Hepatitis B at children – the infectious damage to a hepatic parenchyma caused by a hepatotrophic virus of V type. Specific displays of hepatitis B at children develop in the icteric period when there is an urine darkening, decolouration a calla, yellow coloring eye a skler, mucous and integuments, weight and pain in the right podreberye. Diagnosis of hepatitis B at children is carried out on the basis of clinical laboratory data (symptomatology, biochemical blood test, definition of markers). Basic therapy of hepatitis B at children includes a diet, an interferonoterapiya, dezintoksikatsionny therapy, purpose of gepatoprotektor, sorbents, vitamins; in hard cases – a plasma exchange and haemo sorption.
Hepatitis B at children
Hepatitis B at children (parenteral or serumal hepatitis) – the specific virus inflammation of a liver proceeding in a sharp or chronic form. The causative agent of hepatitis B at children is the DNA-containing virus, highly pathogenic and extremely steady against influences of the environment. At infection of the child with a virus of hepatitis B in the perinatal period or chest age the probability of chronic damage of a liver increases up to 70-90%. At 20-35% of the people infected with hepatitis B in the childhood cirrhosis or primary gepatotsellyulyarny carcinoma develops further. Prevention and increase in efficiency of treatment of hepatitis B at children serves one of priority problems of pediatrics.
The hepatitis B reasons at children
Hepatitis B at children is a typical antroponozny infection; both sick people, and virus carriers act as a source of infection. Serve as the main ways of infection of children with hepatitis B transplacentary (pre-natal infection), intranatalny (in the course of childbirth), post-natal (postnatal).
The transplacentary way of transfer is implemented in 6-8% of all recorded cases. Especially often infection of a fruit happens against the background of fetoplatsentarny insufficiency and an otsloyka of a placenta. Pre-natal infection of a fruit with a virus of hepatitis B threatens with premature birth. Intranatalny transfer of a virus of hepatitis B at children (about 90%) is caused by contact of the child with biological liquids and blood of the infected mother when passing on patrimonial ways. Post-natal infection of the child occurs in the course of feeding by a breast or care of the baby: at violation of integrity of skin and mucous membranes at the child, close contact with the infected mother, allocation of a virus with blood from cracks of nipples.
At more advanced age infection of children with hepatitis B can occur when using the general towels, basts, toothbrushes, etc. sanitary products, and also sexually (at teenagers). The possibility of infection of children with hepatitis B when carrying out a hemotransfusion, invasive medical and diagnostic procedures is not excluded. The risk of development of hepatitis B is increased at the children who are on kidney dialysis. The probability of infection among the teenage addicts using the general needles and syringes is high.
Immaturity of immune system of children causes bystry spread of a virus of hepatitis B through liquid environments of an organism and defeat of a parenchyma of a liver. Usually sharp form of hepatitis B at children proceeds quickly and comes to an end with recovery with development of resistant lifelong immunity to a virus. At the latent, asymptomatic course of hepatitis B at children at adult age cicatricial change of tissue of liver can be incidentally revealed. Children with chronic hepatitis B are lifelong virus carriers.
Hepatitis B symptoms at children
The cyclic course of hepatitis B at children includes incubatory (latent), preicteric, icteric the periods and the period of a convalescence.
Duration of the incubatory period makes 2-4 months and is defined by the infecting dose, way of infection and age of the child. In case of transfusion of the infected blood components duration of a latent course of hepatitis B at the child decreases up to 1,5-2 months, at other ways of infection can increase up to 4-6 months. The age of the child is less, the incubatory period is shorter. At this stage clinical displays of hepatitis are absent, however at the end of the period in blood hepatitis B markers (HBsAg, HBeAg, anti-Ag IgM) and high activity of hepatic enzymes are found.
In the preicteric period which lasts from several hours to 2-3 weeks the general infectious adynamy (weakness, slackness), mialgiya and artralgiya, skin rashes, an abdominal syndrome, vomiting, vomiting, a loss of appetite, a meteorizm, a diarrhea prevails. Sometimes darkening of urine and decolouration a calla are the first clinical signs of hepatitis B at children. In blood the increased level is noted and direct bilirubin, virus DNA is found.
The jaundice period at hepatitis B at children can last from 7-10 days to 1,5-2 months. Emergence of jaundice in all cases is preceded by change of color of urine and a calla. Intensity of icteric coloring of skin and visible mucous membranes increases within 7 days and 1-2 more weeks remain. Unlike hepatitis A, at hepatitis B with the advent of jaundice it is general a state does not improve, and the intoksikatsionny syndrome, on the contrary, amplifies: body temperature increases to 38 °C, slackness, block, an adinamiya increases. At children with hepatitis B emergence of spotty and papular rash on skin, arterial hypotonia, increase in the sizes of a liver, sometimes – spleens can be noted. At height of the icteric period in blood the maximum activity , decrease in PTI, a gipoalbuminemiya is registered.
At the favorable course of hepatitis B at children the disease terminates in the convalescence period which proceeds 3-4 months. Gradually jaundice disappears, appetite, a dream, activity, blood indicators is normalized. Hepatitis B at children can have sharp (up to 3 months), long (up to 6 months) and chronic (more than 6 months) a current.
At babies medium-weight and severe forms of hepatitis B prevail, lethal outcomes owing to the malignant course of a disease are possible. In the latter case at children the picture of hepatic encephalopathy, liver failure quickly accrues, the hepatic coma develops.
Diagnosis of hepatitis B at children
Statement of the reasonable diagnosis is promoted by survey of the child by the pediatrician and children's infectiologist, the analysis of data on development and the course of a disease (recurrence, characteristic symptomatology), the epidemiological anamnesis (preceding a hemotransfusion, an injection, invasive manipulations, operations), etc.
The main role in diagnosis of hepatitis B at children belongs to laboratory methods: to detection of markers (HBsAg, HBeAg, anti-HBs, ANTI-NVA, anti-NVS), to change of biochemical indicators of blood (increase in level of bilirubin and increase in activity of transferases).
At suspicion of hepatitis B at children in the preicteric period it is necessary to exclude flu, a SARS, food toksikoinfektion, arthritis; in the icteric period - viral hepatitises A, C, E, yellow fever, infectious , a Cytomegaloviral infection, Gilbert's syndrome, ZhKB, holangit, pancreatitis, cirrhosis and so forth. For the purpose of differential diagnostics MR a holangiografiya, by ultrasonography of a liver and a gall bladder, a liver stsintigrafiya, a punktsionny biopsy of a liver are in addition carried out.
Treatment of hepatitis B at children
Children with the diagnosed hepatitis B are subject to hospitalization in infectious office. During all icteric period the bed rest is shown, then – the sparing mode. The diet (a table No. 5 on Pevznera) with prevalence dairy and vegetable, mechanically and chemically sparing food, plentiful drink is appointed.
Basic medicinal therapy of hepatitis B at children includes vitamins of groups B, C, A, E; spazmolitik (papaverine, ), gepatoprotektor, bile-expelling means. At severe forms of hepatitis B at children interferona, dezintoksikatsionny therapy, transfusions of plasma and albumine, if necessary - glucocorticoids, heparin, diuretic medicines, a plasma exchange, haemo sorption are shown.
Dispensary observation of rekonvalestsent is made during 1 year (each 3 months) with survey of skin and visible mucous, determination of the sizes of a liver and spleen, assessment of color of urine and a calla, definition of laboratory indicators. Sanatorium treatment in institutions of a gastroenterologichesky profile is recommended to the children who had hepatitis B.
The forecast and prevention of hepatitis B at children
Typical forms of hepatitis B at children, as a rule, come to an end with recovery. Transition to a chronic form is noted in 2-18% of cases. The hepatitis B postponed in the childhood is followed by formation of resistant lifelong immunity.
At children the chronic hepatitis or cirrhosis which are sharply increasing risks of development of a gepatotsellyulyarny carcinoma at adult age can be hepatitis B complications. At the malignant course of hepatitis B at children the lethality is extremely high (75%).
The most reliable way of prevention of hepatitis B at children is vaccination which is performed is triple: in the first days after the birth of the child, 1 and 6 months of life recombinant vaccines Regevak, Endzheriks In, Euvaks In, Kombiotekh, etc. Vaccination against hepatitis B provides to 95% protection against an infection for 15 years.
Nonspecific prevention of hepatitis B at children assumes use of disposable medical tools, careful processing and sterilization of reusable tools, inspection of donors, performing transfusion therapy according to strict indications.