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It should be noted that hepatitis A is one of the most common in the world intestinal infections . Many carry the disease in childhood and develop lifelong immunity.
Viral hepatitis E, selected from the group consisting of hepatitis "neither A nor B" using the diagnostic marker, resulting in liver damage and is accompanied by an acute course and is particularly severe in pregnant women. In severe hepatitis E is observed not only damage the liver and kidneys. Chronic forms of hepatitis E, as well as its carrier is not revealed.
Causes of hepatitis
Pathogen - hepatitis A virus belonging to the family Picornaviridae, stable in the environment, but which may be inactivated during the 5-minute boiling.
Hepatitis A (jaundice, Botkin's disease) suffer mostly children 4-15 years old in the autumn-winter period, who are trained in kindergartens, schools, children's homes, especially in poor sanitary conditions . In addition, the observed increase in cyclic hepatitis A after 3-5, and then after 7-20 years . Transmission occurs by the fecal-oral route, from the virus carrier or person with hepatitis through water, food and household items . Waterway infection leads to diseases of people who used contaminated water, swimming in contaminated pools, lakes . It is also possible through the contamination of vegetables if they had been fertilizing human feces, infected with a virus . They are dangerous and dishes made from heat-treated seafood, especially shellfish . The infection occurs among drug users who share syringes, as well as among gays . In addition, it is likely infected with the hepatitis A virus in hot countries - the traditional areas of tourism - namely, Africa (Egypt), Asia (Turkey, India), Central America, as well as during disasters related to water .
Hepatitis E virus It is transmitted through the water, mainly from open water sources, at least - by the fecal-oral route. Likely to be infected with hepatitis E adult population (30-40 years).
Distributed hepatitis E in countries with subtropical and tropical climates (South-East Asia, Africa), especially in areas with poor water supply of the population, and where there is a shortage of it. In our latitudes, hepatitis E is relatively rare. Particularly susceptible to hepatitis E is a woman in the third trimester of pregnancy, children fall ill relatively rare.
By drinking water or foods infected with hepatitis B virus, they penetrate into the intestine, and then the blood to the liver cells and its - hepatocytes , Disrupting their membranes. The liver tissues begin inflammatory reactions, impaired bile flow, increase the size of the liver.
Due to immune mechanisms that are struggling with the virus, it is through the bile duct enters the intestine and released into the environment.
Symptoms of hepatitis A
Distinguish acute (icteric - adolescents and adults) subacute (anicteric) and suklinicheskuyu form of the disease (in the absence of clinical manifestations - mostly young children).
Hepatitis A is characterized by a clear change of periods - dozheltushnogo . jaundice and recovery period .
The incubation period lasts from two to four weeks (hepatitis E - up to 50 days). After that the patient can be observed both flu-like symptoms . Namely, raising the temperature to 38-39 `C, accompanied by general weakness, pain in the muscles, the lability of heart rate, cough, sore throat, and dyspeptic syndrome, characterized by loss of appetite, while there may be nausea, vomiting, especially after meals, diarrhea , Epigastric discomfort, pain and heaviness in the right upper quadrant, bitter taste in the mouth , Belching. After 3-7 days the temperature drops, and there comes the so-called icteric period . Which lasts 2-3 weeks, this time manifested symptoms of hepatitis A as lowering body temperature and pigmentation. The skin and mucous membranes of the eyes, the mouth (hard palate, tongue-tie), become jaundiced, urine becomes dark (the color of strong black tea), and discolored stool, as produced in the liver bile enters the bloodstream.
Dimensions of the liver increased, its palpation is painful, often enlargement of the spleen. There are nasal bleeding , Coated tongue, and lowering blood pressure. Against this background, may occur dizziness , Sleep disorders, bradycardia. Recovery occurs gradually over 2-3 months and is characterized by a gradual decrease in the symptoms of the disease, up to their disappearance, normalization of appetite, reduction of the size of the liver. Also develops lifelong immunity. Hepatitis A virus does not become chronic, and due to the fact that mostly runs in an easy manner, that complications are rare, a recurrence of the disease and biliary tract lesions, bile stone disease.
Symptoms of hepatitis E
Viral hepatitis E is particularly dangerous in the second and third trimesters of pregnancy, because it is fatal in 40% of cases. When the disease is pregnant with hepatitis E, jaundice period is short, it goes into an acute renal failure as a result of which patients may fall into a coma, and the fetus dies. Miscarriages and birth in patients with hepatitis E is usually accompanied by large blood loss and a very high death rate of newborns.
Particularly dangerous clinical forms of hepatitis A and E are cholestatic and fulminant form . At first, due to the stagnation of bile in the body, pronounced yellowness of the skin, mucous membranes, a strong increase in liver itching . When fulminant (lightning) form of viral hepatitis A is more common in the elderly, hepatic necrosis, and acute liver encephalopathy That may develop over several days, lead to renal coma. There nosebleeds, vomiting, severe swelling of the legs. All this leads to death.
Diagnostics
All forms of viral hepatitis is successfully diagnosed and cured under Early treatment .
Diagnosis is based on symptoms of the disease, are taken into account the possibility of the disease from contact with a patient with hepatitis A (leaving the patient in terms corresponding to the incubation period of the disease in Asia, Africa), and to confirm the diagnosis of viral hepatitis conduct laboratory tests, namely - blood chemistry to detect leukopenia, lymphocytosis, increase levels of bilirubin, as well as differential diagnosis viral hepatitis (determination of specific antibodies to the virus) - polymerase chain reaction (PCR). As additional diagnostic methods used biopsy, ultrasound, and computed tomography of the liver. The final form of hepatitis is set based on the detection of relevant immunological markers. In the study found urobilin urine and bile pigments. The most significant confirmation of the diagnosis of hepatitis A is achieved by immuno-chemical methods (RIA, ELISA)
Diagnosis of Hepatitis E is complicated by the fact that its clinical course is very similar to the other for viral hepatitis, and suspicion of the disease in pregnant women is conducted diagnostic marker (identifying antiviral immunoglobulin M and G), as well as determination of RNA virus in a patient's blood by PCR.
Treatment of hepatitis A and E
Treatment of patients with viral hepatitis A or E is performed on an outpatient basis, subject to hospitalization in patients with severe disease treatment, if there is a severe concomitant diseases (hospital infection). Patients were assigned a bed rest (10-15 days), and nutrition. Appointed diet №5 Consisting of easily digestible products with the addition of carbohydrate and decrease the amount of fat. According to this diet, the food should be taken 5-6 times a day, preferably in a warm boiled, steamed or baked form. Excluded from the diet trudnousvoyaemye meats (pork), fish (sturgeon, catfish), fried foods, soups on meat, fish broth, canned food, savory snacks, spices, coffee, chocolate, mushrooms, radishes, pickles, peppers, smoked, alcohol . Preference is given to plant and dairy foods, lean fish, beef, poultry, vegetables, oatmeal, buckwheat, cottage cheese, tea, broth hips, nonacidic juices and compotes, and with the addition of B vitamins, ascorbic acid, 5% glucose solution.
Thus, the current treatment for hepatitis A and E are directed to removal from the body of harmful substances resulting from the damage to the liver, and cope with the virus the immune system of the patient. To reduce the concentration of toxins and recovery of liver cells is administered dezitoksikatsionnye solutions polyionic solutions albumin Vitamins, glucose and special preparations - hepatoprotectors Protecting liver cells, attributed to drink plenty of fluids (up to 3 liters. Per day). For detoxifying their intestines take entersorbenty - Vaul . Polyphepanum . enterosgel . To improve the digestive function of the stomach may be administered enzyme preparations ( Creon . Festal . abomin . likreaza . zimopleks ), Are taken together with food. Antiviral medications are usually not appointed. Formulations for lowering the temperature are also not recommended because it will interfere with the body's resistance iimunologicheskoy and speedy recovery. You can use cold compresses to the forehead, enemas with 2% solution of sodium bicarbonate at room temperature. Also in convalescence appointed zhelchengonnye drugs .
Generally hepatitis A is almost always ends in recovery, especially if the person has good health and comply with bed rest during an illness, and hepatitis E can cause hemolysis - Destruction of erythrocytes that leads to renal and hepatic failure, and 5% of liver cirrhosis can occur. An important role in the outcome of patients with hepatitis E in pregnant women plays obstetric tactics aimed at preventing premature births and miscarriages.
After recovery, recover from hepatitis A, subject to dispensary observation for 4-6 months in the presence of residual effects.
Prevention of hepatitis A and E
The key to prevention of infection with viral hepatitis A and E, as well as other intestinal infections, include the provision of safe drinking water and the implementation of the sanitary rules in the procurement, storage, preparation and sale of food products. It is important to maintain proper anti-epidemic regime in children and adults educational and work collectives. The need to verify the quality of tap water on virus contamination and disease outbreaks in the disinfection with chlorine-containing agents. For people who have been at risk of infection, medical supervision is 35 days.
Efficiency is via immunoglobulin Manifested in the conduct of vaccinations for children in kindergartens, in children's homes and schoolchildren . Intravenous immunoglobulin provides short-term protection from the disease (3-4 months), as a vaccine to prevent infection and block the hepatitis A virus, help to preserve the immunity of up to 10 years old, costly . Children 1-6 years immunoglobulin administered simultaneously 0, 75 ml, aged 7-10 - 1, 5 ml . And children older than 10 years and adults introduced 3 mL of immunoglobulin . Vaccines that protect against hepatitis A, consists of killed hepatitis A virus and are highly immunogenic . It Havrix 1440 AWACS, Waqt, GEO-A-in-WAC . Vaccination is carried out in two parts with an interval of 6 months, including children from 2 years . Vaccinations are advised to make those who are not ill with hepatitis A, and those who have a higher chance of contracting, namely the military and those who travel to countries where there are problems with the water, the workers of water services and sanitation professionals in the field of trade, food, staff children's educational institutions, as well as those with chronic liver disease .
Particular importance is given to disinfection of drinking water in the outbreaks of hepatitis E.
But the main prevention of hepatitis A and E is limited to compliance general hygiene principles - Wash hands before eating and after using the restroom, wash fruits and vegetables, eating a well-processed meats and all seafood and boiled water.
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