Viral hepatitis C
Hepatitis C – the viral infectious disease of a liver which is transmitted transfuzionno, differing in a lung, often subclinical more rare a medium-weight current in a phase of primary infection and tendency to synchronization, cirrhosis and an ozlokachestvleniye. In most cases hepatitis C has the bezzheltushny malosimptomny beginning. In this regard it can remain not diagnosed within several years and comes to light when in liver tissues cirrhosis already develops or there is a malignant transformation in gepatotsellyulyarny cancer. The diagnosis of hepatitis C is considered rather reasonable at identification in blood of virus RNA and antibodies to it as a result of repeated researches the PTsR method and different types of serological reactions.
Viral hepatitis C
Hepatitis C – the viral infectious disease of a liver which is transmitted transfuzionno, differing in a lung, often subclinical more rare a medium-weight current in a phase of primary infection and tendency to synchronization, cirrhosis and an ozlokachestvleniye. Viral hepatitis C is caused by the RNA-containing Flaviviridae family virus. Tendency of this infection to synchronization is caused by ability of the activator to stay in an organism long time, without causing intensive displays of an infection. As well as other flavivirusa, a virus of hepatitis C it is capable, breeding, to form quasistrains, having various serological options that prevents an organism to form the adequate immune answer and does not allow to develop an effective vaccine.
The virus of hepatitis C does not breed in cellular cultures that does not give the chance in detail to study its stability in the external environment, however it is known that it is steadier, than HIV, perishes at influence of ultraviolet rays and maintains heating to 50 °C. The tank and a source of an infection are sick people. The virus contains in plasma of blood of patients. Persons with asymptomatically the proceeding infection are infectious as having acute or chronic hepatitis C, and.
The mechanism of transfer of a virus of hepatitis C – parenteral, is mainly transmitted through blood, but there can sometimes be infection and at contact with other biological liquids: saliva, urine, sperm. An indispensable condition for infection is direct hit of enough a virus in blood of the healthy person.
In most cases now infection occurs at joint use of drugs intravenously. Spread of an infection among addicts reaches 70-90%. The persons using drugs are the most dangerous source of viral hepatitis C. in the epidemic plan Besides, the risk of infection with an infection increases at the patients receiving medical care in the form of repeated blood transfusions, surgical actions, parenteral injections and punctures with use of unsterile tools of repeated use. Transfer can be carried out during the drawing tattoos, piercing, cuts during manicure and a pedicure, manipulations in stomatology.
In 40-50% of cases it is not possible to trace a way of infection. In medical professional collectives incidence of hepatitis C does not exceed that among the population. Transfer from mother to the child is carried out when in blood of mother high concentration of a virus collects, or at a hepatitis C virus combination to a human immunodeficiency virus.
Possibility of development of hepatitis C at single hit of small number of the activator in a blood-groove of the healthy person it is small. The sexual way of transmission of infection is implemented seldom, first of all - at persons with the accompanying HIV infection, sexual partners, inclined to frequent change. The natural susceptibility of the person to a hepatitis C virus substantially depends on the received activator dose. Post-infectious immunity is insufficiently studied.
Symptoms of viral hepatitis C
The incubatory period of viral hepatitis C fluctuates ranging from 2 up to 23 weeks, sometimes dragging on up to 26 weeks (that is caused in one way or another transfers). The sharp phase of an infection in most cases (95%) is not shown by the expressed symptomatology, proceeding in bezzheltushny subclinical option. Late serological diagnosing of hepatitis C can be connected with probability of "an immunological window" - the period when, despite the available infection, antibodies to the activator are absent, or their caption is immeasurably small. In 61% of cases viral hepatitis is diagnosed laboratory 6 and more months later after the first clinical symptoms.
Clinically the demonstration of viral hepatitis C can be shown in the form of the general symptomatology: weakness, apathy, the lowered appetite, bystry saturation. Local signs can be noted: weights and discomfort in the right podreberye, dyspepsia. Fever and intoxication at viral hepatitis C are quite rare symptoms. Body temperature if rises, then to subfebrilny values. Intensity of manifestation of these or those symptoms often depends on concentration of a virus in blood, the general condition of immunity. Usually the symptomatology is insignificant and patients are not inclined to attach it significance.
In blood test during the sharp period of hepatitis C quite often note the lowered maintenance of leukocytes and platelets. In a quarter of cases short-term moderate jaundice is noted (the skler and biochemical manifestations is often limited to an ikterichnost). Further at synchronization of an infection episodes of jaundice and increase in activity of hepatic transferases accompany exacerbations of a disease.
The heavy course of viral hepatitis C is noted no more than in 1% of cases. At the same time autoimmune violations can develop: , aplastic anemia, neuritis of peripheral nerves. At such current the lethal outcome in the doantitelny period is probable. In everyday occurences viral hepatitis C proceeds slowly, without the expressed symptomatology, for years remaining not diagnosed and being shown already at considerable destruction of tissue of liver. Often for the first time make to patients the diagnosis of hepatitis C when symptoms of cirrhosis or gepatotsellyulyarny cancer of a liver already take place.
Complications of viral hepatitis C are cirrhosis and primary cancer of a liver (a gepatotsellyulyarny carcinoma).
Diagnosis of viral hepatitis C
Unlike viral hepatitis B where allocation of a virus anti-gene is possible, clinical diagnosis of viral hepatitis C is made by means of serological techniques (IgM antibodies to a virus decide on the help of IFA and RIBA), and also definition in blood of virus RNA by means of PTsR. At this PTsR it is carried out twice as there is a probability of false positive reaction.
At identification of antibodies and RNA it is possible speaks about sufficient reliability of the diagnosis. Definition in IgG blood can mean both existence of a virus in an organism, and earlier postponed infection. To patients with hepatitis C conducting biochemical tests of a liver, a koagulogramma, ultrasonography of a liver, and in some difficult diagnostic cases - a liver biopsy is appointed.
Treatment of viral hepatitis C
Therapeutic tactics at hepatitis same, as well as at viral hepatitis B: the diet No. 5 (restriction of fats, in particular refractory is registered, at a normal ratio of proteins and carbohydrates), an exception of the products stimulating secretion of bile and hepatic enzymes (salty, fried, tinned food), saturation of a diet of a lipoliticheska with active agents (cellulose, pectins), a large amount of liquid. Alcohol is completely excluded.
Specific therapy of viral hepatitis is a purpose of interferon in combination with ribaviriny. Duration of a therapeutic course – 25 days (at option of a virus, resistant to antiviral therapy, lengthening of a course up to 48 days is possible). As prevention of a holestaz include medicines of ursodeoksikholiyevy acid in a complex of therapeutic measures, and as antidepressant (as psychological state of patients quite often affects efficiency of treatment) – . Action of antiviral therapy directly depends on quality of interferon (extent of cleaning), intensity of therapy and the general condition of the patient.
According to indications basic therapy can be supplemented with oral desintoxication, spazmolitichesky means, enzymes (mezy), antihistaminic medicines and vitamins. At the heavy course of hepatitis C intravenous desintoxication by solutions of electrolytes, glucose, a dextran is shown, if necessary therapy is supplemented with Prednisolonum. In case of development of complications the course of treatment is supplemented with the appropriate measures (treatment of cirrhosis and cancer of a liver). If necessary make a plasma exchange.
The forecast at viral hepatitis C
At due treatment 15-25% of cases come to an end with recovery. Most often hepatitis C passes into a chronic form, promoting development of complications. Death at hepatitis C, as a rule, comes owing to cirrhosis or cancer of a liver, the lethality makes 1-5% a case. The forecast of the combined infection viruses of hepatitis B and C is less favorable.
Prevention of viral hepatitis C
General measures of prevention of hepatitis C include careful observance of the sanitary mode in medical institutions, control over quality and sterility of the transfused blood, and also sanitary inspection over the institutions rendering services to the population with use of traumatic techniques (a permanent make-up, piercing).
In addition, explanatory, educational activity among youth is conducted, individual prevention is advertized: safe sex and refusal of drugs, implementation medical and other traumatic procedures in the certified institutions. Among addicts disposable syringes extend.