Hepatitis C at children – the diffusion infectious and inflammatory damage of a liver caused by a hepatitis C virus. The clinical course of chronic hepatitis C at children often asymptomatic; the asthenic syndrome, abdominal pains, temperature increase, nausea, vomiting, jaundice are characteristic of typical sharp process. The diagnosis of hepatitis C at children is based on cumulative data of survey, the anamnesis, functional hepatic tests, serological and PTsR-inspections, liver biopsies. Treatment of hepatitis C at children includes antiviral and symptomatic therapy, reception of inductors of interferon and immunomodulators, a diet.
Hepatitis C at children
Hepatitis C at children – the inflammatory process arising in a liver parenchyma at infection with the hepatitis C virus getting directly to the patient's blood. Hepatitis C at children is characterized by tendency to synchronization with progressing in cirrhosis, a liver failure and malignant new growths. In structure of acute viral hepatitises at children up to 14 years about 1%, among chronic viral hepatitises – to 41% is the share of hepatitis C.
Virus of hepatitis C (HCV) – extremely dangerous RNA-containing virus capable it is long (sometimes for life) to persistirovat in a human body due to high genetic variability, ability to mask and to leave easily from under control of immune system. The main target of a virus of hepatitis C are hepatocytes. The virus of hepatitis C has direct tsitopatichesky effect on hepatic cells, activates autoimmune reactions and immune the infected cages, causes a necrosis and nodal proliferation of a parenchyma, growth of connecting fabric (fibrozirovaniye) of a liver. Viriona of hepatitis C can get into tissues of heart, brain, immune cages, provoking serious associated diseases (vaskulita, arthritises, polimiozit, encephalopathies).
The hepatitis C reasons at children
Hepatitis C source at children is the infected person, most often a sick chronic form of an infection. Ways of spread of viral hepatitis C at children – parenteral and vertical (from mother to a fruit). Children and teenagers can catch a hepatitis C virus at direct contact with the infected blood or its medicines. Infection of children with hepatitis C can happen at various medical expeditious and injection interventions, a hemodialysis, dental treatment (to reuse of badly sterilized medical tools), organ transplantation, a hemotransfusion and transfusion of medicines of blood (plasma, fibrinogen, an anti-hemophilic factor to children with hemophilia). Level of spread of hepatitis C among addicts owing to numerous use of the polluted syringes at intravenous administration of drugs is high.
Frequency of perinatal transfer of a virus of hepatitis C (in labor, when passing by the child of patrimonial ways of the infected mother) makes about 5%. In the presence the pregnant woman has koinfektion of HCV and HIV, degree of risk of infection of the child with a virus of hepatitis C increases by 3-4 times.
There is a possibility of transfer of hepatitis C at children of teenage age at non-compliance with the rules and standards of hygiene in time performing procedures connected with damage of integuments (tattoos, piercing); through cuts and grazes when using of the general means of hygiene (toothbrushes, razors, manicure devices), at the unprotected sexual contact with the virus carrier.
Classification of hepatitis C at children
On duration of a current allocate sharp (up to 6 months) and chronic (over 6 months) hepatitises C at children. The chronic form of hepatitis C at children can be an outcome of sharply begun disease, but most often develops as initially chronic process, has the long progressing current and leads to serious damage of a liver and violation of its functions.
Depending on the nature of clinical manifestations acute hepatitises of C at children can have typical (the jaundices which are followed by symptoms) and atypical (bezzheltushny) options of a current. At children cases of an atypical course of hepatitis C prevail. Typical acute hepatitises of C at children usually proceed in easy and medium-weight forms; severe and malignant (fulminantny) forms of a disease are extremely seldom possible.
Hepatitis C symptoms at children
The hidden (incubatory) period at hepatitis C at children averages 7-8 weeks. The acute hepatitis of C begins gradually with development in the child of an astenovegetativny syndrome and dispepsichesky violations. At children the abdominal pain syndrome, sometimes large joint pains is noted, temperature increase of a body to subfebrilny values, decolouration a calla and darkening of urine is possible. Intoxication is followed by nausea, vomiting, a headache.
Symptoms of jaundice at children with hepatitis C (a yellow shade a skler and skin) appear not always (in 15-40% of cases); the icteric period proceeds from 1 to 3 weeks and proceeds easier, than at other parenteral hepatitises. The sharp course of hepatitis C at children is noted in 10-20% of cases, its frequent outcome is formation of a chronic form of a disease.
Chronic hepatitis C at children for many years can proceed without clinically expressed symptoms, coming to light at casual inspections. At rather satisfactory condition of children and lack of complaints, chronic hepatitis C is shown by the gepatomegaliya, in 60% of cases which is followed by a splenomegaliya. At 1/3 children with chronic hepatitis C the adynamy, increased fatigue, extra hepatic symptomatology is noted (teleangiektaziya, kapillyarita).
Despite the minimum and low degree of activity of chronic hepatitis C at children, the resistant tendency to a liver fibrozirovaniye is observed (in a year after infection in 50% of cases, in 5 years – in 87% of cases). Even at poorly expressed fibrozirovaniye degree at chronic hepatitis C children have a risk of development of cirrhosis. Hepatocellular insufficiency, bleedings, a heavy bacterial infection, a renal failure belong to complications of an acute hepatitis of C at children.
Diagnosis of hepatitis C at children
In diagnosis of hepatitis C at children consider data of clinical examination and the epidemiological anamnesis, results of biochemical, serological (IFA) and PTsR of researches, a punktsionny biopsy of a liver.
At all children with hepatitis C in serum of blood increase in activity of the ALT and ACT hepatic enzymes, in certain cases - increase in level of the general bilirubin (direct fraction), decrease in a protrombinovy index, a disproteinemiya is noted.
RNA of a virus of hepatitis C appears in blood plasma in 3-4 days after infection (long before formation of antibodies). PTsR in real time is the earliest method of diagnosis of hepatitis C at children allowing to find HCV RNA, to define a genotype and concentration of a virus in blood (virus loading). The more virus loading, the is heavier the forecast of hepatitis C and the zarazny the patient is considered. The genotype of a virus of hepatitis C is reliable predictive criterion of further development of an infection, and also duration and efficiency of antiviral therapy. Most often at children with a chronic form of a disease the genotype 1b a virus of hepatitis C of which 90% synchronization of an infection, heavier current, smaller percent of steady success of treatment is characteristic is allocated.
The serological research (IFA) at children allows to confirm existence of markers of hepatitis C - antibodies to specific proteins (anti-HCV-core, - NS3, - NS4, - NS5), to define sharpness and activity of a viral infection (anti-HCV IgM), a disease stage, prescription of infection (anti-HCV IgG an avidnost).
Hepatitis C at children needs to be differentiated with other viral hepatitises, first of all, hepatitis B, a hemolytic disease, angiokholetsistity, obturatsionny jaundice.
Treatment of hepatitis C at children
The general principles of therapy of hepatitis C at children are similar to those at other viral hepatitises and include a bed rest, a medical diet, symptomatic means.
Treatment of hepatitis C at children is directed to prevention of synchronization of a sharp form of an infection and influence on the developed chronic process. In pediatrics at chronic hepatitis C medicines of recombinant interferon alpha (IFN-) in the form of rectal candles and parenteral forms are applied. The scheme of treatment of hepatitis C to the child is selected individually. In treatment of hepatitis C at children aged from 3 up to 17 years which do not have contraindications monotherapy or a combination of medicines of recombinant IFN- with ribaviriny or remantadin (at children 7 years are more senior) is appointed. Also appoint inductors (a meglyumin ) and immunomodulators (extracts of a timus of cattle). Duration of treatment of hepatitis C at children depends on many factors and makes from 24 to 48 weeks.
The forecast and prevention of hepatitis C at children
The forecast at viral hepatitis C at children is variable. The sharp form of a disease at children can end with an absolute recovery which comes slowly (approximately in a year) or an outcome in the chronic process proceeding many decades and leading to development of cirrhosis and a gepatotsellyulyarny carcinoma.
At extremely severe and malignant forms of hepatitis C the lethal outcome is possible.
Nonspecific measures of prevention of viral hepatitis C at children include prevention of perinatal infection of newborns, use of disposable and sterile reusable medical tools, careful inspection of blood donors and testing of medicines of blood, observance of rules of personal hygiene, fight against drug addiction.