Hepatitis A: Symptoms, Treatment, How is hepatitis A

Hepatitis A, which is also called Botkin's disease - a viral disease of the liver cells, which manifests itself by means of jaundice and intoxication. Unlike other forms of hepatitis, hepatitis A is not conducive to the processes of chronic lesions of liver cells and is a very rare cause of death in humans. Defeating the disease symptoms can be as early as 2 weeks, and will take about one to two months to bring back to normal structure and function of the liver after an illness.

there is a certain group of individuals in the population who have been exposed to the disease above the rest, everything, in equal conditions are at risk of illness: children, men, women of different social status and age years. Moreover, in children aged from one year to 10-year milestone in a particularly easy transfer of symptoms of the disease, and the elderly and kids the first year of life - the sick in a complicated form.

What it is?

Hepatitis A - is an RNA virus that belongs to the family Pikornoviridy, genus Enterovirus. Its size is 27-30 nm. We do not have the virus envelope. Typing conducted in 1973. Next allotted four more human virus genotype and genotype of three monkeys.

It is found that, regardless of genotype, all type A viruses have similar antigenic, immunogenic and protective properties. That is one serotype of the virus, is determined by the same standard set of reagents, the same is preventable with vaccines.

Kinds

Known forms of viral hepatitis A:

• icteric;
• worn with jaundice;
• anicteric.

Separately allocated subclinical (inapparent) form, which is diagnosed only on the basis of laboratory results.

Course of the disease may be acute, protracted, subacute and chronic (extremely rare). Acute hepatitis B infection in the severity of clinical manifestations can be easy, moderate and severe.

How is hepatitis A?

The source of infection are sick people in the subclinical stage, and the initial manifestations of the disease, including anicteric form. After staining of the sclera and skin infectivity is greatly reduced. In the third week of the pathogenesis, dangerous virus is allocated only 5% of patients.

infectiousness period, taking into account the incubation period lasts about a month, sometimes up to six months.

Proven sources of virus spread, in descending order:

1. Colonized food. This transmission method has the great value epidemic. However, set the type of dangerous food is almost impossible because of the long incubation period.
2. Direct contact with the patient. Typical for people with undeveloped hygiene habits and professional people in contact with them. This is the case of transmission in pre-school and school community, homes for people with disabilities.
3. Stool, urine, discharge from the nose and throat. Such a transmission method is called by the fecal-oral. Key factors proven hepatitis A virus transmission include direct contact of the healthy and the sick. The virus may also be transmitted with food, water droplets by (some authors eliminate) at sexual intercourse, with non-sterile intravenous administration, through fly - mechanical vectors virus.

Meanwhile identified foods that are often factors in the transmission of the virus:

1. Garden berries in fresh and frozen (after thawing) form, especially if the beds near berry plants, found shellfish, slugs, which can store the virus, if the ridge poured fertilizer from human excreta.
2. Products prepared without heat treatment or used after storage (salads, vinaigrettes, snacks, dried fruits and berries, particularly in Kazakhstan and Central Asia);
3. Aerosol. Hypothetically possible in groups of children at stratification outbreaks of respiratory disease in groups with low resistance. The virus is transmitted by coughing, sneezing, nasal secretions of a sick person.
4. Water. Typical for areas with poor utility infrastructure, poor organization of water supply, diversion of sewage and wastewater. Significantly increasing the risk of infection during accidents and natural disasters.
5. Parenteral. Not ruled out transmission of the virus during blood transfusions, intravenous fluids, particularly in the environment, eliminating the observance of sterility (drug addicts).
6. Transmissive (transmission of the virus through the flies). Researchers do not exclude the possibility of transfer of infection by flies, but not studied the prevalence of this factor.
7. Sexual. The literature indicated as a possible factor in the transmission of homosexuals, it is not decrypted causal link homosexuality and hepatitis A.

Stages of development

There are several variants of hepatitis A. The disease can occur with typical clinical picture and symptoms. In the case of manifest (occurring with bright symptoms) forms in the development of the disease have identified a number of stages.

incubation period	It lasts 35-55 days, with any symptoms are absent.
prodromal stage	Lasts 3 - 10 days. Manifested symptoms of general intoxication: weakness, fatigue, lack of appetite, mild fever. Often, patients develop diarrheal symptoms such as nausea, vomiting, disorders stool, feeling of heaviness in the right upper quadrant.
icteric period	Has varying degrees of severity, it lasts 15 - 20 days. In mild cases, there is yellowing of the visible mucous membranes, in severe jaundice changes color. With the development of jaundice, most patients feel better. Urine darkens its color is compared with the dark beer or tea brewing. Some patients with discolored feces.
recovery period	It occurs after disappearance of jaundice lasts 2-4 weeks. At this time, there is a normalization of functional parameters of the liver, the liver itself is reduced to normal size.

After transferring infection resistant formed lifelong immunity. Can I get hepatitis A again? It is possible, after the transfer of the disease organism produces cells that protect against reinfection.

Symptoms of hepatitis A

Viral hepatitis A usually begins acutely. Prodromal period can occur in different clinical variants: diarrheal, fever or astenovegetativnogo.

For febrile (influenza-like) shape prodromal period characterized by:

• fever;
• general weakness;
• headache and muscle pain;
• sore throat, dry cough;
• rhinitis.

When diarrheal embodiment dozheltushnogo period of mild intoxication. Patients usually complain of various digestive disorders (belching, bitter taste in the mouth, bloating, abdomen), pain in the epigastric or right upper quadrant, defecation disorders (constipation, diarrhea, or striping).

Astenovegetativnogo form prodromal period in viral hepatitis A is not specific. It shows weakness, lethargy, adynamic and sleep disorders.

1. Going disease icteric stage is characterized by improving the general condition, the normalization of body temperature on the background of the gradual development of jaundice. However, the severity of dyspeptic manifestations in the icteric period, not only does not weaken, but rather enhanced.
2. In severe hepatitis A patients it may develop a hemorrhagic syndrome (spontaneous nosebleeds, bleeding in the skin and mucous membranes, petechial rash).

On palpation reveals moderately painful, protruding from hypochondria liver. Approximately 30% of cases there is an increase of the spleen. With increasing jaundice occur feces lightening and darkening of the urine. After some time the urine becomes saturated dark color, and feces becomes pale gray (aholichny stool).

Icteric replaced during convalescence. There is a gradual normalization of laboratory values ​​and the improvement of the general condition of the patients. Recovery period can last for up to six months.

Diagnostics

Diagnosis of hepatitis A based on clinical signs of disease: enlargement of the liver, jaundice and other symptoms. The doctor takes into account the epidemiological factors, that is, as infected infection (drinking unboiled water of unknown purity of the products and so on).

Crucial laboratory tests. Specific tests for the disease:

• polymerase chain reaction for detection of viral genetic material;
• enzyme-linked immunosorbent assay for detection of antibodies to the causative agent of class IgM.

If the body are determined only IgG antibodies - it speaks about past illnesses or immunity to it. The chronic form of the disease does not occur, but there are cases of healthy virus carriers.

Nonspecific laboratory signs of the disease in women, and other groups of patients are needed to assess the severity of infection and the effectiveness of prescribed drugs:

• ALT and AST;
• bilirubin, and its fractions (direct, indirect);
• protein levels in serum fibrinogen.

To clarify the size of the liver ultrasound is applied.

complications

Hepatitis A is rarely gives complications, usually a disease ends complete recovery. The most serious complication of infective hepatitis - liver failure. After recovery from hepatitis A strong immunity usually stored and recurrent disease is not possible. However, if treatment is not completed, and not complete recovery occurred, may cause retransmission waves disease - relapse. This happens in 15% of cases the disease Botkin and can be repeated many times.

Liver failure - this is a rare and potentially life-threatening complication of hepatitis B in which liver may cease to function normally. Usually it susceptible to the following groups of people:

• People with weakened immune systems (resulting in a chronic disease such as diabetes, or a side effect of some treatments, such as chemotherapy).
• People with existing liver disease such as cirrhosis or hepatitis C (heavier type hepatitis);

Some symptoms of hepatic failure are similar to the symptoms of hepatitis A and include jaundice, nausea and vomiting.

Treatment of hepatitis A

Patients diagnosed with Hepatitis A subject to immediate hospitalization infectious separation. The duration of the isolation of patients with at least four weeks.

In periods of development and the height of the disease, bed rest is required. Patients assigned a diet that consists of easily digestible foods fortified with vitamins. Haemorrhagic phenomena intramuscularly administered menadione, and inside - vitamin K. In the case of protracted severe disease, as well as the presence of itching are assigned corticosteroids (prednisolone, most often) and subcutaneously and intravenously administered a glucose solution. In complicated cases, and also in the presence of concomitant diseases Antibiotics (terramycin, penicillin etc.). To improve the flow of bile, a second duodenal intubation.

Treatment of patients with toxic dystrophy complex including a glutamic acid, corticosteroid hormones, neomycin, low-protein diet with plenty of fluids.

In most reported cases, Hepatitis A complete recovery ends, and this applies to severe cases. However, there are patients in whom the disease becomes chronic, characterized by recurrent exacerbations with impaired liver functioning adequately.

Chronic Hepatitis A can later purchase admission result, various disorders hygienic and dietary regimes mental and physical stress, alcohol consumption, as well as in the case of diseases joined (gastroenterocolitis, flu and etc.). These forms with symptoms of liver failure patients can be fatal.

Vaccination

Fortunately, there is a vaccine that can reduce the sensitivity of people to hepatitis A, but it is not included in the compulsory vaccination calendar because of the high cost. There are two types of preventive vaccines, it is:

• based solution neutralized virus provocateur disease;
• immunoglobulin containing antibody to hepatitis and other diseases (infection) derived from blood donations. It is administered IV drip to the people living in the same area with the patient urgently to the early days of the detection of the disease. This procedure significantly reduces the risk of infection.

Immunoglobulin is administered most at risk of infection groups:

• military personnel;
• refugees;
• health workers;
• people working on the mass production of food;
• traveling through third world countries, where many recorded cases of the disease.

Diet

The mainstay of treatment of diseases of the digestive system - it is a balanced diet. Diet for Hepatitis A begins in the period of development of the disease and continues after a few months of recovery.

How to feed the sick?

1. It is impossible to reduce the amount of proteins, fat and carbohydrates, their ratio must be correct. Limited to some indigestible animal fat: beef, pork and mutton.
2. You can not reduce calorie intake, calories must meet the physiological norm.
3. You need to drink the optimum amount of fluid - 2-3 liters of water per day.
4. Five meals in small portions recommended for patients with hepatitis A.

Such a dietary regimen should be followed even after six months of recovery. We must not forget that prohibits all harmful and spicy foods, so as not to create a burden on the liver.

Prevention of illness

Prevent or significantly reduce the risk of contracting hepatitis A is possible by means of vaccination. A vaccine is a preparation containing a non-viable viruses whose introduction into the body, causes the production of antibodies and activation of the immune system. For the formation of the protection for a few years, a single vaccination is sufficient.

To achieve a long-lasting immunity, for 20-25 years, the vaccine should be used twice with 1-1.5 years.