What is the mode of transmission of hepatitis a. What are the routes of infection with hepatitis A? Given the etiological factor

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

Hepatitis C is an inflammation of the liver of a viral origin, clinical manifestations of which in most cases are significantly delayed in time or so little expressed that the patient himself may not notice that a “gentle” killer virus has settled in his body, as the hepatitis C virus (HCV) is commonly called.

Once upon a time, and this continued until the end of the 80s of the last century, doctors knew about the existence of a special form of hepatitis that did not fit into the concept of "Botkin's disease" or jaundice, but it was obvious that it was hepatitis that affects the liver in no way less than their own " brethren" (A and B). An unfamiliar species was called hepatitis neither A nor B, since its own markers were still unknown, and the proximity of pathogenesis factors was obvious. It was similar to hepatitis A in that it was transmitted not only parenterally, but suggested other routes of transmission. The similarity with hepatitis B, called serum hepatitis, was that it could also be infected by receiving someone else's blood.

At present, everyone knows that, called neither A nor B hepatitis, is open and well studied. This is hepatitis C, which in its prevalence is not only not inferior to the infamous HIV infection, but also far exceeds it.

Similarities and differences

Botkin's disease was previously called any inflammatory liver disease associated with a certain pathogen. The understanding that Botkin's disease can represent an independent group of polyetiological pathological conditions, each of which has its own pathogen and the main route of transmission, came later.

Now these diseases are called hepatitis, but a capital letter of the Latin alphabet is added to the name according to the sequence of discovery of the pathogen (A, B, C, D, E, G). Patients often translate everything into Russian and indicate hepatitis C or hepatitis D. However, the diseases assigned to this group are very similar in the sense that the viruses they cause have hepatotropic properties and, when ingested, affect the hepatobiliary system , each in its own way violating its functional abilities.

Different types of hepatitis are unequally prone to chronization of the process, which indicates the different behavior of viruses in the body.

Hepatitis C is considered the most interesting in this regard., which for a long time remained a mystery, but even now, being widely known, it leaves secrets and intrigues, since it does not make it possible to give an accurate forecast (it can only be assumed).

Inflammatory processes of the liver caused by various pathogens do not differ in relation to sex, therefore, they equally affect both men and women. There was no difference in the course of the disease, however, it should be noted that in women during pregnancy, hepatitis can be more severe. In addition, the penetration of the virus in recent months or the active course of the process can adversely affect the health of the newborn.

If liver diseases of viral origin still have a clear similarity, then considering hepatitis C, it is advisable to touch on other types of hepatitis, otherwise the reader will think that only the “hero” of our article should be afraid. But through sexual contact, you can become infected with almost every type, although this ability is attributed more to hepatitis B and C, and therefore they are often referred to as sexually transmitted diseases. In this regard, other pathological conditions of the liver of viral origin are usually kept silent, since their consequences are not as significant as the consequences of hepatitis B and C, which are recognized as the most dangerous.

In addition, there are hepatitis of non-viral origin (autoimmune, alcoholic, toxic), which should also be mentioned, because one way or another, they are all interconnected and significantly aggravate each other.

How is the virus transmitted?

Depending on which way the virus could "run across" to a person and what things it will start to "do" in the body of a new "host", different types of hepatitis are distinguished. Some are transmitted in everyday life (through dirty hands, food, toys, etc.), appear quickly and pass, basically, without any consequences. Others, called parenteral, having the potential of chronicity, often remain in the body for life, destroying the liver to cirrhosis, and in some cases to primary liver cancer (hepatocarcinoma).

In this way, hepatitis according to the mechanism and routes of infection are divided into two groups:

Having an oral-fecal transmission mechanism (A and E); Hepatitis, for which the blood-contact (hemopercutaneous), or, more simply, the path through the blood, is the main one (B, C, D, G - a group of parenteral hepatitis).

In addition to the transfusion of infected blood or flagrant non-compliance with the rules for medical manipulations associated with damage to the skin (the use of insufficiently processed instruments, for example, for acupuncture), often there is the spread of hepatitis C, B, D, G and in other cases:

Various fashionable procedures (tattoos, piercings, ear piercings) performed by a non-professional at home or in any other conditions that do not meet the requirements of the sanitary and epidemiological regime; By using one needle for several people, this method is practiced by syringe addicts; Transmission of the virus through sexual intercourse, which is most likely for hepatitis B, hepatitis C in such situations is transmitted much less frequently; Cases of infection by the "vertical" route (from mother to fetus) are known. Active disease, acute infection in the last trimester, or HIV carriers greatly increase the risk of hepatitis. Unfortunately, up to 40% of patients cannot remember the source that “gifted” the hepatitis B, C, D, G virus.

The hepatitis virus is not transmitted through breast milk, so women with hepatitis B and C can safely feed their baby without fear of infecting him.

We can agree that the fecal-oral mechanism, water, contact-household, being so interconnected, cannot exclude the possibility of transmission of the virus and sexually just as well as other types of hepatitis transmitted through the blood, have the ability to penetrate into another organism during sex.

Signs of an unhealthy liver

After infection, the first clinical signs of different forms of the disease appear at different times. For example, the hepatitis A virus declares itself in two weeks (up to 4), the causative agent of hepatitis B (HBV) is somewhat delayed and manifests itself in the interval from two months to six months. As for hepatitis C, it the pathogen (HCV) can detect itself after 2 weeks, after 6 months, or it can “hide” for years, turning a healthy person into a carrier and source of infection for a rather serious disease.

The fact that something is wrong with the liver can be guessed from the clinical manifestations of hepatitis:

Temperature. With it and the phenomena of influenza infection, hepatitis A usually begins (headache, pain in the bones and muscles). The onset of HBV activation in the body is accompanied by subfebrile temperature, and with C-hepatitis it may not rise at all; Jaundice varying degrees of expression. This symptom appears a few days after the onset of the disease, and if its intensity does not increase, then the patient's condition usually improves. A similar phenomenon is most characteristic of hepatitis A, which cannot be said about hepatitis C, as well as toxic and alcoholic hepatitis. Here, a more saturated color is not attributed to signs of an impending recovery, rather, on the contrary: with a mild form of inflammation of the liver, jaundice may be absent altogether; Rashes and itching more characteristic of cholestatic forms of inflammatory processes in the liver, they are caused by the accumulation of bile acids in tissues due to obstructive lesions of the hepatic parenchyma and injury to the bile ducts; Decreased appetite; Heaviness in the right hypochondrium, possible enlargement of the liver and spleen; Nausea and vomiting. These symptoms are more characteristic of severe forms; Weakness, malaise; Joint pain; dark urine, dark beer-like, discolored stools are typical signs of any viral hepatitis; Laboratory indicators: liver function tests (AlT, AST, bilirubin), depending on the severity of the course, can increase several times, the number of platelets decreases.

During viral hepatitis, 4 forms are distinguished:

Mild, more often characteristic of hepatitis C: jaundice is often absent, subfebrile or normal temperature, heaviness in the right hypochondrium, loss of appetite; Moderate: the above symptoms are more pronounced, there is pain in the joints, nausea and vomiting, there is practically no appetite; Heavy. All symptoms are present in a pronounced form; Fulminant (fulminant), not found in hepatitis C, but very characteristic of hepatitis B, especially in the case of coinfection (HDV / HBV), that is, a combination of two viruses B and D that cause superinfection. The fulminant form is the most dangerous, because as a result of the rapid development of massive necrosis of the hepatic parenchyma, the death of the patient occurs.

Hepatitis, dangerous in everyday life (A, E)

In everyday life, first of all, liver diseases that have a predominantly fecal-oral route of transmission can lie in wait, and these are, as you know, hepatitis A and E, so you should dwell a little on their characteristic features:

Hepatitis A

Hepatitis A is a highly contagious infection. Previously, it was simply called infectious hepatitis (when B was serum, and others were not yet known). The causative agent of the disease is a small but incredibly resistant virus containing RNA. Although epidemiologists note susceptibility to the pathogen as universal, it is predominantly children who have stepped over the age of one who are ill. Infectious hepatitis, triggering inflammatory and necrobiotic processes in the hepatic parenchyma, giving symptoms of intoxication (weakness, fever, jaundice, etc.), usually ends in recovery with the development of active immunity. The transition of infectious hepatitis to a chronic form practically does not occur.

Video: hepatitis A in the program "Live healthy!"

Hepatitis E

Its virus also belongs to RNA-containing ones, it “feels good” in the aquatic environment. It is transmitted from a sick person or carrier (in the latent period), there is a high probability of infection through food that has not undergone heat treatment. Mostly young people (15-30 years old) living in the countries of Central Asia and the Middle East get sick. In Russia, the disease is extremely rare. The contact-household route of transmission is not excluded. Cases of chronicity or chronic carriage have not yet been established or described.

Hepatitis B and dependent hepatitis D virus

Hepatitis B virus (HBV), or serum hepatitis, is a complex DNA-containing pathogen that prefers liver tissue for its replication. A tiny dose of infected biological material is enough to transmit the virus, why this form passes so easily not only during medical manipulations, but also during sexual intercourse or in a vertical way.

The course of this viral infection is multivariate. It may be limited to:

Carrying; Give acute liver failure with the development of a fulminant (fulminant) form, often taking the life of the patient; When the process is chronic, it can lead to the development of cirrhosis or hepatocarcinoma.

adverse development of hepatitis B

The incubation period of this form of the disease lasts from 2 months to six months, and the acute period in most cases has symptoms characteristic of hepatitis:

Fever, headache; Decreased performance, general weakness, malaise; Pain in the joints; Disorder of the function of the digestive system (nausea, vomiting); Sometimes rashes and itching; Heaviness in the right hypochondrium; Enlargement of the liver, sometimes - the spleen; Jaundice; A typical sign of liver inflammation is dark urine and discolored stools.

Combinations of HBV with the causative agent of hepatitis D (HDD) are very dangerous and unpredictable, which was previously called delta infection - a unique virus that is invariably dependent on HBV.

The transmission of two viruses can be simultaneous, which leads to the development of co-infection. If the D-causative agent later joined the HBV-infected liver cells (hepatocytes), then we will talk about superinfection. A serious condition, which was the result of such a combination of viruses and the clinical manifestation of the most dangerous type of hepatitis (fulminant form), often threatens to be fatal in a short time.

Video: hepatitis B

The most significant parenteral hepatitis (C)

various hepatitis viruses

The “famous” C-hepatitis virus (HCV, HCV) is a microorganism with unprecedented heterogeneity. The causative agent contains a single-stranded positively charged RNA encoding 8 proteins (3 structural + 5 non-structural), to each of which corresponding antibodies are produced during the course of the disease.

The hepatitis C virus is quite stable in the external environment, it tolerates freezing and drying well, but it is not transmitted in negligible doses, which explains the low risk of infection by the vertical route and during sexual intercourse. A low concentration of an infectious agent in the secrets released during sex does not provide the conditions for the transmission of the disease, unless other factors are present that "help" the virus "move". These factors include concomitant bacterial or viral infections (HIV in the first place), which reduce immunity, and a violation of the integrity of the skin.

The behavior of HCV in the body is difficult to predict. Having penetrated into the blood, it can circulate for a long time at a minimum concentration, forming in 80% of cases a chronic process that can eventually lead to severe liver damage: cirrhosis and primary hepatocellular carcinoma (cancer).

hepatitis C development scheme

The absence of symptoms or a slight manifestation of signs of hepatitis is the main feature of this form of inflammatory liver disease, which remains unrecognized for a long time.

However, if the pathogen nevertheless “decided” to immediately start damaging the liver tissue, then the first symptoms may already appear after 2-24 weeks and last 14-20 days.

The acute period often proceeds in a mild anicteric form, accompanied by:

weakness; Joint pains; indigestion; Slight fluctuations in laboratory parameters (liver enzymes, bilirubin).

The patient feels some heaviness on the side of the liver, sees a change in the color of urine and feces, however, pronounced signs of hepatitis, even in the acute phase, are generally not typical for this species and are rare. It is possible to diagnose C-hepatitis when the corresponding antibodies are detected by enzyme-linked immunosorbent assay (ELISA) and pathogen RNA by PCR (polymerase chain reaction).

Video: film about hepatitis C

What is Hepatitis G

Hepatitis G is considered the most mysterious today. It is caused by a virus containing single-stranded RNA. The microorganism (HGV) has 5 varieties of genotypes and is structurally very similar to the causative agent of C-hepatitis. One (first) of the genotypes chose the west of the African continent for its habitat and is not found anywhere else, the second has spread throughout the globe, the third and fourth “liked” Southeast Asia, and the fifth settled in southern Africa. Therefore, the inhabitants of the Russian Federation and the entire post-Soviet space have "chance" to meet with a representative of type 2.

For comparison: a map of the spread of hepatitis C

In epidemiological terms (sources of infection and transmission routes), G-hepatitis resembles other parenteral hepatitis. As for the role of HGV in the development of inflammatory liver diseases of infectious genesis, it is not defined, the opinions of scientists differ, and the medical literature data remain contradictory. Many researchers associate the presence of the pathogen with the fulminant form of the disease, and also tend to think that the virus plays a role in the development of autoimmune hepatitis. In addition, a frequent combination of HGV with hepatitis C (HCV) and B (HBV) viruses was noticed, that is, the presence of coinfection, which, however, does not aggravate the course of monoinfection and does not affect the immune response during treatment with interferon.

HGV monoinfection usually proceeds in subclinical, anicteric forms, however, as the researchers note, in some cases it does not pass without a trace, that is, even in a latent state it can lead to morphological and functional changes in the hepatic parenchyma. There is an opinion that a virus, like HCV, can hide, and then strike no less, that is, transform into cancer or hepatocellular carcinoma.

When does hepatitis become chronic?

Chronic hepatitis is understood as a diffuse-dystrophic process of an inflammatory nature, localized in the hepatobiliary system and caused by various etiological factors (viral or other origin).

The classification of inflammatory processes is complex, however, like other diseases, besides, there is still no universal methodology, therefore, in order not to load the reader with incomprehensible words, we will try to say the main thing.

Given that in the liver, for certain reasons, a mechanism is triggered that causes degeneration of hepatocytes (liver cells), fibrosis, necrosis of the hepatic parenchyma and other morphological changes that lead to a violation of the functional abilities of the organ, they began to distinguish:

Autoimmune hepatitis, characterized by extensive damage to the liver, and, therefore, an abundance of symptoms; Cholestatic hepatitis, caused by a violation of the outflow of bile and its stagnation as a result of an inflammatory process affecting the bile ducts; Chronic hepatitis B, C, D; Hepatitis caused by the toxic effects of drugs; Chronic hepatitis of unknown origin.

It is obvious that the classified etiological factors, associations of infections (coinfection, superinfection), phases of the chronic course, do not fully provide a complete picture of inflammatory diseases of the main organ of detoxification. There is no information about the reaction of the liver to the damaging effects of adverse factors, toxic substances and new viruses, that is, nothing is said about very significant forms:

Chronic alcoholic hepatitis, which is the source of alcoholic cirrhosis; Nonspecific reactive form of chronic hepatitis; Toxic hepatitis; Chronic hepatitis G, discovered later than others.

For this reason, it was determined 3 forms of chronic hepatitis based on morphological features:

Chronic persistent hepatitis (CPH), which is usually inactive, manifests itself clinically for a long time, infiltration is observed only in the portal tracts, and only the penetration of inflammation into the lobule will indicate its transition to the active phase; Chronic active hepatitis (CAH) is characterized by the transition of the inflammatory infiltrate from the portal tracts into the lobule, which is clinically manifested by varying degrees of activity: slight, moderate, pronounced, pronounced; Chronic lobular hepatitis, due to the predominance of the inflammatory process in the lobules. The defeat of several lobules with multibular necrosis indicates a high degree of activity of the pathological process (necrotizing form).

Given the etiological factor

Inflammatory process in the liver refers to polyetiological diseases, as it is caused by a number of reasons:

The classification of hepatitis has been revised many times, but experts have not come to a consensus. Currently, only 5 types of liver damage associated with alcohol have been identified, so it hardly makes sense to list all the options, because not all viruses have been discovered and studied yet, and not all forms of hepatitis have been described. Nevertheless, it may be worthwhile to acquaint the reader with the most understandable and accessible division of chronic inflammatory liver diseases according to etiological grounds:

Viral hepatitis, caused by certain microorganisms (B, C, D, G) and indefinite - little studied, unconfirmed by clinical data, new forms - F, TiTi; autoimmune hepatitis(types 1, 2, 3); Inflammation of the liver (drug-induced), often detected in "chronics", associated with the long-term use of a large number of drugs or the use of drugs that show severe aggression to hepatocytes for a short time; Toxic hepatitis due to the influence of hepatotropic toxic substances, ionizing radiation, alcohol surrogates and other factors; Alcoholic hepatitis, which, together with the drug-induced one, is classified as a toxic form, but in other cases is considered separately as a social problem; Metabolic taking place in congenital pathology - Konovalov-Wilson's disease. The reason for it lies in the hereditary (autosomal recessive type) violation of copper metabolism. The disease is extremely aggressive, quickly ends with cirrhosis and death of the patient in childhood or young age; Cryptogenic hepatitis, the cause of which, even after a thorough examination, remains unknown. The disease is characterized by progression, requires monitoring and control, as it often leads to severe liver damage (cirrhosis, cancer); Nonspecific reactive hepatitis (secondary). It is often a companion of various pathological conditions: tuberculosis, renal pathology, pancreatitis, Crohn's disease, ulcerative processes in the gastrointestinal tract and other diseases.

Considering that some types of hepatitis are very related, widespread and quite aggressive, it makes sense to give a few examples that are likely to be of interest to readers.

Chronic form of hepatitis C

An important question regarding hepatitis C is how to live with it and how many years they live with this disease. After learning about their diagnosis, people often panic, especially if they receive information from unverified sources. However, this is not necessary. With C-hepatitis they live a normal life, but they have it in mind in terms of some diet (you should not load the liver with alcohol, fatty foods and substances toxic to the organ), increasing the body's defenses, that is, immunity, being careful at home and when sexual contacts. You just need to remember that human blood is contagious.

As for life expectancy, there are many cases when hepatitis, even among lovers of good food and drink, has not shown itself in 20 years, so you should not bury yourself prematurely. The literature describes both cases of recovery and the reactivation phase, which occurs after 25 years, and, of course, a sad outcome - cirrhosis and cancer. Which of the three groups you get into sometimes depends on the patient, given that there is currently a drug - synthetic interferon.

Hepatitis associated with genetics and immune response

Autoimmune hepatitis, which occurs in women 8 times more often than in men, is characterized by rapid progression with a transition to portal hypertension, renal failure, cirrhosis, and ends with the death of the patient. In accordance with the international classification, autoimmune hepatitis can occur in the absence of blood transfusions, liver damage from alcohol, toxic poisons, and drugs.

The cause of autoimmune liver damage is believed to be a genetic factor. Positive associations of the disease with antigens of the major histocompatibility complex (HLA leukocyte system), in particular, HLA-B8, which is recognized as an antigen of hyperimmunoreactivity, were revealed. However, many may have a predisposition, but not all get sick. Some drugs (for example, interferon), as well as viruses can provoke an autoimmune lesion of the hepatic parenchyma:

Epstein-Barra; Corey; Herpes 1 and 6 types; Hepatitis A, B, C.

It should be noted that about 35% of patients who were overtaken by AIH already had other autoimmune diseases.

The vast majority of cases of autoimmune hepatitis begin as an acute inflammatory process (weakness, loss of appetite, severe jaundice, dark urine). After a few months, signs of an autoimmune nature begin to form.

Sometimes AIT develops gradually with a predominance of symptoms of asthenovegetative disorders, malaise, heaviness in the liver, slight jaundice, rarely the onset is manifested by a significant increase in temperature and signs of another (extrahepatic) pathology.

The following manifestations may indicate a detailed clinical picture of AIH:

Severe malaise, loss of working capacity; Heaviness and pain on the side of the liver; Nausea; Skin reactions (capillaritis, telangiectasia, purpura, etc.) Itching of the skin; Lymphadenopathy; Jaundice (intermittent); Hepatomegaly (enlargement of the liver); Splenomegaly (enlargement of the spleen); In women, the absence of menstruation (amenorrhea); In men - an increase in the mammary glands (gynecomastia); Systemic manifestations (polyarthritis),

Often AIH is a companion of other diseases: diabetes mellitus, diseases of the blood, heart and kidneys, pathological processes localized in the organs of the digestive system. In a word, autoimmune - it is autoimmune and can manifest itself in any, far from hepatic pathology.

Any liver "does not like" alcohol ...

Alcoholic hepatitis (AH) can be considered as one of the forms of toxic hepatitis, because they have one reason - a negative effect on the liver of irritating substances that have a detrimental effect on hepatocytes. Hepatitis of alcoholic origin is characterized by all the typical signs of inflammation of the liver, which, however, can take place in a sharply progressive acute form or have a persistent chronic course.

Most often, the onset of an acute process is accompanied by signs:

Intoxication: nausea, vomiting, diarrhea, aversion to food; weight loss; Jaundice without itching or with itching due to the accumulation of bile acids in the cholestatic form; A significant increase in the liver with its compaction and soreness in the right hypochondrium; Tremor; Hemorrhagic syndrome, renal failure, hepatic encephalopathy with fulminant form. Hepatorenal syndrome and hepatic coma can cause the death of the patient.

Sometimes in the acute course of alcoholic hepatitis, a significant increase in body temperature is observed, bleeding and the addition of bacterial infections are possible, causing inflammation of the respiratory and urinary tract, gastrointestinal tract, etc.

Chronic persistence of hypertension is oligosymptomatic and often reversible if a person manages to stop in time. Otherwise, the chronic form becomes progressive with transformation into cirrhosis.

… And other toxic substances

For the development of acute toxic hepatitis a single dose of a small dose of a toxic substrate is sufficient, which has hepatotropic properties, or a large number of substances that are less aggressive towards the liver, for example, alcohol. Acute toxic inflammation of the liver manifests itself by its significant increase and pain in the right hypochondrium. Many people mistakenly believe that the organ itself hurts, but this is not so. Pain is caused by stretching of the liver capsule due to an increase in its size.

With toxic liver damage, the symptoms of alcoholic hepatitis are characteristic, however, depending on the type of poisonous substance, they can be more pronounced, for example:

Feverish state; progressive jaundice; Vomiting with an admixture of blood; Nose and gingival bleeding, hemorrhages on the skin due to damage to the vascular walls by toxins; Mental disorders (excitation, lethargy, disorientation in space and time).

Chronic toxic hepatitis develops over a long period of time when small but constant doses of toxic substances are ingested. If the cause of the toxic effect is not eliminated, then after years (or only months) complications can occur in the form of cirrhosis of the liver and liver failure.

Markers for early diagnosis. How to deal with them?

Viral hepatitis markers

Many have heard that the first step in the diagnosis of inflammatory liver diseases is a study on markers. Having received a piece of paper with the answer to the analysis for hepatitis, the patient is unable to understand the abbreviation if he does not have a special education.

Viral hepatitis markers are determined using enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), inflammatory processes of non-viral origin are diagnosed by other methods, including ELISA. In addition to these methods, biochemical tests, histological analysis (based on liver biopsy material) and instrumental studies are carried out.

However, we should return to the markers:

Infectious hepatitis A antigen can be determined only in the incubation period and only in the feces. In the phase of clinical manifestations, antibodies begin to be produced and class M immunoglobulins (IgM) appear in the blood. HAV-IgG synthesized somewhat later indicate recovery and the formation of lifelong immunity, which these immunoglobulins will provide; The presence or absence of the causative agent of viral hepatitis B determined by the “Australian antigen” - HBsAg (surface antigen) detected from time immemorial (albeit not by modern methods) and the inner shell antigens - HBcAg and HBeAg, which became possible to identify only with the advent of laboratory diagnostics by ELISA and PCR. HBcAg is not detected in the blood serum, it is determined using antibodies (anti-HBc). To confirm the diagnosis of HBV and monitor the course of the chronic process and the effectiveness of treatment, it is advisable to use PCR diagnostics (detection of HBV DNA). The patient's recovery is evidenced by the circulation of specific antibodies (anti-HBs, total anti-HBC, anti-HBe) in his blood serum in the absence of the HBsAg antigen itself; Diagnosis of C-hepatitis without detection of virus RNA (PCR) is difficult. IgG antibodies, having appeared at the initial stage, continue to circulate throughout life. The acute period and the reactivation phase are indicated by class M immunoglobulins (IgM), the titer of which is increasing. The most reliable criterion for diagnosing, monitoring and controlling the treatment of hepatitis C is the determination of virus RNA by PCR. The main marker for the diagnosis of hepatitis D(delta infection) class G immunoglobulins (anti-HDD-IgG) are considered to persist throughout life. In addition, to clarify monoinfection, super (association with HBV) or coinfection, an analysis is carried out that detects class M immunoglobulins, which remain forever with superinfection, and disappear with coinfection in about six months; The main laboratory study of hepatitis G is the determination of viral RNA using PCR. In Russia, antibodies to HGV are detected using specially designed ELISA kits that can detect immunoglobulins to the E2 envelope protein, which is a component of the pathogen (anti-HGV E2).

Hepatitis markers of non-viral etiology

Diagnosis of AIH is based on the detection of serological markers (antibodies):

SMA (tissue to smooth muscle); ANA (antinuclear); Immunoglobulins class G; Anti-LKM-1 (microsomal antibodies).

In addition, the diagnosis uses the determination of biochemical parameters: protein fractions (hypergammaglobulinemia), liver enzymes (significant activity of transaminases), as well as the study of the histological material of the liver (biopsy).

Depending on the type and ratio of markers, types of AIH are distinguished:

The first is more often manifested in adolescents or in adolescence, or “waits” up to 50; The second most often affects childhood, has high activity and resistance to immunosuppressors, quickly transforms into cirrhosis; The third type used to stand out as a separate form, but now it is no longer considered in this perspective; Atypical AIH representing cross-hepatic syndromes (primary biliary cirrhosis, primary sclerosing cholangitis, chronic viral hepatitis).

Direct evidence of the alcoholic origin of liver damage does not exist, therefore there is no specific analysis for hepatitis associated with the use of ethanol, however, some factors that are very characteristic of this pathology have been noticed. For example, ethyl alcohol acting on the hepatic parenchyma promotes the release of alcoholic hyaline, called Mallory bodies, which leads to the appearance of ultrastructural changes in hepatocytes and stellate reticuloepithelial cells, indicating the degree of negative effects of alcohol on the "long-suffering" organ.

In addition, some biochemical indicators (bilirubin, liver enzymes, gamma fraction) indicate alcoholic hepatitis, but their significant increase is characteristic of many pathological conditions of the liver when exposed to other toxic poisons.

Clarification of anamnesis, identification of a toxic substance that affected the liver, biochemical tests and instrumental examination are the main criteria for diagnosing toxic hepatitis.

Can hepatitis be cured?

Treatment of hepatitis depends on the etiological factor that caused the inflammatory process in the liver. Of course, hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment.

Viral hepatitis A and E, although of infectious origin, are acute and, as a rule, do not give chronicity. The human body in most cases is able to resist them, so it is not customary to treat them, except that sometimes symptomatic therapy is used to eliminate headaches, nausea, vomiting, and diarrhea.

The situation is more complicated with inflammation of the liver caused by viruses B, C, D. However, given that delta infection practically does not occur on its own, but obligately follows HBV, B-hepatitis has to be treated first of all, but with increased doses and lengthened course.

It is not always possible to cure hepatitis C, although the chances of a cure nevertheless appeared with the use of interferons-alpha (a component of the immune defense against viruses). In addition, at present, to enhance the effect of the main drug, combined regimens are used that involve combinations of prolonged interferons with antiviral drugs, for example, ribavirin or lamivudine.

It should be noted that not every immune system adequately responds to the intervention of immunomodulators introduced from the outside into its work, therefore, interferon, for all its advantages, can produce undesirable effects. In this regard, interferon therapy is carried out under the close supervision of a doctor with regular laboratory monitoring of the behavior of the virus in the body. If it is possible to completely eliminate the virus, then this can be considered a victory over it. Incomplete elimination, but the cessation of replication of the pathogen is also a good result, allowing you to "lull the enemy's vigilance" and delay the likelihood of hepatitis turning into cirrhosis or hepatocellular carcinoma for many years.

How to prevent hepatitis?

The expression “It is easier to prevent a disease than to cure” has long been hackneyed, but not forgotten, since many troubles can really be avoided if preventive measures are not neglected. As for viral hepatitis, special care will not be superfluous here either. Compliance with the rules of personal hygiene, the use of specific protective equipment when in contact with blood (gloves, fingertips, condoms) in other cases may well become an obstacle to the transmission of infection.

Medical workers in the fight against hepatitis specifically develop action plans and follow them every point. Thus, in order to prevent the incidence of hepatitis and the transmission of HIV infection, as well as reduce the risk of occupational infection, the Sanitary and Epidemiological Service recommends adhering to certain prevention rules:

Prevent "syringe hepatitis" common among people who use drugs. To this end, organize points for the free distribution of syringes; Prevent any possibility of transmission of viruses during blood transfusions (organization of PCR laboratories at stations for transfusion and quarantine storage of drugs and components obtained from donor blood at ultra-low temperatures); Minimize the likelihood of occupational infection to the maximum, using all available personal protective equipment and complying with the requirements of the sanitary and epidemiological supervision authorities; Pay special attention to departments with an increased risk of infection (hemodialysis, for example).

We should not forget about the precautions for sexual intercourse with an infected person. The chance of sexually transmitting hepatitis C virus is negligible, but for HBV it increases significantly, especially in cases associated with the presence of blood, such as menstruation in women or genital trauma in one of the partners. If you can’t do without sex, then at least you shouldn’t forget about a condom.

There is a higher chance of getting infected in the acute phase of the disease, when the concentration of the virus is especially high, so for such a period it would be better to abstain from sexual relations altogether. Otherwise, carrier people live a normal life, give birth to children, remembering their peculiarities, and be sure to warn doctors (ambulance, dentist, when registering at a antenatal clinic and in other situations that require increased attention) about what is included in risk group for hepatitis.

Increasing resistance to hepatitis

Hepatitis prevention also includes vaccination against a viral infection. Unfortunately, a vaccine against hepatitis C has not yet been developed, but available vaccines against hepatitis A and B have significantly reduced the incidence of these types.

The hepatitis A vaccine is given to children 6-7 years of age (usually before school entry). A single use provides immunity for a year and a half, revaccination (re-vaccination) extends the protection period to 20 years or more.

The HBV vaccine is administered to newborn babies still in the maternity hospital without fail, for children who for some reason have not been vaccinated, or for adults there are no age restrictions. To ensure a full-fledged immune response, the vaccine is administered three times over several months. The vaccine was developed on the basis of the surface ("Australian") HBs antigen.

The liver is a delicate organ

Treating hepatitis on your own means taking full responsibility for the outcome of the inflammatory process in such an important organ, therefore, in the acute period or in the chronic course, it is better to coordinate any of your actions with the doctor. After all, anyone understands: if the residual effects of alcoholic or toxic hepatitis can neutralize folk remedies, then they are unlikely to cope with the rampant virus in the acute phase (meaning HBV and HCV). The liver is a delicate organ, albeit a patient one, so home treatment should be thoughtful and reasonable.

Hepatitis A, for example, does not require anything other than diet, which is necessary, in general, in the acute phase of any inflammatory process. Nutrition should be as sparing as possible, since the liver passes everything through itself. In the hospital, the diet is called the fifth table (No. 5), which is also observed at home for up to six months after the acute period.

In chronic hepatitis, of course, it is not advisable to offer strict adherence to a diet for years, but it would be right to remind the patient that one should not irritate the organ once again. It is advisable to try to eat boiled foods, exclude fried, fatty, pickled, limit salty and sweet. Strong broths, strong and weak alcoholic and carbonated drinks, the liver also does not accept.

Can folk remedies save?

Folk remedies in other cases help the liver cope with the load that has fallen on it, raise natural immunity, and strengthen the body. However they cannot cure hepatitis, therefore, to engage in amateur activities, to treat liver inflammation without a doctor is unlikely to be correct, because each of the types has its own characteristics that must be taken into account in the fight against it.

"Blind" sounding

Often the attending physician himself, when discharging a convalescent from the hospital, recommends simple home procedures for him. For example - "blind" probing, which is done on an empty stomach in the morning. The patient drinks 2 chicken yolks, throwing away the proteins or using them for other purposes, after 5 minutes he drinks it all with a glass of still mineral water (or clean from the tap) and puts it on the right barrel, putting a warm heating pad under it. The procedure takes an hour. You should not be surprised if after it a person runs to the toilet to give away everything unnecessary. Some people use magnesium sulphate instead of yolks, however, this is a saline laxative, which does not always give such comfort to the intestines as, say, eggs.

Horseradish?

Yes, some people use finely grated horseradish (4 tablespoons) as a treatment, diluting it with a glass of milk. Drinking the mixture immediately is not recommended, so it is first heated (almost to a boil, but not boiled), left for 15 minutes so that a reaction occurs in the solution. Use the medicine several times a day. It is clear that such a remedy will have to be prepared every day if a person tolerates a product such as horseradish well.

Soda with lemon

They say that in the same way some people lose weight. But still we have another goal - to treat the disease. Squeeze the juice of one lemon and pour a teaspoon of baking soda into it. After five minutes, the soda will be extinguished and the medicine is ready. Drink for 3 days three times a day, then rest for 3 days and repeat the treatment again. We do not undertake to judge the mechanism of action of the drug, but people do it.

Herbs: sage, mint, milk thistle

Some say that milk thistle, known in such cases, which helps not only with hepatitis, but also with cirrhosis, is absolutely ineffective against hepatitis C, but in return, people offer other recipes:

1 tablespoon peppermint; Half a liter of boiling water; Infused for a day; Strained; Used throughout the day.

Or another recipe:

Sage - a tablespoon; 200 - 250 grams of boiling water; A tablespoon of natural honey; Honey is dissolved in sage with water and infused for an hour; Drink the mixture on an empty stomach.

However, not everyone adheres to a similar point of view regarding milk thistle and offers a recipe that helps with all inflammatory liver diseases, including C-hepatitis:

A fresh plant (root, stem, leaves, flowers) is crushed; Put in the oven for a quarter of an hour to dry; Remove from the oven, lay out on paper and place in a dark place to complete the drying process; Select 2 tablespoons of dry product; Add half a liter of boiling water; Insist 8-12 hours (preferably at night); Drink 3 times a day, 50 ml for 40 days; Arrange a break for two weeks and repeat the treatment.

Video: viral hepatitis in the "School of Dr. Komarovsky"

Hepatitis B infection can occur when the virus enters the bloodstream. Also, any fluid that is excreted from the body of an infected person and contains the virus can cause the onset of the disease. In order not to get infected, you need to know the main routes of transmission and be sure to get vaccinated against this disease. What are the symptoms of hepatitis infection?

By what signs can you find out about the disease

Symptoms of hepatitis usually do not appear immediately, but after a period of 2-6 months passes. At this time, a person is a carrier of the virus, but does not feel a deterioration in well-being, therefore, does not know about his condition.

Depending on the form of the disease, various symptoms are distinguished.

Acute viral hepatitis B in its initial manifestations resembles the flu, the body temperature rises, aches and weakness appear. When the patient's skin begins to turn yellow, this is an exact symptom of hepatitis.

In addition, a person has the following symptoms:

joint pain; allergic reaction on the skin; loss of appetite; pain in the abdomen; nausea and vomiting.

According to clinical manifestations, darkening of urine and lightening of feces are noted. The patient has an enlarged liver. After blood tests, a more complete picture emerges: the level of bilirubin and liver enzymes is increased. If the disease does not become chronic, two weeks after the yellowing of the skin, the patient feels better, because all the symptoms subside.

Important! With a poorly developed response of the immune system to the virus, the disease can be asymptomatic and become chronic.

Viral hepatitis B of the chronic form is the most dangerous for a person, because it is not only difficult to treat, but also has severe symptoms and leads to complications. A person constantly experiences weakness and general malaise. These are the primary symptoms that very often go unnoticed. The patient may experience nausea and vomiting, upset stool, pain in the abdomen, muscles and joints.

In advanced cases of the disease, jaundice, venous reticulum, skin itching, exhaustion appear, the liver and spleen increase in size.

Transmission routes

Viral hepatitis B is the type that is transmitted only by direct contact of a healthy person with the blood, saliva or seminal fluid of a sick person.

This virus is not transmitted by the fecal-oral route.

You can get infected from a patient with chronic or acute hepatitis. In newborns, the main mechanism of transmission of the virus is blood during childbirth. Also, children can become infected with viral hepatitis from their sick brothers or sisters.

Important! Viral hepatitis is 50 times more contagious than HIV, but it is not transmitted through breast milk.

There are such ways of infection:

Through the blood. In this way, you can become infected by using a single syringe, for example, by injecting drugs, or by using non-sterile instruments that had blood on them, for example, in tattoo parlors or operating rooms. Infection is possible with the infusion of donor blood, of course, such a mechanism for transmitting the virus is quite rare, about 2% of cases have been recorded. The risk of infection increases with repeated transfusions of blood or blood components. Sexually. The probability of sexually transmitted infection is very high and reaches 30%, because the virus is found in seminal fluid and secretions from the genital tract of women. The person may not even be aware of their illness, so unprotected sex should be avoided. The route of transmission from mother to child. It is worth noting that intrauterine infection of the fetus cannot occur (if the placenta retains its integrity), the risk of infection increases during the birth itself. Children born to mothers with hepatitis are immediately vaccinated against hepatitis B at the maternity hospital, which reduces the risk of developing a chronic form of this disease. Household way. There is minimal risk of infection in this way. The thing is that the mechanism of transmission of the virus is not only hematogenous, but also with the help of saliva, urine or sweat. If this biological fluid gets even on the damaged skin of a healthy person in a small amount, then infection will not occur. If the concentration of the virus in the contents of the liquid is large, then infection cannot be avoided.

Important! In the absence of damage to the skin by household means, it is impossible to get infected.

Factors such as the integrity of the skin and the concentration of the virus in the body fluid affect the likelihood of infection in a household way.

In 30% of cases, the mechanism of transmission of the virus cannot be determined. After all, the disease can exist asymptomatically for a long time, especially in a chronic form.

It is worth noting that the disease can be transmitted only if the blood, saliva or sweat of the patient enters the blood of a healthy person, unless, of course, he has immunity from this disease.

The patient after infection becomes a carrier of the virus long before the first symptoms of the disease appear. In this case, there is a risk of infecting loved ones.

What is the most common form of virus transmission?

Most likely, you can catch the virus through casual sexual contact, less often from mother to child during childbirth. Since the mechanism of transmission is not only through the blood, but also through saliva, you can get hepatitis B by kissing. You should also not use a toothbrush, washcloth or towel of the patient, because biological fluid, such as sweat or saliva, which is a source of infection, may remain on them.

The probability of becoming infected when donated blood is infused is small, because recently all blood is tested for the presence of various viruses before infusion.

In rare cases, infection can occur germinally when a healthy egg is infected with an infected sperm, in which case the child is born with congenital hepatitis B.

What to do if there was contact with an infected person. How to know if there is a risk of contracting hepatitis B?

How to determine the likelihood of infection?

Everyone can learn their risk of contracting viral hepatitis. He needs to be tested for the presence of the antigen of the virus and antibodies to it. If the result is negative, then such a person must be vaccinated. Otherwise, upon contact with an infected person, there is a 100% chance of becoming infected.

If the HBsAg virus is found in the blood after the test, then this indicates that the infection has already occurred and the person can infect others. Antibodies to the virus in the blood are a good sign, in which case you can not get vaccinated, because hepatitis B is not terrible in this case.

How to find out if there was contact with the virus?

In people who have had viral hepatitis, antibodies to the virus can be detected, so re-infection is impossible.

Many are concerned about the question of whether it is possible not to become infected after contact with the patient. What factors influence this process? Infection can be avoided only after vaccination, and communication with a sick person is not scary for people who have previously had viral hepatitis, because antibodies are produced in their blood. Also, children born to infected mothers are protected from infection for life, because at birth they are injected with immunoglobulin against hepatitis B.

If an unprotected person, such as a health worker, has had direct contact with patients, then to reduce the risk of infection, he can be injected with immunoglobulin, which will protect against the disease.

We can distinguish the following groups with a high probability of getting hepatitis:

injection drug addicts; persons of unconventional orientation; people who have multiple sexual partners; sexual partners of patients; family members where there are infected; people who are on hemodialysis or need frequent blood transfusions;

health workers; people with hemophilia or organ transplants; children born to infected mothers.

There are certain factors that increase the risk of infection, namely:

contact with the patient's blood or its components; intravenous administration of drugs or drugs with reusable syringes; acupuncture; the use of non-sterile instruments for various manipulations on the body (ear piercing, piercing or tattoos).

Individuals who are at risk should take steps towards prevention. First of all, you need to get vaccinated and follow the rules of personal hygiene.

Family members with a patient with chronic hepatitis should be screened for the presence of the virus and antibodies to it and, if necessary, be vaccinated.

Knowing how the hepatitis virus is transmitted can help protect yourself from serious illness. To be 100% safe, you need to get vaccinated.

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.

Hepatitis C is an inflammation of the liver of a viral origin, clinical manifestations of which in most cases are significantly delayed in time or so little expressed that the patient himself may not notice that a “gentle” killer virus has settled in his body, as the hepatitis C virus (HCV) is commonly called.

Once upon a time, and this continued until the end of the 80s of the last century, doctors knew about the existence of a special form of hepatitis that did not fit into the concept of "Botkin's disease" or jaundice, but it was obvious that it was hepatitis that affects the liver in no way less than their own " brethren" (A and B). An unfamiliar species was called hepatitis neither A nor B, since its own markers were still unknown, and the proximity of pathogenesis factors was obvious. It was similar to hepatitis A in that it was transmitted not only parenterally, but suggested other routes of transmission. The similarity with hepatitis B, called serum hepatitis, was that it could also be infected by receiving someone else's blood.

At present, everyone knows that, called neither A nor B hepatitis, is open and well studied. This is hepatitis C, which in its prevalence is not only not inferior to the infamous, but also far exceeds it.

Similarities and differences

Botkin's disease was previously called any inflammatory liver disease associated with a certain pathogen. The understanding that Botkin's disease can represent an independent group of polyetiological pathological conditions, each of which has its own pathogen and the main route of transmission, came later.

Now these diseases are called hepatitis, but a capital letter of the Latin alphabet is added to the name according to the sequence of discovery of the pathogen (A, B, C, D, E, G). Patients often translate everything into Russian and indicate hepatitis C or hepatitis D. However, the diseases assigned to this group are very similar in the sense that the viruses they cause have hepatotropic properties and, when ingested, affect the hepatobiliary system , each in its own way violating its functional abilities.

Different types of hepatitis are unequally prone to chronization of the process, which indicates the different behavior of viruses in the body.

Hepatitis C is considered the most interesting in this regard., which for a long time remained a mystery, but even now, being widely known, it leaves secrets and intrigues, since it does not make it possible to give an accurate forecast (it can only be assumed).

Inflammatory processes of the liver caused by various pathogens do not differ in relation to sex, therefore men are equally affected, and women. There was no difference in the course of the disease, however, it should be noted that in women during pregnancy, hepatitis can be more severe. In addition, the penetration of the virus in recent months or the active course of the process can adversely affect the health of the newborn.

If liver diseases of viral origin still have a clear similarity, then considering hepatitis C, it is advisable to touch on other types of hepatitis, otherwise the reader will think that only the “hero” of our article should be afraid. But through sexual contact, you can become infected with almost every type, although this ability is attributed more to hepatitis B and C, and therefore they are often referred to as sexually transmitted diseases. In this regard, other pathological conditions of the liver of viral origin are usually kept silent, since their consequences are not as significant as the consequences of hepatitis B and C, which are recognized as the most dangerous.

In addition, there are hepatitis of non-viral origin (autoimmune, alcoholic, toxic), which should also be mentioned, because one way or another, they are all interconnected and significantly aggravate each other.

How is the virus transmitted?

Depending on which way the virus could "run across" to a person and what things it will start to "do" in the body of a new "host", different types of hepatitis are distinguished. Some are transmitted in everyday life (through dirty hands, food, toys, etc.), appear quickly and pass, basically, without any consequences. Others, called parenteral, having the potential of chronicity, often remain in the body for life, destroying the liver to cirrhosis, and in some cases to primary liver cancer (hepatocarcinoma).

In this way, hepatitis according to the mechanism and routes of infection are divided into two groups:

• Having an oral-fecal transmission mechanism (A and E);
• Hepatitis, for which the blood-contact (hemopercutaneous), or, more simply, the path through the blood, is the main one (B, C, D, G - a group of parenteral hepatitis).

In addition to the transfusion of infected blood or flagrant non-compliance with the rules for medical manipulations associated with damage to the skin (the use of insufficiently processed instruments, for example, for acupuncture), often there is the spread of hepatitis C, B, D, G and in other cases:

1. Various fashionable procedures (tattoos, piercings, ear piercings) performed by a non-professional at home or in any other conditions that do not meet the requirements of the sanitary and epidemiological regime;
2. By using one needle for several people, this method is practiced by syringe addicts;
3. Transmission of the virus through sexual intercourse, which is most likely for hepatitis B, hepatitis C in such situations is transmitted much less frequently;
4. Cases of infection by the "vertical" route (from mother to fetus) are known. Active disease, acute infection in the last trimester, or HIV carriers greatly increase the risk of hepatitis.
5. Unfortunately, up to 40% of patients cannot remember the source that “gifted” the hepatitis B, C, D, G virus.

The hepatitis virus is not transmitted through breast milk, so women with hepatitis B and C can safely feed their baby without fear of infecting him.

We can agree that the fecal-oral mechanism, water, contact-household, being so interconnected, cannot exclude the possibility of transmission of the virus and sexually just as well as other types of hepatitis transmitted through the blood, have the ability to penetrate into another organism during sex.

Signs of an unhealthy liver

After infection, the first clinical signs of different forms of the disease appear at different times. For example, the hepatitis A virus declares itself in two weeks (up to 4), the causative agent of hepatitis B (HBV) is somewhat delayed and manifests itself in the interval from two months to six months. As for hepatitis C, it the pathogen (HCV) can detect itself after 2 weeks, after 6 months, or it can “hide” for years, turning a healthy person into a carrier and source of infection for a rather serious disease.

The fact that something is wrong with the liver can be guessed from the clinical manifestations of hepatitis:

• Temperature. With it and the phenomena of influenza infection, hepatitis A usually begins (headache, pain in the bones and muscles). The onset of HBV activation in the body is accompanied by subfebrile temperature, and with C-hepatitis it may not rise at all;
• Jaundice varying degrees of expression. This symptom appears a few days after the onset of the disease, and if its intensity does not increase, then the patient's condition usually improves. A similar phenomenon is most characteristic of hepatitis A, which cannot be said about hepatitis C, as well as toxic and alcoholic hepatitis. Here, a more saturated color is not attributed to signs of an impending recovery, rather, on the contrary: with a mild form of inflammation of the liver, jaundice may be absent altogether;
• Rashes and itching more characteristic of cholestatic forms of inflammatory processes in the liver, they are caused by the accumulation of bile acids in tissues due to obstructive lesions of the hepatic parenchyma and injury to the bile ducts;
• Decreased appetite;
• Heaviness in the right hypochondrium, possible enlargement of the liver and spleen;
• Nausea and vomiting. These symptoms are more characteristic of severe forms;
• Weakness, malaise;
• Joint pain;
• dark urine, dark beer-like , discolored feces - typical signs of any viral hepatitis;
• Laboratory indicators: liver function tests (AlT, AST, bilirubin), depending on the severity of the course, can increase several times, the number of platelets decreases.

During viral hepatitis, 4 forms are distinguished:

1. Easy, often characteristic of hepatitis C: jaundice is often absent, subfebrile or normal temperature, heaviness in the right hypochondrium, loss of appetite;
2. Medium: the above symptoms are more pronounced, there is pain in the joints, nausea and vomiting, there is practically no appetite;
3. heavy. All symptoms are present in a pronounced form;
4. Lightning (fulminant), which is not found in hepatitis C, but is very characteristic of hepatitis B, especially in the case of coinfection (HDV / HBV), that is, a combination of two viruses B and D that cause superinfection. The fulminant form is the most dangerous, because as a result of the rapid development of massive necrosis of the hepatic parenchyma, the death of the patient occurs.

Hepatitis, dangerous in everyday life (A, E)

In everyday life, first of all, liver diseases that have a predominantly fecal-oral route of transmission can lie in wait, and these are, as you know, hepatitis A and E, so you should dwell a little on their characteristic features:

Hepatitis A

Hepatitis A is a highly contagious infection. Previously, it was simply called infectious hepatitis (when B was serum, and others were not yet known). The causative agent of the disease is a small but incredibly resistant virus containing RNA. Although epidemiologists note susceptibility to the pathogen as universal, it is predominantly children who have stepped over the age of one who are ill. Infectious hepatitis, triggering inflammatory and necrobiotic processes in the hepatic parenchyma, giving symptoms of intoxication (weakness, fever, jaundice, etc.), as a rule, ends with recovery with the development of active immunity. The transition of infectious hepatitis to a chronic form practically does not occur.

Video: hepatitis A in the program “Live healthy!”

Hepatitis E

Its virus also belongs to RNA-containing ones, it “feels good” in the aquatic environment. It is transmitted from a sick person or carrier (in the latent period), there is a high probability of infection through food that has not undergone heat treatment. Mostly young people (15-30 years old) living in the countries of Central Asia and the Middle East get sick. In Russia, the disease is extremely rare. The contact-household route of transmission is not excluded. Cases of chronicity or chronic carriage have not yet been established or described.

Hepatitis B and dependent hepatitis D virus

hepatitis virusB(HBV), or serum hepatitis, is a DNA-containing pathogen with a complex structure, which prefers liver tissue for its replication. A tiny dose of infected biological material is enough to transmit the virus, why this form passes so easily not only during medical manipulations, but also during sexual intercourse or in a vertical way.

The course of this viral infection is multivariate. It may be limited to:

• Carrying;
• Give acute liver failure with the development of a fulminant (fulminant) form, often taking the life of the patient;
• When the process is chronic, it can lead to the development of cirrhosis or hepatocarcinoma.

The incubation period of this form of the disease lasts from 2 months to six months, and the acute period in most cases has symptoms characteristic of hepatitis:

1. Fever, headache;
2. Decreased performance, general weakness, malaise;
3. Pain in the joints;
4. Disorder of the function of the digestive system (nausea, vomiting);
5. Sometimes rashes and itching;
6. Heaviness in the right hypochondrium;
7. Enlargement of the liver, sometimes - the spleen;
8. Jaundice;
9. A typical sign of liver inflammation is dark urine and discolored stools.

Combinations of HBV with the causative agent of hepatitis D (HDD) are very dangerous and unpredictable, which was previously called delta infection - a unique virus that is invariably dependent on HBV.

The transmission of two viruses can be simultaneous, which leads to the development co-infections. If the D-causative agent later joined the HBV-infected liver cells (hepatocytes), then we will talk about superinfection. A serious condition, which was the result of such a combination of viruses and the clinical manifestation of the most dangerous type of hepatitis (fulminant form), often threatens to be fatal in a short time.

Video: hepatitis B

The most significant parenteral hepatitis (C)

various hepatitis viruses

The “famous” C-hepatitis virus (HCV, HCV) is a microorganism with unprecedented heterogeneity. The causative agent contains a single-stranded positively charged RNA encoding 8 proteins (3 structural + 5 non-structural), to each of which corresponding antibodies are produced during the course of the disease.

The hepatitis C virus is quite stable in the external environment, it tolerates freezing and drying well, but it is not transmitted in negligible doses, which explains the low risk of infection by the vertical route and during sexual intercourse. A low concentration of an infectious agent in the secrets released during sex does not provide the conditions for the transmission of the disease, unless other factors are present that "help" the virus "move". These factors include concomitant bacterial or viral infections (HIV in the first place), which reduce immunity, and a violation of the integrity of the skin.

The behavior of HCV in the body is difficult to predict. Having penetrated into the blood, it can circulate for a long time at a minimum concentration, forming in 80% of cases a chronic process that can eventually lead to severe liver damage: cirrhosis and primary hepatocellular carcinoma (cancer).

The absence of symptoms or a slight manifestation of signs of hepatitis is the main feature of this form of inflammatory liver disease, which remains unrecognized for a long time.

However, if the pathogen nevertheless “decided” to immediately start damaging the liver tissue, then the first symptoms may already appear after 2-24 weeks and last 14-20 days.

The acute period often proceeds in a mild anicteric form, accompanied by:

• weakness;
• Joint pains;
• indigestion;
• Slight fluctuations in laboratory parameters (liver enzymes, bilirubin).

The patient feels some heaviness on the side of the liver, sees a change in the color of urine and feces, however, pronounced signs of hepatitis, even in the acute phase, are generally not typical for this species and are rare. It is possible to diagnose C-hepatitis when the corresponding antibodies are detected by the method (ELISA) and the RNA of the pathogen by conducting (polymerase chain reaction).

Video: film about hepatitis C

What is Hepatitis G

Hepatitis G is considered the most mysterious today. It is caused by a virus containing single-stranded RNA. The microorganism (HGV) has 5 varieties of genotypes and is structurally very similar to the causative agent of C-hepatitis. One (first) of the genotypes chose the west of the African continent for its habitat and is not found anywhere else, the second has spread throughout the globe, the third and fourth “liked” Southeast Asia, and the fifth settled in southern Africa. Therefore, the inhabitants of the Russian Federation and the entire post-Soviet space have "chance" to meet with a representative of type 2.

For comparison: a map of the spread of hepatitis C

In epidemiological terms (sources of infection and transmission routes), G-hepatitis resembles other parenteral hepatitis. As for the role of HGV in the development of inflammatory liver diseases of infectious genesis, it is not defined, the opinions of scientists differ, and the medical literature data remain contradictory. Many researchers associate the presence of the pathogen with the fulminant form of the disease, and also tend to think that the virus plays a role in the development of autoimmune hepatitis. In addition, a frequent combination of HGV with hepatitis C (HCV) and B (HBV) viruses was noticed, that is, the presence of coinfection, which, however, does not aggravate the course of monoinfection and does not affect the immune response during treatment with interferon.

HGV monoinfection usually proceeds in subclinical, anicteric forms, however, as the researchers note, in some cases it does not pass without a trace, that is, even in a latent state it can lead to morphological and functional changes in the hepatic parenchyma. There is an opinion that a virus, like HCV, can hide, and then strike no less, that is, transform into cancer or hepatocellular carcinoma.

When does hepatitis become chronic?

Chronic hepatitis is understood as a diffuse-dystrophic process of an inflammatory nature, localized in the hepatobiliary system and caused by various etiological factors (viral or other origin).

The classification of inflammatory processes is complex, however, like other diseases, besides, there is still no universal methodology, therefore, in order not to load the reader with incomprehensible words, we will try to say the main thing.

Given that in the liver, for certain reasons, a mechanism is triggered that causes degeneration of hepatocytes (liver cells), fibrosis, necrosis of the hepatic parenchyma and other morphological changes that lead to a violation of the functional abilities of the organ, they began to distinguish:

1. Autoimmune hepatitis, characterized by extensive damage to the liver, and, therefore, an abundance of symptoms;
2. Cholestatic hepatitis, caused by a violation of the outflow of bile and its stagnation as a result of an inflammatory process affecting the bile ducts;
3. Chronic hepatitis B, C, D;
4. Hepatitis caused by the toxic effects of drugs;
5. Chronic hepatitis of unknown origin.

It is obvious that the classified etiological factors, associations of infections (coinfection, superinfection), phases of the chronic course, do not fully provide a complete picture of inflammatory diseases of the main organ of detoxification. There is no information about the reaction of the liver to the damaging effects of adverse factors, toxic substances and new viruses, that is, nothing is said about very significant forms:

• Chronic alcoholic hepatitis, which is the source of alcoholic cirrhosis;
• Nonspecific reactive form of chronic hepatitis;
• Toxic hepatitis;
• Chronic hepatitis G, discovered later than others.

For this reason, it was determined 3 forms of chronic hepatitis based on morphological features:

1. Chronic persistent hepatitis (CPH), which is usually inactive, manifests itself clinically for a long time, infiltration is observed only in the portal tracts, and only the penetration of inflammation into the lobule will indicate its transition to the active phase;
2. Chronic active hepatitis (CAH) is characterized by the transition of the inflammatory infiltrate from the portal tracts into the lobule, which is clinically manifested by varying degrees of activity: slight, moderate, pronounced, pronounced;
3. Chronic lobular hepatitis, due to the predominance of the inflammatory process in the lobules. The defeat of several lobules with multibular necrosis indicates a high degree of activity of the pathological process (necrotizing form).

Given the etiological factor

Inflammatory process in the liver refers to polyetiological diseases, as it is caused by a number of reasons:

The classification of hepatitis has been revised many times, but experts have not come to a consensus. Currently, only 5 types of liver damage associated with alcohol have been identified, so it hardly makes sense to list all the options, because not all viruses have been discovered and studied yet, and not all forms of hepatitis have been described. Nevertheless, it may be worthwhile to acquaint the reader with the most understandable and accessible division of chronic inflammatory liver diseases according to etiological grounds:

1. Viral hepatitis, caused by certain microorganisms (B, C, D, G) and uncertain - poorly studied, unconfirmed by clinical data, new forms - F, TiTi;
2. autoimmune hepatitis(types 1, 2, 3);
3. Inflammation of the liver (drug-induced), often detected in "chronics", associated with the long-term use of a large number of drugs or the use of drugs that show severe aggression to hepatocytes for a short time;
4. Toxic hepatitis due to the influence of hepatotropic toxic substances, ionizing radiation, alcohol surrogates and other factors;
5. Alcoholic hepatitis, which, together with the drug-induced one, is classified as a toxic form, but in other cases is considered separately as a social problem;
6. Metabolic that occurs in congenital pathology - disease Konovalov-Wilson. The reason for it lies in the hereditary (autosomal recessive type) violation of copper metabolism. The disease is extremely aggressive, quickly ends with cirrhosis and death of the patient in childhood or young age;
7. Cryptogenic hepatitis, the cause of which, even after a thorough examination, remains unknown. The disease is characterized by progression, requires monitoring and control, as it often leads to severe liver damage (cirrhosis, cancer);
8. Nonspecific reactive hepatitis (secondary). It is often a companion of various pathological conditions: tuberculosis, renal pathology, pancreatitis, Crohn's disease, ulcerative processes in the gastrointestinal tract and other diseases.

Considering that some types of hepatitis are very related, widespread and quite aggressive, it makes sense to give a few examples that are likely to be of interest to readers.

Chronic form of hepatitis C

An important question regarding hepatitis C is how to live with it and how many years they live with this disease. After learning about their diagnosis, people often panic, especially if they receive information from unverified sources. However, this is not necessary. With C-hepatitis they live a normal life, but they have it in mind in terms of some diet (you should not load the liver with alcohol, fatty foods and substances toxic to the organ), increasing the body's defenses, that is, immunity, being careful at home and when sexual contacts. You just need to remember that human blood is contagious.

As for life expectancy, there are many cases when hepatitis, even among lovers of good food and drink, has not shown itself in 20 years, so you should not bury yourself prematurely. The literature describes both cases of recovery and the reactivation phase, which occurs after 25 years, and, of course, a sad outcome - cirrhosis and cancer. Which of the three groups you get into sometimes depends on the patient, given that there is currently a drug - synthetic interferon.

Hepatitis associated with genetics and immune response

Autoimmune hepatitis, which occurs in women 8 times more often than in men, is characterized by rapid progression with a transition to portal hypertension, renal failure, cirrhosis, and ends with the death of the patient. In accordance with the international classification, autoimmune hepatitis can occur in the absence of blood transfusions, liver damage from alcohol, toxic poisons, and drugs.

The cause of autoimmune liver damage is believed to be a genetic factor. Positive associations of the disease with antigens of the major histocompatibility complex (HLA leukocyte system), in particular, HLA-B 8 , which is recognized as an antigen of hyperimmunoreactivity, were revealed. However, many may have a predisposition, but not all get sick. Some drugs (for example, interferon), as well as viruses can provoke an autoimmune lesion of the hepatic parenchyma:

• Epstein-Barra;
• Corey;
• Herpes 1 and 6 types;
• Hepatitis A, B, C.

It should be noted that about 35% of patients who were overtaken by AIH already had other autoimmune diseases.

The vast majority of cases of autoimmune hepatitis begin as an acute inflammatory process (weakness, loss of appetite, severe jaundice, dark urine). After a few months, signs of an autoimmune nature begin to form.

Sometimes AIT develops gradually with a predominance of symptoms of asthenovegetative disorders, malaise, heaviness in the liver, slight jaundice, rarely the onset is manifested by a significant increase in temperature and signs of another (extrahepatic) pathology.

The following manifestations may indicate a detailed clinical picture of AIH:

1. Severe malaise, loss of working capacity;
2. Heaviness and pain on the side of the liver;
3. Nausea;
4. Skin reactions (capillaritis, telangiectasia, purpura, etc.)
5. Itching of the skin;
6. Lymphadenopathy;
7. Jaundice (intermittent);
8. Hepatomegaly (enlargement of the liver);
9. Splenomegaly (enlargement of the spleen);
10. In women, the absence of menstruation (amenorrhea);
11. In men - an increase in the mammary glands (gynecomastia);
12. Systemic manifestations (polyarthritis),

Often AIH is a companion of other diseases: diabetes mellitus, diseases of the blood, heart and kidneys, pathological processes localized in the organs of the digestive system. In a word, autoimmune - it is autoimmune and can manifest itself in any, far from hepatic pathology.

Any liver "does not like" alcohol ...

Alcoholic hepatitis (AH) can be considered as one of the forms of toxic hepatitis, because they have one reason - a negative effect on the liver of irritating substances that have a detrimental effect on hepatocytes. Hepatitis of alcoholic origin is characterized by all the typical signs of inflammation of the liver, which, however, can take place in a sharply progressive acute form or have a persistent chronic course.

Most often, the onset of an acute process is accompanied by signs:

• Intoxication: nausea, vomiting, diarrhea, aversion to food;
• weight loss;
• Jaundice without itching or with itching due to the accumulation of bile acids in the cholestatic form;
• A significant increase in the liver with its compaction and soreness in the right hypochondrium;
• Tremor;
• Hemorrhagic syndrome, renal failure, hepatic encephalopathy with fulminant form. Hepatorenal syndrome and hepatic coma can cause the death of the patient.

Sometimes in the acute course of alcoholic hepatitis, a significant increase in body temperature is observed, bleeding and the addition of bacterial infections are possible, causing inflammation of the respiratory and urinary tract, gastrointestinal tract, etc.

Chronic persistence of hypertension is oligosymptomatic and often reversible if a person manages to stop in time. Otherwise the chronic form becomes progressive with transformation into cirrhosis.

… And other toxic substances

For the development of acute toxic hepatitis a single dose of a small dose of a toxic substrate is sufficient, which has hepatotropic properties, or a large number of substances that are less aggressive towards the liver, for example, alcohol. Acute toxic inflammation of the liver manifests itself by its significant increase and pain in the right hypochondrium. Many people mistakenly believe that the organ itself hurts, but this is not so. Pain is caused by stretching of the liver capsule due to an increase in its size.

With toxic liver damage, the symptoms of alcoholic hepatitis are characteristic, however, depending on the type of poisonous substance, they can be more pronounced, for example:

1. Feverish state;
2. progressive jaundice;
3. Vomiting with an admixture of blood;
4. Nose and gingival bleeding, hemorrhages on the skin due to damage to the vascular walls by toxins;
5. Mental disorders (excitation, lethargy, disorientation in space and time).

Chronic toxic hepatitis develops over a long period of time when small but constant doses of toxic substances are ingested. If the cause of the toxic effect is not eliminated, then after years (or only months) complications can be obtained in the form cirrhosis of the liver and liver failure.

Markers for early diagnosis. How to deal with them?

Viral hepatitis markers

Many have heard that the first step in the diagnosis of inflammatory liver diseases is a study on markers. Having received a piece of paper with the answer to the analysis for hepatitis, the patient is unable to understand the abbreviation if he does not have a special education.

Viral hepatitis markers determined with the help of and, inflammatory processes of non-viral origin are diagnosed by other methods, not excluding ELISA. In addition to these methods, biochemical tests, histological analysis (based on liver biopsy material) and instrumental studies are carried out.

However, we should return to the markers:

• Infectious hepatitis A antigen can be determined only in the incubation period and only in the feces. In the phase of clinical manifestations, class M immunoglobulins (IgM) begin to be produced and appear in the blood. HAV-IgG synthesized somewhat later indicate recovery and the formation of lifelong immunity, which these immunoglobulins will provide;
• The presence or absence of the causative agent of viral hepatitis B are determined by the “Australian antigen” - HBsAg (surface antigen) detected from time immemorial (though not by modern methods) and the inner shell antigens - HBcAg and HBeAg, which became possible to identify only with the advent of laboratory diagnostics by ELISA and PCR. HBcAg is not detected in the blood serum, it is determined using antibodies (anti-HBc). To confirm the diagnosis of HBV and monitor the course of the chronic process and the effectiveness of treatment, it is advisable to use PCR diagnostics (detection of HBV DNA). The patient's recovery is evidenced by the circulation of specific antibodies (anti-HBs, total anti-HBC, anti-HBe) in the serum of his blood in the absence of the antigen itselfHBsAg;
• Diagnosis of C-hepatitis without detection of virus RNA (PCR) is difficult. IgG antibodies, having appeared at the initial stage, continue to circulate throughout life. The acute period and the reactivation phase are indicated by class M immunoglobulins (IgM), the titer of which increases. The most reliable criterion for diagnosing, monitoring and controlling the treatment of hepatitis C is the determination of virus RNA by PCR.
• The main marker for the diagnosis of hepatitis D(delta infection) class G immunoglobulins (anti-HDD-IgG) are considered to persist throughout life. In addition, to clarify monoinfection, super (association with HBV) or coinfection, an analysis is carried out that detects class M immunoglobulins, which remain forever with superinfection, and disappear with coinfection in about six months;
• The main laboratory study of hepatitis G is the determination of viral RNA using PCR. In Russia, antibodies to HGV are detected using specially designed ELISA kits that can detect immunoglobulins to the E2 envelope protein, which is a component of the pathogen (anti-HGV E2).

Hepatitis markers of non-viral etiology

Diagnosis of AIH is based on the detection of serological markers (antibodies):

In addition, the diagnosis uses the determination of biochemical parameters: protein fractions (hypergammaglobulinemia), liver enzymes (significant activity of transaminases), as well as the study of the histological material of the liver (biopsy).

Depending on the type and ratio of markers, types of AIH are distinguished:

• The first is more often manifested in adolescents or in adolescence, or “waits” up to 50;
• The second most often affects childhood, has high activity and resistance to immunosuppressors, quickly transforms into cirrhosis;
• The third type used to stand out as a separate form, but now it is no longer considered in this perspective;
• Atypical AIH representing cross-hepatic syndromes (primary biliary cirrhosis, primary sclerosing cholangitis, chronic viral hepatitis).

Direct evidence of the alcoholic origin of liver damage does not exist, therefore there is no specific analysis for hepatitis associated with the use of ethanol, however, some factors that are very characteristic of this pathology have been noticed. For example, ethyl alcohol, which acts on the hepatic parenchyma, promotes the release of alcoholic hyaline called Mallory bodies, which leads to the appearance of ultrastructural changes in hepatocytes and stellate reticuloepithelial cells, indicating the degree of negative impact of alcohol on the "long-suffering" organ.

In addition, some biochemical indicators (bilirubin, liver enzymes, gamma fraction) indicate alcoholic hepatitis, but their significant increase is characteristic of many pathological conditions of the liver when exposed to other toxic poisons.

Clarification of anamnesis, identification of a toxic substance that affected the liver, biochemical tests and instrumental examination are the main criteria for the diagnosis of toxic hepatitis.

Can hepatitis be cured?

Treatment of hepatitis depends on the etiological factor that caused the inflammatory process in the liver. Of course , hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment .

Viral hepatitis A and E, although of infectious origin, are acute and, as a rule, do not give chronicity. The human body in most cases is able to resist them, therefore it is not customary to treat them, except that sometimes symptomatic therapy is used to eliminate headaches, nausea, vomiting, and diarrhea.

The situation is more complicated with inflammation of the liver caused by viruses B, C, D. However, given that delta infection practically does not occur on its own, but obligately follows HBV, B-hepatitis has to be treated first of all, but with increased doses and lengthened course.

It is not always possible to cure hepatitis C, although the chances of a cure nevertheless appeared with the use of interferons-alpha (a component of the immune defense against viruses). In addition, at present, to enhance the effect of the main drug, combined regimens are used that involve combinations of prolonged interferons with antiviral drugs, for example, ribavirin or lamivudine.

It should be noted that not every immune system adequately responds to the intervention of immunomodulators introduced from the outside into its work, therefore, interferon, for all its advantages, can produce undesirable effects. In this regard, interferon therapy is carried out under the close supervision of a doctor with regular laboratory monitoring of the behavior of the virus in the body. If it is possible to completely eliminate the virus, then this can be considered a victory over it. Incomplete elimination, but the cessation of replication of the pathogen is also a good result, allowing you to "lull the enemy's vigilance" and delay the likelihood of hepatitis turning into cirrhosis or hepatocellular carcinoma for many years.

How to prevent hepatitis?

The expression “It is easier to prevent a disease than to cure” has long been hackneyed, but not forgotten, since many troubles can really be avoided if preventive measures are not neglected. As for viral hepatitis, special care will not be superfluous here either. Compliance with the rules of personal hygiene, the use of specific protective equipment when in contact with blood (gloves, fingertips, condoms) in other cases may well become an obstacle to the transmission of infection.

Medical workers in the fight against hepatitis specifically develop action plans and follow them every point. Thus, in order to prevent the incidence of hepatitis and the transmission of HIV infection, as well as reduce the risk of occupational infection, the Sanitary and Epidemiological Service recommends adhering to certain prevention rules:

1. Prevent "syringe hepatitis" common among people who use drugs. To this end, organize points for the free distribution of syringes;
2. Prevent any possibility of transmission of viruses during blood transfusions (organization of PCR laboratories at stations for transfusion and quarantine storage of drugs and components obtained from donor blood at ultra-low temperatures);
3. Minimize the likelihood of occupational infection to the maximum, using all available personal protective equipment and complying with the requirements of the sanitary and epidemiological supervision authorities;
4. Pay special attention to departments with an increased risk of infection (hemodialysis, for example).

We should not forget about the precautions for sexual intercourse with an infected person. The chance of sexually transmitting hepatitis C virus is negligible, but for HBV it increases significantly, especially in cases associated with the presence of blood, such as menstruation in women or genital trauma in one of the partners. If you can’t do without sex, then at least you shouldn’t forget about a condom.

There is a higher chance of getting infected in the acute phase of the disease, when the concentration of the virus is especially high, so for such a period it would be better to abstain from sexual relations altogether. Otherwise, carrier people live a normal life, give birth to children, remembering their peculiarities, and be sure to warn doctors (ambulance, dentist, when registering at a antenatal clinic and in other situations that require increased attention) about what is included in risk group for hepatitis.

Increasing resistance to hepatitis

Hepatitis prevention also includes vaccination against a viral infection. Unfortunately, a vaccine against hepatitis C has not yet been developed, but available vaccines against hepatitis A and B have significantly reduced the incidence of these types.

The hepatitis A vaccine is given to children 6-7 years of age (usually before school entry). A single use provides immunity for a year and a half, revaccination (re-vaccination) extends the protection period to 20 years or more.

The HBV vaccine is administered to newborn babies still in the maternity hospital without fail, for children who for some reason have not been vaccinated, or for adults there are no age restrictions. To ensure a full-fledged immune response, the vaccine is administered three times over several months. The vaccine was developed on the basis of the surface ("Australian") HBs antigen.

The liver is a delicate organ

Treating hepatitis on your own means taking full responsibility for the outcome of the inflammatory process in such an important organ, therefore, in the acute period or in the chronic course, it is better to coordinate any of your actions with the doctor. After all, anyone understands: if the residual effects of alcoholic or toxic hepatitis can neutralize folk remedies, then they are unlikely to cope with the rampant virus in the acute phase (meaning HBV and HCV). The liver is a delicate organ, albeit a patient one, so home treatment should be thoughtful and reasonable.

Hepatitis A, for example, does not require anything other than diet, which is necessary, in general, in the acute phase of any inflammatory process. Nutrition should be as sparing as possible, since the liver passes everything through itself. In the hospital, the diet is called the fifth table (No. 5), which is also observed at home for up to six months after the acute period.

In chronic hepatitis, of course, it is not advisable to offer strict adherence to a diet for years, but it would be right to remind the patient that one should not irritate the organ once again. It is advisable to try to eat boiled foods, exclude fried, fatty, pickled, limit salty and sweet. Strong broths, strong and weak alcoholic and carbonated drinks, the liver also does not accept.

Can folk remedies save?

Folk remedies in other cases help the liver cope with the load that has fallen on it, raise natural immunity, and strengthen the body. However they cannot cure hepatitis, therefore, to engage in amateur activities, to treat liver inflammation without a doctor is unlikely to be correct, because each of the types has its own characteristics that must be taken into account in the fight against it.

"Blind" sounding

Often the attending physician himself, when discharging a convalescent from the hospital, recommends simple home procedures for him. For example - "blind" probing, which is done on an empty stomach in the morning. The patient drinks 2 chicken yolks, throwing away the proteins or using them for other purposes, after 5 minutes he drinks it all with a glass of still mineral water (or clean from the tap) and puts it on the right barrel, putting a warm heating pad under it. The procedure takes an hour. You should not be surprised if after it a person runs to the toilet to give away everything unnecessary. Some people use magnesium sulphate instead of yolks, however, this is a saline laxative, which does not always give such comfort to the intestines as, say, eggs.

Horseradish?

Yes, some people use finely grated horseradish (4 tablespoons) as a treatment, diluting it with a glass of milk. Drinking the mixture immediately is not recommended, so it is first heated (almost to a boil, but not boiled), left for 15 minutes so that a reaction occurs in the solution. Use the medicine several times a day. It is clear that such a remedy will have to be prepared every day if a person tolerates a product such as horseradish well.

Soda with lemon

They say that in the same way some people lose weight . But still we have another goal - to treat the disease. Squeeze the juice of one lemon and pour a teaspoon of baking soda into it. After five minutes, the soda will be extinguished and the medicine is ready. Drink for 3 days three times a day, then rest for 3 days and repeat the treatment again. We do not undertake to judge the mechanism of action of the drug, but people do it.

Herbs: sage, mint, milk thistle

Some say that milk thistle, known in such cases, which helps not only with hepatitis, but also with cirrhosis, is absolutely ineffective against hepatitis C, but in return, people offer other recipes:

• 1 tablespoon peppermint;
• Half a liter of boiling water;
• Infused for a day;
• Strained;
• Used throughout the day.

Or another recipe:

• Sage - a tablespoon;
• 200 - 250 grams of boiling water;
• A tablespoon of natural honey;
• Honey is dissolved in sage with water and infused for an hour;
• Drink the mixture on an empty stomach.

However, not everyone adheres to a similar point of view regarding milk thistle and offers a recipe that helps with all inflammatory liver diseases, including C-hepatitis:

1. A fresh plant (root, stem, leaves, flowers) is crushed;
2. Put in the oven for a quarter of an hour to dry;
3. Remove from the oven, lay out on paper and place in a dark place to complete the drying process;
4. Select 2 tablespoons of dry product;
5. Add half a liter of boiling water;
6. Insist 8-12 hours (preferably at night);
7. Drink 3 times a day, 50 ml for 40 days;
8. Arrange a break for two weeks and repeat the treatment.

Video: viral hepatitis in the “School of Dr. Komarovsky”

Moscow doctors record an increase in the incidence of viral hepatitis A and B among Muscovites, unusual for the winter season, although the epidemiological threshold for this disease has not yet been exceeded, the Moskovsky Komsomolets newspaper writes 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, it takes from 7 to 50 days. Most often, the onset of the disease is accompanied by a rise in temperature and may resemble the flu. Most cases end spontaneously 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 It is 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 there are rashes. There is an increase in the liver and spleen. 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 fell ill after a blood transfusion. This is due to the fact that testing of donated blood for the hepatitis C virus began only a few years ago. Quite often, infection occurs through syringes in drug addicts. Sexual transmission is also possible from mother to fetus. The greatest danger is the chronic form of this disease, which often turns into cirrhosis and liver cancer.

Chronic course develops in approximately 70-80% of patients. The combination of hepatitis C with other forms of viral hepatitis sharply aggravates the disease and threatens with a fatal outcome.

Hepatitis D- "companion disease", complicating the course of hepatitis B.

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

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

Ways of infection

Hepatitis viruses enter the human body in two main ways. A sick person can excrete the virus with feces, after which it enters the intestines of other people with water or food. Doctors call this mechanism of infection fecal-oral. It is characteristic of hepatitis A and E viruses. Thus, hepatitis A and hepatitis E occur mainly due to poor personal hygiene, as well as when the water supply system is not perfect. 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 of infection, is represented by hepatitis B and C viruses.

The situations in which the most common infection:

Donor blood transfusion. Worldwide, an average of 0.01-2% of donors are carriers of hepatitis viruses, therefore, at present, donor blood is examined for the presence of hepatitis B and C viruses before transfusion to the recipient. The risk of infection increases in people who need repeated blood transfusions or its products

The use of one needle by 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 commonly transmitted sexually. It is believed that the likelihood of contracting hepatitis C in spouses is low.

The path of infection from mother to child (doctors call it "vertical") is not so common. The risk is increased if the woman has an active form of the virus or has experienced acute hepatitis in the last months of pregnancy. The likelihood of infection of the fetus increases dramatically 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 by tattooing, acupuncture, ear piercing with non-sterile 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 with hepatitis A, up to 2-4 and even 6 months with hepatitis B. After this period, during which the virus multiplies and adapts in the body, the disease begins Express yourself.

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

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, pains appear in the right hypochondrium, nausea, vomiting, urine darkens and feces become discolored. Doctors fix an increase in the liver and less often - in the spleen. Changes characteristic of hepatitis are found in the blood: specific markers of viruses, bilirubin increases, liver tests increase by 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 that causes the disease, due to intoxication of the body. In the rest of the patients gradually, within a few weeks, there is a reverse development of symptoms. This is how acute forms of viral hepatitis proceed.

The clinical course of hepatitis can be of varying severity: mild, moderate and severe forms. There is also a fourth, fulminant, that is, a lightning-fast form. This is the most severe type of hepatitis, in which massive liver necrosis develops, usually ending 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 increased fatigue by the end of the day, the inability to perform previous physical activity. At an advanced stage of chronic viral hepatitis, jaundice, darkening of urine, skin itching, bleeding, weight loss, enlarged liver and spleen, and spider veins are found.

Treatment

The duration of hepatitis A is on average 1 month. Special antiviral treatment for this disease is not required. Treatment includes: basic therapy, bed rest, diet. If there are indications, detoxification therapy (intravenously or orally), symptomatic therapy is prescribed. It is generally advised to avoid alcohol, which, as a poisonous substance, can weaken an already damaged liver.

Acute viral hepatitis B with severe clinical symptoms ends with recovery in more than 80% of cases. In patients who have undergone anicteric and subclinical forms, hepatitis B often becomes chronic. Chronic hepatitis leads over time to the development of cirrhosis and liver cancer. There is practically no complete cure for chronic hepatitis B, but a favorable course of the disease can be achieved if certain recommendations are followed regarding the regime of work and rest, nutrition, psycho-emotional stress, as well as when taking drugs that improve metabolic processes in liver cells.

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

Hepatitis C is the most serious type of hepatitis. The development of the 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 mechanism of action of this drug is to prevent infection of new liver cells (hepatocytes). The use of interferon cannot guarantee a 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, as the human body is strong enough to get rid of the virus without the help of treatment. In a month and a half there is a complete recovery. Sometimes doctors prescribe symptomatic therapy to eliminate headaches, nausea, and other unpleasant symptoms.

Complications

Functional and inflammatory diseases of the biliary tract and hepatic coma can become complications of viral hepatitis, and if a violation in the work 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 due to the combined action of hepatitis B and D viruses. Hepatic coma occurs due to massive necrosis (necrosis) of liver cells. The decay products of the liver tissue enter the bloodstream, 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 infection with hepatitis, you must follow simple rules. Do not use unboiled water, always wash fruits and vegetables, do not neglect the heat treatment of food. This can help prevent hepatitis A infection.

In general, contact with other people's body fluids should be avoided. For protection against hepatitis B and C - primarily with blood. In microscopic quantities, blood can remain on razors, toothbrushes, nail scissors. Do not share these items with other people. You can not do piercings and tattoos with non-sterile devices. Precautions must be taken when having sex.

The material was prepared on the basis of information from open sources

Almost everyone is familiar with hepatitis A (Botkin's disease). The patient's outpatient card is marked with special symbols, and after that, for many years, the person is re-examined for the presence of the virus in the body. Although the latter is not necessary, because after the infection there are no people with a chronic course. Nevertheless, you need to know about the disease because of some features of the course.

Hepatitis A - what is it and how is it transmitted? What is the difference between this type of viral liver disease? What you need to know about the disease and its treatment?

What is Hepatitis A

Scientists have calculated that among all cases of liver damage by viruses, hepatitis A is about 40%. Almost every second case! The infection is not included in the category of particularly dangerous, it proceeds relatively favorably and almost always ends in complete recovery.

Why is hepatitis A dangerous?

1. The disease does not manifest itself for a long time, sometimes after 4-6 weeks only its first signs will appear.
2. A person infects others in the last days of the incubation period, when even the patient himself does not know about the disease. During this time, you can manage to infect hundreds of people.
3. The causative agent of hepatitis A is a virus that is stable in the external environment; on surfaces at a temperature of only 4 ° C, it persists for several years.
4. The microorganism tolerates exposure to ultraviolet radiation, detergents, formalin.
5. Boiling alone kills the virus within 5 minutes.
6. It affects equally all children and adults, susceptibility to the virus is universal.
7. A large number of latent or anicteric forms of the disease.

So what is this disease - hepatitis A? This is an infectious disease of the liver, the cause of which is a type A virus. A simple transmission route, a high susceptibility of the population and many unusual forms of the disease are characteristic of it. Even the best modern methods of prevention will not save people from this infection. Hepatitis A circulates throughout the world and infects the population at regular intervals. Therefore, you need to remember about it.

Reasons for the spread of hepatitis A virus

In nature, the virus is found only among humans. It is transmitted from person to person, it does not infect or infect animals. This is a severe anthroponotic infection (circulating only between people).

Ways of infection with viral hepatitis A are as follows.

1. Contact-household way, through infected objects in the environment around people. The danger is a sick person at the stage of isolation of the hepatitis A virus.
2. Alimentary route - in case of ingestion of a microorganism through contaminated food.
3. One of the leading ways of infection is water. Infection with hepatitis A occurs most often due to the ingress of the virus into sewers, natural reservoirs and other sources.
4. A controversial, but quite possible route of transmission is parenteral, which is less common than others, but doctors have recorded isolated cases of hepatitis A virus entering the body through injections, droppers.

All this is explained only by the ability of the virus to survive in any conditions and the inability to neutralize it in ways available to everyone.

How is hepatitis A transmitted from person to person? The mechanism of transmission is fecal-oral, which is realized if the pathogenic microorganism is located and multiplies in the intestine. With urine, vomit or feces, the virus enters the environment, if hygiene standards are not observed or violated, it remains on surrounding objects. People become infected when they are touched, causing the microorganism to infect the next person.

Countries with a low level of development are considered the most unfavorable in terms of epidemics, where they become infected as a result of the widespread spread of the virus and due to the low level of development of sanitary and epidemic standards.

Stages of development of viral hepatitis A

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.

1. The incubation period of viral hepatitis A begins from the moment the pathogen enters the human body and up to the moment of initial manifestations. It can last from 1 to 7 weeks, but on average it is 21-28 days.
2. The prodromal period lasts about 7 days, sometimes three weeks. It resembles the onset of a viral disease of the upper respiratory tract.
3. The peak of the disease or the period of familiar typical clinical manifestations lasts about two or three weeks, but in special cases it reaches two months.
4. Reconvalescence or recovery.

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.

The first signs of the disease

The incubation period does not give itself away. This, from the point of view of epidemiology, is the most dangerous period, since at the end of it a person is already contagious to others, but he still does not know about it. Therefore, hepatitis A is considered dangerous.

The next stage in the development of the disease is prodromal. A person is contagious throughout.

Manifestations of the prodromal period of hepatitis A are as follows:

• the disease begins acutely with an increase in body temperature to 38-40 ° C, which is observed for at least three days;
• the first signs of hepatitis A include redness of the throat, headaches, mild nasal congestion;
• nausea, loss of appetite, vomiting is possible, but in rare cases;
• perhaps the appearance of pain in the stomach or a feeling of discomfort;
• after about two days, the urine becomes dark in color, many draw an analogy with the color of dark beer or strong tea, the stool becomes discolored and becomes liquid;
• it is during this period of hepatitis A that the liver and spleen enlarge and become painful on palpation.

At the very beginning, the prodrome period resembles a respiratory infection, and only at the end, before the peak, its symptoms become more understandable.

Symptoms of Hepatitis A

This stage takes up to two months, and with a typical course, the diagnosis almost never raises questions. Moderate course of the disease is approximately as follows.

Jaundice, liver enlargement and dyspeptic symptoms are typical hallmarks of Botkin's disease.

Features of the course of hepatitis A in children and adults

In adults and children, sometimes the disease occurs with some features that depend on the immune system and on the body itself.

How is hepatitis A different in children?

1. Most often, children aged 3 to 12 get sick, especially those who are in organized children's groups: in kindergartens, schools, boarding schools.
2. In babies up to a year, in most cases, mother's or passive immunity is preserved.
3. Symptoms of hepatitis A in children: severe intoxication, an increase in the size of the liver, noticeable not only on palpation, but also visually, as a rule, of moderate severity.
4. A protracted course of the disease is observed only in 3% of cases.
5. What are the signs of hepatitis A in a young child? - the child becomes nervous, whiny, refuses to eat, sleeps badly, vomiting occurs after eating, does not allow himself to be examined, because the stomach is painful on palpation, chronic infections become aggravated against the background of the underlying disease and new ones often join.

How does hepatitis A progress in adults? The average severity of the disease is fully consistent with the above clinical picture. Easy or protracted flow is slightly different.

1. Most adults develop active immunity by the age of 35 or 40, sometimes due to the transfer of a latent form of infection.
2. Mixed infections proceed aggressively and for a long time, for example, if a person becomes infected with hepatitis A and B at the same time.
3. Symptoms of hepatitis A in adults are varied - the temperature at the onset of the disease may increase or rise sharply; dyspeptic phenomena are expressed: discomfort in the stomach, nausea, repeated vomiting, and jaundice can manifest itself in a mild form.
4. With age, the likelihood of death due to hepatitis A increases, in patients older than 50 years the number of such complications is 4 times higher than mortality in childhood.

Hepatitis A at the very beginning, during active manifestations, resembles more of a respiratory disease, therefore, during protracted infections, it is necessary to be fully examined for a correct diagnosis.

Diagnosis of hepatitis A

The diagnosis of hepatitis A is based on several tests.

Complications of hepatitis A

A favorable course of the disease does not mean that there are no consequences. The only thing that pleases after the transfer of hepatitis A is that there is no chronic course of the disease, that is, having been ill once, a person will no longer become infected.

What changes does the hepatitis A virus cause after an acute illness?

1. In 90% of cases, the disease ends with an absolute complete recovery without any residual effects. The remaining 10% were less fortunate.
2. Prolonged course and resumption of symptoms during the period of extinction of the infection sometimes indicates additional infection with other types of hepatitis or weak immunity.
3. After the disease, signs of damage to the biliary tract are found: inflammation, dyskinesia.
4. Sometimes the disease is complicated by extrahepatic manifestations: pneumonia, inflammation of the heart muscle, impaired production of blood cells.
5. Mortality is no more than 0.04% of cases.

Hepatitis A treatment

Therapy for infectious liver disease primarily includes adherence to the regimen. Full sleep, walks in the fresh air and daytime sleep are the norm for patients with hepatitis A.

How long should patients and their contacts be monitored? The patient is isolated for 30 days, and quarantine for hepatitis A for contact persons is at least 35 days.

Diet for hepatitis A

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 caloric content of food, calories must correspond to the physiological norm.
2. 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.
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.

Prevention of hepatitis A

Protection against the development of the disease or prevention of hepatitis A is carried out in the focus of detection of infection. The patient is isolated, and in the place of his residence, surfaces are treated with chlorine-containing agents. The patient's belongings are subject to special treatment - chamber disinfection.

In addition to the above measures, after a year, children are vaccinated against hepatitis A. Some vaccines can only be administered three years after the birth of a child.

Who should be vaccinated against hepatitis A?

1. Since the year, the hepatitis A vaccine has been administered to children living in countries with a high incidence rate.
2. According to epidemic indications, all contacts in the foci of infection are vaccinated.
3. Immunization is also carried out for people from risk groups.

The drug is administered twice intramuscularly into the deltoid muscle. Revaccination is carried out no earlier than one month after the first injection of the vaccine. This scheme provides full protection against the disease for at least 20 years.

Vaccination against hepatitis A is carried out with the following drugs:

The peculiarity of hepatitis A vaccinations is that all of them are well tolerated, provide early protection, and after their introduction, there are practically no complications.

How dangerous is hepatitis A? It belongs to the category of mild infections, which anyone can get infected, and almost 100% of the sick are cured. But these are all positives. The disease proceeds for a long time, is complicated by damage to neighboring organs, and even deaths are possible. You cannot hide from hepatitis A, but timely prevention saves even small children.