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Viral hepatitis of A and E
July 31, 2011
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Viral hepatitis — the diseases caused by viruses of hepatitis A and E which are shown in damage of a liver and the general intoxication of an organism. Viruses of hepatitises A and E do not influence a liver independently, and the inflammation of a liver comes from the fact that protective blood cells begin to react to changes of the hepatic fabric caused by viruses A and E.
It is necessary to notice that hepatitis A is among the intestinal infections, most widespread in the world. Many have this disease in the childhood and gain lifelong immunity.
The viral hepatitis E allocated from group of the hepatitises "And, In" by means of marker diagnosis leads to damage of a liver and is followed by an acute current and especially heavy current at pregnant women. At a severe form of hepatitis E defeat not only a liver, but also kidneys is observed. Chronic forms of a viral hepatitis E, as well as its carriers are not revealed.
Reasons of hepatitises
The activator — the hepatitis A virus relating to family of picornaviruses steady in environment, however which can be inactivated during 5-minute boiling.
Hepatitis A (jaundice, infectious disease) children of 4-15 years during the autumn and winter period which are trained in kindergartens, schools, orphanages, especially in the conditions of an unsatisfactory sanitary state have generally. Besides, also cyclic increase by incidence of hepatitis A through 3-5, and then in 7-20 is observed. Infection comes in the fecal and oral way, from a virus carrier or the person sick with hepatitis, through water, food stuffs and household objects. The waterway of infection leads to diseases of persons which used the infected water, swam in the contaminated pools, lakes. Perhaps also infection through vegetables if they were exposed to fertilizer excrements of the person infected with a virus. Also the dishes prepared from thermally raw seafood, especially mollusks are dangerous. The infection meets among addicts who use the general syringes, and also among homosexuals. Besides, the probability to catch a hepatitis A virus in tropical countries — traditional places of tourism, namely — in the countries of Africa (Egypt), Asia (Turkey, India), Central America is high, and also during the cataclysms connected with water.
The virus of hepatitis E is transmitted through water, generally from open water sources, is more rare — a fecal and oral way. E adult population (30-40 years) is subject to infection with a hepatitis virus.
Hepatitis E is widespread in the countries with subtropical and tropical climate (the country of Southeast Asia, Africa), especially in territories with bad water supply of the population and where its deficit is observed. In our latitudes hepatitis E meets rather seldom. E women in the third trimester of pregnancy are especially susceptible to a hepatitis virus, children get sick rather seldom.
At the use of water or products infected with a hepatitis virus they get into intestines, and then with blood get into a liver and its cells — hepatocytes, breaking their membranes. In tissues of a liver inflammatory reactions begin, bile outflow is broken, the sizes of a liver increase.
Thanks to immune mechanisms which struggle with a virus it, through bilious channels, comes to intestines and is allocated in environment.
Hepatitis A symptoms
Distinguish acute (icteric — at teenagers and adults), subacute (anicteric) and suklinichesky forms of an illness (in the absence of clinical manifestations — most often at small children).
Hepatitis A is characterized by accurate change of the periods — dozheltushny, icteric and the period of recovery.
The incubation interval lasts from two to four weeks (at hepatitis E — till 50 days). Then at the patient can be observed as grippopodobny symptoms. Namely: temperature increase till 38-39 'C, followed by the general weakness, muscle pains, lability of pulse, cough, pharyngalgias, and the dispeptic syndrome which is characterized by loss of appetite at the same time can be observed nausea, vomiting, especially after meal, diarrhea, discomfort in epigastric area, pain and weight in right hypochondrium, bitterness in a mouth, an eructation. In 3-7 days temperature falls down, and there comes the so-called icteric period. Which proceeds 2-3 weeks, such symptoms of hepatitis A as fall of temperature of a body and pigmentation are shown at this time. Skin and mucous membranes of eyes, mouth (hard palate, language bridle), get an icteric shade, urine becomes dark (color of strong black tea), and fecal masses becomes colourless as the bile produced in a liver gets to blood.
The sizes of a liver are increased, its palpation is painful, increase in a spleen is often observed. There are nasal bleedings, an oblozhennost of language and lowering of arterial pressure. Against it dizzinesses, frustration of a dream, bradycardia can be shown. Recovery comes gradually, within 2-3 months, and is characterized by gradual reduction of symptoms of an illness, up to their disappearance, appetite normalization, recovery of the sizes of a liver. Also lifelong immunity develops. The virus of hepatitis A does not pass into a chronic form and because generally passes benign, complications meet seldom, in the form of recurrence of a disease and defeat of zhelchevyvodyashchy ways, bile of a stone illness.
Hepatitis E symptoms
At hepatitis E at an initial stage rise in temperature, gradual disturbance of digestion is observed. From the beginning of the icteric period the condition of patients with hepatitis A improves while at hepatitis E icteric period short (till 15 days), and the health of patients during this period does not improve, the main symptoms of hepatitis E during this period of pain in right hypochondrium. The absolute recovery comes in 2-4 weeks. Besides, at hepatitis E severe forms at which occurs defeat both a liver, and kidneys are often observed. In hard cases cholecystitis, cirrhosis develops.
The viral hepatitis E is especially dangerous in the second and third trimesters of pregnancy since it leads to a lethal outcome in 40% cases. At a disease pregnant with a hepatitis E virus, the icteric period is short, it turns into acute hepatonephric insufficiency as a result of which patients can fell into a coma, and the fruit fades. Abortions and childbirth at patients with hepatitis E usually are followed by big blood loss and very high frequency of death of newborns.
Especially dangerous clinical forms of hepatitis A and E are cholestatic and fulminantny forms. At the first, because of stagnation of bile in an organism, yellowness of skin, mucous membranes is brightly expressed, strong increase in a liver and a skin itch is observed. At a fulminantny (fulminant) form of a viral hepatitis And, meeting at elderly people more often, the necrosis of a liver and acute hepatic encephalopathy which can develop within several days, lead to a renal coma. Nasal bleeding, vomiting, severe hypostases of legs is observed. All this leads to a lethal outcome.
All forms of a viral hepatitis successfully are diagnosed and recover at early treatment.
Diagnosis is based on manifestations of symptoms of a disease, possibility of an illness because of contact with sick hepatitis A is considered (departure of the patient in the terms corresponding to a disease incubation interval to the countries of Asia, Africa), and for confirmation of the diagnosis of a viral hepatitis carry out laboratory analyses, namely — biochemical analysis of blood for detection of a leukopenia, a lymphocytosis, increase of level of bilirubin, and also differential diagnosis of a viral hepatitis (definition of specific antibodies to a virus) — the polimerazny chain reaction (PCR). As additional diagnostic methods apply a biopsy, ultrasonic research and a computer tomography of a liver. The type of hepatitis is finalized on the basis of detection of the corresponding immunological markers. At research of urine urobilin and bilious pigments is found. The most reliable confirmation of the diagnosis of hepatitis A is reached by means of immunochemical methods (RIA, IFA)
Diagnosis of hepatitis E is complicated by the fact that its clinical current is very similar to the course of other viral hepatitis, and at suspicions of this disease at pregnant women marker diagnosis is carried out (identifications of anti-virus immunoglobulin M and G), and also virus RNA definition in the patient's blood by PTsR method.
Treatment of hepatitis A and E
Treatment of patients with a viral hepatitis of A or E is carried out in out-patient conditions, hospitalization are subject patients with heavy treatment of an illness if there are serious associated diseases (in an infectious hospital). The patient appoints a bed rest (10-15 days) and good nutrition. The diet No. 5 consisting of digestible products with addition of carbohydrates and reduction of amount of fats is appointed. According to this diet, it is necessary to eat food 5-6 times a day, it is desirable in the warm boiled, stewed or baked look. Hardly assimilable grades of meat (pork), fishes (sturgeon, som), fried food, soups on beef-infusion, fish broths, canned food, acute snack, spices, coffee, chocolate, mushrooms, a garden radish, marinated vegetables, pepper, smoked products, alcohol are excluded from a diet. The preference is given to vegetable and milk food, low-fat grades of fish, beef, a bird, vegetables, porridge, buckwheat, cottage cheese, tea, dogrose broth, not acid juice and compotes and with addition of vitamins of groups B, ascorbic acid, 5% solution of glucose.
Thus, modern treatment of hepatitis A and E is directed to removal from an organism of the harmful substances which are formed at injury of a liver, and the immune system of the patient copes with a virus. For decrease in concentration of toxins and for recovery of cells of a liver, enter dezitoksikatsionny solutions, polyionic solutions, albumine, vitamins, glucose and special drugs — attribute the gepatoprotektor protecting liver cells to drink a lot of liquid (to 3 l. in days). For a conclusion of toxins of their intestines accept entersorbenta — Vaulen, Polyphepanum, Enterosgel. For improvement of digestive function of a stomach fermental drugs (kreon, festal, abomin, a likreaza, zimopleks) which are accepted along with food can be appointed. Antiviral drugs usually are not appointed. Drugs for decrease in temperature are also not recommended since it will disturb iimunologichesky resistance of an organism and the speedy recovery. It is possible to use cold compresses on a forehead, enemas from 2% solution of Natrii hydrocarbonas of room temperature. Also during recovery zhelchengonny drugs are appointed.
Usually hepatitis A almost always comes to an end with recovery, especially if the person has good health and observed a bed rest during an illness, and hepatitis E can cause hemolysis — destruction of erythrocytes that leads to damage of kidneys and a liver failure, and in 5% of cases there can be cirrhosis. An important role in the outcome at patients with hepatitis E at pregnant women is played by the obstetric tactics directed to the prevention of premature births and abortions.
After recovery, had a viral hepatitis And, is subject to dispensary observation within 4-6 months in the presence of the residual phenomena.
Prevention of hepatitis A and E
To the main measures of prevention of infection with a viral hepatitis of A and E, as well as other intestinal infections, providing the population with high-quality drinking water and performance of health regulations at preparation, storage, preparation and implementation of food stuffs belong. Maintenance of the appropriate antiepidemiological mode in nurseries and adult educational and working collectives is important. Quality check of tap water on virus pollution, and in the incidence centers carrying out disinfection by chlorine-containing drugs is necessary. For people, put risk of infection, medical supervision makes 35 days.
The immunoglobulinoprofilaktika which is shown in carrying out inoculations to children in kindergartens, in children's homes and to school students is effective. Administration of immunoglobulin provides short-term protection against a disease (for 3-4 months), and the vaccines preventing infection and blocking a hepatitis A virus promote preservation of immunity till 10 flyings, expensive. To children of 1-6 years immunoglobulin is entered at the same time 0,75 ml, at the age of 7-10 — 1,5 ml., and to children 10 years are more senior and the adult enters 3 ml of immunoglobulin. The vaccines protecting from hepatitis A consist of the killed viruses of hepatitis A and possess a high immunogenicity. It is Havriks 1440, Avaksim, Vakta, GEP-A-in-VAK. Vaccination is carried out to two calling with an interval of 6 months, including to children since 2 years. Vaccination is advised to do to those who had no hepatitis A, and that who has high chance to catch, namely: the military and persons leaving to the countries where there are problems with water, employees of services of water supply and the sewerage, workers of the sphere of trade, food, personnel of children's educational institutions, physicians, and also those who have chronic diseases of a liver.
Special value is given to disinfecting of drinking water in the centers of a disease of hepatitis E.
The main prevention of hepatitis A and E is reduced to observance of the principles of the general hygiene — washing of hands before food and after visit of the bathroom, washing of vegetables and fruit, the use in food of well processed meat and all seafood, and also boiled water.
Section: Infectious diseases