How is hepatitis A transmitted: the main methods of infection. Viral hepatitis: symptoms, routes of infection, treatment methods. Reference

Moscow doctors record an unusual winter season an increase in the incidence of viral hepatitis A and B among Muscovites, although the epidemiological threshold for this disease has not yet been exceeded, the Moskovsky Komsomolets newspaper wrote on Wednesday.

Viral hepatitis is a common and dangerous infectious liver disease.

Of all forms of viral hepatitis hepatitis A is the most common. From the moment of infection to the appearance of the first signs of the disease, 7 to 50 days pass. Most often, the onset of the disease is accompanied by a rise in temperature and may resemble the flu. Most cases result in spontaneous recovery and do not require active treatment. In severe cases, droppers are prescribed to eliminate the toxic effect of the virus on the liver.

Virus hepatitis B transmitted sexually, by injection with non-sterile syringes from drug addicts, from mother to fetus. In typical cases, the disease begins with fever, weakness, joint pain, nausea and vomiting. Sometimes rashes appear. The liver and spleen become enlarged. There may also be darkening of the urine and discoloration of the stool.

Hepatitis C- the most severe form of viral hepatitis, which is also called post-transfusion hepatitis. This means that they contracted it after a blood transfusion. This is due to the fact that testing of donor blood for the hepatitis C virus began only a few years ago. Quite often, infection occurs through syringes among drug addicts. Sexual transmission is possible from mother to fetus. The greatest danger is the chronic form of this disease, which often develops into cirrhosis and liver cancer.

A chronic course develops in approximately 70-80% of patients. The combination of hepatitis C with other forms of viral hepatitis dramatically worsens the disease and can lead to death.

Hepatitis D- a “companion disease” that complicates the course of hepatitis B.

Hepatitis E similar to hepatitis A, but begins gradually and is more dangerous for pregnant women.

The last in the hepatitis family, hepatitis G, similar to C but less dangerous.

Routes of infection

Hepatitis viruses enter the human body in two main ways. A sick person can shed the virus in their feces, after which it enters the intestines of other people through water or food. Doctors call this mechanism of infection fecal-oral. It is characteristic of the hepatitis A and E viruses. Thus, hepatitis A and hepatitis E arise mainly due to poor personal hygiene, as well as imperfect water supply systems. This explains the greatest prevalence of these viruses in underdeveloped countries.

The second route of infection is human contact with infected blood. It is characteristic of hepatitis B, C, D, G viruses. The greatest danger, due to the prevalence and severe consequences infections are represented by hepatitis B and C viruses.

Situations in which infection occurs most often:

Transfusion donated blood. Worldwide, on average, 0.01-2% of donors are carriers of hepatitis viruses, therefore, donor blood is currently tested for the presence of hepatitis B and C viruses before transfusion to the recipient. The risk of infection increases in persons who require repeated transfusions of blood or its products

Single needle use different people greatly increases the risk of infection with hepatitis B, C, D, G. This is the most common route of infection among drug addicts;

Viruses B, C, D, G can be transmitted through sexual contact. Hepatitis B is most often transmitted sexually. It is believed that the likelihood of contracting hepatitis C in spouses is low.

The route of infection from mother to child (doctors call it “vertical”) is not observed so often. The risk increases if the woman has an active form of the virus or recent months suffered acute hepatitis during pregnancy. The likelihood of infection of the fetus increases sharply if the mother, in addition to the hepatitis virus, has HIV infection. The hepatitis virus is not transmitted through mother's milk. Hepatitis B, C D, G viruses are transmitted through tattooing, acupuncture, and ear piercing with unsterile needles. In 40% of cases, the source of infection remains unknown.

Symptoms

From the moment of infection to the appearance of the first signs of the disease, different times pass: from 2-4 weeks for hepatitis A, to 2-4 and even 6 months for hepatitis B. After this period, during which the virus multiplies and adapts in the body, the disease begins Express yourself.

At first, before the appearance of jaundice, hepatitis resembles the flu and begins with fever, headache, general malaise, body aches, as with hepatitis A. With hepatitis B and C, the onset is usually more gradual, without a sharp rise in temperature. Thus, the hepatitis B virus manifests itself with a slight fever, joint pain, and sometimes rashes.

The initial manifestations of hepatitis C may be limited to weakness and loss of appetite. After a few days, the picture begins to change: appetite disappears, pain appears in the right hypochondrium, nausea, vomiting, urine darkens and feces become discolored. Doctors record an enlargement of the liver and, less commonly, the spleen. Changes characteristic of hepatitis are found in the blood: specific markers of viruses, bilirubin increases, liver tests increase 8-10 times.

Usually, after the appearance of jaundice, the condition of patients improves. However, this does not happen with hepatitis C, as well as in chronic alcoholics and drug addicts, regardless of the type of virus, causing disease, due to intoxication of the body. In other patients, gradually, over several weeks, reverse development symptoms. This is how acute forms of viral hepatitis occur.

The clinical course of hepatitis can be of varying degrees of severity: mild, moderate and severe. There is also a fourth, fulminant, that is, lightning-fast form. This is the most severe type of hepatitis, in which massive liver necrosis develops and usually ends in the death of the patient.

The greatest danger is the chronic course of hepatitis. Chronization is typical only for hepatitis B, C, D. The most characteristic signs of chronic hepatitis are malaise and worsening by the end of the day increased fatigue, inability to perform previous physical activities. At an advanced stage of chronic viral hepatitis, jaundice, dark urine, itching, bleeding, weight loss, enlarged liver and spleen, and spider veins are detected.

Treatment

The duration of hepatitis A is on average 1 month. No special antiviral treatment is required for this disease. Treatment includes: basic therapy, bed rest, dieting. If indicated, detoxification therapy (intravenously or orally) and symptomatic therapy are prescribed. It is usually recommended to avoid drinking alcohol, which, as a poisonous substance, can weaken an already damaged liver.

Acute viral hepatitis B with severe clinical symptoms ends in recovery in more than 80% of cases. In patients who have suffered from anicteric and subclinical forms, hepatitis B often becomes chronic. Chronic hepatitis leads over time to the development of cirrhosis and liver cancer. Complete cure chronic hepatitis It practically does not occur, but a favorable course of the disease can be achieved provided that certain recommendations regarding work and rest, nutrition, psycho-emotional stress, and also when taking drugs that improve metabolic processes in liver cells are followed.

Basic therapy is mandatory. Antiviral treatment is prescribed and carried out under the strict supervision of a doctor and in cases where there are indications. Antiviral treatment includes drugs from the interferon group. Treatment is long-term. Sometimes repeated courses of therapy are necessary.

Hepatitis C is the most serious type of hepatitis. The development of a chronic form is observed in at least every seventh patient. These patients are at high risk of developing cirrhosis and liver cancer. The basis of all treatment regimens is interferon-alpha. The way this drug works is to prevent new liver cells (hepatocytes) from becoming infected. The use of interferon cannot guarantee complete recovery, however, treatment with it prevents the development of cirrhosis or liver cancer.

Hepatitis D occurs only against the background of hepatitis B. Treatment of hepatitis D should be carried out in a hospital. Both basic and antiviral therapy are required.

There is no cure for hepatitis E because the human body is strong enough to get rid of the virus without treatment. After a month and a half, complete recovery occurs. Sometimes doctors prescribe symptomatic therapy to eliminate headaches, nausea and other unpleasant symptoms.

Complications

Complications of viral hepatitis can include functional and inflammatory diseases biliary tract and hepatic coma, and if a disorder in the functioning of the biliary tract can be treated, then hepatic coma is a formidable sign of a fulminant form of hepatitis, ending in death in almost 90% of cases. In 80% of cases, the fulminant course is caused by the combined effect of hepatitis B and D viruses. Hepatic coma occurs due to massive necrosis (necrosis) of liver cells. The breakdown products of liver tissue enter the blood, causing damage to the central nervous system and the extinction of all vital functions.

Chronic hepatitis is dangerous because the lack of adequate treatment often leads to cirrhosis and sometimes liver cancer.

The most severe course of hepatitis is caused by a combination of two or more viruses, for example B and D or B and C. Even B+D+C occurs. In this case, the prognosis is extremely unfavorable.

Prevention

To protect yourself from hepatitis infection, you must follow simple rules. You should not drink unboiled water, always wash fruits and vegetables, and do not neglect heat treatment of products. This way you can prevent hepatitis A infection.

In general, contact with other people's body fluids should be avoided. To protect against hepatitis B and C - primarily with blood. Blood in microscopic quantities can remain on razors, toothbrushes, and nail scissors. You should not share these items with other people. Piercings and tattoos should not be done with non-sterile equipment. It is necessary to take precautions when having sex.

The material was prepared based on information from open sources

Hepatitis A or Botkin's disease– an acute viral disease of the liver that causes damage to the cells of the organ. It is manifested by general intoxication and jaundice. Hepatitis A is transmitted through the fecal-oral route, which is why it is also called “dirty hands disease.”

Compared to other hepatitis (B, C, E), this disease is considered the most benign. In contrast, hepatitis A does not cause chronic damage and has a low mortality rate of less than 0.4%. In an uncomplicated course, the symptoms of the disease disappear within 2 weeks, and liver function is restored within a month and a half.

Both men and women of all ages are equally susceptible to the disease. Children from one to 10 years of age experience a mild form of the disease, while infants and the elderly experience a severe form. After the illness, a strong immunity remains, so people only get hepatitis A once.

Hepatitis A incidence statistics. According to WHO, 1.5 million people suffer from the disease every year. In fact, the number of cases is many times higher. The fact is that 90% of children and 25% of adults suffer from a hidden asymptomatic form of the disease.

Viral hepatitis A is common in developing countries with poor sanitation^ Egypt, Tunisia, India, countries of Southeast Asia, South America and the Caribbean. Tourists going on vacation to hot countries should remember this. In some countries, the disease is so widespread that all children are ill before the age of ten. The territory of the CIS belongs to countries with an average risk of infection - 20-50 cases per 100 thousand population. Here, a seasonal increase in incidence is noted in August – early September.

Story. Hepatitis A has been known since antiquity under the name “icteric disease.” Large epidemics broke out during the war, when masses of people found themselves in unsanitary conditions, which is why hepatitis was also called “trench jaundice.” For a long time, doctors associated the disease only with blockage of the bile ducts. In 1888, Botkin hypothesized that the disease was infectious in nature, so it was subsequently named after him.
The hepatitis virus was identified only in the 70s of the twentieth century. At the same time, it became possible to create a vaccine that would protect against infection.

Properties of the hepatitis A virus

Structure. The virus has a round, spherical shape and consists of a single strand of RNA enclosed in a protein shell - the capsid.

HAV has 1 serotype (variety). Therefore after past illness Antibodies to it remain in the blood even when re-infection the disease no longer develops.

Stability in the external environment. Despite the fact that the virus does not have an envelope, it persists in the external environment for quite a long time:

• when drying on household items – up to 7 days;
• in a humid environment and on food 3-10 months;
• when heated to 60°C, withstands up to 12 hours;
• When frozen below – 20°C, it is preserved for years.

HAV life cycle. With food, the virus enters the mucous membrane of the mouth and intestines. From there it penetrates the bloodstream and the liver.

From the moment the virus enters the body until the disease manifests itself, it takes from 7 days to 7 weeks. In most cases, the incubation period lasts 14-28 days.

Next, the virus penetrates into liver cells - hepatocytes. How he manages to do this has not yet been established. There it leaves the shell and is integrated into the ribosomes of cells. It rearranges the work of these organelles so that they create new copies of the virus - virions. New viruses enter the intestines with bile and are excreted in the feces. The affected liver cells wear out and die, and the virus moves into neighboring hepatocytes. This process continues until the body produces a sufficient number of antibodies that destroy the viruses.

Causes of hepatitis A

A sick person releases a huge amount of viruses into the environment with feces. They can get into water, food, and household items. If the pathogen gets into the mouth of a healthy person susceptible to infection, hepatitis will develop.

You can become infected with hepatitis A in such situations

• Swimming in polluted pools and ponds. The virus enters the mouth with fresh and sea ​​water.
• Eating contaminated foods. These are often berries that have been fertilized with human feces.
• Eating raw shellfish and mussels from contaminated water bodies, where the pathogen can persist for a long time.
• When using poorly purified water. Contaminated water is not only dangerous to drink, but also to use for washing hands and dishes.
• When living together with a sick person, infection occurs through household items (door handles, towels, toys).
• During sexual contact with a patient. This route of transmission is especially common among homosexuals.
• When administering drugs intravenously with a non-sterile syringe. The virus circulates in the blood and is transmitted from one person to another through a needle.

• failure to comply with personal hygiene rules
• staying in crowded places: boarding schools, barracks
• staying in conditions where there is no running water or sewerage: refugee camps, field camps for military personnel
• travel to areas with high incidence rates without prior vaccination
• living with a person with hepatitis A
• lack of access to safe drinking water

Symptoms of hepatitis A

Treatment of hepatitis A

Treatment of hepatitis A with medications

Is hospitalization required for hepatitis A treatment?

• for complicated forms of hepatitis A
• with the co-occurrence of Botkin's disease and other hepatitis
• with alcoholic liver damage
• in elderly patients and children under 1 year of age
• in weakened patients with severe concomitant diseases

Diet for hepatitis A

• dairy products: low-fat cottage cheese, kefir, yogurt, low-fat sour cream for dressing
• lean meat: beef, chicken, rabbit
• meat products: steamed dumplings, meatballs, meatballs, sausages and boiled beef sausages
• Not fatty fish : pike perch, pike, carp, hake, pollock
• vegetables: potatoes, zucchini, cauliflower, cucumbers, beets, carrots, cabbage, tomatoes
• side dishes: cereals (except legumes and pearl barley), pasta
• soups low-fat vegetables, dairy with added cereals
• bread yesterday's, crackers
• eggs: white omelette, 1 soft-boiled egg per day
• Dessert: mousses, jellies, jelly, marshmallows, marmalade, marshmallows, hard biscuits, honey, homemade jam dried fruits
• fats: butter 5-10 g, vegetable oils up to 30-40 g
• beverages: black tea, herbal tea, compotes, juices, uzvar, rose hip decoction, coffee with milk, alkaline mineral waters, 5% glucose solution.
• rehydration medications recovery electrolyte balance Rehydron, Humana electrolyte, Gidrovit forte are recommended.

• fried smoked dishes
• canned food fish, meat, vegetables
• fatty meats: pork, goose, duck
• fatty fish: sturgeon, gobies, spicy herring, caviar
• fats: lard, lard, margarine
• bakery from butter and puff pastry, fresh bread
• full fat dairy products: whole milk, cream, full-fat cottage cheese, salty cheese
• soups on concentrated meat, fish broth, sour cabbage soup
• vegetables: radish, radish, sauerkraut, sorrel, onion, parsley, pickled vegetables, mushrooms
• Dessert: ice cream, chocolate, products with cream, sweets, steamed
• beverages: strong coffee, cocoa, carbonated drinks, alcohol

It is very important to adhere to the drinking regime. To remove toxins, you need to consume at least 2 liters clean water without gas.

Can Hepatitis A be treated at home?

• the patient has been examined, taken tests, and will regularly visit the doctor
• the disease occurs in a mild, uncomplicated form
• It is possible to isolate the patient in a separate room
• diet and bed rest

Restrictions. It is not advisable to involve the patient in cooking. All family members must strictly observe personal hygiene rules and wash their hands thoroughly after using the toilet.

Mode. Pre-icteric period - bed rest is required. The patient experiences severe weakness and excess energy expenditure can lead to additional stress on the liver. And in a horizontal position, the diseased organ receives more blood, which promotes a speedy recovery.

Jaundice period– Semi-bed rest is allowed. Once the symptoms of the disease have subsided, you can gradually increase your activity. This helps restore physical and emotional well-being.

Consequences of hepatitis A

The most common complications of hepatitis A

• Biliary dyskinesia– impaired motility of the biliary tract, resulting in stagnation of bile. Symptoms: pain in the right hypochondrium, radiating to right shoulder, occurs after eating and physical activity. diabetes mellitus

Prevention of hepatitis A

1. Disinfection in the area of ​​hepatitis A

   Disinfection is carried out in the apartment of the sick person. Medical personnel teach family members how to handle objects that the sick person has come into contact with.

   • Bed linen and clothes are boiled in a 2% soap solution (20g of any washing powder per liter of water) for 15 minutes, and then washed as usual.
   • After eating the dishes are boiled for 15 minutes in 2% soda solution
   • Carpets are cleaned with a brush soaked in a 1% chloramine solution.
   • Floors and other surfaces are washed with hot 2% soap or soda solution. The door handles of the toilet and flush cistern are treated in the same way.
2. Vaccination against hepatitis A

   Vaccination is aimed at reducing susceptibility to the virus.

   • Human immunoglobulin is normal. The drug is administered intravenously to people living in the same apartment as the sick person. The drug contains ready-made donor antibodies against hepatitis A and other infections. Its use reduces the risk of getting sick several times.
   • Hepatitis A vaccine– a mixture of neutralized purified viruses. In response to the vaccine, the body produces specific antibodies. Therefore, if infection occurs, the disease does not develop - antibodies quickly neutralize the viruses.
   The vaccine is not included in the list of mandatory vaccinations due to its expensive cost.
   • For travelers departing to countries with low level hygiene
   • Military personnel, long time staying in the field
   • People in refugee camps and other places where hygiene is impossible due to lack of running water and sewerage
   • medical staff
   • food industry workers
3. Hygiene rules
   • wash your hands thoroughly after using the toilet
   • drink only boiled water
   • wash vegetables, fruits and herbs
   • do not swim in bodies of water that may have received sewage
   • thoroughly boil and fry foods when cooking
4. Measures regarding contact persons

   To prevent the spread of infection, health workers monitor people who have been in contact with the patient:

   • Quarantine in groups and children's groups for a period of 35 days from the moment of isolation of the last sick person
   • Monitoring of all contacts. Check to see if there is jaundice on the mucous membranes and sclera, and if the liver is enlarged. If flu-like symptoms appear, they should be isolated
   • Blood test for the presence of specific antibodies to the hepatitis A virus (IgG)

Hepatitis A - what is it and how is it transmitted? Hepatitis A is the same “jaundice” that parents warn every child about the danger of. The disease is often considered a “disease of dirty hands”, since the main route of its spread is fecal-oral. The disease is often severe and in some cases can be fatal. Therefore, everyone should be well aware of what hepatitis A is, what it is and how it is transmitted, symptoms, causes of the disease.

What is hepatitis A

The disease has been known since ancient times, but previously doctors did not know what hepatitis A was or what kind of disease it was. It was thought to be caused by blockage of the bile ducts. Only at the end of the 19th century the famous Russian doctor S.P. Botkin suggested infectious nature diseases. Hepatitis A is also sometimes called Botkin's disease in his honor. Currently, medicine has accumulated a lot of data about hepatitis A, what it is and how it is transmitted, how to treat it, and how to avoid the disease.

The causative agent of the disease was discovered only in the 1960s of the 20th century. It turned out to be a virus of the picornavirus family. “Pico” means “small” in Latin, which is the main characteristic of this infectious agent. It is really very small, its diameter is only 30 nm. Externally, the virus is a protein ball with an RNA molecule inside. It is still unknown exactly how the virus penetrates liver cells once in the body. However, it does a similar thing without much difficulty and, by transferring its genetic code to the ribosomes of hepatocytes, causes them to produce new viruses. As a result, the death of liver tissue occurs. And viruses produced by hepatocytes enter the bile and from there into the human intestines.

The virus is highly resistant to adverse conditions. It does not die in an acidic environment (for example, in the stomach), and can be preserved for years in sea or lake water when frozen to –20 °C. It lasts for up to 10 months on food products, for a week on household items, and for 12 hours when heated to +60 °C.

Many antiseptics are also powerless against the virus, for example, ethanol. The following can deactivate the virus:

• formalin,
• bleaching powder,
• potassium permanganate,
• boil for 5 minutes.

Hepatitis A accounts for approximately 40% of all cases of viral hepatitis. The disease is mainly typical for hot developing countries, where there are no clean sources of drinking water, and the hygienic culture of the population leaves much to be desired. The large number of cases is explained by the illiteracy of the local population. People don’t know anything about hepatitis A, what kind of disease it is, what symptoms the disease has. It is believed that 90% of the population in third world countries suffered from this disease in childhood.

In developed countries, people have a lot of information about hepatitis A, what it is and how the disease is transmitted. This is largely why incidence rates in Europe and North America are relatively low. What makes this circumstance quite dangerous for individual person. After all, there is a high risk that the disease will strike a person in old age, when the likelihood of severe pathology is much higher.

In Russia and the CIS countries, 20-50 cases of the disease per 100,000 people are recorded annually. The peak incidence occurs in August-late September.

The disease has only an acute form, there is no chronic form. This is due to the fact that the immune system neutralizes the virus, and it disappears from the body. At the same time, a person who has recovered from hepatitis retains lifelong immunity.

At proper treatment and patient care, mortality from hepatitis is low. It is 0.5% in children and 1.5% in people over 60 years of age. In older people, the disease is generally more severe. Most deaths from the disease are associated with the presence of other viral hepatitis (B or C), severe somatic diseases, and immunodeficiency conditions in the patient. Death is also possible due to improper treatment or the patient’s lifestyle (for example, drinking alcohol).

How is hepatitis A transmitted: transmission factors and routes of infection

The cause of the disease is the entry of a virus into the body. Any person who has not previously suffered from this disease and has not been vaccinated against it can become infected with the hepatitis A virus.

The virus is transmitted, as a rule, by the oral-fecal route. Since the virus can persist for a long time in unfavorable conditions, it is found in huge quantities in various bodies of water. Consequently, the main reason for contracting the disease is the use of unboiled water contaminated with the virus. Moreover, not only drinking water, but also water used for other procedures, for example, brushing teeth, washing hands, dishes, vegetables and fruits. It is also possible to become infected after swimming in polluted waters.

If uninfected people are in the same room as a sick person, transmission of the virus through household items (door handles, dishes, towels) is possible.

Infection through hematogenous routes is also possible, but such cases are rare. This method of distribution is more typical for developed countries. In particular, people who inject drugs are susceptible to it. Infection through anal sex is also possible.

Terms of the disease

The disease is usually treated within a period of 1 week to 1.5-2 months. The duration of the disease depends on many factors:

• age of the patient;
• the amount of virus that has entered the body;
• immunity status;
• treatment methods;
• presence in the patient concomitant diseases primarily the liver.

Gradually, the symptoms of the disease disappear and the patient recovers. However, in in rare cases Relapses may also occur, when an apparently recovered person may again experience one or two more episodes of exacerbation.

Incubation period

The period starting from the moment of infection and ending with the appearance of the first clinical signs is called incubation. The incubation period of the disease can last from 7 to 50 days, most often 14-28 days. It should be noted that during the incubation period the patient is a virus carrier and poses a danger to others as a source of infection.

Forms of hepatitis A

The disease can have both icteric and anicteric forms. In the anicteric form, the disease is much more difficult to identify by its manifestations than in the icteric form. The anicteric form is more typical for children under 6 years of age; approximately 90% of them experience the disease in a similar form. In adults, the anicteric form is observed only in 30% of cases.

Also, in addition to the acute form of hepatitis A, there is also a fulminant form of the disease. It is extremely rare in children and young people, but in old age it accounts for several percent of all cases of the disease. As already mentioned, in the acute form, mortality is relatively low, which cannot be said about the fulminant form. In the fulminant form, acute liver failure quickly develops and death is very likely.

How it manifests itself

After an incubation period, during which there are no signs of the disease, a prodromal period begins when the first clinical symptoms appear.

Unfortunately, many people know little about the disease - what it is, how it is transmitted, the symptoms of the disease. According to a common misconception, the very first manifestation of Botkin's disease is jaundice. But in fact, the signs of hepatitis A initially resemble the symptoms of the flu - high fever, headaches. The temperature usually rises to +38-39 °C. However, in many cases there is no such symptom.

Then signs of indigestion appear - nausea, vomiting, stool disorders, abdominal pain. Bitterness appears in the mouth, the color of urine and feces changes. Due to the presence of bile pigment - bilirubin - in the urine, the urine becomes dark in color. The same cannot be said about feces, since, on the contrary, it becomes discolored due to a lack of the pigment stercobilin supplied with bile, which is normally responsible for the dark color of excrement. May appear discomfort in the area of ​​the right hypochondrium - heaviness or dull pain, as well as pain in muscles and joints, itching.

The next stage in the development of signs of the disease is the appearance of jaundice, which occurs only on days 5-10. Due to excess bilirubin in the blood skin, the patient's mucous membranes and eyeballs acquire yellow. A similar phenomenon is observed when the concentration of bilirubin in the blood increases to 200-400 mg/ml. After the appearance of jaundice, the temperature usually subsides. This syndrome will soon go away.

By the time jaundice appears, the patient stops secreting viruses and being infectious to others. Therefore, bed rest for the patient can be changed to semi-bed rest. The icteric period lasts from 5 to 30 days and ends with a recovery period.

In severe cases of the disease, nosebleeds and hemorrhages on the skin may occur, which should be feared, as they are evidence of hemorrhagic syndrome.

Also, with hepatitis A, an enlarged liver is usually observed, and in 30% of cases, an enlarged spleen. The latter is associated with an increased load on the immune system, an important component which is the spleen.

Diagnostics

When diagnosing, it is important to separate other infectious diseases from hepatitis A due to its increased contagiousness. Diagnosis is complicated by the fact that the disease has symptoms similar to those of other types of hepatitis. And it is not always possible to say with certainty that such symptoms appear specifically with hepatitis A, and not, say, with the serum form of the disease. Examination of the patient alone is usually not enough to identify the disease. Although many characteristic signs (jaundice, enlarged liver) indicate an inflammatory process in the liver, they may not always accompany the disease.

To determine the type of hepatitis, various methods are used, such as a blood test for antibodies. There is also more reliable method PCR, however, it requires expensive equipment and cannot be carried out everywhere.

Biochemical and general blood tests are also performed. Elevated levels of liver enzymes - bilirubin, AST and ALT indicate pathological processes in the liver. With the disease, an increase in the prothrombin index is also observed, increase in ESR, leukocytosis. Ultrasound, radiography, CT and MRI methods allow us to assess the physical condition of the liver and adjacent organs.

Hepatitis A - how to treat and how to avoid

Treatment of the disease and its prevention are issues that are most important from a practical point of view. How to treat and how to avoid the disease? Treatment is usually carried out at home, except in cases of severe liver failure. Children under one year old and elderly patients are also hospitalized. The disease is usually treated by an infectious disease specialist. Sometimes self-medication is practiced, which should be avoided, since only an experienced specialist knows everything about hepatitis A, what kind of disease it is and how to treat it.

There are no specific antiviral drugs, directed against the hepatitis A virus. However, in severe cases, the patient may be given interferon injections. In general, in most cases the body copes with the disease on its own. It is important to provide the patient with bed rest. He also needs plenty of fluids to detoxify the body. Medicines are prescribed to the patient only by a doctor. A large number of medications can create problems for the patient's diseased liver. In particular, according to WHO recommendations, paracetamol should not be used to reduce fever in case of hepatitis A.

To restore liver functions impaired due to hepatitis, may be prescribed vitamin complexes, hepatoprotectors. Enterosorbents are used to remove toxins from the intestines, enzyme preparations are used to improve digestion, and choleretic agents and antispasmodics are used to speed up the excretion of bile.

Diet for hepatitis

Also important element The treatment is diet. From the patient's diet it is necessary to exclude fried, salty and spicy foods, canned food, indigestible dishes, mushrooms, animal fats ( fatty varieties meat and fish), fresh bread, baked goods, coffee and chocolate, carbonated drinks.

Food must be taken in small portions, but often (5-6 times a day).

The diet should be followed not only during hepatitis, but also during the recovery period (about six months).

Prevention

In order to avoid the disease, all people should be well informed about the disease, know what it is, how it is transmitted, and the symptoms of the disease.

Reducing the incidence of hepatitis on a national and regional scale is facilitated by measures to provide the population with clean drinking water, as well as the disposal of sewage and food waste, and monitoring compliance with sanitary and hygienic standards by employees of public catering establishments and medical personnel.

The family of a person with hepatitis A should be careful when interacting with him to avoid infection. The patient should be given a separate room. Before washing, the patient's bed linen must undergo a disinfection procedure (boiling in 2% soapy water for 15 minutes). The dishes from which the patient ate must also be boiled in a 2% soda solution for 15 minutes. Floors, door handles and other surfaces should be washed with a warm solution of soap or soda 2%.

In general, measures to prevent hepatitis A are simple. These include:

• refusal to use raw, unboiled water, not only for drinking, but also for washing dishes or brushing teeth;
• regular hand washing, especially after using the toilet;
• washing vegetables and fruits.

Particular caution should be exercised by those who visit southern countries and try local exotic food. In particular, the hepatitis A virus can live in some shellfish caught in contaminated water. Therefore, you should make it a rule in such conditions not to eat any food that has not undergone sufficient heat treatment.

If there is no access to clean, disinfected water, then water from unsafe sources must be boiled for at least 10 minutes.

Hepatitis A vaccination

also in for preventive purposes vaccination against hepatitis A is possible. The vaccine contains neutralized viruses. There are several categories of citizens who are required to be vaccinated - doctors, workers in the food industry and catering establishments, military personnel who spend a lot of time in field camps. Vaccinations are also recommended for people traveling to hot countries.

Immunity after vaccination against hepatitis A is not formed immediately, but after 3-4 weeks. To enhance the effect, repeated vaccination is necessary. It is done 6 months after the first one. A series of two vaccinations, however, does not provide lifelong immunity. It is usually valid for 8 years.

Forecast and consequences

The prognosis for hepatitis is favorable. However complete cure It may take a long time for the consequences of the disease to recover.

The recovery period after an active period of hepatitis can last up to 6 months. During of this period the patient must follow a gentle diet.

After the disease, the patient has strong immunity for life, so re-infection with hepatitis is unlikely. However, an active disease can cause some damage to the liver, and the person who has had it can feel the consequences of hepatitis for the rest of his life.

Possible complications of hepatitis A include:

• biliary dyskinesia,
• cholecystitis,
• chronic,
• cholangitis.

Hepatitis A, also called Botkin's disease, is a viral disease of liver cells, manifested by jaundice and intoxication. Unlike other forms of hepatitis, hepatitis A does not contribute to the chronicity of liver cell damage and very rarely causes death in people. You can overcome the symptoms of the disease in just 2 weeks, and it will also take about one to two months to normalize the structure and function of the liver after the disease.

There is no specific group of people among the population who would be more susceptible to the disease than others; absolutely everyone, under equal conditions, is at risk of the disease: children, men, women of different social status and age. Moreover, children aged from one year to 10 years have a particularly mild tolerance to the symptoms of the disease, while old people and children in their first year of life suffer from a complicated form.

What it is?

Hepatitis A is an RNA virus that belongs to the Picornoviridae family, Enterovirus genus. Its size is 27-30 nm. The virus does not have an envelope. Typing was carried out in 1973. Further, four more genotypes of the human virus and three genotypes of monkeys were identified.

It has been established that, regardless of genotypes, all type A viruses have similar antigenic, immunogenic and protective properties. That is, one serotype of a virus is determined by the same standard sets of reagents and can be prevented by the same vaccines.

Kinds

The following forms of viral hepatitis A are known:

• icteric;
• with erased jaundice;
• anicteric.

A separate subclinical (inapparent) form is distinguished, which is diagnosed only on the basis of laboratory test results.

The course of the disease can be acute, protracted, subacute and chronic (extremely rare). Spicy infectious hepatitis According to the severity of clinical manifestations, it can be mild, moderate and severe.

How is hepatitis A transmitted?

The source of infection are sick people at the subclinical stages and initial manifestations diseases, including the anicteric form. After staining the sclera and skin, contagiousness is significantly reduced. In the third week of pathogenesis, dangerous virus is isolated only in 5% of patients.

The period of infectivity, taking into account the incubation period, lasts about a month, less often up to one and a half months.

Proven sources of spread of the virus, in descending order:

1. Contaminated food. This method transmission is of great epidemic importance. However, it is almost impossible to determine the type of dangerous food due to the long incubation period.
2. Direct contact with the patient. Characteristic of people with undeveloped hygienic skills and people in professional contact with them. This is how the pathogen is transmitted in preschool and school groups, and boarding schools for people with disabilities.
3. Feces, urine, nasopharyngeal discharge. This method of transmission is called fecal-oral. The main proven factors of transmission of the hepatitis A virus include direct contact between a healthy person and a sick person. The virus can also be transmitted through food, water, airborne droplets (some authors exclude), sexual contact, non-sterile intravenous injections, and through flies - mechanical carriers of the virus.

Meanwhile, products that are more often factors in transmitting the virus have been identified:

1. Garden berries in fresh and frozen (after thawing) form, especially if mollusks and slugs are found in the beds, next to the berry plants, which can accumulate the virus if the beds are watered with fertilizer made from human feces.
2. Products prepared without heat treatment or consumed after storage (salads, vinaigrettes, cold appetizers, dried fruits and berries, especially from Kazakhstan and Central Asia);
3. Aerosol. Hypothetically possible in children's groups when outbreaks of respiratory diseases accumulate in groups with reduced resistance. The virus is transmitted by coughing, sneezing and secretions from the nasopharynx of a sick person.
4. Water. Characteristic of areas with undeveloped communal infrastructure, poor organization of water supply, sewerage and wastewater disposal. The risk of infection increases significantly during accidents and natural disasters.
5. Parenteral. Transmission of the virus through blood transfusions and intravenous administration of solutions cannot be ruled out, especially in an environment that precludes sterility (drug addicts).
6. Transmissible (transmission of the virus through flies). Researchers do not exclude the possibility of transmission of infection through flies, but the prevalence of this factor has not been studied.
7. Sexual. In the literature, it is indicated as a possible factor of transmission in homosexuals, but the causal relationship between homosexuality and hepatitis A is not deciphered.

Stages of development

There are several variants of the course of hepatitis A. The disease can occur with a typical clinical picture and asymptomatic. In the case of manifest (proceeding with vivid symptoms) forms, several stages are distinguished in the development of the disease.

After infection, persistent lifelong immunity is formed. Is it possible to get hepatitis A again? This is impossible; after suffering from the disease, the body produces cells that protect against re-infection.

Symptoms of hepatitis A

Viral hepatitis A usually begins acutely. The prodromal period can occur in different clinical variants: dyspeptic, febrile or asthenovegetative.

The febrile (flu-like) form of the prodromal period is characterized by:

• increased body temperature;
• general weakness;
• headache and muscle pain;
• sore throat, dry cough;
• rhinitis.

In the dyspeptic variant of the pre-icteric period, the manifestations of intoxication are mild. Typically, patients complain of various digestive disorders (belching, bitterness in the mouth, bloating), pain in the epigastrium or right hypochondrium, defecation disorders (constipation, diarrhea or their alternation).

The asthenovegetative form of the prodromal period in viral hepatitis A is not specific. Manifested by weakness, lethargy, adynamism and sleep disorders.

1. The transition of the disease to the icteric stage is characterized by an improvement in general condition, normalization of body temperature against the background gradual development jaundice. However, the severity of dyspeptic manifestations in the icteric period not only does not weaken, but, on the contrary, intensifies.
2. In severe cases of viral hepatitis A, patients may develop hemorrhagic syndrome(spontaneous nosebleeds, hemorrhages on the skin and mucous membranes, petechial rash).

Palpation reveals a moderately painful liver protruding from the hypochondrium. In approximately 30% of cases, there is an enlarged spleen. As jaundice increases, stool becomes lighter and urine becomes darker. After some time, the urine becomes saturated dark color, and the stool becomes light gray in color (acholic stool).

The icteric period gives way to the stage of convalescence. Gradual normalization is taking place laboratory parameters and improvement of the general condition of patients. The recovery period can last up to six months.

Diagnostics

Diagnosis of hepatitis A is based on clinical signs of the disease: liver enlargement, jaundice and other symptoms. The doctor also takes into account epidemiological factors, that is, how the infection is contracted (drinking unboiled water, products of unknown purity, and so on).

Decisive laboratory research. Disease-specific tests:

• polymerase chain reaction to detect viral genetic material;
• enzyme immunoassay for detecting antibodies to pathogens of the IgM class.

If only antibodies are detected in the body IgG class- this indicates a previous disease or immunity to it. The chronic form of the disease does not occur, but there are cases of healthy virus carriers.

Nonspecific laboratory signs diseases in women and other groups of patients are necessary to assess the severity of the infectious process and the effectiveness of prescribed drugs:

• ALT and AST;
• bilirubin and its fractions (direct, indirect);
• serum protein level, fibrinogen.

Ultrasound is used to determine the size of the liver.

Complications

Hepatitis A rarely causes complications; usually the disease ends in complete recovery. The most severe complication of Botkin's disease is liver failure. After recovery from hepatitis A, strong immunity usually remains and re-infection is not possible. However, if treatment is not completed and complete recovery has not occurred, a second wave of the disease may occur - a relapse. This happens in 15% of people with Botkin's disease and can occur repeatedly.

Liver failure is a rare and potentially life-threatening complication of hepatitis in which the liver may stop functioning normally. Usually susceptible to it the following groups of people:

• people with weakened immune system(as a result of a chronic disease such as diabetes, or side effect some treatments, such as chemotherapy).
• people with existing liver disease such as cirrhosis or hepatitis C (a more severe type of hepatitis);

Some symptoms of liver failure are similar to those of hepatitis A and include jaundice, nausea and vomiting.

Treatment of hepatitis A

Patients diagnosed with Hepatitis A are subject to immediate hospitalization in the infectious diseases department. The duration of isolation of patients is at least four weeks.

During periods of development and height of the disease, bed rest is required. Patients are prescribed a diet consisting of easily digestible foods enriched with vitamins. For hemorrhagic phenomena, Vikasol is prescribed intramuscularly, and vitamin K orally. In case of prolonged severe disease, as well as in the presence of itching, corticosteroids are prescribed (most often prednisolone), and glucose solution is administered subcutaneously and intravenously. In complicated cases, as well as in the presence of concomitant diseases, antibiotics are prescribed (terramycin, penicillin, etc.). To improve the flow of bile, repeat duodenal intubation is performed.

Treatment of patients with toxic dystrophy is complex, including glutamic acid, corticosteroid hormones, neomycin, and a low-protein diet with plenty of fluid.

In the majority of recorded cases, Hepatitis A ends in complete recovery, and this also applies to severe cases. However, there are patients in whom this disease takes on a chronic course, characterized by periodic exacerbations with disruption of adequate liver function.

Hepatitis A can become chronic due to late hospitalization, various violations of dietary and hygienic regimes, mental and physical stress, consumption of alcoholic beverages, as well as in the case of associated diseases (gastroenterocolitis, influenza, etc.). These forms can result in death for patients with symptoms of liver failure.

Vaccination

Fortunately, there is a vaccine that can reduce people's sensitivity to the hepatitis A virus, but it is not included in the mandatory vaccination schedule due to its high cost. There are two types of preventive vaccines:

• a solution based on a neutralized virus that causes the disease;
• immunoglobulin containing antibodies to hepatitis and other diseases (infections) derived from donor blood. It is administered by dropper to people living in the same area as the patient, urgently in the first days of detection of the disease. This procedure significantly reduces the risk of infection.

Immunoglobulin is administered to the population groups most at risk of infection:

• military personnel;
• refugees;
• medical workers;
• people working on mass food production;
• traveling to third world countries where many cases of the disease are reported.

Diet

The basis for the treatment of all diseases of the digestive system is a balanced diet. The diet for hepatitis A begins during the development of the disease and continues after recovery for several more months.

How do patients eat?

1. You cannot reduce the amount of proteins, fats and carbohydrates; their ratio must be correct. Only some hard-to-digest animal fats are limited: beef, pork and lamb.
2. You cannot reduce the calorie content of food; calories must correspond to the physiological norm.
3. You need to drink the optimal amount of fluid - 2–3 liters of water per day.
4. Five small meals a day are recommended for patients with hepatitis A.

This dietary regimen must be followed for another six months after recovery. We must not forget that all harmful and spicy foods are prohibited so as not to put a strain on the liver.

Disease Prevention

The risk of hepatitis A infection can be prevented or significantly reduced through vaccination. A vaccine is a preparation containing non-viable viruses, the introduction of which into the body causes the production of antibodies and activation of the immune system. A single vaccination is sufficient to provide protection for several years.

To achieve longer-lasting immunity, the vaccine must be administered twice every 1-1.5 years over a period of 20-25 years.