Viral hepatitis B
Viral hepatitis B (serumal hepatitis) – the infectious disease of a liver proceeding in various clinical options (from an asymptomatic carriage before destruction of a hepatic parenchyma). At hepatitis In defeat of cells of a liver has autoimmune character. Concentration of a virus, sufficient for infection, is only in biological liquids of the patient. Therefore infection with hepatitis B can parenterally occur at a hemotransfusion and holding various traumatic procedures (dental manipulations, tattoos, a pedicure, piercing), and also sexually. In diagnosis of hepatitis In a crucial role plays identification in HbsAg blood of an anti-gene and HbcIgM of antibodies. Treatment of viral hepatitis B includes basic antiviral therapy, obligatory observance of a diet, desintoxication and symptomatic treatment.
Viral hepatitis B
Viral hepatitis B (serumal hepatitis) – the infectious disease of a liver proceeding in various clinical options (from an asymptomatic carriage before destruction of a hepatic parenchyma). At hepatitis In defeat of cells of a liver has autoimmune character.
Characteristic of the activator
Hepatitis B virus – DNA-containing, belongs to the sort Orthohepadnavirus. In blood find the viruses of three types differing on morphological features in the infected persons. Spherical and threadlike shapes of virus particles have no virulence, infectious properties show Dane's particles – two-layer rounded full-structural virus shapes. Their population in blood seldom exceeds 7%. The particle of a virus of hepatitis B possesses a superficial anti-gene of HbsAg, and three internal anti-genes: HBeAg, HBcAg and HbxAg.
Resistance of a virus to environmental conditions is very high. In blood and its medicines the virus keeps viability for years, there can be several months at the room temperature on the linen, medical tools, objects polluted by the patient's blood. The inactivation of a virus is carried out when processing in autoclaves when heating to 120 °C about a current of 45 minutes, or in a sukhozharovy case at 180 °C within 60 minutes. The virus perishes at influence of chemical disinfectants: chloroamine, formalin, hydrogen peroxide.
Source and the tank of viral hepatitis B are sick people, and also healthy virus carriers. Blood infected with hepatitis In people to become infectious much earlier, than the first clinical manifestations are noted. The chronic asymptomatic carriage develops in 5-10% of cases. The virus of hepatitis B is transmitted at contact with various biological liquids (blood, sperm, urine, saliva, bile, tears, milk). The main epidemiological danger is constituted by blood, sperm and, somewhat, saliva as usually only in these liquids concentration of a virus is sufficient for infection.
Transmission of infection happens mainly parenterally: at hemotransfusions, medical procedures with use of unsterile tools, when carrying out medical manipulations in stomatology, and also at traumatic processes: drawing tattoo and piercing. There is a probability of infection in manicure salons when carrying out cut manicure or pedicure. The contact way of transfer is implemented at sexual contacts and in life at joint use of objects of individual hygiene. The virus takes root into a human body through microdamages of integuments and mucous membranes.
The vertical way of transfer is implemented intranatalno, during normal pregnancy we do not pass a placentary barrier to a virus, however in case of a rupture of a placenta transfer of a virus before childbirth is possible. The probability of infection of a fruit repeatedly increases at identification at pregnant HbeAg besides HbsAg. People possess rather high susceptibility to an infection. By transfusion transfer hepatitis develops in 50-90% of cases. The probability of development of a disease after infection directly depends on the received dose of the activator and a condition of the general immunity. After transferring of a disease long, possibly lifelong immunity is formed.
The vast majority getting sick with hepatitis B are persons at the age of 15-30 years. Among the dead from this disease the share of addicts makes 80%. The persons which are carrying out injections of narcotic substances have the biggest risk of infection with hepatitis B. In view of frequent direct contact with blood, health workers (surgeons and operational sisters, laboratory assistants, stomatologists, the staff of blood transfusion stations, etc.) also enter into risk group on viral hepatitis B.
Symptoms of viral hepatitis B
The incubatory period of viral hepatitis B fluctuates in quite wide limits, the interval from the infection moment before development of clinical symptomatology can make from 30 to 180 days. It is impossible to estimate the incubatory period of a chronic form of hepatitis B often. Acute viral hepatitis B begins to quite often similarly viral hepatitis A, however its preicteric period can proceed also to an artralgichesky form, and also by astenovegetativny or dispepsichesky option.
The Dispepsichesky option of a current is characterized by appetite loss (up to anorexia), ongoing nausea, episodes of causeless vomiting. Temperature increase and obshcheintoksikatsionny symptomatology, usually without catarrhal signs, but with frequent, mainly night and morning, artralgiya is characteristic of a grippopodobny form of a clinical current of the dozheltushny period of hepatitis B (at the same time visually joints are not changed). After the movement in a joint pain usually for some time abates.
In case during this period the artralgiya, combined with rashes as a small tortoiseshell is noted, the course of a disease promises to be heavier. Most often such symptomatology is followed by fever. In a preicteric phase the expressed weakness, drowsiness, dizziness, bleeding of gums and episodes of nasal bleedings (a hemorrhagic syndrome) can be noted.
At emergence of jaundice of improvement of health it is not observed, more often the general symptomatology is aggravated: dyspepsia, an adynamy accrues, there is a skin itch, gemorragiya (at women the hemorrhagic syndrome can promote early approach and intensity of periods) amplify. Artralgiya and an ekzantem in the icteric period disappear. Integuments and mucous membranes have intensive okhryany a shade, petekhiya and roundish hemorrhages are noted, urine darkens, the kcal becomes lighter up to full decolouration. The liver of patients increases in sizes, its edge acts from under a costal arch, to the touch – painful. If at an intensive ikterichnost of integuments the liver keeps the normal sizes, it is a harbinger of heavier course of an infection.
In a half and more cases the gepatomegaliya is followed by increase in a spleen. From cardiovascular system: bradycardia (or tachycardia at hard proceeding hepatitis), moderate hypotonia. The general state is characterized by apathy, weakness, dizzinesses, sleeplessness is noted. The icteric period can last month and more then there comes the convalescence period: at first the dispepsichesky phenomena disappear, then there is a gradual regress of icteric symptomatology and normalization of level of bilirubin. Return of a liver to the normal sizes quite often takes several months.
In case of tendency to a holestaz, hepatitis can gain slow (torpedo) character. At the same time intoxication ill-defined, steadily increased level of bilirubin and activity of hepatic enzymes, kcal akholichny, urine dark, a liver is with firmness increased, body temperature keeps in subfebrilny limits. In 5-10% of cases viral hepatitis B proceeds in a chronic form and promotes development of viral cirrhosis.
Complications of viral hepatitis B
The most dangerous complication of viral hepatitis B which is characterized by high degree of a lethality is the acute liver failure (a gepatargiya, a hepatic coma). In case of massive death of hepatocytes, considerable losses of functionality of a liver, the heavy hemorrhagic syndrome which is followed by toxic impact of the substances released as a result of a tsitoliz on the central nervous system develops. Hepatic encephalopathy develops, passing consistently following stages.
- Prekoma I: the condition of the patient worsens sharply, aggravated jaundice and dyspepsia (nausea, repeated vomiting), the hemorrhagic symptomatology is shown, at patients the specific hepatic smell from a mouth is noted (sickeningly sweetish). Orientation in space and time is broken, emotional lability is noted (apathy and slackness is replaced by hyper excitement, euphoria, uneasiness is increased). The thinking is slowed down, inversion of a dream takes place (at night patients cannot fall asleep, feel insuperable drowsiness in the afternoon). At this stage violations of small motility (a promakhivaniye are noted at paltsenosovy test, handwriting distortion). In a liver patients can note pains, body temperature increases, pulse unstable.
- Prekoma II (the menacing coma): consciousness violations progress, it is frequent happens is confused, the full disorientation in space and time is noted, short-term flashes of euphoria and aggression are replaced by apathy, intoksikatsionny and hemorrhagic syndromes progress. At this stage signs edematous a syndrome develop, the liver becomes less and disappears under edges. Note a small tremor of extremities, language. Stages of a prekoma can proceed from several hours to 1-2 days. Further the neurologic symptomatology (pathological reflexes, meningealny symptoms, violations of breath as Kussmul, Cheyna-Stokes can be noted) is aggravated and actually hepatic coma develops.
- The terminal stage – a coma, is characterized by consciousness oppression (a stupor, a sopor) and further its total loss. Originally reflexes remain (corneal, glotatelny), patients can react to intensive irritant actions (a painful palpation, a loud sound), further reflexes are oppressed, reaction to irritants is lost (a deep coma). The death of patients is caused by development of sharp cardiovascular insufficiency.
At the heavy course of viral hepatitis B (a lightning coma), in particular in case of its combination to hepatitis D and hepatitis C, the hepatic coma often develops in early terms and comes to an end letalno in 90% of cases. Sharp hepatic encephalopathy in turn promotes secondary infection with development of sepsis, and also threatens with development of a kidney syndrome. The intensive hemorrhagic syndrome can become the reason of considerable blood loss at internal bleedings. Chronic viral hepatitis B develops in cirrhosis.
Diagnosis of viral hepatitis B
Diagnostics is performed by identification in blood of patients of specific anti-genes of a virus in blood serum, and also immunoglobulins to them. By means of PTsR it is possible to emit virus DNA that allows to be defined in degree of its activity. Crucial importance at diagnosis plays identification of a superficial anti-gene of HbsAg and antibodies of HbcIgM. Serological diagnostics is made by means of IFA and RIA.
In dynamics of a disease make regular laboratory researches for definition of a functional condition of a liver: biochemical blood test and urine, to a koagulogramm, ultrasonography of a liver. A significant role matters a protrombinovy index which falling to 40% speaks about critical condition of the patient also below. According to separate indications the liver biopsy can be carried out.
Treatment of viral hepatitis B
Complex therapy of viral hepatitis B includes dietary food (the diet No. 5 sparing for a liver in variations depending on a phase of a disease and weight of a current is appointed), basic antiviral therapy, and also pathogenetic and symptomatic means. The sharp phase of a disease is the indication to hospitalization. The bed rest, plentiful drink, flat refusal of alcohol is recommended. Basic therapy means purpose of interferon (alpha interferon is most effective) in combination with ribaviriny. The course of treatment and dosages pay off individually.
As auxiliary therapy dezintoksikatsionny solutions (at a heavy current carry out infusions of kristalloidny solutions, a dextran, according to indications corticosteroids are appointed), means are applied to normalization of water-salt balance, potassium medicines, a laktuloza. For removal of spasms of bile-excreting system and vascular network of a liver – , . At development of a holestaz medicines UDHK are shown. In case of heavy complications (hepatic encephalopathy) – intensive therapy.
Forecast and prevention of viral hepatitis B
Acute viral hepatitis B seldom leads to a lethal outcome (only in cases of a heavy lightning current), the forecast considerably worsens at the accompanying chronic pathologies of a liver, at the combined defeat by viruses of hepatitis C and D. Death infected with hepatitis In a thicket is caused several decades later the chronic course and development of cirrhosis and cancer of a liver.
The general prevention of viral hepatitis B means a complex of the sanitary and epidemiologic actions directed to decrease in risk of infection at blood transfusion, control of sterility of medical tools, introduction to mass practice of disposable needles, catheters, etc. Measures of individual prevention mean use of separate personal care products (razors, toothbrushes), the prevention of traumatizing integuments, safe sex, refusal of drugs. Vaccination is shown to the persons entering into professional risk group. Immunity after a hepatitis B inoculation remains about 15 years.