Viral hepatitis

Viral hepatitis - a group of infectious diseases with different mechanisms of transmission, characterized by predominantly hepatic lesions. They belong to the most common diseases in the world.
Cause. Viral hepatitis caused by viruses belonging to different families. They are marked by letters of the alphabet: A, B, C, D, E. Accordingly called hepatitis caused by them.
The hepatitis A virus belongs to the family of picornaviruses. Boiling kills 5 minutes. At room temperature in a dry environment persists week in water - 3-10 months in feces - up to 30 days.
Hepatitis E - a representative of a new, not yet established by the family of viruses. As compared with hepatitis A virus it is less resistant to various environmental factors.
Hepatitis B virus belongs to the family gepadnavirusov. He made difficult. The outer layer of the virus, composed of a shell particles zhirobelkovoy called surface antigen (HBsAg). Antigen - a foreign protein that has the ability, once in the body, eliciting a protective response of the immune system - the formation of antibodies. First, the antigen called an Australian, as it was first detected in the serum of the Australian Aborigines. The shell of the virus packed its core, which consists of two foreign protein body: insoluble - the core antigen (HBcAg) and soluble - antigen infectiousness (HBe- Ag). The hepatitis B virus is highly resistant to high and low temperatures, the chemical and physical influences. At room temperature 3 months stored in the refrigerator - 6 years, frozen - 15-20 years. Boiling secures the destruction of the virus only in the duration of over 30 minutes. The virus is resistant to almost all disinfectants. Autoclaving at 120 ° C suppresses the virus after 5 minutes exposure to dry heat (160 ° C) - 2 hours.
Hepatitis C virus belongs to the family of flaviviruses, is unstable in the environment.
Hepatitis D - unclassified heat resistant virus.
Hepatitis A and E are united by the fecal-oral mechanism of transmission. The source of infection are patients of any form of the disease: jaundice, anicteric, erased, and the incubation period of the disease early, which is found in the feces of hepatitis A or E. The greatest epidemiological importance anicteric sick, worn out forms, the number of which can be 2-10 times higher than the number of patients with icteric forms of the disease. Isolation of the virus in faeces begins the second half of the incubation period, and the maximum infectiousness noted in the last 7-10 days of incubation and predzheltushnogo period. When the patient turns yellow, it has, as a rule, is not contagious. Infection most commonly occurs through contaminated sewage water. The susceptibility to the virus without a history - absolute. Hepatitis A sick mainly children, hepatitis E - mostly adults.
Hepatitis A is found everywhere, while hepatitis E - mostly in tropical and subtropical regions of Central Asia.
Hepatitis B, C and D are transmitted parenterally. Infection occurs with blood or its products, semen, saliva, vaginal secretions, sweat and tears of people with severe and unexpressed forms of acute and chronic hepatitis, liver cirrhosis, carriers HBsAg (surface antigen of hepatitis B virus or "Australian" antigen) and those with the presence of anti-HCV (anti-HCV), 70-80% of whom are chronic carriers of hepatitis C virus The virus enters through broken skin and mucous membranes through intravenous drug use, headdresses, therapeutic and diagnostic manipulation in pregnancy and childbirth, during sexual intercourse, while household microtraumas (manicure, combing the hairdresser sharp combs, shaving razor alien device, and so on. n.). Human milk is never contagious.
The process of developing the disease. Causative agents of hepatitis A and E are introduced into the human body through the mucous membrane of the gastrointestinal tract and the blood flow recorded in liver cells it penetrate and reproduce in them. At the same time they destroy the viruses. Quickly increases immunity, the virus is neutralized, the affected cells and viral particles are removed from the body. After the hepatitis A develops a lifelong immunity to the pathogen. After suffering a hepatitis E immunity unstable and possible re-infection.
Hepatitis B virus in blood, in which it enters, and is stored in the liver, without damaging liver cell, is integrated into it. In a normal, fairly strong protective reaction of the body cells destroy infected cells and the virus is removed from the liver tissue. The patient suffers an acute form of hepatitis moderate gradually recover, and he formed a strong immunity.
With a weak defense response or no virus in liver cells live for months, and often longer (years, decades, a lifetime). Develops asymptomatic or subclinical form of the disease with the transition to the subsequent to chronic hepatitis (5-10%). Chronic carriers of HBsAg is asymptomatic chronic hepatitis. In this case, the genetic program of cells gradually modified and it can degenerate into a tumor (0.1%). The most common reason for the lack of a protective reaction to the hepatitis B virus - "addictive" to him even in the womb, if a pregnant woman is a carrier of the virus.
Hepatitis Virus D, typically laminated to hepatitis B, chronic or more prolonged (asymptomatic or severe), and liver cell damage activates the process dramatically. In this lightning often develop forms of disease, expressed chronic hepatitis, cirrhosis and even liver cancer.
Hepatitis C virus, once in the liver cells, damaging them. However, this does not lead to the rapid release of the body from the virus as hepatitis A. Hepatitis C virus "escapes" from under the protective mechanisms of the body by continuous change, play themselves in all new varieties. This feature determines whether the virus many years, virtually lifelong survival of the virus in the infected organism. It is the main cause of chronic hepatitis, cirrhosis and liver cancer. Immunity after hepatitis C unstable, the possibility of reinfection.
Signs. When viral hepatitis on the severity of symptoms of the disease are the following forms: icteric, anicteric, erased, asymptomatic. When icteric forms distinguish the following periods: preicteric, jaundice and recovery.
Hepatitis A. The incubation period is on average 15 to 30 days.
Preicteric period is usually 5-7 days. Disease begins acutely. The body temperature rises to 38-39 ° C and lasts 1-3 days. There are flu-like symptoms - headache, marked weakness, a feeling of weakness, muscle pain, chilliness, drowsiness, restless sleep at night. Against this background, there dyspeptic disorders - loss of appetite, taste perversion, bitterness in the mouth, nausea, sometimes vomiting, a feeling of heaviness and discomfort in the right upper quadrant and epigastric region, aversion to smoking. After 2-4 days, a change in urine color. It acquires the color of beer or strong brewed tea. Then there is the discoloration of feces. It appears yellowness of the sclera, indicating the transition of the disease in the icteric phase.
Icteric period lasts 7-15 days. The first painting becomes jaundiced mucous membrane of the mouth (frenulum of tongue, hard palate), and sclera, in the future - the skin. With the advent of a number of signs of jaundice predzheltushnogo period is reduced and a significant proportion of patients disappear, while the longest preserved weakness, loss of appetite.
The outcome of hepatitis A is usually favorable. Full clinical recovery in the majority of cases (90%) occurs within 3-4 weeks from the onset of the disease. In 10% of the recovery period is delayed up to 3-4 months, but does not develop chronic hepatitis.
Hepatitis E. The disease is similar to hepatitis A. In pregnant women, there is a severe course fatal in 10 - 20%.
Hepatitis B. The incubation period is on average 3-6 months.
Predzheltushnogo period lasts 7-12 days. The disease begins gradually with malaise, weakness, fatigue, feeling of weakness, headaches, sleep disorders. In 25 - 30% of the observed joint pain, mainly during the night and morning. In 10% of patients have itchy skin. Many patients have dyspeptic disorders - loss of appetite, nausea and often vomiting, a feeling of heaviness, sometimes dull pain in the right upper quadrant. At the end of the period predzheltushnogo dark urine, usually in combination with lightening stool.
Jaundice period is characterized by the most severe manifestations of the disease. Jaundice is at its maximum. In some patients with severe disease are bleeding gums, nosebleeds. The total duration of this period depending on the severity of the disease is 1-3 weeks.
recovery period is longer than for hepatitis A and is 1.5-3 months. There is the slow disappearance of the symptoms of the disease and, as a rule, long-term remains a weakness and discomfort in the right upper quadrant. Full recovery occurs in 70%. In other cases, there are residual effects in the form of the continuing increase in the liver in the absence of complaints or abnormalities in the blood. In addition, there is the defeat of the biliary tract or pancreas, manifested by pain in the right upper quadrant and epigastric region associated with eating. Less commonly, there may be a functional hyperbilirubinemia, characterized by an increase in serum levels of free bilirubin and other indicators unchanged. Residual effects do not threaten the development of chronic hepatitis.
Worn icteric form is characterized by a satisfactory state of health of patients and mild jaundice, which is limited to the sclera jaundice, dark urine and feces with a slight lightening icteric staining of the skin. This and the following two forms of hepatitis in most cases evidence of chronic illness threat.
Anicteric form manifested by weakness, malaise, fatigue, poor appetite, feeling of bitterness in the mouth, discomfort in the epigastric region, a feeling of heaviness in the right upper quadrant. On examination, the doctor determines an increase in liver laboratory examination reveals changes in blood biochemical parameters.
Asymptomatic form is characterized by the complete absence of visible manifestations of disease, the presence of hepatitis B virus in the blood antigens B. This form of the disease usually threaten the development of chronic hepatitis.
Hepatitis C. The incubation period lasts about 2-3 months. The disease is in most cases (90%) starts without clearly defined signs of the disease for a long time and remains unrecognized.
Manifestations of the disease are to feel unwell, lethargy, weakness, fatigue, poor appetite. When jaundice, her expression is very weak. There is a slight yellowness of the sclera, a slight staining of the skin, short dark urine and feces lightening. Recovery in Acute hepatitis C often occurs with icteric form of illness.
The rest, the majority of patients (80-85%) develop chronic carriers of hepatitis C. The majority of infected individuals consider themselves healthy. In a minority of infected periodically arise complaints of decreased performance, slightly enlarged liver, determined by biochemical changes in the blood.
Resumption of the disease occurs in 15-20 years of chronic hepatitis. Patients worried about fatigue, decreased performance, sleep disturbances, feeling of heaviness in the right upper quadrant, appetite loss, weight loss. In 20-40% of patients with chronic hepatitis C develop cirrhosis, which is not a recognized for many years. The final link of the disease, particularly liver cirrhosis, liver cancer may appear.
Recognition of the disease. The appearance of weakness, lethargy, malaise, fatigue, appetite deterioration, potashnivanie should always be a reason for seeking medical attention. A sense of bitterness in the mouth, feeling of heaviness in the right upper quadrant, the more darkening of the urine indicate liver damage and require immediate treatment for medical assistance. Jaundice is first detected in the sclera, mucous membrane under the tongue and palate, then appears on the skin. Detection of viral hepatitis based on disease manifestations and epidemiological data, and the results of special laboratory studies (detection in serum antibodies to hepatitis A, C, D, E, hepatitis B virus antigens and their corresponding antibodies).
Treatment. All the patients with viral hepatitis, other than hepatitis A infection to be treated in hospital departments. The basis of treatment is polupostelny regime, diet (with the exception of alcohol, fried, smoked, refractory fats, canned food, hot spices, chocolate, sweets), multivitamins, which is sufficient for the treatment of patients with mild forms of viral hepatitis A and E.
When viral hepatitis B and C, proceeding with the threat of chronic, currently under interferon treatment aimed at suppressing the virus.
In acute hepatitis B - is erased patients with jaundice, anicteric and asymptomatic forms of the disease. In such patients treated without the use of interferon Chronic hepatitis develops in approximately 15% of the interferon in the treatment - 3% of cases.
In hepatitis C, all patients in the acute phase of the disease, especially anicteric form of the disease, showing treatment with interferon. In the appointment of interferon recovery occurs in 60% of patients without it - at 15-20% of patients.
In chronic hepatitis B treated with interferon provides a sustainable recovery in 35-40% of patients with hepatitis B and 20-30% - with hepatitis C.
Chronic carriers of hepatitis B and C, interferon is not used.
Among the significant amount of the interferon medications most effective in hepatitis drugs are alpha-2b-interferon: Intron A), and IFN realdiron dry for injection.
Given that the advantageous results of treatment with interferon are achieved when it is implemented in possible early after infection and the high cost of interferon, it should be borne in mind that in acute hepatitis B and C course of interferon is 3 months, while chronic hepatitis B - 6 months at chronic hepatitis C - 12 months.
Clinical examination. The disappearance of jaundice with icteric forms of viral hepatitis is far ahead of the regenerative processes in the liver. Therefore, for patients with acute hepatitis during the recovery period begin monitoring in the hospital and outpatient continue to identify potential threats to chronic disease and timely conduct, if necessary, treatment with interferon. Clinical examination involves repeated examinations infectious diseases, biochemical studies of blood in hepatitis B, C and D antigen determination and antibodies to viruses.
All recover from viral hepatitis within 30 days after discharge from the hospital are the primary outpatient examination by an infectious disease.
When hepatitis A and E in the absence of variations in health status and blood biochemical parameters of clinical supervision is terminated. When you save the abnormality is carried out additional examination after 3 months.
When hepatitis B, C and D, repeat surveys are conducted at 3, 6, 9 and 12 months after discharge from hospital. These terms may be changed depending on the results of the previous survey. Clinical supervision is terminated not earlier than in a year at the recovery and release of the body of the virus. If there are signs pointing to the formation of chronic hepatitis B, the observation and treatment continues.
During the recovery period after hepatitis for six months is contraindicated in hard physical labor and sports. At this time, it is recommended to exclude from power the above products. Absolutely contraindicated use of any alcoholic beverages. The use of drugs should be limited as much as possible. Within 6 months contraindicated immunizations, undesirable operations, except emergency. By decision of infectious disease rehabilitation in the recovery period after viral hepatitis can be carried in a sanatorium:. Arshan in Buryatia, hot key in the Khabarovsk Territory, Darasun or Shivanda in the Chita region, Essentuki or Pyatigorsk in the Stavropol region, Izhevsk mineral water, Lipetsk, Bear Lake in Kurgan reg., Nalchik in Kabardino-Balkaria, Sestroretsk in the Leningrad region., Staraya Russa in the Novgorod region., Khilovo in the Pskov region., Shmakovka in Primorsky Krai, Yumatovo in Bashkiria, Transbaikalia Yamarovka or other local motels. После гепатита В женщинам не рекомендуется беременеть в течение года – может родиться ребенок с зараженной печенью.
При болях в правом подреберье, что чаще всего связано с поражением желчевыводящих путей, помогают лекарственные растения, обладающие желчегонными, желчеобразовательными и успокаивающими свойствами. Рекомендуются семена клена, настои березовых листьев и некоторых сборов лекарственных растений.
Не дозревшие семена («крылатки») клена остролистного в просушенном виде измельчить в кофемолке. Полученный порошок принимать по 1/2 чайной ложки за 20 мин до еды.
Настой березовых листьев – 40 г чистых листьев березы бородавчатой положить в сосуд и залить кипятком. Сосуд закрыть крышкой и укутать полотенцем. Через 2 ч настой готов. Употреблять в процеженном виде по 0,5 стакана за 30 мин до еды в течение 10 дней, затем 10 дней перерыв.
Сбор I. Трава чистотела – 15 г, листья вахты трехлистной – 10 г, цветки аптечной ромашки – 15 г. Сухое сырье заливают 0,5 л крутого кипятка в термосе. За ночь трава настаивается. Может храниться в термосе 1 сут. Принимают утром и вечером по 1 стакану через 1 ч после еды.
Сбор II. Корень валерианы лекарственной – 20 г, кора барбариса обыкновенного – 10 г, цветки боярышника кроваво-красного – 20 г, листья мяты перечной – 10 г. Принимают утром и вечером по 1 стакану после еды.
При задержке стула рекомендуется
Сбор III. Трава золототысячника зонтичного – 20 г, плоды тмина обыкновенного – 10 г, листья мяты перечной – 20 г, плоды фенхеля обыкновенного – 10 г, кора крушины ольховидной – 20 г, трава тысячелистника обыкновенного – 20 г. Принимают по 0,5 стакана 3 раза в день за 30 мин до еды.
Носители поверхностного антигена вируса гепатита В и больные хроническим гепатитом находятся под постоянным медицинским наблюдением и 2 раза в год обследуются у инфекциониста. Они чрезвычайно уязвимы к вредным воздействиям, в первую очередь – к алкоголю.
При хроническом гепатите необходимо полноценное диетическое питание. Оно должно быть дробным – 4-5 раз в день понемногу. Блюда в основном отварные, паровые или запеченные в духовке.
Из рациона исключаются химические раздражители – экстрактивные, ароматические вещества, продукты, богатые эфирными маслами, холестерином, тугоплавкими животными жирами. Нельзя есть мясные, рыбные и грибные супы, крепкие овощные отвары. Запрещаются яичные желтки, мозги, почки, печень, жирные сорта мяса и баранина, жирная свинина, гуси, утки, телятина, рыба жирных сортов, все жирные блюда, копчености, консервы. Исключаются уксус, перец, горчица, хрен, алкоголь в любых видах. Соли, как можно меньше. Следует отказаться от сдобы, пирожных, тортов, шоколада, какао. Не противопоказаны сахар, варенье, мед, сладкие соки, морсы, сиропы, арбузы, виноград.
Рекомендуются постное мясо, нежирная рыба, молочные продукты, лучше кисломолочные, все мучное, кроме сдобы, хлеб вчерашний, зелень и овощи в большом количестве, как в отварном и тушеном, так и в сыром виде, жиры молочные и больше растительные, чай или слабый кофе с молоком, соки фруктовые и овощные, отвары шиповника.
Prevention of disease.
Гепатиты А и Е. Соблюдение правил личной гигиены, употребление доброкачественной питьевой воды и пищевых продуктов.
Против гепатита А имеется вакцина. Вакцинация рекомендуется в первую очередь детям. Иммунитет сохраняется в течение 10 лет. Прививки могут быть сделаны всем желающим при приобретении вакцины за свой счет в центре вакцинации.
За лицами, находившимися в контакте с больным гепатитом А, устанавливается медицинское наблюдение в течение 35 дней. Детям, посещающим детские учреждения, не позже 10-14 дня после контакта, вводят иммуноглобулин человека нормальный, содержащий антитела к вирусу. Иммуноглобулин, введенный до заражения или в инкубационном периоде гепатита А в 85% предупреждает его развитие или смягчает течение заболевания. Его защитное действие ограничивается 3-5 мес.
Большое количество источников вируса гепатита В в виде лиц, страдающих бессимптомными вариантами болезни, множественные пути передачи делают вакцинацию основным средством профилактики этого заболевания. Заболеваемость острым гепатитом В среди привитых в 10-15 раз меньше, чем среди непривитых.
С 1996 года вакцинация против гепатита В включена в календарь обязательных детских профилактических прививок в России. Предусмотрена вакцинация всех новорожденных, детей в возрасте 11 лет, а также взрослых, относящихся к группам высокого риска заражения гепатитом В: медицинских работников, имеющих непосредственный контакт с кровью больных, студентов медицинских институтов и учащихся средних медицинских учебных заведений, семейное окружение больных хроническим гепатитом В и носителей поверхностного антигена вируса гепатита В, наркоманов.
Прививки могут быть сделаны всем желающим при приобретении вакцины за свой счет в центре вакцинации.
Вакцинация против гепатита В состоит из 3 прививок: две первые с интервалом в 1 мес, третья через 6 мес. Длительность невосприимчивости к гепатиту В после вакцинации составляет 7 лет. Поэтому через каждые 7 лет должна проводиться ревакцинация.
Члены семьи больного гепатитом В находятся под медицинским наблюдением в течение 6 мес. Для предупреждения заболевания лиц, подвергшихся риску заражения гепатитом В, может быть проведена вакцинация, проводимая в этих случаях по ускоренной схеме.
Имеется иммуноглобулин человека против гепатита В. Используется при высокой вероятности заражения в течение суток после предполагаемого заражения. Обычно вводится в сочетании с вакциной. Применение этого иммуноглобулина ограничивается его дороговизной.
Члены семьи больных хроническим гепатитом В и носителей – поверхностного антигена вируса гепатита В должны строго выполнять правила личной гигиены с индивидуализацией всех ее предметов (расчески, зубные щетки, мочалки, полотенца, бритвенные приборы и др.). Половым партнерам рекомендуется использовать механические контрацептивные средства.
От гепатита D защищает вакцинация против гепатита В, так как заражение гепатитом D, как правило, требует наличия в организме поверхностного антигена вируса гепатита В.
Гепатит С. Меры предупреждения те же, что и при гепатите В, кроме вакцинации и введения иммуноглобулина, в связи с их отсутствием.