Viral hepatitis E
Viral hepatitis E – damage of a liver of the infectious nature. The infection has the fecal and oral mechanism of transfer, proceeds sharply, cyclically and quite dangerously for pregnant women. The incubatory period of viral hepatitis E can lasts up to 2 months. The clinical picture of a disease has a lot of viral hepatitis A, similar to symptoms. Differential diagnostics is carried out by identification of specific virus anti-genes by the PTsR method. Inspection of a condition of a liver (ultrasonography, hepatic biochemical tests, liver MRT) is in parallel made. Treatment of viral hepatitis E includes a dietotherapy, symptomatic and dezintoksikatsionny treatment.
Viral hepatitis E
Viral hepatitis E – damage of a liver of the infectious nature. The infection has the fecal and oral mechanism of transfer, proceeds sharply, cyclically and quite dangerously for pregnant women. Hepatitis E is mainly widespread in the tropical countries and regions where supply of the population with clear water is not enough (the country of Central Asia).
Characteristic of the activator
The virus of hepatitis E belongs to the sort Calicivirus, RNA-containing is, has smaller resistance to influence of the external environment, than a hepatitis A virus. The activator keeps viability at 20 °C and less, when freezing and the subsequent thawing – perishes, chlorine - and iodinated disinfectants is well inactivated. The tank and a source of a virus of hepatitis E are sick people and carriers of an infection. The period of transmissibility of the person is insufficiently investigated, but presumably contageousness takes place in the same terms, as at hepatitis A.
The virus of hepatitis E is transmitted through the fecal and oral mechanism mainly by the waterway. In rare instances (at pollution of ware, life objects a virus) the contact and household way of transfer is implemented. Food infection is possible when eating crude mollusks. Preference of the waterway of spread of an infection is confirmed by its low ochagovost, emergence of epidemics in connection with seasonal rainfall, change of level of ground waters. The highest natural susceptibility – at pregnant women is after the 30th week of pregnancy. The postponed infection presumably leaves resistant lifelong immunity.
Symptoms of viral hepatitis E
The clinical course of viral hepatitis E is similar to that at infection with viral hepatitis A. The incubatory period fluctuates ranging from 10 up to 60 days, averaging 30-40 days. Beginning of a disease, as a rule, gradual. In the preicteric period of a disease patients note weakness, a general malaise, the lowered appetite, in a third of cases arises nausea, vomiting. Most of patients complains of pain in the right podreberye and the top part of a stomach, is frequent - quite strong. In certain cases belly-ache is the first symptom of an infection. Body temperature usually remains within norm or increases to subfebrilny values. Artralgy, rashes usually is not marked out.
Duration of the preicteric period can make from one to nine days then signs of functional violations of work of a liver appear: urine becomes dark, the kcal becomes colourless, at first skler, and then and integuments get a yellow shade (in certain cases very intensive). Biochemical blood test during this period notes increase in level of bilirubin and activity hepatic . Unlike viral hepatitis A, at this infection at development of an icteric syndrome regress of symptoms of intoxication is not noted. Weakness, lack of appetite and belly-ache remain, the skin itch can join (it is connected with high concentration of bilious acids in blood). Increase in a liver is noted (the liver edge can act from under a costal arch more than on 3 cm).
1-3 weeks later clinical manifestations begin to regress, there comes the recovery period which can proceed 1-2 months before full normalization of a condition of an organism (according to laboratory tests). More long course of an infection is sometimes noted. Development of the hemolytic syndrome which is followed by a gemoglobinuriy, gemorragiy, sharp renal failure is characteristic of hard proceeding hepatitis E. Gemoglobinuriya arises at 80% of patients with viral hepatitis E with a heavy current and in all cases of the developed hepatic encephalopathy.
The hemorrhagic symptomatology can be very expressed, bleedings are characteristic massive internal (gastric, intestinal, uterine). The condition of patients and weight of a course of hepatitis directly depends on concentration of plasma factors of folding. Decrease in their quantity, and also reduction of activity of plasma proteases, promotes noticeable weighting of a condition of the patient and aggravation of clinical symptomatology up to threat of development of hepatic encephalopathy.
The pregnant women who caught viral hepatitis E usually extremely hard have the infection developing in the main ambassador 24 weeks of pregnancy. Sharp deterioration in a state just before childbirth or spontaneous termination of pregnancy is characteristic. The hemorrhagic syndrome is expressed, in labor intensive bleeding is noted, hepatic encephalopathy quickly develops up to a hepatic coma (progressing of symptomatology quite often happens in 1-2 days). Pre-natal death of a fruit, a kidney and hepatic syndrome is frequent.
Diagnosis of viral hepatitis E
Specific diagnosis of viral hepatitis E is based on identification of specific antibodies (immunoglobulins M and G) by means of serological techniques and detection of anti-genes of a virus by means of PTsR.
Other laboratory and diagnostic actions are directed to clarification of a functional condition of a liver and identification of threat of development of complications. Treat them: koagulogramma, hepatic tests, ultrasonography of a liver, MRT, etc.
Treatment of viral hepatitis E
Treatment of an easy and medium-weight form of patients with viral hepatitis E is made in infectious offices of a hospital, the diet (the table No. 5 on Pevznera - the sparing diet with the lowered content of fatty acids and rich with cellulose is shown), plentiful drink is appointed. Symptomatic therapy (spazmolitichesky, antihistamines) according to indications. If necessary oral desintoxication is made by solution of 5% of glucose.
At a heavy current patients are treated in intensive care unit, infusional dezintoksikatsionny therapy (salt solutions, glucose, electrolytic mixes), inhibitors of proteases is made, according to indications enter Prednisolonum. At threat of development of a hemorrhagic syndrome etamsylate is appointed . At massive internal bleedings – pour plasma, trombotsitarny weight.
Special attention is paid to treatment of pregnant women. The issue of a premature rodorazresheniye is resolved individually, measures to the emergency termination of pregnancy are quite often taken.
Forecast and prevention of viral hepatitis E
Most often viral hepatitis E comes to an end with recovery, however the severe form of a disease threatens with development of life-threatening complications: renal and liver failure, hepatic coma. Mortality among patients with viral hepatitis E makes 1-5%, this indicator among pregnant women reaches 10-20%. In case of infection with viral hepatitis of E persons having hepatitis B, the forecast considerably worsens, death at such combination comes in 75-80% of cases.
The general prevention of viral hepatitis E consists in improvement of living conditions of the population and control over a condition of water sources. Individual prevention means respect for sanitary and hygienic norms, the use of qualitative water from reliable sources. It is desirable to pay special attention to prevention of viral hepatitis E to the pregnant women going to epidemiologically unsuccessful regions (Uzbekistan, Tajikistan, North Africa, India and China, Algeria and Pakistan).