Hepatitis A (infectious hepatitis, Botkin’s disease) is a disease that occurs with damage to the liver and biliary system and is caused by a virus. Transmitted by household contact.
Most often, viral hepatitis A is diagnosed in children: in 60% of cases of the disease.
Seasonality is inherent in this disease, outbreaks of the virus are observed in the autumn-winter period. It is noted that mainly the population of developing countries suffers from hepatitis A.
In addition, the described pathology is widespread in regions with hot climates, so tourists traveling to countries in Asia, Egypt, Turkey and other “warm places” should be careful and take special care to observe hygiene.
The following forms of viral hepatitis A are known:
- with erased jaundice;
Separately allocated subclinical (inapparantnaya) form, which is diagnosed only on the basis of the results of laboratory tests.
The course of the disease can be acute, protracted, subacute and chronic (extremely rare). Acute infectious hepatitis on the severity of clinical manifestations can be mild, moderate and severe.
The causative agent of the disease is the hepatitis A virus, which belongs to the family of picornaviruses. It is very stable in the environment, is stored for several months at +4 of C, and for several years at -20 for S. Dies virus only after five minutes of boiling.
The source of infection becomes a sick person, regardless of what form of the disease he has: icteric or anicteric. Patients are most at risk at the end of the incubation period and during the preicteric stage. With the appearance of jaundice, the virus is not detected in the blood, and the risk of infection is reduced to the maximum.
The main ways of spreading the infection are:
- alimentary (food);
- contact and household;
Some doctors are of the opinion that the virus can be transmitted by airborne droplets, but this point of view does not have sufficient evidence. Therefore, hepatitis A is referred to as intestinal infections.
You can get hepatitis A by drinking:
- food prepared by an infected person;
- vegetables and fruits washed with contaminated and unboiled water;
- food prepared by a person who does not follow the rules of personal hygiene or cares for a sick child;
- raw seafood caught in the waters contaminated with the causative agent of hepatitis A (sewage is not excluded);
- as well as having homosexual contact with a sick person.
Risk groups for hepatitis A infection:
- households of a person with hepatitis A;
- people who have sex with a patient;
- people, especially children, who live in areas with a high prevalence of hepatitis A;
- homosexual men;
- employees of kindergartens, institutions of public catering and water supply;
- children who attend preschool;
- drug addicts.
The incubation period of the disease lasts an average of 2-3 weeks, a maximum of 50 days, and a minimum of 7.
Signs of anicteric form and form with erased jaundice
In children, hepatitis A usually occurs without jaundice or with an erased picture of jaundice.
Difficulties in the diagnosis of these forms is that the temperature rise is short, observed in the first 2-3 days, then it decreases or (rarely) remains subfebrile.
The main and important signs are an enlarged liver and spleen (hepatosplenomegaly). The liver protrudes 2-3 cm from under the edge of the costal arch, during palpation its sensitivity is noted. In a smaller proportion of patients, an enlarged spleen is palpable.
Perhaps rapid passing darkening of urine.
Most patients complain about:
- decreased appetite;
- pulling pains in the epigastrium and in the right hypochondrium;
- joint pains;
- in the upper respiratory tract catarrhal phenomena are detected.
If hepatitis A is acute, then its stages are clinically well diagnosed:
- the height of the disease (jaundice);
- convalescence (recovery).
The preicteric stage usually does not exceed 7 days, in children it is shorter, up to 4-5 days, in adults it is 7-8 days.
Depending on which syndrome prevails in the preicter period, its variants are distinguished:
- asthenovegetative (weakness, fatigue, drowsiness, malaise);
- dyspeptic (nausea, lack of appetite, vomiting, pain in the right hypochondrium);
- respiratory tract catarrh (rhinitis, sore throat and mucosal redness, cough, fever up to 39–40 degrees);
- falsely rheumatic (joint pain);
The icteric stage is characterized by yellowing of the skin and sclera, which first grow and then decrease. These manifestations are detected either by the patient himself or by friends or relatives.
Signs of intoxication do not increase, it is possible the occurrence of pruritus. The patient continues to be disturbed by the severity and aching pains in the hypochondrium, fecal discoloration and darkening of the urine are noted. The liver and spleen are enlarged.
In the recovery period, the clinical symptoms of the disease gradually disappear. Appears appetite, the liver returns to its original size, urine brightens, the color of feces normalizes.
The differential diagnosis of hepatitis A is necessary both in the preichelous stage: many symptoms are similar to acute respiratory viral infections and acute gastroenteritis, and after the onset of jaundice: to distinguish hepatitis A from other hepatitis , cholangitis, bile stasis and gallstone disease .
For the diagnosis of the disease are important:
- history taking;
- clarification of the epidemiological situation and the possibility of contacts with patients with hepatitis A;
- confirmation of an increase in the liver and spleen;
- complaints of light feces and dark urine.
From laboratory methods use:
- determination of the activity of AST and ALT , aldolase, thymol test;
- conducting ELISA or PHA to detect specific antibodies of the class of immunoglobulins M (anti-HAV IgM);
- complete blood count ( increase in lymphocytes and monocytes with a reduced number of leukocytes and ESR );
- biochemical blood test (increased bilirubin , reduced total protein);
- general urine analysis;
- blood test for clotting, in particular for the prothrombin index;
- Ultrasound of the liver.
Hepatitis A is treated by an infectious diseases doctor. All patients are required to be hospitalized in the infectious disease ward or in the hospital.
Special medication is usually not prescribed: to improve the blood supply to the liver and other organs, bed rest, rest and a sparing diet are essential.
It is necessary to exclude from food:
- animal fats;
- fried, spicy, salted and smoked products;
- limit the intake of vegetable fat;
- alcohol is prohibited.
In moderate and severe situations:
- intravenous infusions (glucose solution, reopolyglukine, ringer’s solution, gemodez) are used for the purpose of detoxification;
- antioxidants (vitamins E, A, PP, C), metabolic and enzyme preparations (Riboxin, Essentiale-forte) are shown;
- enterosorbents (polyphepan, enterosgel) and plenty of alkaline drinks are recommended.
Viral hepatitis A rarely causes complications.
In some patients, an increase in the recovery period is possible, in which case they are prescribed a general strengthening treatment and multivitamins.
Chronization process is extremely rare. After an illness, biliary tract dyskinesias and cholecystitis sometimes occur . Rarely cholangitis and pancreatitis develop. Sometimes after hepatitis A, Gilbert’s disease manifests.
The prognosis is favorable.