Viral hepatitis A
Viral hepatitis A (Botkin's disease) – the sharp infectious damage of a liver which is characterized by a good-quality current, followed by a necrosis of hepatocytes. Viral hepatitis A enters into group of intestinal infections as has the fecal and oral mechanism of infection. In the clinical course of viral hepatitis A allocate the dozheltushny and icteric periods, and also a convalescence. Diagnostics is performed according to biochemical blood test, to results of RIA and IFA. Hospitalization of patients with viral hepatitis A is necessary only in hard cases. Out-patient treatment includes a diet and symptomatic therapy.
Viral hepatitis A
Viral hepatitis A (Botkin's disease) – the sharp infectious damage of a liver which is characterized by a good-quality current, followed by a necrosis of hepatocytes. Botkin's disease belongs to the viral hepatitises which are transmitted on fecal oral mechanism and is one of the most widespread intestinal infections.
Characteristic of the activator
The virus of hepatitis A belongs to the sort Hepatovirus, its genome is presented to RNA. The virus is quite steady in the environment, remains for several months at 4 °C and years - at -20 °C. In room temperature several weeks keep viability, perish at boiling 5 minutes later. Ultraviolet rays inactivate a virus a turn one minute. The activator can keep some time viability in the chlorinated water from a water supply system.
Hepatitis A is transmitted through the fecal and oral mechanism in mainly water and alimentary way. Infection with a contact and household way when using of use objects, ware is in certain cases possible. The outbreaks of viral hepatitis A at realization of the waterway of infection usually arise at hit of a virus in tanks of water of public use, the food way of infection is possible as at consumption of the polluted vegetables and fruit, and crude mollusks living in the infected reservoirs. Realization of a contact and household way it is characteristic of children's collectives where not enough attention is paid to the sanitary and hygienic mode.
Natural susceptibility to a hepatitis A virus at people high, the greatest – at children of dopubertatny age, post-infectious immunity intense (a little smaller tension is characteristic after a subklinicheska of the proceeding infection) and long. Infection with viral hepatitis A most often occurs in children's collectives. Among adults the staff of catering departments of preschool and school nurseries, and also treatment-and-prophylactic and sanatorium institutions, plants of food enter into risk group. Now the collective outbreaks of an infection among addicts and homosexuals are even more often noted.
Symptoms of viral hepatitis A
The incubatory period of viral hepatitis A makes 3-4 weeks, the beginning of a disease usually sharp, the current is characterized by consecutive change of the periods: dozheltushny, icteric and convalescences. The Dozheltushny (prodromalny) period proceeds in various clinical options: feverish, dispepsichesky, astenovegetativny.
The feverish (grippopodobny) option of a current is characterized by sharply developed fever and intoksikatsionny symptomatology (degree of expressiveness of an obshcheintoksikatsionny syndrome depends on weight of a current). Patients complain of the general weakness, mialgiya, a headache, a dry tussiculation, irritation in a throat, rhinitis. Catarrhal signs are expressed is moderated, reddening of a pharynx usually is not noted, their combination to dyspepsia (nausea, deterioration in appetite, an eructation) is possible.
The Dispepsichesky option of a current is not followed by catarrhal symptomatology, intoxication is expressed a little. Patients complain mainly of disorders of digestion, nausea, vomiting, bitterness in a mouth, an eructation. Dull moderate ache in the right podreberye, an epigastriya is quite often noted. Disorder of defecation (diarrheas, locks, their alternation) is possible.
The Dozheltushny period proceeding by astenovegetativny option is a little specific. Patients are sluggish, apathetic, complain of the general weakness, suffer from frustration of a dream. In certain cases prodromalny signs are not noted (latent option of the dozheltushny period), the disease begins with jaundice at once. In case there are signs of several clinical syndromes, speak about the mixed option of a current of the dozheltushny period. Duration of this phase of an infection can make from two to ten days, on average usually prodromalny period takes week, gradually passing into the following phase – jaundice.
In the icteric period of viral hepatitis A disappearance of symptoms of intoxication, fall of fever, improvement of the general condition of patients is characteristic. However the dispepsichesky symptomatology remains, as a rule, and aggravated. Jaundice develops gradually. At first note urine darkening, the yellowish shade is got by skler, mucous membranes of a bridle of language and a soft palate. Further skin turns yellow, getting an intensive shafranny shade (hepatic jaundice). Disease severity can correlate with intensity of coloring of skin, but it is more preferable to be guided by dispepsichesky and intoksikatsionny symptomatology.
At the heavy course of hepatitis signs of a hemorrhagic syndrome can be noted (petekhiya, hemorrhages on mucous membranes and skin, nasal bleedings). At fizikalny inspection note a yellowish raid in language, teeth. The liver is increased, at a palpation moderately painful, in a third of cases increase in a spleen is noted. Pulse a little (bradycardia), arterial pressure it is lowered. Kal brightens up to full decolouration at the height of a disease. Besides dispepsichesky frustration, patients can complain of astenovegetativny symptomatology.
Duration of the icteric period usually does not exceed month, averages 2 weeks., then the convalescence period begins: there is a gradual regress clinical and laboratory symptoms of jaundice, intoxication, the liver size is normalized. This phase can be quite long, convalescence period duration usually reaches 3-6 months. The course of viral hepatitis A mainly easy or medium-weight, but hard proceeding disease forms are in rare instances noted. Synchronization of process and virus infection carrier state are not characteristic of this infection.
Complications of viral hepatitis A
Viral hepatitis A is usually not inclined to aggravations. In rare instances the infection can provoke inflammatory processes in biliarny system (holangita, cholecystitis, dyskinesia of biliary tract and a gall bladder). Sometimes hepatitis A is complicated by accession of a secondary infection. Heavy complications from a liver (sharp hepatic encephalopathy) are extremely rare.
Diagnosis of viral hepatitis A
In the general blood test the lowered concentration of leukocytes, is noted, SOE is raised. The biochemical analysis shows sharp increase in activity of aminotransferases, a bilirubinemiya (mainly at the expense of the connected bilirubin), the lowered content of albumine, a low protrombinovy index, increase sulemovy and decrease timolovy tests.
Specific diagnostics is performed on the basis of serological methods (antibodies come to light by means of IFA and RIA). In the icteric period increase of Ig M, and in rekonvalestsentny – IgG is noted. The most exact and specific diagnostics – virus RNA identification in blood by means of PTsR. Allocation of the activator and a virologic research is possible, but in view of labor input to the general clinical practice is inexpedient.
Treatment of viral hepatitis A
Botkin's disease it is possible to treat on an outpatient basis, hospitalization is made at severe forms, and also - according to epidemiological indications. In the period of the expressed intoxication the bed rest, a diet No. 5 (to patients in option for the sharp course of hepatitis), vitamin therapy is prescribed. Food is fractional, the greasy food, products stimulating production of bile is excluded, dairy and vegetable components of a diet are encouraged.
The complete elimination of alcohol is necessary. Etiotropny therapy is not developed for this disease, the complex of medical measures is directed to simplification of symptomatology and pathogenetic correction. For the purpose of desintoxication plentiful drink, if necessary infusion of kristalloidny solutions is appointed. For the purpose of normalization of digestion and maintenance of a normobiotsenoz of intestines appoint laktuloza medicines. Spazmolitiki is applied to prevention of a holestaz. If necessary appoint medicines UDKH (ursodezoksikholiyevy acid). After clinical recovery patients are on dispensary observation at the gastroenterologist of 3-6 more months.
In most cases forecast favorable. At complications from biliary tract treatment drags on, but at false therapy the forecast is not aggravated.
Prevention of viral hepatitis A
The general preventive actions are aimed at providing high-quality clarification of sources of drinking water, control over dumping of sewage, sanitary and hygienic requirements to the mode at catering establishments, in catering departments of child care and medical institutions. Epidemiological control of production, storage, transportation of foodstuff is exercised, at the outbreaks of viral hepatitis A in organized collectives (both nurseries, and adults) carry out the relevant quarantine activities. Patients are isolated for 2 weeks, their transmissibility after the first week of the icteric period comes to naught. The admission to study and work is carried out on approach of clinical recovery. For contact persons carry out observation for 35 days from the moment of contact. In children's collectives the quarantine is appointed to this time. In the center of an infection necessary disinfection actions are made.
Vaccination against hepatitis A is recommended to children from age 1 year and to the adult who are driving off in the zones dangerous on viral hepatitis A.