Viral hepatitis E is an acute infectious liver disease caused by the RNA-containing hepatitis E virus (HEV).
The disease is characterized by the development of fever, general malaise and signs of an inflammatory process in the liver (pain in the right hypochondrium, yellowing of the skin, darkening of the urine, discoloration of feces).
Each year, about 20 million people become infected with viral hepatitis E and about 56.5 million die. The disease is more common in people of predominantly young age from 18 to 30 years and children, men and women are equally affected.
Viral hepatitis E is common in countries with a hot (humid or moderately dry) climate, where sanitary conditions of life are sharply violated. These countries include:
- South American countries (Chile, Peru, Brazil, Argentina, Venezuela, Bolivia, Colombia, Uruguay),
- Central American countries (Honduras, Nicaragua, El Salvador, Cuba, Costa Rica, Guatemala),
- North American countries (central and southern Mexico),
- Asian countries (Iran, Iraq, Pakistan, India, China, Tibet, Nepal, Vietnam, Laos, Thailand, Bangladesh).
Along with these countries, outbreaks of viral hepatitis E epidemic develop in places of military operations, in conflict zones, in refugee zones or in countries after emergencies, which primarily include floods.
The prognosis for hepatitis E is generally favorable, with the usual course of the disease, recovery occurs after 2 to 3 months, liver function is fully preserved and subsequently in the body, as with hepatitis A, a stable lifelong immunity is developed, i.e. re-infected with hepatitis E is not possible.
If the patient develops a fulminant form of the disease (this occurs in 1 to 3% of cases, of the total incidence), then the prognosis for the patient's life is not favorable, since an acute form of liver failure develops, leading to death.
There is a risk group for people who may develop a fulminant infection:
- persons already suffering from liver diseases of viral and non-viral etiology,
- persons with reduced immunity (body resistance):
- HIV infected
- AIDS patients
- due to diseases of the endocrinological system - diabetes mellitus, hypothyroidism,
- cancer patients
- patients taking a large amount of glucocorticosteroids (hormones) daily
- persons after organ transplantation,
- persons on hemodialysis (artificial kidney apparatus),
- chronic infection in the body (tuberculosis, syphilis, osteomyelitis),
- drug addicts.
The cause of the disease is the ingestion of hepatitis E virus by the HEV virus. The virus is represented by a single chain of hereditary information - RNA, without an outer shell, and is therefore rather unstable in the environment (dies when exposed to ultraviolet rays, when boiled, under the influence of antiseptic substances ), but the virus can persist for a long time in fresh water. The length of viral particles is 32 - 34 nanometers.
The source of infection is a sick person or a virus carrier (the type of people who do not have symptoms of the disease, but the examination can detect hepatitis E virus in the blood or feces).
The main route of transmission of the virus is fecal-oral. The mechanism of this pathway is the transmission of hepatitis E virus through contaminated drinking water to the feces of a sick person. This happens when there is insufficient wastewater and drinking water treatment, or their mixing.
Along with the main fecal-oral route of transmission, several more possible pathways of infection with the virus have been identified:
- eating animal foods that have been infected with hepatitis E virus,
- transfusion of blood and plasma infected with viral hepatitis E,
- transmission from an infected mother during pregnancy to the fetus.
Viral hepatitis E - liver damage of an infectious nature. The infection has a fecal-oral transmission mechanism, it is acute, cyclical, and quite dangerous for pregnant women. Hepatitis E is predominantly distributed in tropical countries and regions where the supply of clean water to the population is not sufficient (Central Asian countries).
Viral hepatitis: what is it?
What causes this disease? In general, hepatitis is commonly called liver inflammation. They can be both infectious and non-infectious in nature. Non-infectious hepatitis - these are those that are caused by reasons not related to the activity of microorganisms. The most common non-infectious hepatitis are toxic and alcoholic.
However, infectious varieties of the disease are much more common. They can be caused by viruses, protozoa and bacteria. Thus, viral hepatitis is a disease caused by viruses that infect liver cells.
Bacterial and parasitic varieties of the disease are relatively rare, which can not be said about viral hepatitis. Estimates show that at least 2 billion people have been infected with viral hepatitis, and 300-400 million people have been infected with hepatitis viruses. Viral hepatitis is one of the ten leading causes of death among people around the world and is comparable in this regard with diseases such as AIDS, tuberculosis and malaria.
What is hepatitis E?
Hepatitis E - An inflammatory infectious liver disease caused by infection of the body with hepatitis E virus (HEV). In severe cases of the disease, the kidneys can also become infected. The main mechanism of infection is the fecal-oral route.
The main danger of hepatitis E virus infection is the acute course of the disease in pregnant women with a frequent unfavorable outcome of pregnancy in the last trimester, leading both the mother and the fetus to death. In other cases, this disease usually proceeds benignly, often a person even heals himself, usually 2-6 weeks after the disease.
Due to the fact that the causative agent of hepatitis E is a viral infection (HEV - Hepatitis E virus), this disease is often called - viral hepatitis E.
HEV is a small (32-34 nm) virus whose genome is a single-stranded coding, positive-polar RNA (ribonucleic acid). Scientists have identified 4 HEV genotypes - 1, 2, 3 and 4. The first and second genotypes were found only in humans, and the third and fourth - in animals (especially pigs and wild boars).
Viral hepatitis - the so-called category of common infectious diseases. They are endowed with a number of differences, but are united by several signs: they have a viral etiology, characteristic symptoms, and most importantly, they have a destructive effect on the liver. What is this group, what forms does it have, what is the danger to human health?
According to severity, there are:
- Mild hepatitis E,
- Viral hepatitis E of moderate severity,
- Severe viral hepatitis E
- Viral hepatitis fulminant (extremely severe).
On the route of transmission of infection, there are:
- Viral hepatitis E with fecal-oral transmission,
- Parenteral transmission of viral hepatitis E (via blood),
- Viral hepatitis E with a vertical transmission path (from mother to fetus),
- Viral hepatitis E with zoonotic transmission (via ingestion of infected animals).
In form, viral hepatitis E is divided into:
Hepatitis E virus belongs to the genus Calicivirus, is RNA-containing, has less resistance to the environment than hepatitis A. The causative agent remains viable at 20 ° C or less, when frozen and thawed, it dies, it is well inactivated by chlorine and iodine-containing disinfectants. The reservoir and source of hepatitis E virus are sick people and carriers of infection. The period of human infectiousness is not well understood, but presumably contagiousness takes place at the same time as with hepatitis A.
Hepatitis E virus is transmitted by the fecal-oral mechanism mainly by water. In rare cases (when dishes, household items are contaminated with a virus), a contact-household transmission path is implemented. Foodborne contamination is possible by eating raw shellfish. The predominance of the waterway of infection spread is confirmed by its low foci, the occurrence of epidemics in connection with seasonal precipitation, and a change in the level of groundwater. The highest natural susceptibility is in pregnant women after 30 weeks of gestation. The transmitted infection presumably leaves a lasting lifelong immunity.
Forms of viral hepatitis
The method of treatment of the disease largely depends on its form. Forms of viral hepatitis are of three main types:
- fulminant (fulminant),
When the virus first enters the body of an uninfected person who does not have immunity, the virus causes an attack of acute hepatitis (rarely, fulminant). The chronic form of viral hepatitis is characteristic only for hematogenous pathogens. Acute hepatitis passes into it if the immune system does not manage to completely destroy the virus.
Causative agents of the disease
Currently, at least 6 viruses specializing in the defeat of liver cells have been isolated. And there is no doubt that this list will be replenished with new items in the coming years. Since there are extremely many types of viral hepatitis, scientists decided to designate them with letters of the Latin alphabet. Currently, medical science has carefully studied the five main varieties of forms of viral hepatitis, denoted by the letters A, B, C, D, E. There are also a number of exotic, little-studied and rare viruses that multiply in the liver. In addition, in rare cases, viral hepatitis can be caused by pathogens of other diseases. These include:
- rubella virus
- Epstein-Barr virus,
- herpes viruses.
All pathogens that cause viral hepatitis, from the point of view of classification, belong to different families. Some of them contain the genetic code in DNA, and some in RNA.
However, the pathogenetic processes leading to the development of the disease in the case of various viruses are approximately the same:
- the virus enters the body from the environment (by hematogenous or oral route),
- the virus enters the liver through the blood stream,
- the virus penetrates the membrane of the liver cells (hepatocytes),
- the virus passes its code to the cell’s genome,
- hepatocyte begins to produce copies of the virus,
- the cell dies either as a result of exposure to the virus, or destroyed by the body’s immune forces (killer lymphocytes and phagocytes),
- there is a massive death of hepatocytes, due to which areas of necrosis are formed in the liver,
- symptoms of impaired liver function are observed.
So an acute type of disease develops. Further development of events can proceed according to several scenarios - either immunity destroys all virus particles and cells infected by them and a person is cured of hepatitis, or immunity manages to restrain the avalanche-like multiplication of viruses, but some of the viruses still remain in the body. The disease passes into the stage of viral chronic hepatitis. However, in some cases, liver failure can lead to the death of the patient.
Some types of viral hepatitis can cause so-called fulminant or fulminant forms of the disease. They are characterized by a faster than in acute hepatitis, an increase in signs of severe intoxication of the body, which within a few days can go into the hepatic coma and lead to death from acute liver failure.
The etiology or cause of HEV is always the same - hepatitis E virus (E).
There are periods of development of the disease:
- incubation (from 15 to 65 days),
- prodromal, or preliminary (from 3 to 7 days),
- manifest, that is, vivid manifestations or heat (on average, 1-3 weeks),
- convalescence, otherwise recovery.
There are different forms:
According to severity, options are distinguished:
Separately, a malignant, or fulminant (fulminant) form is considered, which is characterized by rapid development with a rapid increase in functional liver failure.
When the pathogen enters the body for the first time, it causes acute viral hepatitis. Often, however, acute hepatitis may not be accompanied by obvious symptoms.
Also, acute hepatitis usually precedes the incubation period. In this period, the symptoms of the disease are not observed, but the patient is already contagious to others.
However, in most cases, signs of acute hepatitis include:
- high temperature
- general malaise, fatigue, weakness,
- indigestion, nausea, vomiting,
- yellowness of the skin,
- drawing or paroxysmal pain in the right hypochondrium,
- enlarged liver, less often - spleen,
- light color of excrement,
- dark color of urine.
In some forms of acute hepatitis, some symptoms may be present, while others may be absent. For example, an acute type of disease can have a flu-like form. In this case, fever, headaches, muscle pain come to the fore. The acute type of disease with gastrointestinal syndrome is manifested by various gastrointestinal disorders (vomiting, diarrhea, flatulence, nausea, abdominal pain, constipation). The main symptoms of hepatitis in the asthenovegetative form are weakness, weakness, and fatigue.
Jaundice syndrome in acute hepatitis (yellow coloration of the mucous membranes, eyeballs, skin) is caused by bilirubin entering the blood from damaged liver cells. Usually jaundice manifests itself in the second phase of the disease, when the patient is recovering. However, acute hepatitis can often proceed according to the anicteric type.
Symptoms of the chronic form of the disease are usually less pronounced than the pathological effects of acute hepatitis. Often, patients do not suspect their illness for decades, and the manifestations of the disease are attributed to overwork, stress or other illnesses. The patient is being treated for some other things, taking a large number of drugs, which makes the liver only worse. Only when the disease enters its final stage, the symptoms of liver failure become apparent.
What signs of hepatitis may deserve close attention:
- fast fatiguability,
- decreased exercise tolerance,
- sleep disturbances
- periodic gastrointestinal disorders,
- heaviness in the right hypochondrium.
Until recently, it was believed that a person who becomes infected with the hepatitis E virus suffers an acute type of disease and always recovers. Moreover, he develops a stable immunity - that is, re-infection is excluded.
However, according to modern research, the likelihood of a chronic process also exists - at risk are people with severe immunodeficiency:
- cancer patients
- recipients - that is, recipients of donor organs,
- persons infected with HIV (human immunodeficiency virus).
Chronic hepatitis E is very rare.It can flow latent (hidden) for many years.
Acute viral hepatitis E
There are no symptoms in the incubation period. The first complaints appear at the prodromal stage: it is weakness, nausea, less often vomiting and diarrhea, pain in muscles and joints, in some cases - fever.
After the prodromal period, the midst stage begins. In the classical form, it occurs with jaundice, therefore, neither the patients nor the doctor usually have doubts that it is hepatitis.
Its characteristic features:
- Preservation of intoxication - severe weakness, chills, fever, fatigue.
- Persistent dyspepsia or digestive disorders - it includes poor appetite, nausea, vomiting, and sometimes flatulence.
- Jaundice is accompanied not only by discoloration of the skin, mucous membranes, sclera of the eyes, as well as itching, darkening of urine, feces acquire a gray, "calcareous" hue.
- The liver is enlarged (hepatomegaly), patients are concerned about pain in the right hypochondrium and epigastrium, combined with a feeling of heaviness, bursting.
At risk for developing a fulminate form of hepatitis E are pregnant women.
Although none of the infected people is safe from this option, it is during the gestation (gestation) period that the probability of a malignant course of infection is especially high.
With fulminate hepatitis, jaundice grows very quickly, liver size decreases ("empty hypochondrium syndrome"), damage to the nervous system (encephalopathy) progresses, manifested by impaired consciousness, tremors, and convulsions.
It is typical for patients with immunosuppression and initially implies an unstable state, the presence of concomitant pathologies - sometimes quite severe, even incurable.
It proceeds mainly latently, with the manifestation of chronic viral hepatitis e (E) can be manifested by numerous symptoms:
- decreased appetite combined with persistent nausea, periodic vomiting,
- pain in the abdominal cavity, concentrated in the right hypochondrium and epigastrium,
- jaundice syndrome with dark urine, lightening feces and itching of the skin,
- weakness, fatigue, fever.
A complication can be damage to the nervous system, pancreas, kidneys.
Diagnosis and therapy
In order to start an effective treatment, it is necessary to make an accurate diagnosis. The diagnosis of viral hepatitis is made taking into account a comprehensive examination of the patient, including:
- visual inspection
- blood test for antibodies and antigens of the virus,
- general blood test (detection of shifts in the leukocyte formula),
- biochemical blood test (determination of bilirubin level, ACT, ALT),
- analysis to determine the presence of the virus in the blood.
The method of treatment of the disease depends on the correct diagnosis, since different types of viral hepatitis are usually treated in different ways.
In most cases, the treatment of the disease is carried out on an outpatient basis. Only in severe acute hepatitis can a patient be hospitalized.
I want to emphasize the importance of studying hepatitis E by talking about one of my patients. So, M., a man at the age of 28, turned to me with complaints of nausea, aching in joints and muscles, pain and heaviness in the abdomen, fever up to 38 ° C, general weakness and chills. During the survey, I found out the fact of a trip made to an Asian country 8 weeks ago.
During an objective examination, I found that the liver is enlarged, painful on palpation. There was no jaundice - looking ahead, I want to note that she appeared later, after hospitalization.
I sent the patient to an infectious diseases hospital, according to the diagnostic results (a blood test with a biochemical complex, urine, feces, enzyme-linked immunosorbent assay for markers of viral liver lesions, including HEV, abdominal ultrasound), the presence of acute hepatitis E.The patient underwent detoxification therapy, recovered without residual effects.
If chronic viral hepatitis is progressing, and there is no adequate treatment for the disease, then healthy liver tissue is becoming less and less. They are gradually replaced by connective tissue. A similar process is called fibrosis. The fourth and last stage of fibrosis is cirrhosis. With this disease, the liver can no longer fulfill its function. Intoxication of the body is growing. First of all, with the accumulation of toxins in the blood, the nervous system suffers. This circumstance often leads to brain damage - hepatic encephalopathy.
Another possible formidable complication of chronic hepatitis is liver carcinoma (cancer). And with cirrhosis, and with carcinoma, the likelihood of death is very high.
The acute type of the disease can also lead to serious consequences, even death, especially in cases where the patient has a weakened immune system or severe concomitant diseases, is in old age.
VIRAL HEPATITIS B
Viral hepatitis B (HBV) is a viral anthroponous infectious disease with contact and vertical pathogen transmission mechanisms. It is characterized by cyclically flowing parenchymal hepatitis with the presence in some cases of jaundice and possible chronicity.
B16. Acute viral hepatitis B.
B16.2. Acute viral hepatitis B without a delta agent with hepatic coma. B16.9. Acute viral hepatitis B without delta agent without hepatic coma.
About 5.5 billion people had contact with HBV infection. About 2 billion people have HBV markers. The number of newly reported cases of HBV is about 4-5 million annually. The number of deaths associated with HBV is 1-2 million annually (of which 15-25% in the outcome of HBV. In the Russian Federation and the CIS, about 10 thousand people die from HBV every year (5 thousand from OHV, 4.5 thousand - from chronic hepatitis B). 10% of those who have become infected with HBV become carriers of HBV.
hepatocellular carcinoma (liver cancer) in HBV infected people is 223 times higher than in its absence.
Hepatitis B virus (HBV) - the parent of the Hepadnaviridae virus family - is hepatotropic, capable of prolonged persistence in the human body. Morphologically, the hepatitis B virus consists of a nucleus (nucleotide), inside which there is double-stranded DNA and a DNA polymerase enzyme. The nucleotide contains an HBc antigen, which is firmly integrated into the nucleus of the target cell (hepatocyte) and is not detected in the blood serum, but during the reproduction of the virus is transformed into an HBe antigen, which is determined in acute infection. The envelope of the virus consists of a surface antigen (HBsAg). Hepatitis B virus replicates primarily in the liver cells, as well as in the cells of the kidneys, pancreas, bone marrow and lymphocytes.
Hepatitis B virus is highly infectious: 10-100 particles of the virus are sufficient for HBV infection, it is stable in the external environment, it persists at t +30 - +32 C 0 - 6 months, at t - 20 C 0 - 15 years, when treated with dry heat (t + 160 C 0) is destroyed within 1 hour, sensitive to ether, not ionic detergents.
Hepatitis B virus is the most variable of the DNA-containing ones, more than 60 mutant strains have been registered, it has 8 genotypes denoted by Latin letters A to G. The relationship of a specific HBV genotype and subtype with the severity of acute and chronic hepatitis, the development of fulminant forms and the effectiveness of therapy.
Sources of HB virus infection in susceptible individuals are patients with various forms of acute hepatitis B (4-6%), chronic hepatitis B, and virus carriers (94-96%). The virus in infected individuals is found in blood, semen, and vaginal secretions.
The mechanism of infection - blood contact (parenteral)
Ways of infection: natural (sexual, perinatal) and artificial, associated with parenteral interventions.
Susceptibility to HBV is universal, due to the presence of specific receptors for HBs antigen on hepatocytes.
- children, adolescents, youth,
- recipients of blood and its components,
- recipients for organ transplants,
- patients of hemodialysis units,
- patients of surgical and other departments with high parenteral load,
- injecting drug users,
- newborns from women infected with HBV,
- Pupils of specialized boarding schools.
The blood contact method of infection provides the hematogenous introduction of the virus into the liver. Hepatitis B virus replication is also possible in bone marrow cells, lymphocytes, kidneys, pancreas, but with less intensity. The complex mechanism of DNA replication, with the formation of nucleocapsids for the synthesis of daughter virions and matrices for the assembly of virions, leads to the possibility of a long-term persistence of the virus in
the body. The virus does not have a direct damaging effect on hepatocytes. Their cytolysis is carried out immuno-indirectly, mainly due to reactions from cellular immunity. The reaction on the part of the humoral link is less significant in immunopathogenesis and consists in the production of specific antibodies to HBV antigens, their binding, with the formation of immune complexes and termination of free circulation in the blood.
At the same time, the significance of the humoral response increases with the development of autoimmune processes that are involved in the genesis of chronic hepatitis. The interaction of HBV with the cell can also lead to the integration of HBV DNA segments into the hepatocyte genome, which in turn can play a role in the development of hepatocellular carcinoma.
As a result of the multiplication of the virus in hepatocytes, the occurrence of massive necrosis of the liver parenchyma, the protein components of the cells begin to act as autoantigens. Hydrolytic autolysis of hepatocytes leads to damage to the capillaries of the liver tissue and its infiltration by plasma elements with the development of phagocytic-lymphocytic activity, which causes the development of mesenchymal-inflammatory syndrome. The occurrence of fulminant hepatitis is associated with the development of an excessive humoral hyperimmune response, resulting in massive liver necrosis. In this case, the regeneration of the liver tissue does not occur or develops slowly. An excessive immune response can be determined immunogenetically. It is assumed that mutant HBV strains (in particular HBe-negative strains), as well as accelerated HBV-induced apoptosis of hepatocytes, can play a role in the genesis of the fulminant course of hepatitis. With a favorable course of hepatitis, the last stage of pathogenesis is the release of the body from viruses and the formation of immunity.
HBV is characterized by a cyclic flow. The incubation period lasts from 45 to 180 days (usually from 2 to 4 months).
During OGV, the preicteric, icteric periods and the convalescence period are distinguished.
The preicteric period lasts 1-5 weeks. Asthenovegetative (weakness, fatigue, fatigue) and dyspeptic (loss of appetite, decreased taste sensations, nausea, sometimes vomiting, bitterness in the mouth, heaviness and dull pain in the right hypochondrium) are characteristic. Headache, sleep disturbances are frequent. Approximately 20-30% of patients experience pain in large joints, an urticarial rash, fever, less often itchy skin. Even before the onset of jaundice, the liver (sometimes the spleen) grows, the urine becomes dark, the activity of ALT and AST increases in the blood serum by 20-30 times, specific markers of HBV infection (HBsAg, HBeAg, antiHBcIgM) are found in the blood. The pre-icteric period may be absent, then darkening of the urine and yellowness of the sclera are the first symptoms of the disease.
With the appearance of jaundice, the well-being of patients does not improve: weakness increases, appetite decreases up to anorexia, nausea, dryness and bitterness in the mouth, often headache and dizziness, arthralgia stops. In the icteric period, the liver increases even more. Jaundice gradually grows, reaching a maximum at 2-3 weeks. Urine becomes dark, feces at the height of jaundice become acholic. The duration of the icteric period varies from several days to several weeks, usually 2-6 weeks.
An increase in ALT activity by a factor of 30-50 is recorded during the entire icteric period. Protein-synthetic function of the liver with HBV is impaired in severe cases of the disease (decreased sublimate test, albumin, prothrombin
index). The thymol test usually does not increase or rises slightly. In the peripheral blood, the white blood cell count is normal or reduced.
The convalescence period can last up to six months. Clinical and biochemical changes disappear slowly: the serum bilirubin content normalizes within 2-4 weeks, increased enzyme activity lasts from 1 to 3 months. In a number of patients, the wave-like nature of hyperenzymemia during convalescence can be observed. Relapse of the disease with enzymatic exacerbation and hyperbilirubinemia requires the exclusion of HDV infection
Clinical options for HBV: icteric, anicteric, erased, inapparent (subclinical).
According to epidemiological studies, the anicteric variant is found 20–40 times more often than the icteric one.
One of the features of the icteric variant of HBV is the severity in some cases of cholestatic syndrome. At the same time, intoxication is insignificant, the main complaint of patients is itchy skin, intense jaundice, with a greenish or gray-green skin tone, lasts a long time. The liver is significantly enlarged, dense. Feces are acholic, urine is dark for a long time. In the blood serum - high bilirubinemia, high cholesterol and alkaline phosphatase activity. The icteric period can be delayed up to 2-4 months, complete normalization of biochemical changes occurs even later.
HBV can occur in mild, moderate or severe form.
The most informative for assessing the severity of viral hepatitis is hepatic intoxication syndrome, which is manifested by weakness, adynamia, decreased appetite, vegetovascular disorders, and in some cases, impaired consciousness. The severity of intoxication in combination with the results of a laboratory study (primarily ALT and prothrombin activity) characterizes the severity of hepatitis.
With a mild form of HBV, intoxication is not very pronounced, the intensity of jaundice is low, an increase in blood bilirubin and hyperfermentemia are detected in biochemical samples (the de Ritis coefficient is less than 1).
With a moderate form of HBV in the icteric period, intoxication is manifested by moderate weakness, intermittent headache, decreased appetite, nausea, and sometimes vomiting after eating, there may be short-term nosebleeds, jaundice bright, persistent. Biochemical tests: increased bilirubin, transaminases, a slight decrease in prothrombin activity can be detected.
Severe HBV is characterized by an increase in severe intoxication in the icteric period (weakness, lack of appetite, constant nausea, frequent vomiting). New clinical signs appear: adynamia, dizziness, flickering flies in front of the eyes, tachycardia, pain in the liver, reduced liver size, hemorrhagic syndrome (nosebleeds, bruising at the injection site, etc.), fever, jaundice increases. At the same time, a significant decrease in prothrombin activity, an increase in ALT activity of more than 80-90 norms, and high hyperbilirubinemia (200 μm l and higher) are noted.
HBV Laboratory Diagnostic Standard
- general blood analysis,
- general urine analysis,
- total blood bilirubin and its fractions, ALT, AST, blood glucose,
- markers of viral hepatitis A, B, C, D, E (HBsAg, anti-HBcIgM, HBeAg, anti HBcIgG, anti-HBV, anti-HBIgM, total anti-HDV).
Additional laboratory diagnostics
In severe, protracted, cholestatic forms, with the development of complications:
- GGT, alkaline phosphatase, blood cholesterol, b-lipoproteins, triglycerides, total protein and protein fractions,
- potassium and sodium of blood,
- ultrasound of the abdominal cavity,
- chest radiography,
- analysis for blood type and Rh factor.
Specific laboratory diagnosis of HBV. Verification of acute HBV is carried out by identifying specific markers. Antigens and antibodies to HB are determined by ELISA. HBsAg appears in the blood 2 weeks - 2 months before the onset of symptoms. With a smooth course of HBV in the period of convalescence, HBsAg disappears, and after 3-4 months from the onset of the disease, antiHBs appear, which indicates the formation of immunity. In severe HBV HBsAg can be detected in small concentrations, while antibodies to HBs antigen are detected early. In the fulminant course of HBV, very fast seroconversion is observed and only anti-HB s can be detected.
The most reliable specific marker of OHV is anti-HBcIgM, which appear at the end of the incubation period and persist throughout the entire period of clinical manifestations. After 4-6 months from the onset of the disease, anti-HBc IgM disappear and anti-HBc IgG appear (they persist for life). In HB carriers, anti-HBcIgM HBs are absent in the blood.
In the incubation period of HBV, simultaneously with HBsAg, the HBe antigen, a marker of active replication of the virus, circulates in the serum, it is detected even before the cytolysis syndrome. HBeAg disappears from the blood during the period of jaundice and antiNBe appears. The presence of HBeAg always reflects the ongoing replicative phase of acute HBV infection, if it is detected for more than 2-3 months, this indicates the possibility of a chronic process. Indication of HBeAg and anti-HBeAg is not so much diagnostic as epidemiological and prognostic value, by changing the genetic code in Pre
When infected with a mutant type of HBV, a high incidence of severe forms of OVHV and fulminant hepatitis is observed. HBeAg as a criterion for replication is not detected; there may be no HBsAg.
HBV DNA is the most sensitive indicator of virus replication. PCR can detect the DNA of the virus in blood serum, lymphocytes, liver cells, which indicates replication. Indication of HBV DNA allows you to diagnose hepatitis caused by mutant strains of HBV.
A total study of antigens and antibodies and the use of PCR allow us to ascertain the presence of HB infection to distinguish between acute infection (HBsAg in combination with anti-HBc IgM) and chronic (HBsAg in combination with anti-HBc IgG), to judge the recovery and the formed protective immunity (anti- HB more than 10 IU), to identify the replicative activity of HBV, to determine the form of chronic HBV (HBV negative or HBE-positive), to predict the course of the disease, to judge the effectiveness of the therapy.
In order to prevent HBV, a thorough selection of donors is carried out with a mandatory blood test for the presence of HBsAg and ALT activity, as much as possible limit the number of indications for blood transfusion. Processing rules required
medical instruments, observance of the rules of work by medical staff (the use of gloves, masks, goggles), public health education (information about the risk of sexual infection with intravenous drug use), examination of pregnant women for the presence of HBsAg.
Specific prevention is carried out using genetically engineered vaccines against HBV.
Monovalent and combination vaccines are registered in Russia.
Combiotech (Russia), DNA recombinant (Russia) Regevak (Russia), Engerix B (Belgium) Shanvak (India) HB-WAX11 (Netherlands), Euwax (Korea), Eberbiovak HB (Cuba).
- Twinrix (Belgium) - a combination vaccine for the prevention of both hepatitis A and hepatitis B virus
- Bubo-kok (Russia) against pertussis, diphtheria, tetanus and HBV)
- Bubo – M (Russia) against HBV, diphtheria, tetanus)
- Tritanrix (UK) against HBV, pertussis, diphtheria, tetanus) Vaccination is the most effective way to prevent HBV.
The effectiveness of modern vaccines is 85-95%. Vaccination is carried out according to the scheme 0-1-6 months. The anti-HB titer is determined 1-3 months after the end of the main course of vaccination. Revaccination is carried out once after 5-7 years in the event of a decrease in the protective level of antibodies (protective level of anti-HBs concentration is 10 IU / ml or more). Vaccinations are primarily intended for people with an increased risk of infection: newborns from mothers who have HBV or who have had HBV during pregnancy (according to the 0-1-2-12 month schedule), medical workers, graduates of medical institutes and schools, patients with hemophilia, patients with hemodialysis centers etc., family members of patients or carriers of HBV. HBV vaccines can be used for emergency prevention of infection. In case of accidental injury to objects contaminated with blood of patients or carriers of HBV, vaccination is carried out according to the scheme 0-1-2-12 months
For emergency prophylaxis in contact with HBs-positive blood and sexual contact with patients with OVHV, vaccination is combined with passive immunization with specific immunoglobulin. The protective effect of the combination exceeds 95%. The adult immunoglobulin dose of 0.04-0.07 ml / kg to the deltoid muscle, simultaneously or within the next few days - the first stage of vaccination is 10-20 μg of the vaccine, the second and third vaccine is administered after 1 and 6 months. The protective effect of immunoglobulin lasts 1-6 weeks.
Treatment of patients with acute HBV
Hospitalization is required. In mild and moderate cases, treatment is carried out as with HAV
- strict bed rest
- possible transfer to parenteral nutrition (in / in amino acid mixtures)
- lactulose by mouth up to 120 ml per day
- infusion therapy: 2-2.5 liters per day under the control of diuresis (isotonic glucose solutions, polyionic solutions, reamberin, glucose-potassium-insulin)
This period lasts from 3 to 8 weeks. The period during which an infected person is contagious to others, i.e. secretes viruses with feces - not known.
In the incubation period, the virus multiplies and accumulates in the body, usually this period is asymptomatic, but in some cases, patients may be concerned about:
- fast fatiguability,
- recurrent headache in the parietal region.
The period of detailed clinical manifestations
- lack of appetite,
- pain in the right hypochondrium,
- pain in the stomach
- enlargement of the liver in size,
- jaundice (yellowing of the skin and mucous membranes),
- dark urine
- feces discoloration
Lightning fast form
This form of the disease is characterized by coming to the fore in the symptomatic picture of the phenomena of portal hypertension (increased blood pressure in the portal vein, which carries blood to the liver to cleanse harmful substances from the organs of the gastrointestinal tract - stomach, duodenum, pancreas, small and large intestines) and hepatic cell failure:
- bleeding from the veins of the esophagus, stomach and rectum,
- ascites (accumulation of fluid in the abdominal cavity),
- hepatic encephalopathy (dementia) - patients cease to navigate in space and time, do not recognize loved ones, periods of aggressive behavior are replaced by a coma,
- lowering blood pressure
- heart rate
- swelling of the lower extremities,
- subcutaneous hemorrhage.
The fulminant form leads to acute liver failure and, accordingly, to death.
Causes of viral hepatitis infection
The mechanism of virus infection can be divided into two categories - fecal-oral (alimentary) and hematogenous. The viruses spreading the first way include hepatitis A and E. All other viruses are hematogenous.
In the fecal-oral type of the disease, viruses from the liver enter the bile, and from there into the intestines and are excreted along with feces. Such viruses can persist for a long time in the environment and in various bodies of water. If a person uses dirty unboiled water, food products containing the virus, or transfers it by hand from surrounding objects into his mouth, then the pathogen enters the digestive tract. Safe pass through the stomach with acidic gastric juice helps viruses special acid-resistant membrane. In the intestines, the virus is absorbed into the bloodstream and then reaches the liver. This closes the virus reproduction cycle.
For viruses with a hematogenous type of infection, in order to get to the liver, it is necessary to get directly into the bloodstream of the human body. In fact, such situations are not so rare:
- blood transfusion,
- the use of the same cutting and piercing objects by infected and healthy people,
- passage of a newborn baby through the birth canal.
Thus, you can even get the virus by going to the hairdresser and shaving there, in the salon where you make tattoos, or in the dental office if the doctor does not properly disinfect the instruments. Nevertheless, the main contingent of hepatitis viruses infected is drug addicts using injecting drugs. Infection during household contacts or through surrounding objects is not excluded, although unlikely. Many hepatitis viruses for a long time, for weeks and months, can exist in the environment, and for their infection in humans a negligible amount is needed.
What is viral hepatitis?
What are hepatitis viral? Those whose causative agent is the virus, today there are 3 main types, designated by the letters C, B, A. They are popularly called jaundice (according to the characteristic symptom of diseases). In one group, they are combined according to the signs:
- the ability to be transmitted from person to person,
- the causative agent is viruses,
- main ways of infection: blood, gastrointestinal tract,
- the organ of damage is the liver, the basis of the disease is the destruction of its cells,
- for this group there are analogies in dynamics and biochemical indicators,
- similar treatment principles.
The incidence of viral hepatitis in the world is in second place after the flu. Types B and C are among the ten most dangerous diseases leading to mortality from consequences.
The most common among the population, has a highly contagious status, the duration of the incubation period is from 7 days, but can also be hidden for about 2 months. It is characterized by an acute phase, during this period it triggers inflammatory and degenerative processes in the cells of the liver parenchyma. After treatment, it ends in recovery, while a person receives quality immunity for life.
Jaundice - viral hepatitis thrives where there is a low standard of living, unsanitary conditions, but isolated outbreaks periodically occur in developed countries. The virus is excreted in the feces of an infected person, and enters the intestines with water contaminated with feces and products, if an infected person touched them. Dirty hands are a common source of infection, which is why viral hepatitis A occurs most often in children.
Viral hepatitis B.
The structure of the species, has a complex structure, is characterized by an aggressive form, is extremely resistant to survival, and can persist at room temperature for up to 6 months. The incubation period for viral hepatitis B is from a month to six months,
Actively present in the biological fluids of its owner, especially a lot of it in saliva and sperm, this is dangerous for viral hepatitis B, infection occurs when the minimum dose enters the bloodstream. In terms of distribution, it is equated with the AIDS virus, most often it is diagnosed in young people.
All types of carriage are inherent in it, in acute form it usually does not lead to death, the exception is a severe course, the condition of the patient can be aggravated by systemic diseases, with parallel infection of D and C.
Hepatitis E Treatment
Treatment of mild and moderate forms of patients with viral hepatitis E is carried out in the infectious wards of the hospital, a diet is prescribed (table Pevzner table No. 5 is shown - a sparing diet with a low content of fatty acids and rich in fiber), heavy drinking. Symptomatic therapy (antispasmodic, antihistamines) as indicated. If necessary, oral detoxification with a solution of 5% glucose is performed.
In severe cases, patients are treated in the intensive care unit, infusion detoxification therapy (saline solutions, glucose, electrolyte mixtures), protease inhibitors are administered, according to indications, prednisone is administered. With the threat of hemorrhagic syndrome, pentoxifylline, etamsylate is prescribed. With massive internal bleeding - transfuse plasma, platelet mass.
Particular attention is paid to the treatment of pregnant women. The issue of premature delivery is decided individually, often measures are taken to emergency termination of pregnancy.
Nutrition is shown with the preservation of calorie content in accordance with the age norm, food is prepared by boiling, baking in the oven or by steam treatment.
- Rich broths
- Fatty Pork, Lamb, Poultry, Fish
- Spicy seasonings
- Fast food
- Butter baking
- Lean meat and soups on it
- Processed vegetables, fruits, berries
- Boiled cereals
- Biscuit cookies
- Rusks, white bread
- Pure boiled or mineral water
- Rosehip broth
- Liquid - at least 1.5-2 liters per day
Do not give patients whole milk or food cooked on it - during a period of vivid manifestations, this product is not always well tolerated. Sweets (honey, marmalade, marshmallows without glaze) are allowed little by little as the condition improves, as are butter and vegetable oil.
How is viral hepatitis transmitted?
The source of viral hepatitis infection is a sick person. The main mode of transmission for B and C agents is hematogenous, that is, through the blood. How do they penetrate into it:
- After a blood transfusion, earlier cases of infection occurred frequently. Now the transmission of viral hepatitis in this way is unlikely, since measures have been developed in which the ingress of infected blood is minimal.
- With repeated use of disposable syringes, needles or cotton wool. This method is usually inherent in drug addicts.
- When carrying out medical manipulations with poorly sterilized instruments.
- When using a healthy person with toothbrushes, nail scissors or a razor patient.
- During a tattoo or piercing procedure.
- During sexual contact, infection can also occur when one of the partners is infected with hepatitis B. Virus C is not so active, therefore infection is possible if intercourse is accompanied by microtraumas with blood in both partners. People who are unintelligible in sexual relations are at risk, they are infected more often.
Most often, viral hepatitis E ends in recovery, but a severe form of the disease threatens the development of life-threatening complications: renal and hepatic failure, hepatic coma. Mortality among patients with viral hepatitis E is 1-5%, this indicator among pregnant women reaches 10-20%. In the case of infection with hepatitis E of people suffering from hepatitis B, the prognosis worsens significantly, death with this combination occurs in 75-80% of cases.
Other dangerous diseases
The course of viral hepatitis is often accompanied by concomitant diseases:
- Viral hepatitis and HIV infection often go side by side. Hepatitis destroys the liver, the infection helps him in this, speeds up the process and leads to the development of complications. At the same time, weakened immunity promotes easier penetration of the virus, the minimum dose is enough for such an organism, while the transmission routes are practically the same, therefore infection occurs in parallel.
- Among tuberculosis patients, the incidence of parenteral infections is quite high. This is explained by the fact that a debilitating illness and prolonged use of drugs significantly reduce immunity, worsen the condition of the liver. Tuberculosis and viral hepatitis weaken a person. The icteric form proceeds harder and longer than in ordinary people, the chronic stage does not manifest itself in any way, which is most dangerous, since the patient experiences a strain on the organ, taking complex therapeutic treatment.
General prevention of hepatitis E virus is to improve the living conditions of the population and control the state of water sources. Individual prevention implies compliance with sanitary standards, the use of high-quality water from reliable sources. Particular attention should be paid to the prevention of hepatitis E for pregnant women traveling to epidemiologically disadvantaged regions (Uzbekistan, Tajikistan, North Africa, India and China, Algeria and Pakistan).
It occurs with the penetration of poisons into the human circulatory system. There are only three options for their implementation:
- through the mouth, into the stomach:
- by inhalation of toxic fumes
- directly into the blood
In the liver, toxins directly affect cells, disrupting their work, cause oxygen starvation, and lead to death. The origin of the poisons is different, it can be:
- industrial toxins
- plant poisons.
Viral toxic hepatitis is represented by 2 types:
- The acute form will manifest itself at most 2 days after the introduction of toxins into the blood.
- The chronic course is due to their constant intake in limited doses, the disease manifests itself in months, even years
The mild form is treated, passes without consequences, in case of severe poisoning, problems characteristic of hepatitis develop.
Developing in a healthy person, jaundice - viral hepatitis with timely treatment ends in recovery, liver cells are restored, the patient acquires immunity for life. Rarely, in some patients, relapse may occur after several months, but it does not go into a chronic form. In people aged, sometimes there are violations of the liver. If the symptoms are atypical, the person is not treated for a long time, does not follow a diet, fibrosis forms, which is fraught with biliary dyskinesia.
The impact on the organ of parental types of viruses leads to fatal consequences:
- Dead hepatocytes are replaced by fat cells, steatosis is formed.
- Scarring leads to fibrosis.
- Changes affect the central nervous system, since the body does not cope with the neutralization of toxins, they enter the brain, and hepatic encephalopathy is not ruled out.
- Fluid accumulates in the abdominal cavity, the abdomen increases.
- Bleeding occurs at the slightest injury.
- The proliferation of organ tissues, circulatory disorders result in cirrhosis. Postponed viral hepatitis B and C, often threatens with these consequences.
- Hepatic coma occurs in connection with massive necrosis, cell death.
Effect on life expectancy
Infectious viral hepatitis does not kill, but contributes to the development of pathological processes that affect life expectancy. No doctor can name a specific date when a critical condition sets in. Each disease is considered individually, due to many factors:
- duration of infection
- the age of the patient
- the state of the immune system
- patient lifestyle
- addiction to alcohol and smoking,
- timeliness and adequacy of therapy,
- concomitant diseases
- the sex of the infected person, for example, in men more often develops fibrosis.
A third of patients take 50 years to develop complications, so a person has a real chance to live a long time, to a very old age. In the same number of patients, progression is twice as fast, and cirrhosis occurs within 20 years. Viral hepatitis in adults develops more slowly than in children. The process slows down significantly if a person adheres to a diet, leads a correct lifestyle.
Viral hepatitis and pregnancy are an extremely undesirable combination, but usually women with such a diagnosis safely carry and give birth to healthy children, but it cannot be completely ruled out that the virus cannot overcome the placental barrier. It depends, first of all, on the general condition of the future mother. The risk is higher if, at the time of pregnancy, the woman has an active form of the virus, HIV infection is present. How great is the danger of vertical infection, the doctor determines:
- based on the survey,
- phases of the disease
- virus activity
- treatment during pregnancy.
Infection occurs when the amniotic fluid ruptures when the integrity of the skin of the baby is impaired during childbirth. Therefore, for all types of viral hepatitis, caesarean section is recommended.
With moderate or passive activity of the virus, a woman is constantly under the supervision of a doctor. When the disease is in the active phase, treatment is carried out, with a successful outcome, a woman gives birth to a child. If treatment is ineffective, the possibility of losing a baby is not ruled out. During periods of exacerbation, pregnancy should not be interrupted, therefore, all opportunities are used to save the fetus.
There is no data on the infection of the baby during breastfeeding, so doctors allow it to be fed if cracks in the nipples appear, it is better to refuse breastfeeding.
Viral infection, hepatitis is insidious, no one is safe from its introduction into the body. It can destroy human health in a short time, therefore, knowledge about this ailment will help to warn a person from illness, take measures so that his whole life does not suffer from his carelessness.
The first signs of viral hepatitis
If you have asthenovegetative hepatitis, you will feel lethargic, drowsy, fatigue will come on very quickly, headache, dizziness, and appetite will decrease. With arthralgic syndrome in the preicteric form, joint pain, redness and itching on the skin appear. Such options are most characteristic of hepatitis B. Its pre-icteric period lasts about one to two weeks, and closer to its end the patient has a significant increase in the liver and darkening of the color of urine.
The icteric period is characterized by a characteristic yellowing of the skin of a person and his mucous membranes. Yellowing appears on the sclera, oral mucosa, face, body, arms and legs. Yellowing occurs in this order, in the process of remission, yellowness goes in the reverse order.
If we are talking about hepatitis A, then yellowing will appear much earlier and the process will go much faster, and during remission, yellowing will disappear faster.
In hepatitis B, jaundice will appear immediately after the pre-icteric period, the process itself will go slowly, and yellowing will remain for a longer time.
How strong the yellowing of the skin and mucous membrane will be, directly depends on the severity of the course of the disease. However, in childhood this pattern may well not be respected. If a person develops jaundice, the urine will turn a dark color resembling strong tea. At the same time, the chair becomes white, or completely discolored.
During pronounced jaundice, the patient is worried about severe scabies of the skin. As soon as yellowing takes on a very pronounced appearance, health, as a rule, becomes much better. The size of the liver and spleen in this period is much higher than normal. The younger a person is, the more significant will be an increase in these organs. The remaining organs, as a rule, remain without any major changes.
In especially severe cases of the development of the disease, minor bruising on the surface of the skin and nosebleeds can be observed, this indicates a continuing increase in intoxication of the body.
The most dangerous are considered to be the lesions associated with the central nervous system. A person becomes too restless and nervous, there is a strong insomnia, if a person manages to fall asleep, then he has nightmares. This is especially pronounced in young children. A person is constantly tormented by vomiting, the pulse rate decreases.
The duration of this period is about fourteen days (if the form is mild), in the middle it lasts about thirty days, and in severe cases it lasts up to ninety. Near the end of the period, yellowness passes, the liver returns to its original size, the usual color of urine and feces is restored.
The most severe form of development is malignant, in which the liver tissue begins to die, and this can pass at any stage of the disease. The size of the lesion area directly depends on the degree of autoimmune damage to the liver. This form is characteristic of children in infancy and is primarily a consequence of a complex autoimmune disorder (therefore, the prevention of hepatitis is so important from the very first years of a person's life). This form is characterized by weakness, sleep disturbance, nausea, a strong enlargement of the liver, sometimes loss of consciousness and incoherent delirium are observed. Children suffering from this form can jump up sharply during sleep, start screaming and try to run away. In this form of the disease, vomiting resembles coffee grounds with a large amount of blood due to internal bleeding of the stomach. There is a strong shortness of breath, it is difficult for the patient to perform heavy physical actions, the heartbeat is very fast, the temperature rises to an average of 38 degrees Celsius. Pain is observed not only on palpation, but also at rest.
With the further development of the disease, a person falls into a coma. The liver becomes even larger, and a characteristic smell of raw liver appears from the mouth. Strong edema appears on the surface of the body, the amount of urine decreases significantly. The concentration of bilirubin drops markedly, liver enzymes cease to be produced, and after a while death occurs. If doctors manage to remove a person from a coma, the disease usually becomes protracted or chronic.
Diagnostic methods for viral hepatitis
More recently, any liver disease was called Botkin's disease. Then they decided to classify these diseases, including on the basis of their clinical manifestations.But no matter what letter is assigned to one or another type of viral hepatitis - A, B, C, D, E - there are common signs of the disease by which it is possible to make a diagnosis. The main task of the doctor is to consistently go through this diagnostic path, using different criteria for the diagnosis of viral hepatitis.
Survey of a patient with viral hepatitis
Interviewing a patient is the first step towards a correct diagnosis. In order to confirm or exclude the disease of viral hepatitis, the doctor should ask the patient:
- Does he have a decrease in appetite?
- feels the urge to vomit and nausea,
- does he feel heaviness under the ribs on the right side, that is, where the liver and spleen are located
- does one observe weakness or malaise for no apparent reason
- Does his joint pain bother him?
At the initial stage, the patient is able to independently diagnose, that is, ask these questions to himself. If the answers to them are positive, then it is likely that the patient still has problems with the liver. Other forms of diagnosis will show the degree of their severity, for the implementation of which it is necessary to consult a doctor.
Examination of a patient with viral hepatitis
In contrast to a survey with a certain degree of subjectivity inherent in it, an examination is called an objective diagnostic method. After all, if during a conversation you can remain silent about any symptoms, then the visual signs of the disease are difficult to hide or not notice. So, what should alert both the patient and the doctor who confirms or refutes the diagnosis of viral hepatitis:
- Body temperature. Its increase is not considered a characteristic sign of the disease, since with hepatitis C temperature indicators can be normal, and with hepatitis A, on the contrary, it is precisely the increased temperature (coupled with signs of influenza) that will signal a potential danger.
- The manifestation of the disease can be expressed by skin rashes, which are accompanied by itching. With a diseased liver, such symptoms are not uncommon. After all, failures in her work cannot but affect the condition of the skin.
- Low blood pressure It is due to the fact that viral hepatitis makes malfunctions in the normal functioning of the cardiovascular system.
- Yellow color of eyeballs, oral mucosa, skin. The so-called jaundice is associated with an excessive concentration in the blood of a substance of bilirubin - one of the components of bile. If there is a lot of bilirubin, then the liver works poorly. And this is clear evidence of the development of viral hepatitis.
- Urine is very dark in color with a possible greenish tint and light feces. Such unnatural colors are also associated with high bilirubin content.
- On palpation, an increase in the size of the liver and spleen is detected.
These signs of viral hepatitis are considered specific, but even they cannot guarantee a 100% diagnosis of viral hepatitis. It is not for nothing that experts note that in chronic cases of hepatitis, in most cases, these symptoms are characterized as possible. They become pronounced only with a severe form of the course of the disease. Therefore, to diagnose the disease, laboratory tests should be called for help, that is, it is necessary to take blood tests for viral hepatitis.
How does hepatitis E infection occur?
The source of the disease is a person infected with hepatitis E virus, which can be not only a patient with an obvious clinical picture of the disease (symptoms), but simply a carrier of infection, not even knowing about his role in the epidemiological process.
The infection mechanism occurs through a person’s contact with the feces of the carrier of the infection, through unwashed hands, but most often through the use of infected water.
Among other methods of infection with HEV can be identified:
- Through the use of poorly processed thermally contaminated food, especially shellfish, meat and meat-containing foods,
- Blood transfusion in poor sanitary conditions, or contaminated blood, as well as organ transplants,
- Medical services in dubious centers, especially dental services,
- In childbirth, from mother to baby.
The risk group also includes clients of tattoo salons, piercings, manicures and pedicures.
Important! Hepatitis A, B, D and E are not transmitted by airborne droplets!
Laboratory diagnosis of viral hepatitis
Laboratory diagnosis of chronic viral hepatitis is the most accurate. Its result is conclusive evidence of the presence or absence of the disease.
Laboratory test for viral hepatitis is a complex of studies, which includes:
- General analysis of blood and urine. Allows you to evaluate the condition of the liver as a whole. It is unsuccessful if the indicators of liver enzymes, bilirubin, proteins exceed the norm.
- Linked immunosorbent assay. A universal method, it is based on a blood test for markers of viral hepatitis - antigens and antibodies that the immune system produces if the virus has entered the human body.
- The polymerase chain reaction method is the most accurate and modern in the diagnosis of viral hepatitis. Allows you to detect the disease at an early stage by viral DNA.
Only by the results of a blood test for viral hepatitis, the doctor can determine what type of hepatitis the patient is sick with, and, accordingly, prescribe the correct treatment.
Based on detoxification:
- With frequent vomiting, salt complexes (Regidron).
- Enterosorbents (Lactofiltrum, White coal).
- Intravenous solutions (5% glucose, 0.9% sodium chloride, dextrose).
According to indications, vitamins, ursodeoxycholic acid preparations, pancreatic enzymes are used.
Etiotropic therapy that destroys the pathogen is absent - therefore, do not use antiviral drugs on your own.
There are no drugs with a “targeted” action guaranteeing the elimination of infection, the use of funds of this general group (namely, Ribavirin, Interferon) is justified only for people with chronic forms of hepatitis E and severe immunodeficiency.
Instrumental methods for the diagnosis of viral hepatitis
Changes in the liver can be detected by other methods of researching the body, which will complement the overall clinical picture:
- Ultrasound of the liver. Hepatitis will not determine, but will allow you to assess the condition of the liver itself and biliary tract, see if there are external signs of inflammation, and also help to exclude oncology, as one of the reasons for the poor functioning of this organ. In addition, with ultrasound, a change in the size of the liver at the initial stage of the disease and cirrhosis at a late stage will be visible.
- Liver biopsy. The method also allows you to determine the stage of the disease.
It can take several months from getting the virus to the onset of symptoms - the length of this period depends on the type of viral hepatitis. It is very difficult to identify the disease in the initial stages, but delayed treatment can lead to complications and even death. That is why the correct diagnosis of viral hepatitis at its earliest stages is so important.
Hepatitis E development
After the hepatitis E virus enters the intestine through the oral cavity, it begins to be absorbed there and enters the bloodstream. Further, the blood transports the infection to the liver, where it selectively attaches to hepatocytes (liver cells). After some time, when the virus increases in quantity, it begins to produce toxins, which are the waste products of the infection. From this moment, the patient begins to show symptoms of intoxication, as well as the clinical picture characteristic of hepatitis.
In addition to poisoning the body with toxins, the HEV virus contributes to the destruction of liver cells, its obesity and necrosis, which over time can develop into liver cirrhosis.Under adverse conditions, this pathological process of liver damage can lead to death of the patient. Transient hepatitis E can also lead to death, with the development of acute liver failure.
Persons who have undergone viral hepatitis e (E) are subject to observation, the first examination is carried out 30 days after recovery, the second and final, if there are no complications, after 3 months.
Based on the patient supervision protocol, I recommend after acute hepatitis E for six months:
- refrain from preventive vaccinations (the only exception is emergency - from tetanus and rabies),
- whenever possible, avoid the use of drugs that are potentially toxic to the liver - in particular, Paracetamol,
- schoolchildren to be transferred to physical education groups with a light load.
I advise healthy people to remember about prevention:
- Drink only boiled or purified water (this also applies to ice used for various purposes).
- Wash thoroughly, and it is better to heat treat plant foods.
- Observe personal and public hygiene requirements.
It is advisable to minimize alcohol consumption or completely abandon it.
Hope this article has been helpful. Share your opinion in the comments.
Hepatitis B (HBV) is spread through the hematogenous route. Hepatitis B virus belongs to the class of DNA viruses and is extremely resistant. More than 2 billion people have been ill with the disease worldwide, and at least 300 million are carriers of the virus.
The incubation period lasts from 50 to 180 days. However, the acute type of the disease is its first stage, at which clinical signs are observed. Acute hepatitis B is usually quite severe. If a person has acute severe hepatitis B, then hospitalization is necessary. Mortality in acute hepatitis B is quite high and can reach 4%. The treatment of the acute form of the disease is mainly symptomatic, antiviral therapy can be used.
Then the disease can become chronic (in 1 out of 10 cases), or a cure is observed. Most often, chronicity of the disease is observed in infants (in 95% of cases). Treatment of a chronic form of the disease includes injections of interferon, taking antiviral drugs and hepatoprotectors. Vaccination against the virus can be carried out from the first days of life to the age of 55 years and protects against the virus for 10-20 years.
Hepatitis E spread
According to statistics, most often viral hepatitis E is found in young people and adults, aged 15 to 40 years.
This disease is most common in countries with a hot climate and poor-quality water supply (a small amount of water or it is polluted). Typically, this group includes countries in Southeast Asia (India, Vietnam, China, Nepal), Africa, Central and South America.
According to WHO statistics, 20 million people become infected with the hepatitis E virus, of which only 3.3 million feel symptoms and 56 thousand die. The rest of the people were just carriers of the infection.
The fetus of HEV-infected pregnant women almost always dies, with maternal mortality rates of up to 40%.
An increase in the number of cases of infection in the summer-autumn period has also been noted.
The spreading disease resembles hepatitis B. However, it is caused by a completely different virus belonging to the class of RNA viruses. Worldwide, there are 70-150 million patients with this disease. This virus causes a large number of diseases in a chronic form. The acute form of hepatitis usually does not proceed as severely as with hepatitis B, and hepatitis C does not have a fulminant form. Also, the virus has at least 11 genotypes. Each genotype, in turn, has subtypes, so the total number of varieties of the virus is about 100.Due to this genetic diversity of the pathogen, a vaccine against it has not yet been developed.
Antiviral agents and hepatoprotectors are used to treat the chronic form of the disease. Some currently available drugs help get rid of the disease in 95% of cases. In addition, vaccines against HBV and HAV viruses are recommended for patients, since simultaneous infection with these viruses can lead to serious complications.
Nutrition for viral hepatitis
One of the most important parts of treatment is the right nutrition. It is so arranged by nature that a large number of metabolic processes take place in the liver. If the liver is impaired, then the disease progresses with greater force. That is why doctors place special emphasis on nutrition. The principle is based on the use of products that contribute to the normalization of liver cells.
Such a diet should be gentle and simple for the body. Food should be boiled, stewed or baked. Frequent meals: about five to six times a day. You can’t eat everything spicy, salty, fried. Forget about pickles and seasonings, do not eat garlic and sweets. It is important to drink plenty of fluids, drink more teas, juices and decoctions, but alcohol will have to be abandoned.
Very useful for the digestive system (and the liver in particular) are foods in which there is dietary fiber. There are many of them in fruits, vegetables and cereals. Important components of such a meal are cellulose and lignin.
If the disease is particularly difficult, intensive therapy is prescribed in the form of injecting plasma proteins, blood substitutes or special solutions aimed at restoring liver cells. An oxygen treatment is prescribed in the pressure chamber. If there is a threat to life due to the severity of the disease, the patient is transferred to the intensive care unit.
The virus of this disease is also often called the delta virus. From a scientific point of view, the virus is very unusual, because it is not only a parasite of the human body, but also to some extent parasitizes on the HBV virus, using the proteins it produces as a shell. A similar type of virus is commonly called satellite viruses. Thus, this disease is not independent, but rather refers to complications caused by the HBV virus. The transmission path of the delta virus is also hematogenous. In various regions, between 1% and 10% of HBV carriers are also infected with the delta virus. It significantly complicates the course of already severe hepatitis B, increasing the percentage of deaths. Specific treatment of this form of the disease is usually not carried out, therefore, when infected with a delta virus, the main emphasis should be on the fight against the HBV virus.
Vaccination and vaccinations against viral hepatitis
Due to the fact that the cause of hepatitis A, B and C is viruses and infections, treatment is aimed primarily at combating them, for which various drugs and medical drugs are used. They eliminate the causative agent of the infection and prevent the disease from moving to the chronic stage. If we are talking about hepatitis type A and E, then antiviral agents are usually not used. In all other cases, chemotherapy and interfering agents are used. The most common are retrovir and famciclovir.
In especially severe cases, the attending physician prescribes interferon, which contains protective protein structures that are produced at the moment when a person is attacked by viral organisms. They counteract them, preventing them from multiplying inside the cells. Interfering means are divided into three main types, which are indicated by the first letters of the Greek alphabet - alpha, beta and gamma. Alpha interferon is produced by white blood cells, beta interferon is produced by fibroblasts, and gamma cells of the immune system by macrophages.For the treatment of hepatitis type B and C, only alpha interferon is used.
It is worth considering the fact that during the treatment with interferons a large number of side effects are possible. The most common of these is a syndrome in which a person begins to show all signs of infection with influenza or SARS. The general temperature of the body rises, weakness is felt, the head is spinning and sore, the appetite disappears, pain in the muscles and joints is felt, increased sweating is noted.
In case of chronic hepatitis B, interferon alpha is used in high doses, and treatment can last from four months to six months. The most high-quality and effective treatment is achieved when interferon is used in combination with drugs that can cause the natural production of interferon in the body, namely, inducers such as neovir, cycloferon and amixin. Famciclovir and retrovir act as synthetic nucleosides. For chronic hepatitis D, treatment with alpha interferon should be continued for at least one year.
However, sometimes treatment can be difficult for the reason that some varieties of viruses and bacteria may have innate resistance to the drugs used, including interferon. Because of this, modern methods of treating viral (and especially chronic) hepatitis consist in the prolonged use of not only alpha interferon, but also in combination with drugs that have other mechanisms for influencing viruses.
Hepatitis E, F, G
This group of relatively rare diseases, whose pathogens were discovered only recently.
With hepatitis E, a fecal-oral mode of distribution is observed. Hepatitis E virus is slightly less resistant than HAV and the disease caused by it usually proceeds in a milder form than Botkin's disease. However, in some cases, for example, during pregnancy, a very severe form is characteristic, often ending in death.
Viral hepatitis G and F are currently little studied. They are transmitted by the hematogenous route and are distributed mainly only among drug addicts using injecting drugs.
If viral hepatitis is diagnosed, the drugs should be selected depending on what kind of infectious disease is detected. A and E are the simplest and most treatable options. You can even get them orally. It is much more difficult to treat hepatitis B, C, D and G. Pathogens enter the body through the bloodstream and affect the liver. If the disease is not treated, its result will be cirrhosis of the liver, which has a fatal outcome.
What drugs should appear in the medicine cabinet
For many, the word “hepatitis” sounds like a sentence. In fact, everything is far from so sad. Especially when it comes to forms A and E. At various stages of the disease, various drugs are used. As a rule, doctors treat patients with the following medicines:
- Glucose (5%), Ringer, etc.,
- Vitamin A,
- Vitamin E
- Ursodeoxycholic acid, etc.
In the treatment of hepatitis C, B, D and G use:
These are traditional drugs used to treat hepatitis that enters the body through the blood. Other dosage forms are also used, however, their effectiveness and safety for other organs are still in question. New, successfully used dosage forms include:
It is important to understand that viral hepatitis is a disease, the independent treatment of which is out of the question. For any abnormalities in the liver, you should immediately consult a doctor.
The main symptoms of hepatitis E are:
- nausea, sometimes with vomiting,
- yellowing of mucous membranes, eye proteins, skin, which occurs due to a violation of the outflow of bile (cholestasis),
- joint pain,
- itching of the skin and rash,
- urine turns dark brown
- feces discolor, sometimes diarrhea develops,
- enlarged liver (hepatomegaly),
- headache and dizziness,
Drugs for the treatment of viral hepatitis A and E
If the disease belongs to classification A or E in a mild form, patients do not need hospitalization. Allowed treatment at home. All that a sick person needs is peace, a sparing regimen and exclusion from the diet of products that can harm the liver. It is fried, smoked, salty, etc. Unreleased E and A pass by themselves and do not leave complications in their memory. Drink plenty of water. And it can be not only teas and water, but also berry juices, compotes. Milk is allowed.
If diseases of these forms have passed into the stage of neglect, patients need hospitalization. In this case, enterosorbent preparations are prescribed: Enterosgel, Enterodesum and the like. If the patient is nauseous and physically cannot drink a lot of fluids, he is prescribed a dropper with glucose or Ringer and similar drugs.
If cholestatic syndrome is detected (bile enters the duodenum in insufficient quantities), vitamins A and E are prescribed. Ursodeoxycholic acid preparations will also be appropriate.
In some cases, ademetionin is prescribed. It is appropriate when a patient has hepatitis with chronic alcohol intoxication. First, the medicine is taken intravenously, and then in the form of tablets.
With these forms of the disease, the best drugs are natural vitamins. If for some reason it is not possible to eat plenty of fruits and berries, doctors prescribe additional vitamins such as Undevit, Aevit, Ascorutin, etc.
If the disease is accompanied by constipation, lactulose is recommended. The dosage is prescribed by the doctor, based on the individual characteristics of the patient's body.
Hepatoprotectors are also effective agents. This is a group of drugs that positively affect the liver and help it deal with damage.
Drugs for the treatment of hepatitis C and other forms of parenteral transmission (through blood).
If the doctor has determined viral hepatitis, drugs are prescribed not only depending on the form of the disease, but also according to the degree of its neglect, individual characteristics of the patient.
With hepatitis C, things are much more complicated than with simpler forms of the disease. In this case, the task of doctors is to at least postpone the development of cirrhosis for an extremely long time, if this process cannot be completely stopped. If properly treated and dieted, you can live 50 years or more with a relatively healthy and completely non-disturbing liver. Sometimes there are cases of complete cure. Most often, the outcome is more dependent on the patient himself, or rather, his behavior after treatment.
The treatment of viral hepatitis C, B and other blood-borne forms is still being developed. The effectiveness of many drugs has not been proven. Only hepatologists should deal with the treatment of these types of hepatitis. The most common type of treatment, the effectiveness of which has been verified by many years of experience, is a combination of interferons and nucleosides. The former help cells successfully cope with the disease, the latter serve as a replacement for the genetic material of the virus. The use of this combination on the one hand protects the liver tissue from damage, on the other hand allows the diseased organ to successfully fight the virus.
A new word in the treatment of chronic viral hepatitis (HCV)
If the result of diagnostic tests is the verdict of hepatitis, medications are always selected individually. As interferon stated above, peginterferon is most often used. Nucleosides is ribavirin. This combination is difficult to tolerate by many patients. Often in patients with contraindications to the use of interferon.Meanwhile, long-term treatment is required.
In modern medicine, there are other drugs for hepatitis. Not so long ago, medical drugs such as telaprevir and boceprevir began to be used in medical practice.
They are not prescribed as a separate treatment. Both drugs have been shown to be effective in combination with traditional medicines. The new combination is a triple therapy method. It has become the newest standard in the practice of treating chronic hepatitis C. So far, this method has been successfully used in Japan and the USA.
Causes of Hepatitis E
Hepatitis E virus enters the body primarily through the oral cavity. Consider what can become a source of infection:
- drinking contaminated water or food,
- swimming in polluted water,
- non-observance of personal hygiene rules,
- living in unsanitary conditions,
- childbirth in unsanitary conditions,
- the use of donated blood and organs,
- dental services
- open injuries and deep cuts,
- tattoo parlor services, piercing, botex, manicure / pedicure.
Additional factors contributing to the development of the disease and its complications are:
- Weakened immunity, resulting in hypovitaminosis, HIV infection and others,
- The presence of other chronic diseases of the digestive tract, especially the liver,
- Alcohol use, smoking and drugs, especially injecting,
Despite the fact that viral hepatitis is a rather insidious and dangerous liver disease, it is treated not only with drugs, but also with the use of traditional medicine.
A famous scientist, Dr. Zalmanov recommends not to use drugs, but to begin treatment of hepatitis with folk remedies that do not have chemical additives.
As an anesthetic, the doctor in the form of prophylaxis applied a heating pad with a warm liquid, since moderate heating of the internal organs improves the blood circulation that the liver passes through itself (up to 100 l / h). Warmer relieves soreness, and the volume of the liver decreases slightly.
The liver is a filter that neutralizes any poison. Patients are often prescribed a large amount of glucose, and instead it is better to replace it with a natural sweet substance - honey, which contains various vitamins and minerals. It should be borne in mind that honey is a strong allergen, and is not always well tolerated by the body.
Traditional medicine offers its patients, for the treatment of liver lesions, to take apple juice with honey every day in the morning and evening hours. (15 g of honey per 100 juice). This recipe effectively treats not only hepatitis, but also jaundice.
Knowledgeable people use the following folk remedies and herbs to treat hepatitis:
Types of Hepatitis E
Hepatitis E can exist in 2 main forms - acute and chronic.
Acute hepatitis E. It is characterized by an acute course of the disease with all signs of viral hepatitis. With good immunity or adequate treatment, healing occurs within 14-42 days. The exception is pregnant women, because their treatment requires painstaking therapy aimed not only at the recovery of the mother, but also the unborn child. In some cases, a transient development of the disease with a fatal outcome can be observed, therefore, when the first signs of the disease appear, consult a doctor.
Chronic hepatitis E. It is characterized by typical clinical manifestations throughout the entire period of the disease, then subsiding, then exacerbating. At this time, there is a killing of liver cells (hepatocytes) and their replacement by stromal cells, which leads to changes in the structure of the liver, inhibition of its activity, fibrosis, and then cirrhosis of the liver. If adequate measures are not taken, the disease can be fatal, but this risk exists mainly in pregnant women.
Diagnosis of hepatitis E
Diagnosis of hepatitis E is carried out by an infectious disease specialist.
Diagnosis of hepatitis E includes the following tests and examination methods:
- History taking and visual examination of the patient,
- PCR method (polymerase chain reaction) with reverse transcriptase (RT-PCR),
- Blood chemistry,
- A blood test for markers of viral hepatitis A, B and E - IgM (anti-HEV IgM) and IgG,
- Biochemical analysis of feces,
- Ultrasound of the abdominal cavity.
Additionally, a liver biopsy may be prescribed.
2.1. Antiviral therapy
For stopping in the body of an infection - the HEV virus, the use of the following antiviral drugs is indicated, sometimes in combination with each other:
- Alpha-interferon group - “Alfaferon”, “Interferon”,
- Nucleoside analogues - "Adefovir", "Lamivudine",
- "Ribavirin" (strongly contraindicated during pregnancy!)
The course of administration is prescribed by the attending physician.
2.2. Liver Health Therapy
Due to the fact that hepatitis viruses settle and act primarily on the liver, it must be supported. To strengthen liver cells, as well as their recovery, hepatoprotectors are prescribed.
Among the hepatoprotectors, one can distinguish: “Hepatosan”, “Karsil”, “Legalon”, “Ursonan”, “Essentiale”.
To accelerate the recovery of hepatocytes, ursodeoxycholic acid (UDCA) is sometimes sometimes prescribed: Ursodex, Ursor.
2.3. Detoxification therapy
If it gets into the body, the infection poisons it with its metabolic products (toxins), which can cause unpleasant symptoms such as nausea, vomiting, and fever. To prevent this from happening, detoxification therapy is used to adsorb toxins and remove them from the body.
Among the detoxification drugs, the following drugs can be distinguished: Atoxil, Albumin, glucose solution (5%), Enterosgel.
2.4. Support the patient's immune system
The immune system, the main role of which is to protect the body from infection and other adverse factors for the normal functioning of the body, in case of disease, needs reinforcement. In a healthy state, immunity will additionally or in the main role destroy the infection.
As immunostimulants, one can note: Vilosen, Zadaxin, Timogen, vitamins, especially vitamin C (ascorbic acid), vitamin E (tocopherol) and B vitamins.
Among the natural sources of vitamin C, scientists note - rose hips, lemon, cranberries and other natural products.
The composition of this herb includes silymarin, which is actively involved in the treatment of this disease. His presence regenerates liver cells - hepatocytes. Viral hepatitis is capable of destroying cells, and fatty tissue is deposited in their place, which initially is fibrosis, which later turns into cirrhosis. Many people know that hepatocytes are able to recover, so silymarin comes to their aid in this work.
Severe hepatitis causes the patient weakness and fatigue - this is due to poor liver function, which negatively affects the state of the brain. A decoction of oats has adsorption properties, while it cleanses hepatocytes (liver cells) and saturates the body with useful amino acids and vitamins. Oat broth should be consumed constantly to maintain immunity.
Herbal collection for the treatment of viral hepatitis
- corn silk,
- Hypericum perforatum
- immortelle sand (cat's feet),
- Calendula officinalis
- dioica nettle,
- rose hips (fruits),
- birch leaves
- licorice (root).
Shredded herbs mixed together, 1 tbsp. l pour the mixture with boiling water, leave to infuse for 2 hours, then strain into a glass and add it with boiled water. Take the infusion before meals three times a day.
Traditional medicine offers a large number of recipes, we have described only a few.All of them to some extent help in the treatment and sometimes even provide a complete recovery. Before proceeding with the prescription of your choice, first of all, be sure to consult your doctor so as not to harm even the already affected organ.