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People who are sick with viral hepatitis B, there are three types of particles. The most common - spherical particles , not so often - filamentous forms . Infectious properties of viral particles do not show. Only 7% of the particles are presented in the form of complex formation with complete structure which exhibits pronounced infectivity. The upper layer is formed superkapsid . Genome is double-stranded DNA molecule and its associated DNA polymerase. Main antigens - is HBsAg and HBcAg . Antibodies are produced in the course of the disease.
Hepatitis B virus is highly resistant to the negative impacts of the environment on it. In the blood, it may be active for years. The antigen of the virus can be found on the needles, bedding, medical and dental instruments. The virus can be inactivate the by autoclaving at 120 ° C for 45 min dry-heat sterilized at 180 ° C for 60 min. also gives a positive result. Formalin . hydrogen peroxide . chloramine and neutralize the virus.
Sources of infection can be both already sick with hepatitis or cirrhosis of the liver and "healthy" virus carriers. Virus appears in the blood of a patient long before the detection of the disease, and is most acute during the period of illness. On our planet, there are about 350 million virus carriers, and all of them can pose a real threat. Active pathological process, and the concentration of antigens in identifying infectious disease infection sources.
Possible routes of transmission can be elimination of the virus from the biological secrets - Saliva, blood, urine, tears, bile, semen, breast milk, and others. But the real epidemiological risk may be only the sperm, blood and possibly saliva. There is so because the rest of the liquid concentration of the virus is very low.
The virus is transmitted primarily through blood transfusions and the use of medical instruments without sterilization. Most patients infected with the passage of medical and diagnostic procedures, which are accompanied by minor violation of the unity of the skin or mucous membranes. This can be a gynecologic exam, dental procedures, injection, etc.
A natural mechanism of transmission disease is the sexual route . Quite often, the infection is carried out with the simultaneous use by several people some everyday items items - toothbrushes, towels, razors, etc. This happens during when the hepatitis B virus enters the human body through the mucous membranes microtrauma and skin.
You can become infected and puncture earlobes, tattooing and other manipulations. There is also the risk of getting and living conditions of transmission - infection within families, in organized collectives of children and adults. There is also a vertical transmission of the virus - infection is possible during childbirth. If special preventive measures are not carried out, hepatitis B can infect up to 90% of children born to mothers-virus carriers.
In communities where children are around the clock - at home baby, orphanages, children's homes, they are often subjected to medical procedures and therefore the spread of viral hepatitis is very dangerous and can cause an outbreak.
Infected with the virus and health workers can house a child, who take care of children. Transfusion of blood that contains HBsAg It leads to hepatitis in 50-90% of recipients. The percentage is dependent on the dose received infection.
But post-infectious immune system long enough, maybe even a lifetime. Relapses are very rare.
The main symptoms of viral hepatitis B
Viral hepatitis B is a common infectious disease. Today, about 2 billion people are infected with the virus each year kills about 2 million patients. Economic damage that causes the disease in the CIS countries is 100 million dollars annually. In the later stages of the disease can develop into a tumor or cirrhosis of the liver . This is particularly evident in people who were infected during childhood. Half of all clinical hepatitis occur in viral hepatitis B. Mortality from it is about 1%.
Of viral hepatitis In get sick mainly in the countries with low socio-economic conditions life. The whole planet can be divided into regions with high, medium and low endemicity.
The so-called "healthy" carriers of the virus there is a very high percentage of latent forms of infection, in which there are no symptoms of hepatitis B. And, then it can be argued that the hidden epidemic process in intensity and growth rates exceeding symptomatic.
In recent years, the beginning of the epidemic process intensively involved young population of the planet. Among patients with predominantly persons aged 15 to 30 years, and about 90% of those infected with the virus. This situation is due to the fact that the main sources of infection are sexual and "addict" pathway. 80% of deaths in patients up to age 30 who use drugs. Most of the deaths - about 42% - is a result of simultaneous infection with several forms of viral hepatitis - B, C, D.
The infection penetrates the human body through the mucous membranes or skin. Then the virus is fixed to liver hepatocytes. But the causative agent of does not render immediate impact on the cells of the liver. A huge role in the pathogenesis of otygryvayut immune complexes Which settle in the lymph nodes and visceral vascular endothelium. As a consequence, there are autoimmune reactions that lead not only to damage to healthy cells, but also leads to the death of these fragments, which entail complications of hepatitis B.
Morphological changes are dystrophic and necrobiotic processes and periportal areas tsentrolobulyarnyh liver lobules. Later, it may form cholestasia and other complications.
Symptoms of hepatitis B
The duration of the incubation period of the disease can vary from 30 to 200 days or more.
Preicteric or the initial period characterized by common symptoms. Patients having complaints of joint pain; although outwardly joints in most cases are not changed. During the night and morning hours are arthralgia, and when moving briefly disappear. They can be accompanied by a rash on the skin by type hives . Availability arthralgia and exanthema foretells more heavy and for a long course of the disease. The body temperature of the patients in this period is often increased. During this period, there dizziness , Persistent drowsiness And sometimes bleeding from the gums and nose.
As a rule, the health of patients in the period of worsening jaundice. Rash and arthralgia are, but increasing dyspeptic symptoms viral hepatitis B.
More often jaundice proceeds rapidly and is accompanied by pruritus. It often happens when skin hemorrhages are a bruises or petechiae. If the disease is severe, can occur bleeding gums, nosebleeds, women - early heavy menstruation . The urine becomes dark in color, feces, usually aholichen.
Liver tenderness, it increases in size; Whilst this may be soft in consistency. Sometimes intense jaundice and liver can not be increased, which is a sign of a more severe course of hepatitis. In half of the cases observed splenomegaly .
Typically, the pulse becomes more scarce relative to the healthy state, but if the disease is difficult, there is tachycardia . Heart sounds are muffled, there is a small hypotension . Patients, as a rule, apathetic, sometimes may experience dizziness, sleep disorder. Jaundice period may last longer than a month. It same can be said and about the changes in sizes the liver. If cholestatic component is added, the disease may become torpid course. In such cases, characterized by unexpressed intoxication . dark urine , Prolonged cholestatic symptoms, enlarged liver, aholichny chair subfebrilitet . Along with the acute form of the disease, there are viral cirrhosis and chronic hepatitis.
Complications of hepatitis B
The most severe and serious complication of the disease is hepatic encephalopathy . It is characterized by a profound inhibition of the liver, progressive psychoneurological symptoms expressed hemorrhagic manifestations. Acute hepatic encephalopathy has three stages.
Stage I (predkomatoznoe state I)
The patient's condition is steadily deteriorating, increasing jaundice and dyspeptic syndrome observed Breath , Is the development of hemorrhagic manifestations. Coordination of movements is broken, lost orientation in space and time. May slow thinking, dizziness, sleep disturbances, feeling of failure into the abyss on closing the eyes. It may be the emotional instability - slackness . apathy , A sense of of longing, anxiety, which is replaced by excitation of, euphoria . Often, pain in the region of the liver, the body temperature rises. Tachycardia or bradycardia replaced normokardiey . Disturbances of consciousness - a rare case, but in some patients it happens.
Stage II (predkomatoznoe state II)
For this step, some characteristic disturbances of consciousness ; quite often it is confused. Infected people are disoriented in space and time, are aggressive or euphoric. But the excitement and momentarily replace it quickly comes apathy, intoxication is amplified to the limit. Appears tremor tip of the tongue and hands, strengthened hemorrhagic syndrome. Blood pressure is reduced, increasing tachycardia. The liver may become inaccessible to palpation, poskol it shrinks. Predkomatoznoe condition may last up to several of day.
Stage III (coma)
Characterized loss of consciousness First shallow in most cases. On palpation of the liver, patients react primarily groan. Reserved corneal and swallowing reflexes. Appears involuntary urination, defecation, appear abnormal reflexes . Unless coma deep reaction to any stimulus is lost, comes arefleksiya. The cause of deaths becomes acute heart failure .
Very fast for hepatitis B is common in young people, especially the combination of a number of clinical hepatitis. In such patients is evolving rapidly an acute enterohepatic encephalopathy with a high percentage of lethal outcomes (up to 90%).
Acute hepatic encephalopathy leads to deterioration of renal function with a decreasing rate of renal blood flow, attaching a secondary infection and sepsis, reducing the concentration of sodium in the urine, increasing its density and can decrease diuresis , Other complications occur.
Diagnosis of viral hepatitis B
Laboratory diagnostics of hepatitis B virus
Patients in serum on different stages of illness exhibit peculiar only for this spell antibody. Such a timely diagnosis of viral hepatitis In as possible should be carried out often enough, to constantly monitor the functional activity of the liver. The great importance the possibility of determining prothrombin index . If this figure falls more than 40%, it indicates heavy and often critically ill patient. Ultrasound also provides important data that indicate violations of the structure of the liver.
Treatment of hepatitis B
If the patient has a severe form of viral hepatitis B, it is hospitalized. In such cases, prescribe prednisolone . Reduce the dose gradually after cessation of symptoms of intoxication. In parallel, the complex of measures to restore the water and electrolyte balance, intensify the detoxication therapy, prescribe antibiotics with reduced resorption from the intestine, are used lactulose antispasmodic preparations . If cholestasis is expressed brightly, it recommended to appoint a preparations ursodeoxycholic acid . In acute hepatic encephalopathy are recommended to eat glucocorticoids Although their effectiveness has not been proved. Fully disease is not curable, it remains a high probability of relapse.
Prevention of hepatitis B
In carrying out preventive activities the main task - to prevent infection with HBV during treatment and diagnostic procedures and blood transfusions.
Donors are examined for the presence of hepatitis B antigens donors can not be people who have had hepatitis B, no matter how long ago it was, as well as those who have communicated with the patients in the last six months. People suffering chronic hepatitis as well as those, who is behind recent years, was subjected to Blood Transfusion To give blood are not allowed. In recent years, it began implementation autotransfusion - When the patient prepares their own blood in advance of the planned operation.
Prevention of hepatitis B use disposable instruments, thorough sterilization of medical instruments, as well as strict control on the detection of viral antibodies in the donor.
Of great importance is the sterilization of medical products, to ensure sanitary measures, separate use and storage of personal hygiene, prevention of all types of injuries, the need to follow the rules of personal hygiene. Prevention of sexual transmission is the elimination of non-permanent, casual sex, the use of mechanical contraceptives. For the prevention of occupational of infections in curative and prophylactic establishments being watched over the observance of antiepidemic rules. This is especially significant for the surgery, hemodialysis, laboratory and other departments where the staff has access to a patient's blood. Rubber gloves necessarily use the when performing of parenteral interventions.
If we consider that the ways of transmission and sources of infection very much, it becomes clear that the most promising prevention is vaccination of viral hepatitis B. Only she can help newborns infected with the disease. This vaccine prevents many diseases of the liver. Today, viral hepatitis B refers to infections, which are controlled by means of specific preventive maintenance. Over the past few years the world has been vaccinated about 100 million people. This made it possible in some countries dramatically reduce the percentage of hepatitis B, a significant impact negatively on the level of virus carriers, and in a few countries is the question of the complete eradication of hepatitis B.
Too many countries are beginning to immunization programs against hepatitis B virus in infants and adolescents. Today, in many countries of the world are doing hepatitis B vaccination in children .
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