Hepatitis epidemic

Hepatitis epidemic (synonym Hypatia And, infectious hepatitis, Botkin's disease) is a viral disease that affects different organs and systems, especially the liver. In addition to the epidemic of hepatitis, there is a clinically similar serum hepatitis. Despite many similarities, they have important clinical and epidemiological differences; every disease requires special measures of prevention, so currently they are registered separately. Because it is not always possible to install this epidemic hepatitis or serum, there are uniting their term Botkin's disease".
Etiology. The causative agent of epidemic of hepatitis a and whey is a filterable virus ispathogenic for humans, it is highly resistant to environmental factors.
Epidemiology. The source of infection is a sick person or the media. The causative agent of epidemic hepatitis is in the blood and excreted in faeces. Infection occurs through infected food, water, is not excluded parenteral, and possibly airborne transmission. Contamination of serum hepatitis occurs only parenteral way - through blood transfusion, the insufficient use of sterile instruments, which remains the blood. For intrusion enough, minute amounts of blood or serum (0.01 ml). Most epidemiological danger patients with mild, erased and Busselton illness.
Pathogenesis and pathological anatomy. With the blood flow to the virus penetrates into the various organs and systems, damage them, especially affect the liver. In the liver cells, are developing inflammatory and destructive changes: protein degeneration, necrosis. Liver cell loses the ability to excrete bilirubinaccumulating in the blood, resulting develops jaundice (see). Broken participation of the liver in different types of protein, carbohydrate, fat, etc., In cases of complications of acute and subacute liver dystrophy (massive necrosis) at showdown are reduced, soft, yellow or brown color liver.
The immune system. A person with a history of an epidemic of hepatitis a, get quite persistent immunity, whereas serum hepatitis a immunity lasts only about a year. Most authors consider that cross-immunity between the epidemic and serum hepatitis there.
The clinical picture. The incubation period is at epidemic hepatitis - 15-45 days, when serum - up to 11 months. Both communicable and serum hepatitis similar in clinical terms. Serum hepatitis diagnosed with a history of blood transfusions, surgery, multiple injections within 6-8 months. before the disease; the disease is usually more severe than the epidemic hepatitis. With the development of infectious and serum hepatitis can be distinguished periods - predzheltushnogo, icteric and the recovery period. Symptoms predzheltushnogo period varied. There are four variants of the course of this period. When astheno-vegetative - patients complain of weakness, fatigue. While dyspeptic - for a reduced appetite, a feeling of bitterness in the mouth, belching, heartburn, nausea, vomiting, gravity in the epigastralna area, in some cases it may be liquid stool. When false rheumatic - on pain in joints, muscles; the joints are usually not changed. When pseudorymosia - cough, runny nose, headache. Often the above options are combined with one another. Urine during this period is dark - color beer or strong brewed tea with yellow foam, feces may be discolored and remind putty. The temperature is often increased in 2-3 days. Approximately 5-7-th day of illness of the liver and spleen to become enlarged and painful. The duration of the period predzheltushnogo 3-14 days, less than 3 weeks. When serum hepatitis predzheltushnogo period longer and more often characterized by weakness, pain in the joints.
For icteric period is characterized by yellowish color of skin and eyes of various intensity from mild to pronounced), intoxication symptoms: weakness, headache, nausea, vomiting, lack of appetite, feeling of heaviness and fullness of stomach, fever. Icteric period is gradually transformed into the recovery period.
Epidemic hepatitis, and serum hepatitis can occur in both acute and chronic form, to give aggravation and relapses. There are slight, moderate and severe disease. The severity of the disease depends on the severity of intoxication and degree of changes in the functional liver samples. The acute form of the disease can evolve into a chronic. The chronic form can last for years, with occasional flare-UPS. Outcome of chronic forms in most is cirrhosis of the liver (see).
Complications. The most serious complication is acute and subacute liver dystrophy, which in most cases ends lethally. The development of dystrophy always precede the forerunners - the perversion of sleep (drowsiness during the day and insomnia at night), abdominal pain, change of patient's behavior: sudden weakness and lethargy or, conversely, euphoria, excited, good mood, not with the disease; some patients experiencing extreme excitement and even aggressive state to prescribe drugs it should!). In the future, patients develop an aversion to food, nausea, vomiting, mouth appear distinctive sweet odor (hepatic). The liver begins to contract rapidly, becoming soft on the skin marked hemorrhage, appears bleeding. Developing hepatic coma. However, liver dystrophy can occur without obvious dyspeptic symptoms. As a rule, death is associated with the development of hepatic coma. The disease can be complicated also by cholangitis (see).
Diagnostics of both types of hepatitis is based on clinical and epidemiological data and laboratory studies. Characterized by increased levels of bilirubin in blood serum (see Bilirubinemia), high content of aldolase and transaminase - salewoman and pyruvic, low sublimate samples (see), increased thymol turbidity samples (see). In the blood, lakopenia with limfotsitoz, ROE slow or normal. In urine is a urobilin and bile pigments. Carefully collected epidemiological anamnesis helps the diagnosis of the epidemic hepatitis (contacts with icteric patients) or serum hepatitis (instructions for operation, blood transfusion, injections for 6-8 months. to this disease). The greatest difficulties in the recognition of the disease occur in predzheltushnogo the period when the disease must be differentiated from the flu, food diseases, infectious mononucleosis, rheumatism. The big help in the diagnosis of this disease before the appearance of jaundice can help change the color of the urine and feces, urine, the urobilin and bile pigments, the definition of enzymes of blood (aldolase transaminaz).
Forecast: in most cases end with the recovery. The mortality rate of 0.1-0.2%.

Treatment. Specific therapeutic tools become available, treatment is based on the pathogenetic basis and should be individualized. Early hospitalization and bed rest are mandatory for all patients regardless of age and severity of disease. The patient needs to ensure peace. The failure to comply with bed rest is often leads to severe disease, exacerbation, recurrence.
A great role in the treatment plays a proper diet. Appoint easily digestible high-calorie diet: adequate amount of carbohydrates (up to 500 g), complete proteins, butter limit to 40 g per day. Food should be enriched with vitamins. Recommended products such as honey, fruit, boiled meat and fish, steam burgers, cereals, cheese, yogurt, potatoes, and excessive drinking (up to 2 litres per day) in the form of compotes, fruit drinks, jelly, sweet tea with lemon, alkaline mineral water (Essentuki № 17, Borjomi). Not allowed to drink refractory fats, spices, smoked products, canned food, grilled meat and fish, cocoa, chocolate and alcohol. With a light and in some cases of moderate severity of the disease, the treatment can be limited to the assignment of appropriate diet and mode of vitamins in pills (vitamin a - 1250 ME, B1- 0.5 mg, B2 - 0.5 mg, With 70 mg, D2 - 250 ME, P - 3 mg).
In severe intoxication prescribed injections of 5% solution of glucose intravenously and subcutaneously, the plasma (under medical supervision), gemodez (synonym: Peniston, neocompsa) intravenous drip (single dose of 100 ml), oxygen therapy, vitamins b and C of parenteral, in severe cases, corticosteroids (prednisone, prednisone, dexamethasone). Starting liver dystrophy is an absolute indication for steroid hormones. Under the influence of hormonal drugs in patients quickly (3-5-day treatment) is removed intoxication, improves overall health, there is an appetite, they get more active, improves urine flow, then gradually decreases jaundice, normalized by the size of the liver, restoring altered liver function. Average daily dose of prednisolone 30-40 mg, followed by a gradual decrease. When hormonal therapy appoint patients table salt restriction (no. 5A of Pevzner). To monitor urine output, blood pressure, to control the amount of sugar in the blood and urine. Because of the long-term purpose of hormones may result in complications such as bleeding (digestive, nasal, uterine, and so on), you need to determine the prothrombin blood test the stool for occult blood. With the appearance of a small bleeding or low prothrombin appoint menadione intramuscularly 1% solution of 2 ml 2-3 days.
Often in patients who are treated with hormones, pain in the heart, caused by increased excretion of potassium. Potassium loss fill his appointment inside (10% solution of potassium acetate 15 ml 3-4 times a day). In case of complications of inflammatory nature prescribe antibiotics (penicillin 200 000 f E 6 times a day intramuscularly with streptomycin 1 g / day, course of 7 days, erythromycin 200 000 IU 4-6 times a day per os 5-7 days, randomized 0.3 g capsules 2 times a day for 5-7 days, and so on).
Prevention. All patients necessarily hospitalized to the infectious diseases hospital for a period of not less than 3 weeks from the moment of occurrence of jaundice (see the Isolation of infectious patients). Discharged in full clinical recovery and the restoration to the rules in the functional liver samples. Patients should not be less than 6 months. after discharge to be under medical supervision. In hospitals regime has been observed, provided for patients with intestinal infections. People who have been in contact with patients must be monitored for 50 days and laboratory tests when symptoms characteristic of the epidemic hepatitis. Important preventive value has sanitary supervision over the work of the food enterprises, especially for water supply. For prevention of the epidemic of hepatitis in people suspected of infection, use of gamma globulin (1 ml intramuscularly). In institutions where children did not enter gamma globulin in preepidemic period, upon the occurrence of the disease gamma globulin enter all exposed to sick, but not later than the 10th day from the date of contact. Prevention of serum hepatitis consists in the following. All instruments (syringes, needles, tweezers, cannula, scalpels, probes, systems for blood transfusion and infusion, tools, surgical and gynecological, after a well-washed and cleansed from the blood) subject to sterilization by dry heat for 1 hour at temperature of 160 degrees or by autoclaving for 30 minutes at 1.5 ATM or by boiling for 45 minutes drive from the initial boiling point. For subcutaneous injection should be used for each patient separate sterile syringe with needle (do infusion one syringe, changing the needle, is prohibited). All kinds of needle Frank should be disused and replaced with special needles-spears disposable.