Hepatitis A( Botkin's Disease): Symptoms, Transmission Routines, Diagnosis and Treatment
Hepatitis A, also known as Botkin's disease, is an acute infectious disease that affects the liver.The source of the pathogen is a sick person.According to the World Health Organization, annually in the world of hepatitis A, up to 10 million people fall ill.In early childhood, pathology can be transferred in an erased form.
The incidence rate directly depends on compliance with personal hygiene rules in certain areas, institutions and teams.Contents: Characteristics of the pathogen Development of the disease Symptoms of viral hepatitis Diagnosis Treatment of viral hepatitis A Prophylaxis of viral hepatitis A
Characteristics of the causative agent
Note: for Botkin's disease is seasonal.The peak incidence falls on the summer-autumn period.The majority of cases are children and adolescents from 4 to 15 years old, as well as young people.
The causative agent of Botkin's disease is the RNA-containing hepatitis A virus( in the English-speaking nomenclature - HAV), belonging to the family Picornaviridae.This infectious agent is devoid of a shell.Currently, only one serological type of virus has been isolated, but there are a number of different genotypes of the virus.
The main way of infection is alimentary - through contaminated water, food and utensils, which the infected person used. The mechanism of virus transfer is fecal-oral. Experts do not exclude that mechanical transmission can be carried out by some kinds of insects( in particular - house flies).There are reports that in rare cases parenteral transmission of HAV( with whole blood, plasma or erythrocyte mass) is possible.
The causative agent of Botkin's disease is very resistant to detergents, acid solutions, ether and chlorine.It retains virulence during drying and thermal exposure( up to + 60 ° C).In the aquatic environment( in both marine and fresh water), the virus can remain viable for several months.HAV is susceptible to formalin, and when boiled dies within 5 minutes.
The excretion of the infectious agent with feces begins at the end of the incubation period and continues throughout the "pre-jaundice" phase.When a patient has such a characteristic clinical symptom as jaundice, HAV ceases to show up in the feces.
Development of the disease
The incubation period of this disease varies from 1 week to 50 days( on average, from 2 to 4 weeks).
Botkin's disease is characterized by the absence of a chronic form of flow.Pathology does not cause permanent damage to the liver.After the disease has been transferred one day, the human immune system produces antibodies, which subsequently ensure a lasting immunity.
The icteric period, caused by a bright manifestation of clinical symptoms, lasts from a week to a month and a half.
The period of convalescence begins with a general improvement in well-being and a decrease in jaundice.Quite long can be preserved subic( jaundice) sclera, a feeling of heaviness in the right hypochondrium, a small hepatomegaly and asthenia.
Symptoms of viral hepatitis
The causative agent has a damaging effect on liver cells.The tissues of the body are subjected to inflammatory and necrotic changes, which is accompanied by a general intoxication of the body.
The "gateway" for the virus is the epithelial cells of the digestive tract.Of these, the pathogen enters the bloodstream and migrates to the liver, where it actively multiplies in Kupfer cells( macrophages) and hepatocytes.Then, HAV enters the bile and is excreted through the intestine.
Early Clinical Symptoms of Botkin Disease:
- loss of appetite;
- general malaise;
- muscle and joint pain;
- liquid stool( not always);
- feverish reaction( the temperature rises to 38.5 ° C).
Important: in many patients, especially in children, early symptoms( signs of intoxication and fever) in Botkin's disease may not manifest at all.
As the hepatitis A virus develops:
- hepatosplenomegaly( enlargement of the liver and spleen in size);
- darkening of urine( before "coffee color");
- fecal discoloration;
- dull pain in the liver region( in the right hypochondrium);
- yellowing sclera of the eyes and skin.
The diagnosis of viral hepatitis A is made by a specialist based on the characteristic clinical picture and the data obtained during laboratory tests.The virus is detected in faeces only at the end of the "latent" period, and in the earlier stages( within 1-2 weeks after the infectious agent enters the body) specific anti-HAV immunoglobulins( IgM) can be detected in the blood.
In the acute phase, an increase in the activity of serum enzymes, in particular - aldolase, AsAT( aspartate aminotransferase) and AlAT( alanine aminotransferase), is detected during laboratory tests.ALT appears due to the destruction of the liver cells by the virus.
Another diagnostic sign of Botkin's disease is a rise in the blood level of bilirubin.During jaundice on the part of the blood, monocytosis, relative lymphocytosis, leukopenia and, in some cases, slowing down the rate of erythrocyte sedimentation can also be determined.
The appearance of a specific IgG in the patient's blood indicates the end of the acute phase of Botkin's disease.From this moment it is possible to talk about the formation of a stable immunity to the hepatitis A virus.
Treatment of viral hepatitis A
There is no etiotropic treatment for Botkin's disease.Patients with suspicion of viral hepatitis are placed in infectious departments of hospitals.
The basis of therapy is a diet( table number 5 with restriction of consumption of table salt) and a sparing regimen.
Patients are required to have a large amount of liquid in the diet for the prompt elimination of toxins.Recommended alkaline mineral water and natural juices of 2-3 liters per day.
For moderate to severe intravenous administration of Ringer-Lock and glucose solutions( 5%) of 250-300 ml.When there is a pronounced intoxication, an intravenous infusion of rheopolyglucin or haemodeza is required for 200-400 ml.
In severe cases, patients are required to be transferred to an intensive care unit where they receive IV up to 1 L of 10% glucose per day, as well as Lobari solution( up to 1.5 L per day).
If the disease is complicated by acute hepatic insufficiency, solutions of albumin( 15%, 200-300 ml per day) and sorbitol( 20%, 250-500 ml per day) and prednisolone( intramuscularly or intravenously) are prescribed to treat Botkin's disease.At 60-90 mg per day and countercrack( 10 000-30 000 units per day).
In certain situations, blood transfusion may be selected.A promising treatment for viral hepatitis A is hyperbaric oxygenation.
Prevention of viral hepatitis A
Against the virus, a vaccine has been developed, which successfully restrains outbreaks of Botkin's disease.Children, as well as pregnant women in contact with infected, in the foci of hepatitis A for preventive purposes, gamma globulin is introduced.
Vaccination is recommended for tourists and military personnel traveling to areas with a high incidence rate.
The vaccine is mandatory introduced to the staff of children's preschool institutions and infectious departments of medical hospitals.
For more information on the symptoms of Botkin's disease, the methods of diagnosis and treatment of this disease, you will receive by reviewing this video review:Konev Alexander, therapist