Ways of infection characteristic of viral hepatitis a. Hepatitis A: ways of transmission, features of the course. Myths about infection with this disease

Unfortunately, hepatitis A is becoming more and more common. There are several types of hepatitis and almost all of them are similar to each other in terms of symptoms, but they are distinguished by a negative effect on the body. To identify hepatitis and provide timely assistance to the patient, it is necessary to undergo an examination and pass special tests. The sooner the type of virus is identified, the sooner treatment will begin and the greater the chance of avoiding complications.

Hepatitis A

Viral hepatitis A is also called Botkin's disease, and the people call it "jaundice". It differs radically from other types of hepatitis, since it does not have chronic forms of the course and is transmitted by the fecal-oral route. In this way, the hepatitis A virus is similar to hepatitis E - the least common form.

Hepatitis A differs from hepatitis C in that it does not act as destructively on liver cells. Essentially, hepatitis A is an inflammatory process that involves liver cells affected by the disease. In response to the penetration of the pathogen, liver cells actively produce protective antibodies.

Hepatitis A is a very common disease that affects every fourth person. As a rule, they get sick in childhood. In childhood, the disease is easily tolerated and almost asymptomatic, in addition, immunity against it is acquired for life. But adults endure "jaundice" in severe form. Often it comes to hospitalization. As a rule, this is due to the fact that an adult has various concomitant diseases.

Today, hepatitis A is most common in countries where the climate is warm and sanitary conditions are unsatisfactory. Often those who have traveled to Turkey, Egypt, Central Asia or India also come to the hospital with symptoms of hepatitis A. Unfortunately, this form of the virus is dangerous because hepatitis A can remain viable under almost any conditions for a long time (sometimes up to several months). Even with targeted processing, the virus does not die immediately. To get rid of the virus you need:

• Boil water for fifteen to twenty minutes;
• Continuously chlorinate the infected surface for 30-40 minutes;
• Treat the infected surface with formalin continuously for three hours;
• Treat the surface with 20% ethyl alcohol.

Modes of transmission of hepatitis A

The only source of hepatitis A infection today is a sick person. With feces, he releases a virus into the environment, which enters the natural water cycle. And this means that there is a high probability that it can get into drinking water, food, and through them penetrate into the body of a healthy person. Therefore, it is necessary to thoroughly thermally process all fish and meat dishes, as well as seafood, before use.

As a rule, most infections occur in the summer, when there are a lot of fruits and vegetables - they also contain the hepatitis A virus. Therefore, before eating the products, they must be thoroughly washed under warm water. For washing, you should not use water that is not suitable for drinking, as it can also contain viruses.

Unlike hepatitis C, hepatitis A is rarely infected through. And there is a simple explanation for this: children in whom this form of hepatitis can be asymptomatic cannot be blood donors, and in adults the disease occurs in a pronounced form, so such blood will not be taken for donation.

The infection scheme is very simple: the hepatitis A virus enters the oral cavity, and from there into the digestive system. From the digestive system, the virus moves to the intestines, where it is absorbed and enters the bloodstream. Through the blood, the virus quickly enters the liver cells, where it begins to multiply and causes an inflammatory process. After that, the virus enters the intestines through the bile ducts, and from there back into the environment.

An infected person is most dangerous in such a period of time: in the first week of the disease and during the last week of the incubation period. The incubation period for hepatitis A is 14–20 days. While the virus is in the human blood, outwardly the disease manifests itself through the following symptoms: runny nose, fever, cough, general signs of intoxication. When the icteric period sets in, the virus has completely left the body by that time. And jaundice is just an immune response to a virus. But hepatitis A can occur without an icteric period.

The appearance of jaundice means that extensive liver damage has occurred (approximately 65%), therefore, in such cases, the patient is immediately hospitalized. It is not recommended to refuse hospitalization, since with improper treatment, the liver can suffer even more. If an absolutely healthy person becomes infected with hepatitis A, then he fully recovers. If there are any diseases, especially chronic forms of other forms of hepatitis, then the disease proceeds for a long time and with complications.

Some patients experience relapses after a while - the symptoms of the icteric period appear again: the sclera of the eyes and mucous membranes turn yellow, intoxication of the body occurs. In such cases, treatment begins again. Relapses occur in 25%.

Sometimes the virus leads to various complications. For example, to hemolysis - the destruction of blood cells (erythrocytes). As a result, kidney damage and acute renal failure can occur.

Diagnosis of hepatitis A

It is not difficult to diagnose this disease if it is not asymptomatic. The doctor first of all pays attention to obvious clinical manifestations - symptoms of acute respiratory disease, icteric manifestations. If necessary, the doctor prescribes an additional series of examinations.

First, donate blood. The laboratory assistant notes an increased content of certain liver enzymes and bilirubin. These indicators indicate damage to the liver tissue. Immediately after this is detected, it is necessary to conduct additional diagnostics for other forms of hepatitis viruses.

Hepatitis A treatment

It is very important to follow a dietary regimen. In the first two weeks of the disease, bed rest must be observed. This is necessary in order for the blood supply to the liver to occur better. As a result, cells damaged by the virus will recover faster. It is equally important to follow a therapeutic diet. You need to eat fractional portions, and the break between meals should not be more than two hours.

Allowed foods for hepatitis A: crackers (but by no means fresh bread), vegetable and milk soups, pasta soups based on vegetable broth, lean beef, chicken breast, lean fish (hake, pike, carp, saffron cod), vegetables, fruits, greens, oatmeal puddings and casseroles, semi-viscous cereals.

If hepatitis is mild, then additional treatment is not required. But despite this, the patient should be under the supervision of doctors. If the symptoms of the disease are pronounced, then additional detoxification therapy is carried out. This therapy helps to reduce the level of toxins in the body. These toxins accumulate as a result of impaired liver function. For detoxification, special drugs are used that are administered intravenously.

Hepatitis A, which is also called Botkin's disease, is a viral disease of liver cells that manifests itself with jaundice and intoxication. Unlike other forms of hepatitis, hepatitis A does not contribute to the chronicity of the processes of damage to liver cells and is very rarely the cause of death in people. You can defeat the symptoms of the disease after 2 weeks, and it will also take about one to two months to normalize the structure and functions of the liver after the disease.

Among the population there is no certain group of people who would be more susceptible to the disease than the rest, absolutely everyone, under equal conditions, is at risk of the disease: children, men, women of different social status and age. Moreover, in children aged from one to 10 years, there is a particularly easy transfer of symptoms of the disease, and the elderly and babies of the first year of life get sick in a complicated form.

What it is?

Hepatitis A is an RNA virus belonging to the family Picornoviridae, genus Enteroviruses. Its size is 27-30 nm. The virus has no shell. Typing was carried out in 1973. Further, four more human virus genotypes and three monkey genotypes 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, the virus, is determined by the same standard sets of reagents, can be prevented by the same vaccines.

Kinds

The following forms of viral hepatitis A are known:

• icteric;
• with obliterated jaundice;
• anicteric.

The subclinical (inapparent) form is singled out separately, which is diagnosed only on the basis of the results of laboratory tests.

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

How is hepatitis A transmitted?

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

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

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

1. Seed food. This method of transmission is of great epidemic importance. However, it is almost impossible to establish the type of dangerous food due to the long incubation period.
2. Direct contact with the patient. It is typical for people with undeveloped hygiene skills and people who are professionally in contact with them. This is how the pathogen is transmitted in preschool and school groups, boarding schools for people with disabilities.
3. Faeces, urine, discharge from the nasopharynx. 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 with food, water, airborne droplets (some authors exclude), sexual contact, non-sterile intravenous injections, and through flies - mechanical carriers of the virus.

Meanwhile, products have been identified that are more likely to be factors in the transmission of the virus:

1. Garden berries in fresh and frozen (after thawing) form, especially if shellfish, slugs are found in the beds, next to berry plants, which can accumulate the virus if the beds are watered with fertilizer 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. It is hypothetically possible in children's groups with a layering of outbreaks of respiratory diseases in groups with reduced resistance. The virus is transmitted by coughing, sneezing with discharge from the nasopharynx of a sick person.
4. Water. It is typical for territories with undeveloped communal infrastructure, poor organization of water supply, sewerage and wastewater disposal. Significantly increase the risk of infection during accidents and natural disasters.
5. parenteral. Transmission of the virus during blood transfusions, intravenous injections of solutions is not excluded, especially in an environment that precludes the observance of 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 transmission factor in homosexuals, while 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 asymptomatically. In the case of manifest (flowing with vivid symptoms) forms, several stages are distinguished in the development of the disease.

After the transfer of the infection, a stable lifelong immunity is formed. Can you get hepatitis A again? This is excluded, after the transfer of the disease, the body produces cells that protect against re-infection.

Symptoms of Hepatitis A

Viral hepatitis A usually has an acute onset. The prodromal period can proceed in different clinical variants: dyspeptic, febrile or asthenovegetative.

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

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

In the dyspeptic variant of the preicteric period, the manifestations of intoxication are weakly expressed. Typically, patients complain of various digestive disorders (belching, bitterness in the mouth, bloating), pain in the epigastric 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, adynamic and sleep disorders.

1. The transition of the disease to the icteric stage is characterized by an improvement in the general condition, normalization of body temperature against the background of the gradual development of jaundice. However, the severity of dyspeptic manifestations in the icteric period not only does not weaken, but, on the contrary, increases.
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 about 30% of cases, there is an increase in the spleen. As jaundice progresses, lighter stools and darker urine occur. After some time, the urine becomes a rich dark color, and the feces become light gray in color (acholic stools).

The icteric period is replaced by the stage of convalescence. There is a gradual normalization of laboratory parameters and an improvement in 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 they become infected (drinking unboiled water, products of unknown purity, and so on).

Laboratory studies are of decisive importance. Disease specific tests:

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

If only IgG antibodies are detected in the body, 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 of the disease 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 gives complications, usually the disease ends with a complete recovery. The most severe complication of Botkin's disease is liver failure. After recovery from hepatitis A, strong immunity is usually maintained and re-infection is not possible. However, if the treatment is not completed, and full recovery has not occurred, a second wave of the disease, a relapse, may occur. This happens in 15% of patients with Botkin's disease and can be repeated repeatedly.

Liver failure is a rare and potentially life-threatening complication of hepatitis in which the liver can stop functioning normally. It usually affects the following groups of people:

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

Hepatitis A treatment

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 peak of the disease, bed rest is mandatory. Patients are prescribed a diet consisting of easily digestible foods enriched with vitamins. In case of hemorrhagic phenomena, vikasol is prescribed intramuscularly, and vitamin K is administered orally. In the case of a protracted severe course of the disease, as well as in the presence of itching, corticosteroids are prescribed (most often prednisolone), and a 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 outflow of bile, repeated duodenal sounding is performed.

The treatment of patients with toxic dystrophy is complex, including glutamic acid, corticosteroid hormones, neomycin, a low-protein diet with plenty of fluids.

In most recorded cases, Hepatitis A ends in complete recovery, and this also applies to severe cases. However, there are patients in whom this disease acquires a chronic course, characterized by periodic exacerbations with impaired adequate functioning of the liver.

Chronic Hepatitis A can be acquired due to late hospitalization, various violations of dietary and hygienic regimens, mental and physical overstrain, alcohol consumption, as well as in the case of associated diseases (gastroenterocolitis, influenza, etc.). These forms with symptoms of liver failure for patients can be fatal.

Vaccination

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

• solution based on a neutralized disease provocateur virus;
• immunoglobulin containing antibodies to hepatitis and other diseases (infections) derived from donated blood. It is administered by droppers to people living in the same area with the patient, urgently on the first days of the discovery of the disease. This procedure greatly reduces the risk of infection.

Immunoglobulin is administered to populations most at risk of infection:

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

Diet

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

How do patients eat?

1. You can not reduce the amount of proteins, fats and carbohydrates, their ratio must be correct. Only some indigestible animal fats are limited: beef, pork and mutton.
2. You can not reduce the caloric 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 create a burden on the liver.

Disease prevention

Vaccination can prevent or significantly reduce the risk of contracting hepatitis A. A vaccine is a preparation containing non-viable viruses, the introduction of which into the body causes the production of antibodies and the activation of immunity. For the formation of protection for several years, a single vaccination is sufficient.

To achieve a longer immunity, for 20-25 years, the vaccine must be applied twice every 1-1.5 years.

It is this question that arises in a person of any age after contact with a sick person. How hepatitis A is transmitted, how likely are the chances of getting this disease, what precautions should be taken - there are quite specific answers to all these questions. By following simple and understandable rules, a person practically cannot become infected with this viral disease.

Features of the hepatitis A virus

Possible ways of infection transmission directly depend on the properties of the pathogen, in this case, certain characteristics of the hepatitis A virus. The virus multiplies mainly in the liver cells, to a lesser extent - in the biliary tract and epithelial cells of the digestive canal.

Hepatitis A virus is resistant to a number of environmental factors, namely chlorine and disinfectants, low temperature. Thus, this pathogen can penetrate into tap water and survive perfectly in it, and the infection can be transmitted despite the traditional chlorination of tap water.

Source of infection

Hepatitis A belongs to the group of anthroponotic infections with a predominant fecal-oral transmission mechanism. This means that in any situation, the source of infection is a sick person. Isolation of the virus is quite long: it begins in the incubation (latent) period and sometimes ends even a little later than the clinical recovery of the patient. Thus, a person poses a danger to others throughout the illness and even before the onset of clinical symptoms.

During viral hepatitis A, the following periods are distinguished:

• incubation (that is, hidden) - its duration is 14-30 (up to 55) days, there are no symptoms of the disease, it is during this period that the probability of becoming infected from an infected person is highest;
• short-term prodromal (preicteric) period - only 6-7 (up to 10) days; intensive isolation of the virus continues;
• the period of obvious clinical manifestations (peak period) may be limited to 10-14 days, and may drag on for a whole month or more if exacerbations or complications develop; virus isolation continues, but less active;
• the isolation of the virus in the period of convalescence (recovery) varies significantly, so it is quite difficult to talk about any average duration in this period.

Another important detail: a person with clearly yellow skin (the so-called manifest form of the disease) and without a significant change in the general condition (the so-called anicteric form) is equally dangerous. In addition, with hepatitis A, the so-called latent or abortive forms of the disease often develop. A person does not feel the signs of a disease in his own body, while he releases the pathogen into the environment and is contagious to other people.

From this point of view, for healthy people, the greatest danger is a person with an anicteric form of the disease. No anti-epidemic measures are taken in this case, since such a condition is rarely diagnosed. A person with obvious jaundice is subject to hospitalization and isolation, all objects surrounding him are disinfected.

How is hepatitis A transmitted?

Modern medical books indicate the following possible ways of infection with hepatitis A:

• water;
• food;
• contact household;
• parenteral.

All methods of transmission involve certain situations that are dangerous in terms of infection. In some cases, infection is unlikely, in others - exactly the opposite.

For hepatitis A, transmission by airborne droplets and transmissible is not typical. The airborne transmission mechanism is infection by inhalation of air containing droplets of mucus from the patient's nasopharynx. Since the hepatitis virus does not multiply in the respiratory tract, infection only through communication (without direct contact) with a sick person is impossible.

The transmissible route of transmission is infection when a sick person is bitten by a live carrier (louse, tick, mosquito, mosquito). With hepatitis A, this option is not described in modern medical literature.

waterway transmission

Most often, hepatitis A is transmitted through contaminated (contaminated by the virus) water. For the so-called "water outbreaks" are typical: a rapid increase in the number of cases, the mass nature of the disease among those living in a particular area or zone. The implementation of the waterway of transmission is possible in the following situations:

• drinking unboiled water from any source (including from the central water supply);
• the most dangerous (potentially contain a greater amount of the virus) are wells, artesian wells, old water supply networks (there is a possibility of mixing sewage and tap water);
• the use of water for washing dishes, vegetables and fruits without subsequent treatment with disinfectants or high temperatures;
• in an existing focus, the virus can enter the oral cavity during brushing your teeth and when performing other hygiene procedures.

Viral hepatitis A in the implementation of the water way of transmission can cover the whole settlements, organized children's groups of closed and open type.

Food way of transmission

Viral hepatitis A is often transmitted by food, for the implementation of which the following situations are dangerous:

• using the same dishes with a sick person;
• the use of some culinary products;
• the inclusion in the diet of poorly washed and non-heat-treated vegetables, fruits and other things.

The food transmission route is most typical for children's groups that eat in the same catering establishment (for example, a school canteen). The spread is facilitated by non-observance of hygiene skills, lack of soap, and so on.

Contact way of transmission

A sick person who infects others touches many objects through which the virus is transmitted to other people.

The contact path of transmission is implemented:

• by direct contact with a sick person;
• when using common household items (toothbrush, towel);
• in the process of playing with common toys (hard and soft);
• non-compliance with the rules of hygienic treatment of the toilet (both public and domestic).

All methods of infection with hepatitis A can be implemented both at home and in public areas. Visiting catering establishments of any class, public toilets increases the risk of infection.

Epidemiological features of hepatitis A

Hepatitis A, transmitted "through dirty hands", has a number of patterns:

• an increase in the incidence is noted in the warm season;
• the predominant age of patients is up to 35 years;
• the ease of infection makes it possible to develop an epidemic outbreak;
• after the illness, lifelong immunity remains;
• careful observance of hygiene rules makes it easy to control this infection.

The transmission of hepatitis A is a fairly easy process, but the rules for preventing this disease are also simple, understandable and accessible to a person of any age.

Related materials

infectium.ru

Hepatitis A, often referred to as Botkin's disease or jaundice, is one of the most common infectious diseases. People of all ages get sick with it, but more often children from 2 to 14 years old, men and women get infected equally often. According to statistics, more than 1.5 million people fall ill in the world every year, but doctors believe that this figure is greatly underestimated, since in childhood the disease is very often completely asymptomatic.

Causes and mechanism of infection with hepatitis A

Through the oral cavity, the hepatitis A virus enters the intestines, from where it is absorbed into the bloodstream and transferred to the liver.

The disease is caused by a virus. The mechanism of transmission of infection is fecal-oral. A sick person with feces releases into the environment a huge amount of pathogens that can get on household items (dishes, toys, door handles, elevator buttons, etc.). From contaminated objects, the causative agent of the disease most often spreads to the hands, and then to the oral cavity. That is why outbreaks of hepatitis A are so often recorded in groups, especially children, and the disease is popularly called the disease of dirty hands.

The virus can enter water and food when cooked by an infected cook. Possible seeding of vegetables, fruits and berries, which could get sewage and sewage. Bathing in polluted waters and drinking from unverified sources can also lead to infection.

The possibility of parenteral transmission of the virus exists, but this happens extremely rarely.

The virus is fairly stable in the environment. On household items at room temperature, it persists for a week, and on food in a humid environment for several months.

From the oral cavity, the virus enters the intestines, from there into the blood, and then to the liver, where it causes an inflammatory process. The causative agent multiplies in the liver cells - hepatocytes, provoking their death. This happens until the body produces enough antibodies to suppress its activity.

Symptoms of Botkin's disease

During the course of the disease, several stages are distinguished: the incubation period, preicteric, icteric and the recovery period.

The incubation period of the disease lasts up to 60 days, all this time the patient releases the pathogen into the environment and can infect others.

Prodromal (preicteric) period

During this period, the first complaints appear in patients, its duration usually does not exceed 7 days. Symptoms of general intoxication of the body appear: fever, weakness, headache, slight runny nose, sore throat. You may experience abdominal pain, nausea, vomiting, diarrhea, or constipation. Sometimes there are no symptoms of intoxication and fever, and digestive disorders come to the fore.

In some cases, the prodromal period is latent and the disease immediately manifests as jaundice.

Height period (icteric)

Patients may be disturbed by pain or heaviness in the right hypochondrium, this is caused by an increase in the liver and stretching of its capsule, and an increase in the spleen is also possible. Nausea, vomiting, flatulence, and stool disturbances may persist. Jaundice comes to the fore: the skin, mucous membranes, sclera acquire a lemon-yellow color. As a rule, with the appearance of this symptom, body temperature returns to normal. Attention is drawn to the darkening of urine (the color of dark beer) and the lightening of feces.

The duration of jaundice averages 2-4 weeks.

The period of convalescence (recovery)

Symptoms gradually disappear, liver function is restored, however, yellowness of the skin and sclera can persist for quite a long time. Full recovery occurs in 1-12 months.

Hepatitis A treatment

A patient with hepatitis A will be prescribed enterosorbents, the most famous of which is activated charcoal.

Hospitalization in the infectious diseases department is usually not required. There is no specific treatment for this disease; symptomatic agents are used. In addition, compliance with the diet indicated for liver pathologies is required (table No. 5 according to Pevzner).

Groups of drugs used in the treatment of Botkin's disease:

1. Detoxification agents: physiological saline and 5% glucose solution, with the addition of ascorbic acid, Reopoliglyukin.
2. Enterosorbents: activated carbon, Enterosgel, Smecta, Polyphepan, Polysorb, etc.
3. Hepatoprotectors: Phosphogliv, Essentiale forte, Prohepar, Heptral, Gepabene.
4. Enzyme preparations: Mezim forte, Creon, Panzinorm, Festal, Pantsitrat, Pancreatin.
5. Cholagogue agents are used only if the patient does not have cholelithiasis: Allochol, Cholenzim, Hofitol, Holosas, Flamin, etc.
6. Vitamins: any multivitamin complexes, but vitamins of group B are especially useful for liver health.

Consequences and prevention

In the vast majority of cases, this disease does not give complications and does not lead to any consequences for the body. As a result of treatment and diet, liver function is restored completely. The diet must be followed for at least six months after the symptoms disappear, several courses of treatment with hepatoprotectors and taking vitamins can also be recommended.

Exceptions are possible only in 2% of cases when patients did not follow a diet, refused therapy, chronically abused alcohol or had a previous liver disease.

Prevention of hepatitis A is not particularly difficult and primarily comes down to observing the rules of personal hygiene and food culture. Wash hands thoroughly with soap (soap for at least 20 seconds) after each use of the toilet and before eating. You should drink only boiled water, fruits and vegetables should be washed before use and preferably poured with boiling water.

If a sick person is identified in the team, then the center needs to be reorganized:

• wet cleaning of the premises with disinfectant solutions;
• disinfection of furniture and toys in kindergartens and schools, quarantine is declared for 35 days from the date of registration of the last case of the disease;
• the dishes that the patient previously used should be thoroughly washed and boiled for 15 minutes in a soda solution, and for the period of illness, he needs to allocate an individual set of dishes, which will also be carefully processed after each meal;
• bed and underwear should be boiled in a solution of washing powder before washing (15 minutes).

Hepatitis A vaccination

To date, an effective vaccine has been developed to prevent this disease, but it is not included in the list of mandatory vaccinations in our country. Several vaccines are used in Russia:

• Havrix;
• Avaxim;
• Wakta;
• HEP-A-in-VAK;
• Hepatitis A vaccine.

• travelers and people who, due to their work, are forced to visit countries with a high level of unsanitary conditions (countries in Africa and Asia);
• people who stay away from full-fledged sources of clean water and sewerage for a long time (military personnel in field exercises, refugee camps);
• food industry workers at enterprises, catering establishments, kitchens of state institutions;
• medical workers, especially in contact with the biological fluids of patients (orderlies, laboratory assistants, nurses, surgeons, infectious disease specialists).

Which doctor to contact

If a child has symptoms of infection, it is necessary to contact a pediatrician or an infectious disease specialist. In the future, consultation with a nutritionist will be useful, since proper nutrition helps liver cells recover faster.

A fragment of the program “About the most important thing” (TV channel “Russia 1”), the theme of the release is “Hepatitis A”:

Hepatitis A - symptoms, causes and treatment

myfamilydoctor.com

Many people have a question: what is the disease of dirty hands, or jaundice, or hepatitis A, how is it transmitted, what is the treatment and how to prevent infection? There is nothing surprising and difficult in the process of acquiring this disease, it is enough just to eat food or drink water with this infection to start the mechanism of rapid infection. Hepatitis A gives serious complications that can result in the death of the patient.

Hepatitis A is an acute bacterial infection caused by the hepatitis A virus (HAV). It is responsible for the processes of inflammation and damage to liver cells.

On a global scale, about 1.2-1.4 million cases of the disease are recorded per year, 20% of patients require absolute hospitalization. Mortality is low and amounts to 0.6-2.1%.

Source of entry into the body

How can you get hepatitis? In 95% of cases, infection occurs through consumption of:

• products, for example, washed in infected water - vegetables, fruits, fish, seafood;
• water contaminated with infected faeces.

Rarely, HAV infection can be transmitted:

• through unprotected sexual contact;
• in close contact with infected people (a person can become infected with hepatitis A within 7 days after the onset of symptoms of the disease), while constantly being with a carrier of the virus;
• other routes of transmission are also possible, arising from the violation of the integrity of tissues (through the blood).

Hepatitis A is often transmitted from children to adults. In them, in turn, infection is accompanied by severe symptoms. In young children, icteric skin is not observed with the disease. More than 40% of patients over the age of 40 require hospitalization. In 10-20% of patients after recovery, a relapse of the disease is observed.

How is hepatitis A transmitted in other ways? The category of people most vulnerable to hepatitis A infection are employees of sewerage organizations. In addition, people working in healthcare, in nurseries, kindergartens and in the army are at risk. The likelihood of getting a viral infection increases during a visit to countries where this disease is still common. In particular, these are the countries of Eastern Europe, the Mediterranean region and Russia.

Manifestation of symptoms

The mechanism of transmission and manifestation of the virus in the human body lasts from 15 to 50 days (about 30 days on average). After this time, symptoms of the disease appear, although sometimes after the transmission of hepatitis, the disease occurs asymptomatically. This can happen in 90% of children before the 5th year of life. If the virus is transmitted to adults, the symptoms of the disease usually get worse.

6-7 days before the appearance of the full form of the disease, the first symptoms may occur: flu, nausea, diarrhea. Then comes the most characteristic and visible symptom of the disease - jaundice (defined as a yellow tint to the skin and whites of the eyes), which may be accompanied by an enlarged liver. This happens because the body increases the production of a yellow pigment - bilirubin. Jaundice disappears in about a month.

In addition, there are:

• poor health and weakness;
• fever;
• lack of appetite;
• nausea and vomiting,
• pain in the abdomen, muscles and joints;
• skin itching;
• dark colored urine.

Acute manifestations of the disease usually disappear after a few days.

Vaccination as protection against the virus

Vaccination is the only effective way to prevent hepatitis A. After a full cycle of vaccination, antibodies are formed in the body that can protect against the virus. Two doses of hepatitis B vaccine are needed for life, administered over a 6 to 12 month schedule.

You should be aware that in accordance with the current hepatitis A vaccination program, immunization is recommended:

• people living in countries with high and medium prevalence of the disease;
• persons engaged in the production and distribution of food products, in the disposal of waste and liquid sewage, as well as in the repair and maintenance of devices intended for this purpose;
• children of preschool, school age and young people who did not have hepatitis A.

Diagnosis of the disease and methods of treatment

If hepatitis is suspected, a blood test for the hepatitis A virus is performed. If infection has occurred, an increased activity of alanine enzymes is noted in the blood plasma, an increase in the concentration of bilirubin is observed. The final diagnosis and clinic of hepatitis A is based on the results of a serological study, which is carried out to determine antibodies.

This disease resolves on its own, within a maximum of 6 months. There is no drug that is designed to eliminate the virus in the body. The patient is advised to limit physical activity, proper nutrition and hydration. In case of increased itching, the patient can be given cholestyramine.

Complications caused by hepatitis A are very dangerous and can lead to death. These include cholestatic jaundice, bone marrow aplasia, acute anemia, hemolytic hepatitis.

In addition, relapses may occur (in 10-20% of cases). Infection (VAG) does not lead to the development of chronic hepatitis, cirrhosis and primary liver cancer.

Diet and fluid therapy

A suitable diet for adults should contain a daily nutrient intake of 2000 kcal (70% easily digestible carbohydrates, 10-20% fat and 10% protein) with gradual expansion according to individual tolerance. You can return to a normal diet after six months. In case of symptoms: severe vomiting and dehydration of the body, feeding through a tube or parenteral administration is necessary. It is better to exclude alcohol from the diet during the treatment period.

During the acute manifestation of the disease, drugs that are metabolized in the liver or cause cholestasis should be avoided.

Preventive measures should be followed:

• observe the rules of hygiene during cooking;
• eat dishes after heat treatment (boiled, baked, fried);
• avoid poorly fried meat, also crustacean meat, do not buy food on street stalls;
• drink only bottled or boiled water (especially while abroad);
• protect food from insects.

It is quite difficult to neutralize the source of infection during the period of virus activation. It is necessary to identify the disease at an early stage of the disease.

To prevent the spread of infection, it is worth observing the rules of hygiene in the production and preparation of food, as well as drinking healthy, clean water.

Boosting immunity is necessary for the body to resist infection. Immunity is strengthened by introducing human gamma globulin to children under 14 years of age in case of contact with a patient with hepatitis A or preventive vaccinations against this virus.

OGepatite.ru

Hepatitis A is a disease of a viral nature, in which an inflammatory process occurs in the liver cells and their subsequent necrosis occurs.

This type of hepatitis is the most common of all forms of this disease. This infection is widely known under the name Botkin's disease. The most commonly used popular name is jaundice.

The high resistance of the virus in the external environment determined the increased susceptibility of the human body to it. Its cells are able to remain active for several weeks at room temperature. Placing the virus in a freezer extends its viability by several years.

It is so strong that it even tolerates some industrial inactivation methods. The most effective treatment today is to boil food for more than 5 minutes.

When ingested, the virus travels through the bloodstream to the liver. There, by binding to a special protein CD81, it penetrates into the hepatocyte cell. In its membrane, the synthesis of virus RNA begins, which occurs until the cell dies on its own or is destroyed by the body's immune system as infected.

After its decay, the synthesized viruses penetrate into new cells. The death of liver cells begins at a tremendous speed. With the breakdown of hepatocytes in the blood, an increase in the level of bilirubin occurs, which is formed during the breakdown of hemoglobin in erythrocytes. Normally, it is excreted in the urine, and with hepatitis it accumulates in the blood, causing yellowing of the skin and sclera of the eyes.

Rice. The proportion of hepatitis A in the structure of the incidence of hepatitis in the population.

The source of infection is a sick person. The most at risk of infection are children from 3 to 7 years old, attending childcare facilities, the elderly and people with malnutrition.

The main modes of transmission of infection

Unlike other hepatitis, this form of infection is an enterovirus, it is transmitted by the fecal-oral route and has its own ways of infection.

The patient becomes infected if the infection enters the reservoir with the secretions of a sick person. An increase in the incidence is observed in autumn and spring, during the period of rains and floods. High-quality wastewater treatment should be on the way to the growth of morbidity.

In regions with an undeveloped sewerage system, many residents carry hepatitis A in childhood. If there are foods washed with contaminated water, the risk of infection also increases.

Source - insufficiently thermally processed seafood (fish, shellfish, mussels and others). The largest number of virus cells is found in the filtration systems and gills of aquatic inhabitants. In the process of preparing food, an infected person must observe meticulous hygiene. Especially when creating snacks, raw and dried foods, salads.

Contact

This path is dangerous when communicating with patients only in case of violation of the rules for caring for them at home, in hospitals, nursing homes, orphanages. It is especially likely to become infected when changing diapers and other close contact with the urine and feces of the patient.

There is no reliable information about infection through the saliva of an infected person, however, studies have shown the presence of hepatitis A in low concentrations in the salivary secretion.

Infection of a person during normal sexual contact does not occur. Hepatitis A was not detected in either semen or vaginal secretions. However, with homosexual intercourse in men and anal intercourse, the likelihood of getting an infection increases many times over.

There is information about several cases of infection from mother to child. However, there is no evidence that infection occurred as a result of the penetration of the virus through the placental barrier.

Parenteral (through the blood)

It is possible when transfusing donor blood taken from a patient in the prodromal (preicteric) period and preparing intermediate products from such blood (for example, plasma). The modern multi-stage quality control system for donated blood has minimized the factor of hepatitis A infection through blood transfusion.

Infection of patients with drug addiction when using sterile syringes also does not occur. In this case, the spread of infection is most often possible if the rules of personal hygiene are not followed (through dirty hands).

Risk groups for hepatitis A

Based on the analysis of the duration of contact with the causative agent of hepatitis A, several categories of people at risk are distinguished, namely:

• people living in areas with poor wastewater treatment;
• persons from socially disadvantaged segments of the population;
• housing and communal services workers associated with the cleaning of sewer systems;
• residents and tourists of Africa, Latin America, Central and Southeast Asia;
• family members of a patient with hepatitis and, to a lesser extent, his social circle;
• medical staff of infectious diseases clinics, preschool institutions, shelters, boarding schools, nursing homes;
• drug addicts;
• homosexuals, people who practice anal sex.

Symptoms of the disease and periods of contagiousness of the patient

A distinctive feature of hepatitis A is its fairly mild course, minimal risk of complications if all doctor's recommendations are followed, and a rare transition to a chronic form. The course of the disease consists of the following stages:

• The incubation period lasts from 15 to 30 days. Runs asymptomatic.
• The preicteric period lasts 3-6 days. During this short period there are:
  • fever, body aches;
  • headache;
  • weakness, fatigue;
  • nausea and pain in the liver;
  • diarrhea or constipation, increased gas formation in the intestines.

Often at this stage, hepatitis A can be confused with the course of a common ARVI. However, this disease has a number of distinctive features.

Table of distinguishing features

• The icteric period lasts 1-2 weeks. It develops against the background of loss of appetite and nausea. It is characterized by darkening of urine (more often to the color of dark beer), then yellowing of the sclera. During this period, the feces brighten, the yellowness of the skin intensifies.
• The period of extinction of hepatitis A. Begins with the restoration of appetite, reducing nausea. Urine becomes light, and feces darken. The amount of virus in the secretions decreases, the liver gradually acquires normal size.

There is also an anicteric form of hepatitis, it occurs three times more often than usual, while the skin and sclera do not turn yellow so much, only morning urine darkens.

There is no specific treatment for hepatitis A. Subject to diet, bed rest, the disease lasts less than two months. A patient with hepatitis A is a source of infection at the end of the incubation period and during the entire preicteric period (about 10-14 days).

Knowing how hepatitis A is transmitted can significantly reduce the number of infection factors.

Prevention for hepatitis A includes:

1. Early diagnosis of diseases in children's, social and medical institutions. Inspection of children in the preschool educational institution at least once a week.
2. Control of the infected and their maximum isolation and constant laboratory examination.
3. Compliance with personal hygiene and general sanitary requirements in all institutions.
4. Refusal to water garden plants with stagnant water.
5. Processing food with boiled water.
6. Processing the toilet and dishes of a patient with hepatitis A.
7. Use of high quality drinking water.
8. Vaccination according to epidemic indications with an inactivated vaccine. There are schemes for double (with an interval of 1 year) and triple administration of the vaccine (1 month and 6 months after the previous vaccination). Belgian vaccines Havrix 1440 for adults and Havrix 720 for children from two years old, Avaxim (France), Vakta (USA) are popular in Russia. The Russian vaccine GEP-A-in-VAK is used for children from the age of three.

Despite the fact that the most likely factors of infection with hepatitis A (water, seafood, unprocessed food) are found everywhere, protecting yourself with elementary preventive measures and timely vaccination, you can successfully avoid infection.

Yakutina Svetlana

Project expert VseProPechen.ru

VseProPechen.ru

Hepatitis A is an acute inflammation of the liver caused by the hepatitis A virus. Hepatitis A differs from others in that it has a favorable outcome and never becomes chronic.

S. P. Botkin believed that hepatitis A is caused by an infection, so the people call the disease Botkin's disease. He also associated jaundice with cirrhosis of the liver. But, only in 1973, the American S. Feinstone proved that hepatitis A is caused by a virus and was able to identify it.

The hepatitis A virus is often the cause of epidemics, especially in countries and regions where sanitary and hygienic living conditions are poor - Asia, Africa, Latin America. Since 1996, the incidence of hepatitis A has been gradually decreasing in Russia. In 2015, it amounted to 4.5 100 thousand. population.

Interesting! The highest incidence rates (13.6 per 100 thousand population) are in Dagestan, Chelyabinsk, Transbaikalia, Krasnodar Territory and Samara Region.

Hepatitis A is more common in childhood. Babies do not get hepatitis, as they receive immunity from their mother's milk. Children often have anicteric forms of the disease. Outbreaks of Botkin's disease are observed in the hot season - summer, early autumn.

People who have been ill with hepatitis A develop active lifelong immunity.

Hepatitis A is caused by the HAV virus (hepatitis A virus), which is a member of the Picornaviridae family.

The hepatitis A virus is an RNA-containing virus, round in shape with a diameter of 27-30 nm.

The HAV virus is stable in the environment. It tolerates drying well and remains active for a week. It is stored in food and water for 3 to 10 months.

Withstands heating up to 60°C for 12 hours. At a temperature of -20 ° C and more, it can be stored for more than one year.

Hepatitis A virus dies when boiled for more than five minutes. Disinfectant solutions of bleach, potassium permanganate, chloramine, formalin also have a detrimental effect on the virus.

How is the hepatitis A virus transmitted?

Hepatitis A can be contracted through water, food, dishes and other household items. This mechanism of infection is called fecal-oral. The transmissible route of transmission (transmission of infection by flies) and parenteral (blood transfusions, intravenous injections) are not excluded.

The HAV virus is excreted into the external environment from the patient with feces and urine.

The source of the hepatitis A virus can be the following people:

• sick people during the incubation period, when there are no signs of hepatitis A;
• patients during the prodromal period, when the first symptoms of the disease appear;
• patients during the height of hepatitis A (icteric stage);
• patients with an asymptomatic course of the disease or anicteric form.

In other words, the patient is contagious from the beginning of the incubation period to the first days, which is approximately a month and a half.

The hepatitis A virus can enter your body in the following situations:

• Swimming in pools and open water.
• Eating unwashed vegetables, fruits, berries, etc. Many owners use human feces to fertilize strawberries.
• Cooking dishes from raw shellfish and mussels, which are caught in reservoirs contaminated with feces.
• Drinking untreated water or using it for domestic needs.
• Use of household items of a patient with hepatitis A, which are untreated with a disinfectant.
• Sexual relations with a patient with hepatitis A.
• Use of non-sterile syringes for intravenous injections.

Who is at risk for hepatitis A?

• Persons who do not follow the rules of personal hygiene.
• People living in boarding schools, barracks, hostels.
• Refugees, military personnel and others who live in poor sanitary or field conditions (no running water, no sewerage).
• Tourists who visit countries with a high incidence of disease without prior vaccination against hepatitis A;
• Persons living with a patient with hepatitis A.
• People who in their professional activities come into contact with patients with hepatitis A.
• Persons living in disaster areas who do not have access to clean drinking water.

Pathogenesis (mechanism of development) of hepatitis A

The hepatitis A virus enters the blood through the lining of the digestive tract. The period from when the hepatitis A virus enters the body until the first signs of the disease appear is called the incubation period.

Interesting! The incubation period of hepatitis A can last from a week to two months, with an average of 2-4 weeks.

With the blood, the hepatitis A virus enters the liver cells, where it invades their ribosomes and programs them so that they begin to produce copies of the virus. "Newborn" viral cells with bile get back into the digestive tract, and are excreted into the external environment with feces and urine.

Liver cells, in which the virus temporarily resided, die and are replaced by connective tissue cells. After that, the pathogen penetrates into a healthy hepatocyte. This could go on until the liver had completely turned into connective tissue.

But, the body produces a sufficient amount of antibodies to the antigens of the pathogen, and they destroy the virus.

In the clinical course of hepatitis A, the following stages (periods) are distinguished:

1. incubation stage (2-4 weeks);
2. prodromal stage, when the first signs of the disease appear (on average, a week);
3. icteric stage or peak stage of hepatitis A (average 2-3 weeks);
4. stage of recovery or convalescence (on average up to a year).

Hepatitis A can have a typical or atypical course.

The typical course, depending on the severity of symptoms, can be mild, moderate and severe.

Atypical hepatitis A occurs in two forms - anicteric and subclinical.

Symptoms of hepatitis A with a typical course, depending on the stage of the disease, may be as follows:

1. The incubation period is asymptomatic;

2. Prodromal period:

• general weakness;
• fast fatiguability;
• decrease or lack of appetite;
• increase in body temperature up to 38-39 ° C, chills, increased sweating.

3. Icteric period:

• yellowing of the sclera, mucous membrane of the tongue, skin;
• skin itching;
• dry skin;
• urine the color of dark beer;
• acholic (discolored) feces;
• heaviness and pain in the right hypochondrium;
• nausea, vomiting, flatulence, constipation, heaviness in the epigastrium;
• muscle pain (myalgia).

4. The period of convalescence: the patient's condition improves, the disease recedes, and the liver function normalizes.

Important! If your skin is yellow, your urine is dark, and your feces are discolored, contact your infectious disease specialist immediately.

The anicteric form of hepatitis A resembles a mild intestinal infection. Patients may have a short-term increase in body temperature up to 37-38°C. There may also be nausea, general weakness, loss of appetite, pain in the right hypochondrium and epigastrium, the liver and spleen increase. In the anicteric form, there is no jaundice.

The disease in the anicteric form is diagnosed on the basis of laboratory tests of blood, urine and feces. I identify the virus by detecting immunoglobulins M or genetic material in the patient's blood.

The subclinical form has no manifestations. The disease is detected mainly in persons who have been in contact with patients with hepatitis A by conducting biochemical and serological blood tests.

The appearance of the patient, complaints of darkening of the urine and discoloration of the feces do not make it possible to make a mistake with the diagnosis. It is imperative to clarify with the patient whether he had contact with a patient with hepatitis A, whether he has visited the countries of Asia, Africa, Latin America in the last month.

On examination, in addition to yellowing of the skin, an increase in the liver, and sometimes the spleen, is determined. The liver is tender on palpation.

In the atypical course of the disease, complaints and examination do not give anything, therefore, it is necessary to conduct an additional laboratory and instrumental examination of the patient.

Laboratory diagnostics:

• In the complete blood count, there may be a slight decrease in the number of white blood cells (leukopenia), an increase in the number of lymphocytes (lymphocytosis) and an acceleration of the erythrocyte sedimentation rate (ESR). These changes are nonspecific and are observed with any viral infection, so a complete blood count is not informative.
• A biochemical blood test will suggest that the inflammatory process is localized in the liver. In hepatitis A, there is an increase in the amount of bilirubin due to the direct fraction, an increase in ALT activity by 10 times or more, a positive Thymol test.
• In the general analysis of urine, bilirubin and urobilin are determined.
• There is no stercobilin in the coprogram, which gives the feces its natural color.
• Polymerase chain reaction (PCR) can detect genetic material (RNA) in the blood and identify the hepatitis A virus.
• An enzyme immunoassay is performed to detect antibodies to the hepatitis A virus. Immunoglobulins M are detected in patients with hepatitis A. Immunoglobulins G are present in the blood of those who have had Botkin's disease or have been vaccinated.

Instrumental and hardware diagnostics:

• An ultrasound examination of the abdominal organs is performed to determine the size of the liver and its structural changes.
• Computed and magnetic resonance imaging are used in rare cases.

Mild hepatitis A can be treated at home. Patients with moderate and severe forms are hospitalized in the infectious diseases department or hospital. Etiotropic treatment of hepatitis A has not been developed.

Basic therapy includes the following:

• bed or semi-bed rest. Limitation of physical activity;
• diet food. It is recommended to drink plenty of fluids - about 2-3 liters. For this, strong tea with milk, rosehip broth, freshly squeezed fruit juices, compotes, fruit drinks, alkaline mineral waters are excellent. It is necessary to limit or exclude the use of fried, smoked, pickled dishes, pork, lamb. Alcoholic drinks are prohibited. The menu of a patient with hepatitis should consist of vegetable soups, chicken, veal, rabbit, low-fat fish. Food should be cooked with gentle heat treatment methods (boiling, baking, steaming);
• with severe intoxication, detoxification therapy is prescribed - enterosorbents (Enterosgel, white coal, etc.), infusions of 5% glucose, Ringer's solution, etc., in severe cases - plasmapheresis;
• hepatoprotectors - Essentiale, Karsil, Gepabene, Heptral.
• in violation of the outflow of bile and severe jaundice - Tocopherol acetate, PRRretinol, enterosorbents, Ursodex, Ursofalk;
• vitamin therapy (vitamins B, C, etc.);
• with constipation, it is necessary to normalize the stool - Dufalac, Normaz;
• in severe liver damage, glucocorticosteroids are prescribed - Prednisolone, Dexamethasone.

Prevention of hepatitis A

1. The following actions are carried out in the focus of infection:

• the patient's dishes are boiled in a 2% soda solution for 15-20 minutes;
• bed linen and clothes of the patient should be boiled with 2% soapy water for 15-20;
• Floors, furniture, doorknobs, toilets and washbasin faucets should be cleaned with a hot 2% soap or soda solution.

2. Be sure to monitor contact:

• in the kindergarten group, quarantine is introduced for 35 days from the moment the last sick child is detected;
• monitoring of all those who have been in contact with a patient with hepatitis A;

3. To identify anicteric and subclinical forms, PCR or ELISA is carried out for contact;

4. In order to create artificial active immunity, hepatitis A vaccination is carried out. For this, human immunoglobulin or hepatitis A vaccine is introduced into the body. Vaccination is carried out at will or by people at risk.

5. Compliance with the rules of personal hygiene:

• wash hands after going to the toilet;
• drink boiled or purified water;
• be sure to wash vegetables, fruits, berries and herbs before eating them;
• avoid swimming in water bodies into which sewage water could flow;
• subject to thorough heat treatment of products when cooking. Measures regarding contact persons.

Consequences of hepatitis A

Complications with Botkin's disease are very rare. Mostly in debilitated patients and those who violate the regimen, diet, doctor's recommendations.

Biliary dyskinesia, inflammation of the gallbladder, pancreatitis may occur.

Hepatitis A, although it is considered a disease with a favorable outcome, still requires a serious attitude in order to avoid complications and a long recovery period.

Hepatitis A - what is it and how is it transmitted? Hepatitis A is the same “jaundice” that parents warn every child about. 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, the symptoms, the causes of the disease.

What is hepatitis A

The disease has been known since ancient times, but before doctors did not know what hepatitis A is, what kind of disease it is. 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 the infectious nature of the disease. In his honor, hepatitis A is also sometimes called Botkin's disease. Currently, medicine has accumulated a lot of data about hepatitis A, what it is and how it is transmitted, how to treat, 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" - translated from Latin means "small", which is the main characteristic of this infectious agent. It is really very small, its diameter is only 30 nm. Outwardly, the virus is a protein ball, inside of which is an RNA molecule. It is still not known exactly how the virus enters the liver cells once in the body. However, it does such a thing without much difficulty and, by transferring its genetic code to the ribosomes of hepatocytes, causes them to produce new viruses. The result is the death of liver tissue. And the viruses produced by hepatocytes enter the bile and from there - into the human intestine.

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

Powerless against the virus and many antiseptics, such as ethyl alcohol. Can deactivate the virus:

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

Hepatitis A accounts for approximately 40% of all cases of viral hepatitis. The disease is mainly characteristic of hot developing countries, where there are no clean sources of drinking water, and the hygienic culture of the population leaves much to be desired. A large number of cases is due to the illiteracy of the local population. People do not 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 have been ill with 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 the incidence rate in Europe and North America is relatively low. What makes this circumstance dangerous enough for an individual. After all, there is a high risk that the disease will strike a person in old age, when the likelihood of a 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 is in August-late September.

The disease has only an acute form, the chronic form is absent. 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 been ill with hepatitis retains lifelong immunity.

With proper treatment and 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 of the deaths from the disease are associated with the presence of other viral hepatitis (B or C), severe somatic diseases, and immunodeficiency states in the patient. A fatal outcome is also possible due to improper treatment or the patient's lifestyle (for example, drinking alcohol).

How hepatitis A is 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 under adverse conditions, it is found in large quantities in various water bodies. Therefore, the main reason for contracting the disease is the use of unboiled water contaminated with the virus. Moreover, not only drinking, but also water used for other procedures, such as brushing teeth, washing hands, dishes, vegetables and fruits. Infection is also possible after swimming in polluted waters.

If uninfected people are in the same room with the patient, then the virus can be transmitted through household items (door handles, dishes, towels).

Hematogenous infection is also possible, but such cases are rare. This mode of distribution is more typical for developed countries. In particular, it affects people who inject drugs. It is also possible to get infected during anal sex.

Terms of the disease

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

• patient's age;
• the amount of the virus that has entered the body;
• state of immunity;
• methods of treatment;
• the presence of concomitant diseases in the patient, especially the liver.

Gradually, the symptoms of the disease disappear, and the patient recovers. However, in rare cases, relapses can also occur, when an outwardly recovered person may again have 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 the incubation period. 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 carry 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 the elderly it makes up a few 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. With a fulminant form, acute liver failure quickly develops and a fatal outcome is very likely.

How does it manifest

After the incubation period, during which there are no signs of the disease, the 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 those of the flu - high fever, headaches. The temperature usually rises to values ​​of + 38-39 ° С. However, in many cases there is no such symptom.

Then there are signs of indigestion - nausea, vomiting, stool disorders, pain in the abdomen. Bitterness appears in the mouth, the color of urine and feces changes. Due to the presence in the urine of the bile pigment - bilirubin, the urine becomes dark in color. What can not be said about feces, since, on the contrary, it becomes discolored due to a lack of the stercobilin pigment supplied with bile, which is normally responsible for the dark color of excrement. Unpleasant sensations may appear in the region of the right hypochondrium - heaviness or dull pain, as well as pain in muscles and joints, skin itching.

The next stage in the development of signs of the disease is the appearance of jaundice, which occurs only on the 5-10th day. Due to an excess of bilirubin in the blood, the skin, mucous membranes and eyeballs of the patient become yellow. A similar phenomenon is observed with an increase in the concentration of bilirubin in the blood to 200-400 mg / ml. After the onset of jaundice, the temperature usually subsides. This syndrome will soon pass.

By the time jaundice appears, the patient ceases to secrete viruses and be contagious to others. Therefore, bed rest for the patient can be changed to half-bed. The icteric period lasts from 5 to 30 days and ends with a recovery period.

In severe cases of the disease, nosebleeds, hemorrhages on the skin can be observed, which should be feared, as they are evidence of a hemorrhagic syndrome.

Also, with hepatitis A, an increase in the liver is usually observed, and in 30% of cases, an increase in the spleen. The latter is associated with an increased load on the immune system, an important component of 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 precisely with hepatitis A, and not, say, with the serum form of the disease. To identify the disease, it is usually not enough just to examine the patient. Although many characteristic signs (jaundice, liver enlargement) indicate an inflammatory process in the liver, however, they may not always accompany the disease.

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

Biochemical and general blood tests are also carried out. An elevated level of liver enzymes - bilirubin, AST and ALT indicates pathological processes in the liver. With the disease, there is also an increase in the prothrombin index, an increase in ESR, and 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 aggravated by severe liver failure. Children under one year of age 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, interferon injections can be made to the patient. 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 to drink plenty of water - to detoxify the body. Medicines are prescribed to the patient only by a doctor. A large number of drugs can create problems for a patient's diseased liver. In particular, according to WHO recommendations for hepatitis A, paracetamol should not be used to reduce fever.

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

diet for hepatitis

Diet is also an important element of treatment. From the patient's diet, it is necessary to exclude fried, salty and spicy foods, canned food, indigestible foods, mushrooms, animal fats (fatty meats and fish), fresh bread, pastries, coffee and chocolate, carbonated drinks.

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

Diets 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 must be well aware of the disease, know what it is, how it is transmitted, the symptoms of the disease.

Measures to provide the population with clean drinking water, as well as to dispose of wastewater and food waste, control over compliance with sanitary and hygienic standards by employees of public catering establishments and medical personnel contribute to reducing the incidence of hepatitis across countries and regions.

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

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 your teeth;
• washing hands regularly, especially after going to the toilet;
• washing vegetables and fruits.

Particular caution should be exercised by those who visit southern countries and taste local exotic food. In particular, the hepatitis A virus can live in some shellfish caught in contaminated water. Therefore, one 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, for preventive purposes, vaccination against hepatitis A is possible. The vaccine contains neutralized viruses. There are several categories of citizens who are vaccinated on a mandatory basis - doctors, workers in the food industry and catering establishments, the military, 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. Re-vaccination is necessary to enhance the effect. It is done 6 months after the first. A series of two vaccinations, however, does not provide lifelong immunity. It is usually valid for 8 years.

Forecast and consequences

The prognosis of hepatitis is favorable. However, complete recovery from the effects of the disease can take a long time.

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

After the disease, the patient remains immune for life, so re-infection with hepatitis is unlikely. However, an active disease can cause some harm to the liver and the consequences of hepatitis can be felt by a person who has had it all his life.

Possible complications of hepatitis A include:

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