HEPATITIS VIRAL

HEPATITIS VIRUS - infectious diseases, characterized by a predominant liver damage, occurring with intoxication and in some cases with jaundice . Distinguish viral hepatitis with a fecal-oral transmission mechanism - hepatitis A and hepatitis E and viral hepatitis with a parenteral mechanism of transmission - hepatitis B, hepatitis C and hepatitis D.

Hepatitis A. Hepatitis A virus belongs to enteroviruses, it has a species-specific antigen bound to the outer shell. It bends at boiling for 5 minutes, at room temperature it persists up to several months. Reproduced (reproduced) in liver cells.

Hepatitis A is one of the most common intestinal infections. The source of the infectious agent is a sick person or a virus carrier. The virus is secreted from the infected organism mainly through the intestine and is found in the feces of patients in the incubation period and at the onset of the disease. It is at this time that patients are most dangerous to others. Since the 4th week of the disease, the virus in the feces has not been detected. In other human isolations, the virus is not detected. Infection of healthy persons occurs through contaminated with faeces of sick or virus carriers, food, water, household items. The highest incidence is observed among children aged 2 to 14 years, organized in the team, in the autumn-winter period with the rise every 3 to 5 years. The susceptibility is high. After the transferred infection in any form (clinically pronounced - subclinical), life-long immunity is produced.

The incubation period is from 7 to 50 days, an average of 20 to 30 days. There are icteric, jaundiced, subclinical and cholestatic forms of the disease.

With icteric form, a pre-dull period of the disease is given with a duration of 5 to 7 days. During this period, short-term fever may occur up to 38-39.5 ° C, headache , decreased appetite, nausea , vomiting , heaviness and dull pain in the right hypochondrium, enlarged liver and spleen, darkening of urine, discoloration of stool. With the onset of icteric period, symptoms of toxicosis disappear, signs of a violation of pigmental metabolism appear (icteric color of the skin and visible mucous membranes, especially sclera, urine of beer color, feces discolored), liver enlargement and often spleen, hypotension and bradycardia , hemorrhages on the skin, itching Skin. Jaundice is usually 1 - 3 weeks. In the blood there are thrombocytopenia, leukopenia , relative lymphocytosis, somewhat reduced ESR.

At anicteric form there are no clinical and even laboratory signs of jaundice, the remaining symptoms are less pronounced. The vast majority of patients in the blood increased the activity of aminotransferases, especially alanine. Subclinical form is characterized by the absence of clinical symptoms and is revealed only by laboratory tests.

With a rare cholestatic form of hepatitis A, more persistent jaundice, achalia of the feces, itching of the skin, a significant increase in the liver, intoxication is absent.

The diagnosis is made on the basis of an epidemiological history (contact with a patient, bathing in contaminated reservoirs, eating contaminated products, water) and clinical picture, as well as the results of biochemical studies (blood increases the amount of bilirubin, the activity of alanine and aspartic aminotransferases, high indices of thymol test, In the urine there are bile pigments - bilirubinuria). The diagnosis is confirmed by the detection of specific antibodies of class lgM or by the growth of titer of IgG class antibodies by 4 times in the study of paired sera, and by the detection of a specific viral nucleic acid by polymerase chain reaction.

Patients and persons suspected of the disease are hospitalized. Assign bed rest, milk and vegetable diet, plentiful drink. With the expressed signs of intoxication detoxication therapy is shown - the introduction of solutions of glucose, electrolytes, blood plasma, blood substitutes. After discharge from the hospital, patients are recommended to limit physical activity in the first months, excluding fatty and spicy food, alcohol. The prognosis is favorable; The disease usually ends in recovery.

Sanitary and preventive measures in case of viral hepatitis A are reduced to permanent sanitary supervision over the work of food enterprises, organization of food and water supply, removal of sewage and garbage, and the destruction of flies. Of particular importance is the protection of food and water sources from possible contamination by faeces. The basis of prevention is the constant control over provision of the population with disinfected water. An important role is given to sanitary propaganda, the education of hygienic skills among the population. In the epidemic focus, medical supervision is carried out for people who have been in contact with the sick (examination is performed at least once a week), and children attending preschool establishments are monitored daily (thermometry, control of urine and skin color, determination of liver size and Spleen) within 35 days from the moment of isolation of the last patient. In addition, the current and final disinfection is carried out. To increase the immunity of persons who have been in contact with patients, children aged 1 to 14 years and pregnant women are given normal (measles) immunoglobulin (gamma globulin), but not later than the 10th day after the first contact with the patient (counting from the onset of the disease , But not from the time of jaundice ).

Having recovered from hepatitis A 1 month after discharge from the hospital should be sent to dispensary supervision. In the absence of residual events (detected clinically or in a laboratory examination), the patients recovered from the register, in the presence of residual events, they are observed in the infectious diseases room for at least 3 months.

Hepatitis B. It refers to viral hepatitis with a parenteral mechanism of transmission, the prevalence is second only to hepatitis A. The causative agent is a virus that has a complex structure, contains several specific antigens that are markers of the pathogen. It is very resistant to chemical and physical factors: it perishes only when autoclaved for 45 minutes at 120 ° C or dry heat sterilized for 60 minutes at 180 ° C.

The source of the causative agent of infection are sick and healthy virus carriers, in which the virus is in the blood, often for life. In Russia there are more than 5 million. Viruses are especially dangerous, as they can be blood donors. Transmission of the pathogen occurs parenterally - when blood is transfused or its preparations (plasma, erythrocyte mass, fibrinogen, prothrombin), as well as the use of insufficiently sterilized virus-infected medical equipment (syringes, needles, scarifiers, scalpels, etc.) when taking blood, Injections of medicines, various surgical manipulations, shaving with a general razor, drawing of a tattoo, etc. Infection of a fetus occurs from a sick mother. The natural way of transmission of the disease is sexual. The incidence is not related to age, seasonality is absent. Often sick medical workers, in contact with the blood of patients or who have recovered from viral hepatitis.

The incubation period is from 45 to 160 days, an average of 60-90 days. Clinical manifestations of hepatitis B differ significantly from Hepatitis A. It is characterized by a more severe and prolonged course. The disease develops gradually, often without a temperature reaction, dominated by lethargy, fatigue, reduced appetite, joint pain, hives are possible. Pre-zheltushny period lasts 1-5 weeks, with the appearance of jaundice, the patient's condition worsens, intoxication and dyspeptic disorders increase. Longer than with hepatitis A, icteric period, which can be delayed up to 3 - 4 months or more. In some cases, hepatitis B does not release the body from viruses, and forms a virus that lasts up to 10 years or more. In a number of cases, the disease takes on a chronic course.

The diagnosis is made on the basis of an epidemiological history (for example, blood transfusion, injections within 45 to 160 days), clinical picture and results of biochemical (same as for hepatitis A), and serological studies: detection of serological markers of the virus B-antigens HBsAg, HBeAg, antibodies to them, as well as to HBcAg.

Treatment is the same as in viral hepatitis A. With severe intoxication, infusion therapy, glucocorticoid hormones, interferon , protease inhibitors (countercranial, tracerol, gordox) are indicated.

The prognosis is favorable in most cases, but worsens with age; With timely diagnosis and properly administered treatment of hepatitis B, usually ends in recovery. Perhaps a protracted course of the disease and the development of chronic hepatitis, as well as cirrhosis.

Prevention consists in recording individuals who have experienced viral hepatitis B and those who have come into contact with them. These persons should be excluded from the number of donors. The survivors of hepatitis B do not undergo preventive vaccinations, except for tetanus and rabies vaccinations . Women are advised to avoid pregnancy within one year after discharge from the hospital. Those who have been ill with hepatitis B are examined in the infectious diseases room at 3, 6, 9 and 12 months after discharge from the hospital. When there are signs of hepatitis, patients are hospitalized.

Use disposable needles, infusion systems and scarifiers. All medical instruments and materials are sterilized and autoclaved in centralized sterilization. Before sterilization, scalpels and other medical instruments (if reused), on which there may be traces of blood, are washed with running water, then immersed for 15 minutes in a warm (at t50 - 55 ° C) washing solution (mixture of 0.5% peroxide solution Hydrogen and 0.5% solution of one of the detergents: "Progress", "Astra" or "Lotus" in a ratio of 1: 1), and then thoroughly washed in a washing solution with cotton-gauze swabs for 30 seconds and rinsed first in a flowing , And then in distilled water an average of 25 s. All manipulations associated with contact with the blood of patients with hepatitis B should be carried out in rubber gloves, damage on the hands should be covered with adhesive plaster or fingertips. Specific prophylaxis is carried out with the help of the hepatitis B vaccine. Vaccinations are primarily for people with an increased risk of infection (medical workers, newborns from HBsAg women carriers, hemophilia patients, family members of HBsAg carriers, etc. In case of accidental trauma, objects contaminated with blood of patients or Carriers of HBsAg, specific immunoglobulin is used for emergency prevention .

Hepatitis C - viral hepatitis with a parenteral mechanism of transmission. It is widely distributed. Antibodies to the causative agent of this disease are found in the population of different regions with a frequency of 0.2 to 9.2%.

The causative agent is a small virus, the properties of which have not been adequately studied. Source of infection - patients with acute and chronic hepatitis C. The main route of transmission is with blood and its preparations, injectable, sexual and vertical (from mother to fetus).

The incubation period is from 2 to 26 weeks. The onset of the disease is gradual. Pre-zheltushny period may be absent. The most frequent symptoms in this period are weakness and decreased appetite, weight in the epigastric region and right hypochondrium. The icteric period proceeds relatively favorably. The share of the jaundice forms of the disease accounts for more than 80% of all cases. At the same time, hepatitis C, especially the jaundiced forms, is characterized by a very high frequency of chronicization of the process. An important feature of the disease is a high frequency (up to 40%) of extrahepatic changes - hemorrhagic manifestations, kidney damage. Chronic forms of the disease often result in cirrhosis of the liver .

Diagnosis is based on clinical and epidemiological data and results of biochemical studies. The diagnosis is confirmed by the detection of a specific marker - anti-HCV, as well as components of the RNA virus through a polymerase chain reaction.

Treatment is carried out according to the principles common to viral hepatitis. For the prevention and treatment of chronic forms of the disease used drugs alpha-2-interferon , as well as ribavirin (virazol). Prevention is the same as for hepatitis B

Hepatitis D (delta-viral infection) has recently been discovered. The causative agent is a defective virus that is capable of reproduction only in the presence of the surface antigen of the hepatitis B virus-HBsAg. The delta virus is stable in the environment.

The sources of hepatitis D pathogens are patients with hepatitis B and carriers of HBsAg, infected with delta virus. The mechanism of transmission of infection is the same as in the case of hepatitis B.

There are two possible variants of hepatitis D: for single-stage infection with hepatitis viruses D and B, coinfection and infection with hepatitis D virus of persons previously infected with the hepatitis B virus, is a superinfection. In the first case there is acute viral hepatitis B + D, in the second - acute hepatitis D in carriers of HBsAg.

The incubation period for acute hepatitis of mixed etiology is from 8 to 10 weeks. The pre-egg period develops more sharply than with hepatitis B, pain in the joints, right hypochondrium, fever , and duration of this period about 5 days are more common. The appearance of jaundice is accompanied by an increase in intoxication, dyspeptic disorders, often an increase in the spleen. Often there is a two-wave course of the disease. In general, a severe, often lightning-fast course of the disease (25%), ending with the death of the patient. In other cases, complete recovery occurs within 1.5 - 3 months.

With superinfection, the disease develops after an incubation period of 3 to 4 weeks. The onset of acute, pre-dull period is short - up to 3-4 days. More than half of the patients have a body temperature exceeding 38 ° C, joint pain and right hypochondrium are often noted. The appearance of jaundice is accompanied by a further deterioration in the condition of patients. The increased body temperature, pain in the joints. Pain in the right hypochondrium often acquires a permanent character. The spleen and liver are significantly enlarged, dense. Almost half of the patients develop edema and ascites . The course of the disease is undulating. The outcome is almost always unfavorable. Patients die from subacute liver dystrophy in an acute period or develop chronic active hepatitis with a rapid outcome in cirrhosis of the liver .

The diagnosis is made on the basis of clinical, epidemiological and biochemical data. It is confirmed by simultaneous detection of active replication markers of both viruses. A polymerase chain reaction is also used.

Treatment is carried out in a hospital. Even in severe cases, the use of corticosteroids is contraindicated. Use reaferon .

Prevention is the same as for hepatitis B and C.

Hepatitis E - refers to viral hepatitis with a fecal-oral transmission mechanism. It is distributed mainly in the countries of Asia and Africa.

The causative agent is a poorly studied virus that is less stable in the environment than the hepatitis A. The source of the pathogen is the sick people who excrete the pathogen with the feces at the onset of the disease. The leading route of transmission is waterway. Large-scale water epidemics are often observed. The susceptibility is high, people are more likely to get sick at the age of 15 to 30 years. Seasonality is summer. Immunity is not strong enough, cases of recurrent disease are described.

The incubation period is from 14 to 60 days. The beginning is more often gradual. The pre-egg period is characterized mainly by a decrease in appetite, nausea , vomiting , pain in the right upper quadrant, lasting from 1 to 14 days. When jaundice appears, the condition of the patients does not improve. The liver increases significantly, the duration of icteric period averaged 2 weeks. The course is sharp, benign. The exception is pregnant women and women in the early postpartum period, the lethality of which reaches 10 - 20%. In this case, acute liver failure and severe hemorrhagic syndrome are observed.

The diagnosis is confirmed by virological methods and polymerase chain reaction.

Treatment is carried out in a hospital in accordance with the principles common to viral hepatitis.

Specific prophylaxis is not developed.