepatitis A within 7 days after the onset of symptoms of the disease), with constant presence with a carrier of the virus;
• other transmission routes are possible, arising from the violation of the integrity of tissues (through the blood).

Hepatitis A is often transmitted from children to adults. They, in turn, have severe symptoms of infection. In young children, icteric skin is not observed with the disease. More than 40% of patients over the age of 40 require hospitalization. A relapse of the disease is observed in 10-20% of patients after recovery.

How is hepatitis A transmitted by other routes? The category of people most vulnerable to hepatitis A infection includes employees of sanitation organizations. In addition, people working in the health sector, in nurseries, kindergartens and in the military are at risk. The likelihood of getting a viral infection increases when visiting countries where the disease is still common. In particular, these are the countries of Eastern Europe, the Mediterranean region and Russia.

Manifestation of symptoms

The transmission mechanism and manifestation of the virus in the human body lasts from 15 to 50 days (an average of about 30 days). After this time, symptoms of the disease appear, although sometimes after transmission of hepatitis, the disease is asymptomatic. This can happen in 90% of children under 5 years of age. If the virus is passed on to adults, the symptoms usually get worse.

6-7 days before the onset of the full form of the disease, the first symptoms may occur: flu, nausea, diarrhea. Then the most characteristic and visible symptom of the disease appears - jaundice (determined by a yellow tint of the skin and the whites of the eyes), which can be accompanied by an enlarged liver. This is because the body produces a yellow pigment called bilirubin. The jaundice disappears in about a month.

In addition, there are:

• poor health and weakness;
• fever;
• lack of appetite;
• nausea and vomiting,
• pain in the abdomen, muscles and joints;
• itchy skin;
• dark urine.

Acute manifestations of the disease usually disappear after a few days.

Vaccination as protection against the virus

Vaccination is the only effective way to prevent hepatitis A. After a full cycle of vaccination, antibodies are formed in the body that can protect against the virus. Two doses of the vaccine are needed to protect against hepatitis for life, administered on a 6 to 12 month schedule.

You should be aware that in accordance with the current vaccination program against hepatitis A, immunization is recommended:

• people living in countries with high and medium detection of the disease;
• persons engaged in the production and distribution of food, in the disposal of waste and liquid sewage, as well as in the repair and maintenance of devices designed for this purpose;
• children of preschool, school age and young people who did not have hepatitis A.

Diagnosis of the disease and methods of treatment

If hepatitis is suspected, a blood test is performed for the hepatitis A virus. If infection has taken place, an increased activity of alanine enzymes is noted in the blood plasma, and an increase in the concentration of bilirubin is observed. The final diagnosis and clinical picture of hepatitis A is based on the results of a serological study, which is carried out to determine antibodies.

This disease goes away on its own, within a maximum of 6 months. There is no drug that is designed to eliminate the virus in the body. The patient is recommended to limit physical activity, proper nutrition and hydration. In case of increased itching, the patient can be given cholestyramine.

Complications caused by hepatitis A are very dangerous and can lead to death. These include cholestatic jaundice, bone marrow aplasia, acute anemia, hemolytic hepatitis.

In addition, relapses may occur (in 10-20% of cases). Infection (VAG) does not lead to the development of chronic hepatitis, cirrhosis and primary liver cancer.

Diet and fluid therapy

An adult-friendly diet should contain a daily nutrient intake of 2000 kcal (70% digestible carbohydrates, 10-20% fat, and 10% protein), gradually increasing according to individual tolerance. You can return to your normal diet after six months. In case of symptoms: severe vomiting and dehydration of the body, tube feeding or parenteral administration is necessary. It is better to exclude alcohol from the diet during the treatment period.

During the acute manifestation of the disease, drugs that are metabolized in the liver or cause cholestasis should be avoided.

Preventive measures should be followed:

• observe hygiene rules while cooking;
• eat food after heat treatment (boiled, baked, fried);
• avoid poorly roasted meat, as well as crustacean meat, do not buy food from street stalls;
• drink only bottled water or boiled water (especially while abroad);
• protect food from insects.

It is quite difficult to neutralize the source of infection during the period of virus activation. It is necessary to identify the disease at an early stage of the disease.

To prevent the spread of infection, it is worth following the rules of hygiene in the production and preparation of food, as well as drinking healthy, clean water.

An increase in immunity is necessary for the body to resist infection. Strengthening of immunity is carried out with the help of injections of human gamma globulin to children under 14 years of age in case of contact with a patient with hepatitis A or preventive vaccinations against this virus.

OGepatite.ru

Hepatitis A is a viral disease in which an inflammatory process occurs in liver cells and their subsequent necrosis occurs.

This type of hepatitis is the most common of all forms of the disease. This infection is widely known as Botkin's disease. The most commonly used popular name is jaundice.

The high resistance of the virus in the external environment has determined the increased susceptibility of the human body to it. Its cells are able to remain active for several weeks at room temperature. Placing the virus in the freezer prolongs its viability by several years.

It is so strong that it even tolerates some industrial inactivation methods. The most effective treatment today is to boil food for more than 5 minutes.

Once in the body, the virus is transported through the blood to the liver. There, binding to a special protein CD81, it penetrates into the hepatocyte cell. In its membrane, the synthesis of the RNA of the virus begins, which occurs until the cell dies itself or is destroyed by the body's immune system, like an infected one.

After its disintegration, the synthesized viruses penetrate into new cells. The death of liver cells begins at a tremendous rate. With the breakdown of hepatocytes in the blood, the level of bilirubin increases, which is formed during the breakdown of hemoglobin of erythrocytes. Normally, it is excreted in the urine, and with hepatitis it accumulates in the blood, causing yellowing of the skin and sclera of the eyes.

Figure: The share of hepatitis A in the hepatitis morbidity structure.

The source of infection is a sick person. The most at risk of infection are children from 3 to 7 years old, attending institutions, the elderly and people with malnutrition.

The main modes of transmission

Unlike other hepatitis, this form of infection is an enterovirus, is transmitted by the fecal-oral route and has its own routes of infection.

A patient becomes infected if an infection enters a body of water with the secretions of a sick person. An increase in the incidence is noted in autumn and spring, during the period of rains and floods. High-quality wastewater treatment should be on the way to increasing morbidity.

In regions with an underdeveloped sewage system, many residents suffer from hepatitis A even in childhood. If there is food washed with contaminated water, the risk of infection in the body also increases.

Source - insufficiently thermally processed seafood (fish, shellfish, mussels and others). The largest number of virus cells is found in the filtration systems and gills of aquatic inhabitants. In the process of preparing food, an infected person must observe good hygiene. Especially when creating snacks, raw and dried foods, salads.

Contact

This path is dangerous when dealing with patients only in case of violation of the rules for caring for them at home, in hospitals, nursing homes, orphanages. It is especially likely to become infected when changing diapers and other close contact with the patient's urine and feces.

There is no reliable information about infection through the saliva of an infected person, however, studies have shown the presence of hepatitis A in a weak concentration in salivary secretions.

Infection of a person during normal sexual contact does not occur. Hepatitis A is not found in semen or vaginal secretions. However, with homosexual contacts in men and anal intercourse, the likelihood of getting an infection increases many times.

There is information about several cases of infection from mother to child. However, there is no evidence that infection was due to the penetration of the virus through the placental barrier.

Parenteral (via blood)

It is possible with transfusion of donor blood taken from a patient in the prodromal (pre-icteric) period and preparation of intermediate products (for example, plasma) from such blood. The modern multistage system of quality control of donor blood has minimized the factor of hepatitis A infection through blood transfusion.

Infection of drug addicts by using sterile syringes also does not occur. In this case, the spread of infection is most often possible if the rules of personal hygiene are not followed (through dirty hands).

Risk groups for hepatitis A

Based on the analysis of the duration of contact with the causative agent of hepatitis A, there are several categories of people at risk, namely:

• people living in areas with an undeveloped wastewater treatment system;
• persons from socially disadvantaged groups of the population;
• housing and communal services workers associated with cleaning sewer systems;
• residents and tourists of Africa, Latin America, Central and Southeast Asia;
• family members of the patient with hepatitis and, to a lesser extent, his social circle;
• medical staff of infectious diseases clinics, preschool institutions, shelters, boarding schools, nursing homes;
• drug addicts;
• homosexuals, people who practice anal sex.

Symptoms of the disease and periods of infection of the patient

A distinctive feature of hepatitis A is its rather mild course, minimal risk of complications if all doctor's recommendations are followed, and a rare transition to a chronic form. The course of the disease consists of the following stages:

• The incubation period lasts from 15 to 30 days. It is asymptomatic.
• The preicteric period lasts 3-6 days. During this short period, the following are observed:
  • fever, body aches;
  • headache;
  • weakness, fatigue;
  • nausea and pain in the liver;
  • diarrhea or constipation, increased gas production in the intestines.

Often at this stage, hepatitis A can be confused with the course of a common ARVI. However, this disease has a number of distinctive features.

Table of distinguishing features

• The icteric period lasts 1-2 weeks. Develops against the background of loss of appetite and nausea. It is characterized by darkening of urine (often to the color of dark beer), then yellowing of the sclera. During this period, the feces brighten, the yellowness of the skin increases.
• The period of extinction of hepatitis A. It begins with the restoration of appetite, reduction of nausea. The urine becomes light and the stool darkens. The amount of virus in the secretions decreases, the liver gradually regains its normal size.

There is also an anicteric form of hepatitis, which occurs three times more often than usual, while the skin and sclera do not turn yellow so much, only morning urine darkens.

There is no specific treatment for hepatitis A. With a diet, bed rest, the disease lasts less than two months. A patient with hepatitis A is a source of infection at the end of the incubation period and during the entire preicteric period (about 10-14 days).

Knowing how hepatitis A is transmitted can significantly reduce the number of infection factors.

Prevention for hepatitis A includes:

1. Early diagnosis of diseases in children's, social and medical institutions. Examination of children at the preschool educational institution at least once a week.
2. Control over the infected and their maximum isolation and constant laboratory examination.
3. Compliance with personal hygiene and general sanitary requirements in all institutions.
4. Refusal to water garden plants with standing water.
5. Food processing with boiled water.
6. Treatment of the toilet and dishes of a patient with hepatitis A.
7. Use of quality drinking water.
8. Vaccination for epidemic indications with an inactivated vaccine. There are schemes for double (with an interval of 1 year) and three doses of the vaccine (1 month and 6 months after the previous vaccination). In Russia, Belgian vaccines Havrix 1440 for adults and Havrix 720 for children from two years of age, Avaxim (France), Vakta (USA) are popular. The Russian vaccine GEP-A-in-VAK is used for children from three years of age.

Despite the fact that the most likely factors of infection with hepatitis A (water, seafood, unprocessed food) are found everywhere, by protecting yourself with elementary preventive measures and timely vaccination, you can successfully avoid infection.

Yakutina Svetlana

Project Expert VseProPechen.ru

VseProPechen.ru