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  • Viral hepatitis A and E - Causes, symptoms and treatment. MF.

    Viral hepatitis A( or Botkin's disease) is a special kind of viral hepatitis;it has no chronic forms and has a fecal-oral mechanism of transmission. The less common type of viral hepatitis has the same properties - hepatitis E .

    Hepatitis A and E viruses do not have a direct damaging effect on the liver. Hepatitis - inflammation of the liver - occurs because the viruses penetrate into the liver cells, thus causing the reaction of protective blood cells against the altered hepatic tissue.

    Hepatitis A is one of the most common infections in the world. Many suffer from this illness in childhood, which is associated with a greater prevalence of hepatitis A in children's institutions, in a closed community. Children carry the infection much easier than adults, many suffer the asymptomatic form of of hepatitis A and acquire lifelong immunity. In adults, severe forms of hepatitis are more likely to require hospitalization, which is most likely due to various concomitant diseases.

    The most widespread viral hepatitis A has acquired in countries with warm climates and poor sanitation. Therefore, the likelihood of catching Hepatitis A increases when traveling to hot countries: Egypt, Tunisia, Turkey, Central Asia, India, etc.

    Hepatitis E is common in countries of Southeast Asia, Africa, Central America. In our latitudes, hepatitis E is much less common.

    Hepatitis A virus

    The hepatitis A virus is extremely resistant to external influences and can last for a long time in the environment.

    • Withstands boiling for 5 minutes.
    • Chlorination - 30 minutes.
    • Formalin treatment - 3 hours.
    • Withstands 20% ethyl alcohol treatment.
    • Withstands an acidic medium( pH 3.0).
    • In water at a temperature of 20ºС lives 3 days.
    • In dishes from meat and shellfish at a temperature of 80 ºС is active for 20 minutes.

    How can you get hepatitis A?

    The source of the infection is a sick person who releases viruses into the environment with feces. Viruses, getting into water, food, penetrate into the body of a healthy person and can cause disease. Especially dangerous are dishes prepared from insufficiently thermally processed seafood. In addition, often the infection occurs when eating vegetables and fruits that can themselves contain hepatitis A viruses or can be washed with contaminated water.

    A less common mechanism for transmission of infection is through contaminated blood. This happens with blood transfusion, use of common syringes by drug addicts, and also with homosexual contacts.

    Development of the hepatitis A and E virus

    Hepatitis viruses through the mouth penetrate the intestine, from there, absorbed into the blood, penetrate into the liver cells, causing their inflammation by attacking their own immune cells of the body. Then the viruses enter the bile ducts, and thence into the intestine and the environment.

    A sick person is dangerous to others in the last week of the incubation period and in the first week of the disease. The incubation period is the period from infection to the first manifestations of the disease. In the case of hepatitis A, it is 14-28 days. And in the case of , hepatitis E can reach 60 days( an average of 40 days).

    While the virus is in the blood, there is no jaundice, there are common signs of intoxication, the infection flows under the mask of ARVI.

    The appearance of jaundice means that there are no more viruses in the blood, the immune response is fully formed. However, viral hepatitis A often occurs without jaundice.

    The appearance of jaundice indicates the defeat of 70% of the liver, so all patients with jaundice are treated in a hospital. However, in most cases, while observing the regimen and adequate treatment, the structure and functioning of the liver is restored completely.

    Free from arthritic period with hepatitis A and E virus

    The non-lean period can last for 1-2 weeks. In this case, there are common symptoms that are very similar to the manifestations of influenza and colds.

    • Decreased appetite.
    • Fatigue.
    • Severe.
    • Fever( usually 38-39ºС, rarely the temperature rises to 40ºC).
    • Pain in muscles and joints.
    • Headache.
    • Cough.
    • Runny nose.
    • Sore throat.
    • Nausea and vomiting.
    • Pain in the abdomen.

    Jaundice period with hepatitis A and E virus

    The first symptom that makes you alert is urine darkening .The urine becomes dark brown, "the color of dark beer."Then, the eye sclera and mucous eyes, the mouth turn yellow, which can be determined by raising the tongue to the upper sky;yellowing is also more noticeable on the palms. Later the skin turns yellow.

    With the onset of icteric period, the general symptoms decrease, the patient usually becomes lighter. However, in addition to yellowing of the skin and mucous membranes, there is a severity and pain in the right hypochondrium. Sometimes there is discoloration of the stool, which is associated with blockage of the bile ducts.

    Complete recovery occurs in 1-2 months.

    Severe forms with hepatitis A and E virus

    The so-called cholestatic forms are referred to severe forms of the disease, when bile congestion occurs due to inflammation of the bile duct walls. In this case, there is a lightening of the stool, there is a skin itch, which is caused by skin irritation with bile components.

    Lightning-fast hepatitis is especially dangerous, with massive liver necrosis, acute liver failure, and often death of the patient. With hepatitis A , a lightning-fast form occurs extremely rarely, and with hepatitis E - its frequency is 1-2%.However, the particular danger of hepatitis E represents for pregnant women - the frequency of the fulminant form of 25%

    The lethality with hepatitis A ranges from 1 to 30%.Mortality increases with age, as well as in chronic carriers of other viral hepatitis.

    Who gets sick more often with the hepatitis A and E virus

    • People who go to countries where the incidence is higher( endemic regions)
    • Children attending preschools
    • Pre-school children
    • Catering workers
    • Sewer and water service workers
    • People,family members who are sick with hepatitis A
    • Homosexuals
    • Addicts

    It should be noted that in countries with a high prevalence of hepatitis A , as well as in rural areasty, many people perebolevayut hepatitis A in childhood, and often mild or asymptomatic forms, acquiring at the same lifelong immunity. While people living in cities are more likely to have hepatitis A, they have a greater risk of contracting a sick person, as well as traveling to endemic areas.

    Prevention of hepatitis A and E virus

    General prevention measures are reduced to elementary principles of general hygiene. It is necessary to wash hands before eating, wash fruits and vegetables with water, the purity of which there is no doubt. Do not consume insufficiently processed meat, fish, especially seafood.

    Immunoglobulin

    With the help of a normal human immunoglobulin, a so-called passive immunization is achieved, i.e.the person is injected with ready-made antibodies( protective proteins) against of hepatitis A viruses .The duration of action of these antibodies is 2 months. When the drug is administered at the beginning of the incubation period, it prevents the development of the disease.

    Immunoglobulin can be used in people who have been in close contact with the sick person, no later than 2 weeks after the alleged infection;as well as in people in an endemic region.

    Immunoglobulin is safe, well tolerated;infection with HIV through it is impossible, because the virus is inactivated during the preparation.

    Vaccination

    Vaccines are available in Russia, which are cultured on cell culture and formalin-inactivated viruses. There are several vaccines of this type: Gep-A-in-vacc( Russia), Avaksim( France), Havrix( Belgium), Vakta( USA).

    Vaccination can be given to children starting from 2 years of age. After a single vaccination, the immunity is formed after 1-4 weeks( depending on the type of vaccine), so it can be used for 1-4 weeks or more before traveling to countries with a high prevalence of hepatitis A. After a single immunization, the immunity is formed for 2 years;after a double - more than 20 years.

    Adult vaccine is given intramuscularly - 2 doses at intervals of 6-12 months. Children 2-18 years of age are given intramuscularly 2 half-doses at an interval of one month and a third dose after 6-12 months.

    Complications of hepatitis A and E

    Hepatitis A , which has developed against a background of complete health, almost always ends in recovery. In elderly patients with concomitant diseases, especially with chronic carrier of other viral hepatitis, the prognosis worsens, more often a prolonged course of the disease is observed.

    In a small number of patients, a relapse may occur after weeks and months after the onset of the disease.return of all symptoms of the disease: intoxication, jaundice. But even in these cases, hepatitis does not go into a chronic form.

    In addition, viral hepatitis E can cause hemolysis - the destruction of blood cells - red blood cells, which can lead to kidney damage and acute kidney failure.

    Liver failure after of hepatitis A is extremely rare, mainly in age-related patients. However, there are cases when hepatitis A occurs in an anus-free form, under the mask of ARVI, when the patient does not comply with bed rest;this can lead to the formation of scar tissue in the liver - hepatic fibrosis, which is dangerous by the development of dyskinesia of the bile ducts - a violation of the normal passage of bile.

    In hepatitis E, cirrhosis occurs in 5% of cases.

    Diagnosis of hepatitis A

    Diagnosis is primarily based on clinical data - i.e.manifestations of the disease.

    A number of laboratory tests are performed to confirm the diagnosis of viral hepatitis. In biochemical blood tests, a significant increase in bilirubin and hepatic enzymes can be detected, which confirms liver damage.

    The differential diagnosis of viral hepatitis is then carried out. Specific diagnosis of hepatitis A is based on the determination of antibodies in the blood to the virus, while specific antibodies specific for acute hepatitis are determined.

    Mode and diet for acute hepatitis

    During acute hepatitis it is better to comply with bed rest. In the supine position blood supply to the internal organs, including the liver, improves, which helps normal recovery of liver cells.

    When acute hepatitis shows a special kind of diet - diet number 5.

    Food should be consumed 5-6 times a day, in a warm form.

    Allowed:

    • The dried bread or bread of yesterday's baking.
    • Soups from vegetables, cereals, pasta on vegetable broth, as well as milk soups.
    • Dishes from low-fat beef, poultry in boiled form or baked after boiling.
    • Low-fat varieties of fish( cod, pike-perch, navaga, pike, carp, silver hake) in boiled or steam form.
    • Different kinds of vegetables and greens, non-acidic sauerkraut, ripe tomatoes.
    • Friable semi-viscous cereals, puddings, casseroles, especially recommended dishes of oatmeal, buckwheat porridge.
    • Eggs - no more than one per day in the form of adding to meals, a protein omelet.
    • Fruits and berries except very acidic, compotes, jelly, lemon( with tea).
    • Sugar, preserves, honey.
    • milk with tea, condensed, dry, cottage cheese skimmed, sour cream in small quantity, cheeses not sharp( Dutch, etc.).Cottage cheese and curd products are especially recommended.
    • Butter, vegetable oil( up to 50 g per day).
    • Tea and soft coffee with milk, non-acidic fruit and berry juices, tomato juice, rose hips.

    Prohibited:

    • All alcoholic beverages.
    • Fresh bakery products, products from dough.
    • Soups on meat, fish, mushroom broths.
    • Fatty grades of meat, poultry, fish( stellate sturgeon, sturgeon, beluga, catfish).
    • Mushrooms, spinach, sorrel, radish, radish, green onion, pickled vegetables. Canned food, smoked meat, caviar.
    • Ice cream, products with cream, chocolate.
    • Beans, mustard, pepper, horseradish.
    • Black coffee, cocoa, cold drinks.
    • Cooking fat, lard. Cranberries, sour fruits and berries.
    • Eggs hardboiled and fried.

    With severe vomiting, parenteral nutrition is performed, i.e.introduce nutrients intravenously. A high-value, high-calorie diet is an important factor in the treatment of these patients.

    Treatment of viral hepatitis A and E

    As a rule, hepatitis A does not require treatment other than severe forms of the disease. In these cases, medical treatment is carried out in detoxification therapy, i.e.decrease in the level of toxins that accumulate in the blood in connection with liver damage. Usually this is an intravenous injection of various detoxification solutions.