The main route of transmission of viral hepatitis A. Types and routes of transmission of hepatitis. Food route of infection

Few people still know how hepatitis A is transmitted from person to person, yet this disease, also called jaundice and Botkin's disease, is one of the most common viral infections in the world. Although this form hepatitis is not considered fatal; in some cases, it can lead to serious disruptions in the functioning of the body. To protect yourself from jaundice and prevent complications of the disease, it is important to know how you can become infected with hepatitis A.

Least likely routes of transmission

Finding out how people get infected with hepatitis A, scientists conducted a series of studies and found out that this infection is anthroponotic. This means that it is a sick person who is the source of infection, and it is impossible to “catch” the virus from animals and insects. At the same time, the human body is very susceptible to infection, so infection of healthy people occurs easily and quickly. This explains the high incidence of Botkin's disease worldwide.

Possible routes of transmission of hepatitis A are associated with the characteristics of the life of the virus in the affected body:

Once in the human body, jaundice pathogens actively multiply in the gastrointestinal tract, therefore the main mechanism of transmission of the hepatitis A virus is nutritional (known as fecal-oral). Pathogenic microorganisms are excreted from the patient's body along with feces and remain in the environment, and then enter the body of a healthy person with food, water, or when the oral mucosa comes into contact with dirty hands.

When an infected person is dangerous

The disease occurs in several stages:

1. The infected person is dangerous to others already from the middle of the incubation period, which lasts from 15 to 50 days.
2. The release of the virus into the environment continues in the prodromal (pre-icteric) period - 6–7 days until the skin and mucous membranes turn yellow.
3. It is believed that at the next stage, when characteristic symptoms of infection occur, the person is no longer contagious, but some studies show that the patient can spread the virus for some time even after all clinical manifestations of jaundice have disappeared.

In addition, it must be taken into account that in some cases hepatitis A is generally asymptomatic, but the person is still a source of infection.

The most common methods of infection

Today, scientists no longer have any doubt about whether viral hepatitis A is contagious. The high resistance of pathogenic microorganisms to unfavorable environmental conditions determines a high percentage of infections in the population around the globe.

The virus can easily withstand not only low and high temperatures, but also many disinfectants, including chlorine. Few people know that in order to become infected with hepatitis A, it is not necessary to have a carrier of the virus in your environment. Under favorable conditions, pathogens can survive in the environment for many days, and freezing can even extend the life of the virus by several years.

The most common sources of hepatitis A infection are water and food. In a humid environment, the virus can persist for up to 10 months, which is why in countries with a low standard of living, where there are problems with drinking water, the highest incidence of Botkin's disease is observed. The causative agent of jaundice can live just as long on food. The danger of infection arises even if food and utensils are washed with contaminated water. For the virus to enter the body, it is not necessary to drink contaminated liquid: swimming in unsafe bodies of water and pools also increases the risk of developing hepatitis A.

The role of contact and household transmission of the virus is no less important. It’s not for nothing that hepatitis A is called the “disease of dirty hands”: many cases of the disease are associated with basic non-compliance with simple hygiene rules. The virus can survive on household items for up to 7 days and easily spread to the skin when touching a contaminated surface. You can introduce it into your body not only when visiting a public toilet, but also when opening doors in any public place with a large crowd of people.

Outbreaks of hepatitis A are characterized by the influence of a seasonal factor - as a rule, an outbreak of the disease is observed in the autumn-winter period. It is important to remember that you can only get hepatitis A once in your life. After an illness, a strong natural defense is formed, and repeated encounters with the virus are no longer scary.

At-risk groups

No one is immune from hepatitis A (except those who already have immunity against the virus), but there are several groups of people who are particularly likely to become infected. The following risk factors for contracting Botkin's disease are called:

Knowing what modes of transmission are typical for hepatitis A can significantly reduce the risk of infection.

Of course, it is quite difficult to avoid contact with a patient, especially without knowing that he is a carrier of the virus, but you can use the simplest measures to help avoid infection: frequent washing hands, using only boiled water for drinking purposes, thorough cleansing and sufficient heat treatment of food.

How hepatitis A is transmitted is the most common question among people of any age group and gender who have had contact with an infected person. This disease belongs to the group intestinal infections, which is how it differs from other types of liver damage.

Hepatitis A virus – HAV is characterized by its resistance to adverse external conditions. In the environment, at room temperature, it is able to maintain its viability for weeks, in cold conditions - for months and years when frozen below twenty degrees. The pathogen can only be killed by boiling - death occurs in about five minutes.

Source of disease

Hepatitis A belongs to the group of anthroponotic infections. This means that the source of infection in all cases is a person, and it does not matter in what form such a pathology occurs in him.

The main role in the widespread prevalence of this disease is played by patients with atypical forms of the disease, which include:

• erased - the main symptoms of the disease are expressed insignificantly and are often completely ignored by people. This means that a person himself provokes the development of complications and prolonged recovery of the affected organ. If therapy is started in a timely manner, the liver returns to normal within six months to one year;
• anicteric - with such a course, the main clinical manifestations are clearly expressed, while specific ones, in the form of changes in the shade of the skin, mucous membranes, urine and feces, are missing. This situation leads to the fact that a similar disease is mistaken for a completely different disorder;
• subclinical – characterized by the fact that symptoms do not appear at all. In such cases, the presence of the disease will be indicated only by laboratory data, which will show changes in blood tests, as well as instrumental examinations, which will indicate an enlarged liver.

It follows that patients, in most cases, lead an active lifestyle and are in contact with other people, in particular children, which makes the infected person a hidden and powerful source of infection.

It is worth noting that exactly atypical course the disease prevails over typical forms.

The greatest danger is posed by people at the beginning or end of the incubation period, the duration of which varies from two weeks to one and a half months, but often does not exceed three weeks.

Another important detail is that a person with both a manifest form of the disease and an anicteric one will be equally dangerous.

Transmission routes

Modern medicine identifies the following main methods of transmission of viral hepatitis A:

• water;
• contact and household;
• parenteral;
• food.

Similar ways of how Botkin's disease can be transmitted constitute a common mechanism - fecal-oral.

The waterborne route of transmission of hepatitis A is considered the most common, since the virus is found in contaminated water. Typical for this type of infection are:

• active increase in the number of infected people;
• the prevalence of the disease among people living in areas near contaminated water bodies.

Waterborne infection is possible in the following cases:

• ingestion of water of dubious origin without prior filtration or boiling. This may include both the closure of the reservoir and the springs;
• use of water for washing dishes;
• brushing teeth or performing other hygiene procedures oral cavity using water.

This method of infection can cause an outbreak of hepatitis A in entire settlements, children's and adult groups of closed or open type.

The second way hepatitis A is transmitted is through food. The following cases are dangerous for its implementation:

• sharing dishes and cutlery with an infected person;
• eating the same dishes together;
• ingestion of food prepared by the patient.

In addition, you can get sick in the following cases:

• when consuming vegetables and fruits that were washed in contaminated water without subsequent heat treatment;
• during the preparation of fish and seafood dishes that could have been caught in unfavorable bodies of water.

This possibility of infection is most typical for children's groups in preschool and school educational institutions.

The virus can also be transmitted through contaminated objects touched by the carrier of the virus.

The contact mechanism of hepatitis A transmission can occur against the background of:

• direct contact with a sick person;
• use of common household items, which include Shaver, nail scissors and toothbrush;
• non-compliance with the rules for cleaning toilets, both home and public.

The parenteral route involves contact of a healthy person with the blood of a patient. How can you become infected with hepatitis A through blood:

• with a blood transfusion from a carrier, however, at present this possibility is reduced to zero, since each donor, before undergoing such a procedure, takes a blood test for infections;
• subsequently transfusions of blood components, such as plasma;
• through the use of a shared syringe with an infected person for injecting substances.

Less common mechanisms of how hepatitis A is transmitted include:

• unprotected sexual contact with a pathogen carrier. Many patients are interested in the question: is hepatitis A transmitted through sex? Infection with this virus through sexual contact is possible only through anal-oral intercourse;
• visits to dental or nail salons;
• tattoo pricking;
• through flies - the possibility cannot be ruled out that these insects could act as carriers.

It is worth noting that Botkin's disease is not transmitted by airborne droplets, even with severe cough or sneezing. There are also no cases of transmission of the virus from mother to child during pregnancy, labor or breastfeeding baby.

This disease is characterized by seasonal outbreaks and frequency of incidence. Thus, the number of patients with hepatitis A increases in the summer and autumn seasons.

Main risk groups

There are several groups of people who are most susceptible to infection with this virus. The main risk categories are:

• workers of medical and children's institutions - due to the fact that hepatitis A is transmitted through contact with blood or the use of shared cutlery;
• food service employees - the danger of infection lies in the fact that such people are forced to come into contact with products grown in contaminated areas;
• military personnel who may end up in countries of Asia and Africa, where the incidence of Botkin's disease reaches high levels;
• drug addicts - viruses are transmitted through a contaminated needle used by an infected person;
• persons who had direct contact with the patient’s household items;
• homosexual men;
• patients suffering from others serious illnesses liver;
• tourists and travelers visiting countries with a high incidence of hepatitis A;
• family members who have a patient with a similar diagnosis.

It is these factors of transmission of the hepatitis A virus that require vaccination against such a disease, which must be carried out for both adults and children. This measure is mandatory, despite the fact that the disease often has a favorable prognosis and quite rarely leads to the development of complications.

It is worth noting that the main difference between Botkin’s disease and other viral liver lesions is that after recovery the patient develops lifelong immunity. However, this is not a reason to refuse vaccination. In addition, today there are a large number of preventive recommendations, compliance with which minimizes the likelihood of infection with this virus.

Almost every person is familiar with hepatitis A (Botkin's disease). The patient's polyclinic card is marked with special symbols, and after that, for many years, the person is re-examined for the presence of the virus in the body. Although the latter is not necessary, because after an infection there are no people with a chronic course. Nevertheless, you need to know about the disease because of some features of its course.

Hepatitis A - what is it and how is it transmitted? How is this type of viral liver disease different? What do you need to know about the disease and its treatment?

What is hepatitis A

Scientists have calculated that among all cases of liver damage by viruses, hepatitis A accounts for about 40%. Almost every second case! The infection is not classified as particularly dangerous; it has a relatively benign course and almost always ends full recovery.

Why is hepatitis A dangerous?

1. The disease does not manifest itself for a long time, sometimes after 4–6 weeks only its first signs appear.
2. A person infects others during the last days of the incubation period, when even the patient himself does not know about the disease. During this time, you can manage to infect hundreds of people.
3. The causative agent of hepatitis A is a virus resistant to external environment, on surfaces at temperatures as low as 4 °C it persists for several years.
4. The microorganism tolerates exposure to ultraviolet radiation well, detergents, formaldehyde.
5. Only boiling kills the virus within 5 minutes.
6. It affects all children and adults equally, and susceptibility to the virus is universal.
7. A large number of latent or anicteric forms of the disease.

So what kind of disease is hepatitis A? This is an infectious liver lesion caused by the type A virus. Simple mode of transmission, high susceptibility of the population and many unusual shapes diseases are characteristic of him. Even the best modern methods of prevention will not save people from this infection. Hepatitis A circulates throughout the world and affects populations at regular intervals. Therefore, you need to remember about it.

Causes of spread of hepatitis A virus

In nature, the virus is found only among humans. It is transmitted from person to person, animals are not infected and are not infected. This is a strictly anthroponotic infection (circulating only between people).

The routes of infection with viral hepatitis A are as follows.

1. Contact-household route, through contaminated objects in surrounding people environment. The danger is posed by a sick person at the stage of hepatitis A virus isolation.
2. Alimentary route - in case of ingestion of a microorganism through contaminated food products.
3. One of the leading routes of infection is water. Infection with hepatitis A most often occurs due to the virus entering sewers, natural bodies of water and other sources.
4. A controversial, but quite possible route of transmission is parenteral, which is less common than others, but doctors have recorded isolated cases of the hepatitis A virus entering the body through injections and droppers.

All this is explained only by the ability of the virus to survive in any conditions and the impossibility of neutralizing it in ways accessible to everyone.

How is hepatitis A transmitted from person to person? The transmission mechanism is fecal-oral, which is realized if the pathogenic microorganism is located and multiplies in the intestines. The virus is released into the environment through urine, vomit or feces; if hygiene standards are not observed or violated, it remains on surrounding objects. People become infected when they are touched, causing the microorganism to infect next person.

Countries with a low level of development are considered the most unfavorable in terms of epidemics, where people become infected as a result of the widespread spread of the virus and due to low level development of sanitary and epidemiological standards.

Stages of development of viral hepatitis A

There are several variants of the course of hepatitis A. The disease can occur with a typical clinical picture and be asymptomatic.

In the case of manifest (proceeding with vivid symptoms) forms, several stages are distinguished in the development of the disease.

1. The incubation period of viral hepatitis A begins from the moment the pathogen enters the human body until the initial manifestations. It can last from 1 to 7 weeks, but on average it is 21–28 days.
2. The prodromal period lasts about 7 days, sometimes three weeks. It resembles the onset of a viral upper respiratory tract disease.
3. The height of the disease or the period of familiar typical clinical manifestations lasts about two or three weeks, but in special cases it reaches two months.
4. Convalescence or recovery.

After infection, persistent lifelong immunity is formed. Is it possible to get hepatitis A again? This is impossible; after suffering from the disease, the body produces cells that protect against re-infection.

The first signs of the disease

The incubation period does not reveal itself at all. This is, from an epidemiological point of view, the most dangerous period, since at the end of it the person is already contagious to others, but he still does not know about it. Therefore, hepatitis A is considered dangerous.

The next stage in the development of the disease is prodromal. A person is contagious throughout his entire life.

Manifestations of the prodromal period of hepatitis A are as follows:

• the disease begins acutely with an increase in body temperature to 38–40 °C, which is observed at least three days;
• The first signs of hepatitis A include redness of the throat, headaches, and mild nasal congestion;
• nausea, loss of appetite, vomiting is possible, but in rare cases;
• perhaps the appearance of pain in the stomach or a feeling of discomfort;
• after about two days the urine becomes dark color, many draw an analogy with the color of dark beer or strong tea, feces become discolored and become liquid;
• It is during this period of hepatitis A that the liver and spleen enlarge and become painful on palpation.

At the very beginning, the prodrome period resembles respiratory infection and it is only at the end, before the climax, that its symptoms become more understandable.

Symptoms of Hepatitis A

This stage lasts up to two months, and when typical course the diagnosis almost never raises questions. The moderate course of the disease looks approximately as follows.

Jaundice, liver enlargement and dyspeptic symptoms are typical hallmarks of Botkin's disease.

Features of the course of hepatitis A in children and adults

In adults and children, sometimes the disease occurs with some features that depend on the immune system and the body itself.

How is hepatitis A different in children?

1. Most often, children aged 3 to 12 years old are sick, especially those in organized children's groups: in kindergartens, schools, and boarding schools.
2. In most cases, infants under one year of age retain maternal or passive immunity.
3. Symptoms of hepatitis A in children: severe intoxication, an increase in liver size noticeable not only upon palpation, but also visually, usually of moderate severity.
4. A protracted course of the disease is observed only in 3% of cases.
5. What are the signs of hepatitis A in a child? younger age? - the child becomes nervous, whiny, refuses to eat, sleeps poorly, vomits after eating, does not allow himself to be examined, since the abdomen is painful on palpation, against the background of the underlying disease, chronic infections worsen and new ones often appear.

How does hepatitis A occur in adults? The average severity of the disease fully corresponds to the clinical picture described above. Mild or protracted course is slightly different.

1. Most adults develop active immunity by the age of 35 or 40, sometimes due to a latent form of infection.
2. Mixed infections occur aggressively and over a long period of time, for example, if a person is infected with hepatitis A and B at the same time.
3. Symptoms of hepatitis A in adults are varied - the temperature at the onset of the disease may increase or rise sharply; Dyspeptic symptoms are expressed: discomfort in the stomach, nausea, repeated vomiting, and jaundice can manifest itself in a mild form.
4. With age, the likelihood of death due to hepatitis A increases; in patients over 50 years of age, the number of such complications is 4 times higher than mortality in childhood.

Hepatitis A at the very beginning, during active manifestations, resembles more of a respiratory tract disease, therefore, during prolonged infections, for a correct diagnosis, you need to be fully examined.

Diagnosis of hepatitis A

The diagnosis of hepatitis A is made based on several tests.

Complications of hepatitis A

A favorable course of the disease does not mean that there are no consequences. The only good thing after suffering from hepatitis A is that there is no chronic course of the disease, that is, having had it once, a person will no longer become infected.

What changes does the hepatitis A virus cause after an acute illness?

1. In 90% of cases, the disease ends in absolute complete recovery without any residual effects. The remaining 10% were less fortunate.
2. A prolonged course and resumption of symptoms during the period of subsidence of the infection sometimes indicate additional infection with other types of hepatitis or weak immunity.
3. After the disease, signs of damage to the biliary tract are detected: inflammation, dyskinesia.
4. Sometimes the disease is complicated by extrahepatic manifestations: pneumonia, inflammation of the heart muscle, impaired blood cell production.
5. Mortality occurs in no more than 0.04% of cases.

Treatment of hepatitis A

Therapy for liver infections primarily involves adherence to the regimen. Adequate sleep, walks in the fresh air and naps during the day are the norm for patients with hepatitis A.

How long should sick people and their contacts be monitored? The patient is isolated for 30 days, and quarantine for hepatitis A for contact persons is at least 35 days.

Diet for hepatitis A

The basis for the treatment of all diseases of the digestive system is a balanced diet.

The diet for hepatitis A begins during the development of the disease and continues after recovery for several more months.

How do patients eat?

1. You cannot reduce the calorie content of food; calories must correspond to the physiological norm.
2. You cannot reduce the amount of proteins, fats and carbohydrates; their ratio must be correct. Only some hard-to-digest animal fats are limited: beef, pork and lamb.
3. You need to drink the optimal amount of fluid - 2–3 liters of water per day.
4. Five small meals a day are recommended for patients with hepatitis A.

This dietary regimen must be followed for another six months after recovery. We must not forget that all harmful and spicy foods are prohibited so as not to put a strain on the liver.

Prevention of hepatitis A

Protection against the development of the disease or prevention of hepatitis A is carried out at the site of infection. The patient is isolated, and surfaces in his place of residence are treated with chlorine-containing products. The patient's belongings are subject to special treatment - chamber disinfection.

In addition to the above measures, after one year children are vaccinated against hepatitis A. Some vaccines can only be administered three years after the birth of the child.

Who is eligible for the hepatitis A vaccine?

1. Since this year, the hepatitis A vaccine has been administered to children living in countries with high incidence rates.
2. According to epidemic indications, vaccination is carried out to all contact persons in foci of infection.
3. Immunization is also carried out for people at risk.

The drug is administered intramuscularly twice into the deltoid muscle. Revaccination is carried out no earlier than a month after the first administration of the vaccine. This scheme provides complete protection against the disease for at least 20 years.

Vaccination against hepatitis A is carried out with the following drugs:

The peculiarity of hepatitis A vaccinations is that they are all well tolerated, provide early protection, and after their administration there are practically no complications observed.

How dangerous is hepatitis A? It belongs to the category of mild infections, which anyone can become infected with, and almost 100% of those sick are cured. But that's all" positive points" The disease lasts a long time, is complicated by damage to neighboring organs, and even death is possible. It is impossible to hide from hepatitis A, but timely prevention saves even small children.

This is exactly the question that arises for a person of any age after contact with a sick person. How hepatitis A is transmitted, how high are the chances of contracting this disease, what precautions should be taken - there are quite specific answers to all these questions. By following simple and clear rules, a person practically cannot become infected with this viral disease.

Features of the hepatitis A virus

From the properties of the pathogen, in in this case Certain characteristics of the hepatitis A virus directly affect the possible routes of transmission. The virus multiplies primarily in liver cells, and to a lesser extent in the biliary tract and epithelial cells of the digestive canal.

The hepatitis A virus is resistant to a number of environmental factors, namely chlorine and disinfectants, and low temperature. Thus, this pathogen can penetrate into tap water and survive well in it, and the infection can be transmitted despite traditional chlorination of tap water.

Source of infection

Hepatitis A belongs to the group of anthroponotic infections with a predominant fecal-oral transmission mechanism. This means that in any situation the source of infection is a sick person. The isolation of the virus is quite long: it begins in the incubation (latent) period and sometimes ends even somewhat later than the patient’s clinical recovery. Thus, a person poses a danger to others throughout the entire illness and even before the onset of clinical symptoms.

During viral hepatitis A, the following periods are distinguished:

incubation (that is, hidden) – its duration is 14-30 (up to 55) days, there are no symptoms of the disease, it is during this period that the probability of becoming infected from an infected person is highest; short-term prodromal (pre-icteric) period - only 6-7 (up to 10) days; intensive virus shedding continues; the period of obvious clinical manifestations (the peak period) may be limited to 10-14 days, or may drag on for a whole month or more if exacerbations or complications develop; virus shedding continues, but is less active; the release of the virus during the period of convalescence (recovery) varies significantly, so it is quite difficult to talk about any average duration in this period.

Another important detail: a person with clearly yellow skin (the so-called manifest form of the disease) and without significant changes is equally dangerous. general condition(the so-called anicteric form). In addition, with hepatitis A, so-called latent or abortive forms of the disease often develop. A person does not feel any signs of illness in his own body, but he releases the infectious agent into the environment and is contagious to other people.

From this point of view, the greatest danger for healthy people is a person with an anicteric form of the disease. No anti-epidemic measures are taken in this case, since this condition is rarely diagnosed. A person with obvious jaundice must be hospitalized and isolated, and all objects around him must be disinfected.

How is hepatitis A transmitted?

Modern medical books indicate the following possible routes of infection with hepatitis A:

water; food; contact and household; parenteral.

All methods of transmission involve certain situations that are dangerous in terms of infection. In some cases, infection is unlikely, in others - exactly the opposite.

For hepatitis A, transmission by airborne droplets and transmission is not typical. The airborne transmission mechanism is infection by inhaling air containing droplets of mucus from the patient’s nasopharynx. Since the hepatitis virus does not replicate in respiratory tract, infection only through communication (without direct contact) with a sick person is impossible.

Transmissible transmission is infection through the bite of a sick person by a live carrier (louse, tick, mosquito, mosquito). For hepatitis A, this option is not described in modern medical literature.

Water transmission route

Most often, hepatitis A is transmitted through contaminated (virus-contaminated) water. The so-called “water outbreaks” are typical: a rapid increase in the number of cases, the spread of the disease among residents of a certain area or zone. The implementation of a waterway transmission route is possible in the following situations:

drinking unboiled water from any source (including from the central water supply); the most dangerous (potentially containing a larger amount of virus) are wells, artesian wells, old water supply networks (there is a possibility of mixing sewage and tap water); using water for washing dishes, vegetables and fruits without subsequent treatment with disinfectants or high temperature; in an existing outbreak, the virus can enter oral cavity during brushing teeth and performing other hygiene procedures.

Viral hepatitis A, when transmitted by water, can cover a whole settlements, organized children's groups of closed and open types.

Food route of transmission

Viral hepatitis A is often transmitted through food, for which the following situations are dangerous:

sharing the same utensils with a sick person; eating only culinary products; inclusion in the diet of poorly washed and not heat-treated vegetables, fruits and other things.

The food route of transmission is most typical for groups of children who eat in the same catering establishment (for example, a school canteen). The spread is facilitated by poor hygiene practices, lack of soap, etc.

Contact transmission path

A sick person who infects others touches many objects through which the virus is transmitted to other people.

The contact transmission path is implemented:

in direct contact with a sick person; when using common household items ( Toothbrush, towel); while playing with shared toys (hard and soft); failure to comply with the rules of hygienic treatment of the toilet (both public and home).

All methods of infection with hepatitis A can be carried out both at home and in public areas. Visiting public catering establishments of any class or public toilets increases the risk of infection.

Epidemiological features of hepatitis A

Hepatitis A, transmitted “through dirty hands,” has a number of patterns:

an increase in incidence is observed in the warm season; The predominant age of patients is under 35 years; the ease of infection makes it possible to develop an epidemic outbreak; after the disease, lifelong immunity remains; careful adherence to hygiene rules makes it easy to control this infection.

The transmission of hepatitis A is a fairly easy process, but the rules for preventing this disease are also simple, understandable and accessible to people of any age.

Related materials

Hepatitis C is an inflammation of the liver of viral origin, the clinical manifestations of which in most cases are significantly delayed in time or so little expressed that the patient himself may not even notice that a “gentle” killer virus, as the hepatitis C virus (HCV) is commonly called, has settled in his body.

Once upon a time, and this lasted until the end of the 80s of the last century, doctors knew about the existence of a special form of hepatitis, which does not fit into the concept of “Botkin’s disease” or jaundice, but it was obvious that this was hepatitis that affected the liver no less than its own “ brothers" (A and B). The unfamiliar species was called non-A, non-B hepatitis, since its own markers were still unknown, and the proximity of pathogenesis factors was obvious. It was similar to hepatitis A in that it was transmitted not only parenterally, but also suggested other routes of transmission. The similarity with hepatitis B, called serum hepatitis, was that it could also be contracted by receiving someone else's blood.

Currently, everyone knows that, called neither A nor B hepatitis, is open and well studied. This is hepatitis C, which in its prevalence is not only not inferior to the notorious HIV infection, but also far exceeds it.

Similarities and differences

Botkin's disease was previously called any inflammatory liver disease associated with a certain pathogen. Understanding that Botkin's disease may represent an independent group of polyetiological pathological conditions, each of which has its own pathogen and main route of transmission, came later.

Now these diseases are called hepatitis, but the name is added capital letter Latin alphabet according to the sequence of pathogen opening (A, B, C, D, E, G). Patients often translate everything into Russian and indicate hepatitis C or hepatitis D. However, the diseases classified in this group are very similar in the sense that the viruses they cause have hepatotropic properties and, when they enter the body, affect the hepatobiliary system , each in its own way disrupting her functional abilities.

Different types of hepatitis are unequally prone to chronicity of the process, which indicates different behavior of viruses in the body.

Hepatitis C is considered the most interesting in this regard., which remained a mystery for a long time, but even now, being widely known, it leaves secrets and intrigues, since it does not make it possible to give an accurate forecast (it can only be guessed).

Inflammatory processes of the liver caused by various pathogens do not differ in relation to gender, therefore they equally affect both men and women. There was no difference in the course of the disease, however, it should be noted that in women during pregnancy, hepatitis can be more severe. In addition, the penetration of the virus in recent months or the active course of the process can negatively affect the health of the newborn.

Since liver diseases of viral origin still have obvious similarities, then when considering hepatitis C, it is advisable to touch on other types of hepatitis, otherwise the reader will think that only the “hero” of our article should be afraid. But through sexual contact you can become infected with almost any type, although this ability is attributed more to hepatitis B and C, and therefore they are often classified as sexually transmitted diseases. In this regard, other pathological conditions of the liver of viral origin are usually kept silent, since their consequences are not as significant as the consequences of hepatitis B and C, which are recognized as the most dangerous.

In addition, there are hepatitis of non-viral origin (autoimmune, alcoholic, toxic), which should also be touched upon, since one way or another, they are all interconnected and significantly aggravate each other.

How is the virus transmitted?

Depending on how the virus could “cross” to a person and what kind of things it will begin to “do” in the body of the new “host”, they distinguish different types hepatitis. Some are transmitted in everyday life (through dirty hands, food, toys, etc.), appear quickly and pass, basically, without any consequences. Others, called parenteral, having the potential for chronicity, often remain in the body for life, destroying the liver to cirrhosis, and in some cases to primary liver cancer (hepatocarcinoma).

Thus, According to the mechanism and routes of infection, hepatitis is divided into two groups:

Having an oral-fecal transmission mechanism (A and E); Hepatitis, for which blood contact (hemopercutaneous), or, more simply, the path through the blood, is the main one (B, C, D, G - group of parenteral hepatitis).

In addition to the transfusion of infected blood or flagrant non-compliance with the rules of medical procedures associated with damage to the skin (use of insufficiently processed instruments, for example, for acupuncture), The spread of hepatitis C, B, D, G is common and in other cases:

Various fashionable procedures (tattoos, piercings, ear piercings) performed by a non-professional at home or any other conditions that do not meet the requirements of the sanitary and epidemiological regime; By using one needle for several people, this method is practiced by syringe addicts; Transmission of the virus through sexual intercourse, which is most likely for hepatitis B, hepatitis C in such situations is transmitted much less frequently; There are known cases of infection through the “vertical” route (from mother to fetus). Active disease, acute infection in the last trimester, or HIV carriage significantly increases the risk of hepatitis. Unfortunately, up to 40% of patients cannot remember the source that gave them the hepatitis B, C, D, G virus.

The hepatitis virus is not transmitted through breast milk, so women who are carriers of hepatitis B and C can safely feed their baby without fear of infecting him.

We can agree that the fecal-oral mechanism, water, contact and household, being so interconnected, cannot exclude the possibility of transmission of the virus through sexual contact, just like other types of hepatitis transmitted through blood, they have the opportunity to penetrate into another body during sex.

Signs of an unhealthy liver

After infection, the first clinical signs of different forms of the disease appear at different times. For example, the hepatitis A virus makes itself known in two weeks (up to 4), the hepatitis B (HBV) pathogen is somewhat delayed and appears in the interval from two months to six months. As for hepatitis C, it the pathogen (HCV) can reveal itself after 2 weeks, after 6 months, or can “lurk” for years, turning a healthy person into a carrier and source of infection of a rather serious disease.

The fact that something is wrong with the liver can be guessed by the clinical manifestations of hepatitis:

Temperature. Hepatitis A usually begins with it and the phenomena of influenza infection ( headache, pain in bones and muscles). The onset of HBV activation in the body is accompanied by low-grade fever, and with C-hepatitis it may not increase at all; Jaundice varying degrees of severity. This symptom appears a few days after the onset of the disease, and if its intensity does not increase, the patient’s condition usually improves. This phenomenon is most characteristic of hepatitis A, which cannot be said about hepatitis C, as well as toxic and alcoholic hepatitis. Here, a more saturated color is not considered a sign of future recovery; rather, on the contrary: with a mild form of liver inflammation, jaundice may be completely absent; Rashes and itching are more characteristic of cholestatic forms of inflammatory processes in the liver; they are caused by the accumulation of bile acids in tissues due to obstructive lesions of the liver parenchyma and injury bile ducts; Decreased appetite; Heaviness in the right hypochondrium, possible enlargement of the liver and spleen; Nausea and vomiting. These symptoms are more typical for severe forms; Weakness, malaise; Joint pain; Dark urine, similar to dark beer, discolored feces - typical signs any viral hepatitis; Laboratory indicators: functional tests liver (AlT, AST, bilirubin), depending on the severity of the disease, can increase several times, the number of platelets decreases.

During viral hepatitis, 4 forms are distinguished:

Mild, more often characteristic of hepatitis C: jaundice is often absent, low-grade or normal temperature, heaviness in the right hypochondrium, loss of appetite; Moderate: the above symptoms are more pronounced, joint pain, nausea and vomiting appear, appetite is practically absent; Heavy. All symptoms are present in a pronounced form; Fulminant (fulminant), not found in hepatitis C, but very characteristic of hepatitis B, especially in the case of coinfection (HDV/HBV), that is, a combination of two viruses B and D that cause superinfection. The fulminant form is the most dangerous, since as a result of the rapid development of massive necrosis of the liver parenchyma, the death of the patient occurs.

Hepatitis, dangerous at home (A, E)

In everyday life, first of all, liver diseases that have a predominantly fecal-oral transmission route can lie in wait, and this, as is known, is hepatitis A and E, so you should dwell a little on their characteristic features:

Hepatitis A

Hepatitis A is a highly contagious infection. Previously, it was called simply infectious hepatitis (when B was serum, and others were not yet known). The causative agent of the disease is a small, but incredibly resistant virus containing RNA. Although epidemiologists note susceptibility to the pathogen as universal, it is predominantly children who are over one year of age who are affected. Infectious hepatitis, triggering inflammatory and necrobiotic processes in the liver parenchyma, giving symptoms of intoxication (weakness, fever, jaundice, etc.), as a rule, ends in recovery with the development of active immunity. The transition of infectious hepatitis to a chronic form practically does not occur.

Video: hepatitis A in the program “Live Healthy!”

Hepatitis E

Its virus also belongs to the RNA-containing type and feels good in the aquatic environment. Transmitted from a sick person or carrier (in the latent period), there is a high probability of infection through food that has not undergone heat treatment. Mostly young people (15-30 years old) living in the countries of Central Asia and the Middle East are affected. In Russia, the disease is extremely rare. The contact and household route of transmission cannot be excluded. Cases of chronicity or chronic carriage not yet established or described.

Hepatitis B and its dependent hepatitis D virus

Hepatitis B virus (HBV), or serum hepatitis, is a DNA-containing pathogen that has complex structure, which prefers liver tissue for its replication. A tiny dose of infected biological material is enough to transmit the virus, why does this form so easily pass not only at medical manipulations, but also during sexual intercourse or vertically.

The course of this viral infection is multivariate. It may be limited to:

Carriage; Give it spicy liver failure with the development of the fulminant (fulminant) form, which often claims the life of the patient; If the process becomes chronic, it can lead to the development of cirrhosis or hepatocarcinoma.

unfavorable development of hepatitis B

The incubation period of this form of the disease lasts from 2 months to six months, and the acute period in most cases has symptoms characteristic of hepatitis:

Fever, headache; Decreased performance, general weakness, malaise; Joint pain; Function disorder digestive system(nausea, vomiting); Sometimes rashes and itching; Heaviness in the right hypochondrium; Enlarged liver, sometimes spleen; Jaundice; A typical sign of liver inflammation is dark urine and discolored stool.

Combinations of HBV with the causative agent of hepatitis D (HD) are very dangerous and unpredictable., which was previously called delta infection - a unique virus that is obligatory dependent on HBV.

Transmission of two viruses can occur simultaneously, which leads to the development of co-infection. If the D-pathogen later joined HBV-infected liver cells (hepatocytes), then we will talk about superinfection. A serious condition that was the result of a similar combination of viruses and the clinical manifestation of the dangerous looking hepatitis (fulminant form), often threatens to be fatal within a short time.

Video: Hepatitis B

The most significant of parenteral hepatitis (C)

viruses of various hepatitis

The “famous” hepatitis C virus (HCV, HCV) is a microorganism with unprecedented heterogeneity. The pathogen contains single-stranded positively charged RNA encoding 8 proteins (3 structural + 5 non-structural), to each of which corresponding antibodies are produced during the disease process.

The hepatitis C virus is quite stable in the external environment, tolerates freezing and drying well, but is not transmitted in negligible doses, which explains the low risk of infection through vertical transmission and sexual intercourse. A low concentration of an infectious agent in secretions released during sex does not provide conditions for transmission of the disease, unless other factors are present that “help” the virus “move.” These factors include concomitant bacterial or viral infections (HIV primarily), which reduce immunity, and damage to the integrity of the skin.

The behavior of HCV in the body is difficult to predict. Having penetrated into the blood, it can circulate for a long time in minimal concentrations, forming in 80% of cases a chronic process that can, over time, lead to severe liver damage: cirrhosis and primary hepatocellular carcinoma (cancer).

hepatitis C development pattern

No symptoms or minor signs of hepatitis – main feature this form of inflammatory liver disease, which remains unrecognized for a long time.

However, if the pathogen nevertheless “decided” to immediately begin damaging the liver tissue, then the first symptoms may already appear after 2-24 weeks and last 14-20 days.

The acute period often occurs in a mild anicteric form, accompanied by:

Weakness; Joint pain; Digestive disorder; Minor fluctuations in laboratory parameters (liver enzymes, bilirubin).

The patient feels some heaviness on the side of the liver, sees a change in the color of urine and feces, but pronounced signs hepatitis, even in acute phase, for this species, in general, are not typical and occur rarely. It becomes possible to diagnose hepatitis C by detecting the corresponding antibodies using enzyme-linked immunosorbent assay (ELISA) and pathogen RNA using PCR (polymerase chain reaction).

Video: film about hepatitis C

What is hepatitis G

Hepatitis G is considered the most mysterious today. It is caused by a virus containing single-stranded RNA. The microorganism (HGV) has 5 varieties of genotypes and is structurally very similar to the causative agent of hepatitis C. One (the first) of the genotypes chose the west of the African continent for its habitat and is not found anywhere else, the second spread throughout the globe, the third and fourth “liked” Southeast Asia, and the fifth settled in southern Africa. Therefore, the residents Russian Federation and the entire post-Soviet space have a “chance” of meeting a representative of type 2.

For comparison: hepatitis C distribution map

In epidemiological terms (sources of infection and routes of transmission), hepatitis G resembles other parenteral hepatitis. As for the role of HGV in the development of inflammatory liver diseases of infectious origin, it has not been determined, the opinions of scientists differ, and the data in the medical literature remain contradictory. Many researchers associate the presence of the pathogen with the fulminant form of the disease, and are also inclined to think that the virus plays a certain role in the development of autoimmune hepatitis. In addition, a frequent combination of HGV with hepatitis C (HCV) and hepatitis B (HBV) viruses has been observed, that is, the presence of co-infection, which, however, does not aggravate the course of mono-infection and does not affect the immune response during interferon treatment.

HGV monoinfection usually occurs in subclinical, anicteric forms, however, as researchers note, in some cases it does not go away without a trace, that is, even in a latent state it can lead to morphological and functional changes in the liver parenchyma. There is an opinion that the virus, like HCV, can lie low and then strike no less, that is, transform into cancer or hepatocellular carcinoma.

When does hepatitis become chronic?

Under chronic hepatitis understand a diffuse-dystrophic process of an inflammatory nature, localized in the hepatobiliary system and caused by various etiological factors (viral or other origin).

The classification of inflammatory processes is complex, however, like other diseases, moreover, there is still no universal method, therefore, in order not to burden the reader with incomprehensible words, we will try to say the main thing.

Considering that in the liver, for certain reasons, a mechanism is triggered that causes degeneration of hepatocytes (liver cells), fibrosis, necrosis of the liver parenchyma and other morphological changes leading to disruption functional abilities organ, they began to distinguish:

Autoimmune hepatitis, characterized by extensive liver damage, and, therefore, an abundance of symptoms; Cholestatic hepatitis caused by impaired outflow of bile and its stagnation as a result inflammatory process affecting the bile ducts; Chronic hepatitis B, C, D; Hepatitis caused by the toxic effects of drugs; Chronic form of hepatitis of unknown origin.

It is obvious that the classified etiological factors, associations of infections (co-infection, superinfection), phases of the chronic course do not fully provide a complete picture of inflammatory diseases of the main organ of detoxification. There is no information about the liver’s reaction to the damaging effects of adverse factors, toxic substances and new viruses, that is, nothing is said about very significant forms:

Chronic alcoholic hepatitis, which is a source of alcoholic cirrhosis; Nonspecific reactive form of chronic hepatitis; Toxic hepatitis; Chronic hepatitis G, discovered later than others.

In this regard, it was determined 3 forms of chronic hepatitis based on morphological characteristics:

Chronic persistent hepatitis (CPH), which is usually inactive, takes a long time to manifest itself clinically, infiltration is observed only in the portal tracts, and only penetration of inflammation into the lobule will indicate its transition to the active phase; Chronic active hepatitis (CAH) is characterized by the transition of the inflammatory infiltrate from the portal tracts into the lobule, which is clinically manifested by varying degrees of activity: slight, moderate, pronounced, pronounced; Chronic lobular hepatitis, caused by the predominance of the inflammatory process in the lobules. The defeat of several lobules by multibular necrosis indicates a high degree of activity of the pathological process (necrotizing form).

Considering the etiological factor

Inflammatory process in the liver refers to polyetiological diseases, since it is caused by a number of reasons:

The classification of hepatitis has been revised many times, but experts have not come to a consensus. Currently, only 5 types of liver damage associated with alcohol have been identified, so it hardly makes sense to list all the options, because not all viruses have been discovered and studied, and not all forms of hepatitis have been described. Nevertheless, it may be worth introducing the reader to the most understandable and accessible division of chronic inflammatory liver diseases according to etiology:

Viral hepatitis, caused by certain microorganisms (B, C, D, G) and undefined - poorly studied, unconfirmed by clinical data, new forms - F, TiTi; Autoimmune hepatitis(types 1, 2, 3); Liver inflammation (drug-induced), often detected in chronic patients, associated with long-term use of a large number of medications or the use of medications that exhibit pronounced aggression towards hepatocytes for a short time; Toxic hepatitis caused by the influence of hepatotropic toxic substances, ionizing radiation, alcohol surrogates and other factors; Alcoholic hepatitis, which, together with the drug-induced one, is classified as a toxic form, but in other cases is considered separately, as social problem; Metabolic, occurring in congenital pathology - Konovalov-Wilson disease. The reason lies in a hereditary (autosomal recessive type) disorder of copper metabolism. The disease is extremely aggressive, quickly ending in cirrhosis and death of the patient in childhood or at a young age; Cryptogenic hepatitis, the reason for which even after thorough examination remains unknown. The disease is progressive and requires observation and control, as it often leads to severe liver damage (cirrhosis, cancer); Nonspecific reactive hepatitis (secondary). It is often a companion to various pathological conditions: tuberculosis, renal pathology, pancreatitis, Crohn's disease, ulcerative processes in the gastrointestinal tract and other diseases.

Considering that some types of hepatitis are very related, widespread and quite aggressive, it makes sense to give a few examples that will likely be of interest to readers.

Chronic form of hepatitis C

An important question regarding hepatitis C is how to live with it and how many years people live with this disease. Upon learning of their diagnosis, people often panic, especially if they receive information from unverified sources. However, this is not necessary. People with C-hepatitis live a normal life, but they keep it in mind in terms of some adherence to a diet (the liver should not be loaded with alcohol, fatty foods and substances toxic to the organ), increasing the body’s defenses, that is, immunity, being careful in everyday life and when sexual intercourse. You just need to remember that human blood is contagious.

As for life expectancy, there are many cases where hepatitis, even in people who like to eat and drink well, has not shown itself in any way for 20 years, so you should not bury yourself prematurely. The literature describes both cases of recovery and the reactivation phase that occurs after 25 years. and, of course, the sad outcome - cirrhosis and cancer. Which of the three groups you can fall into sometimes depends on the patient, given that there is currently a medicine - synthetic interferon.

Hepatitis associated with genetics and immune response

Autoimmune hepatitis, which occurs in women 8 times more often than in men, is characterized by rapid progression with the transition to portal hypertension, renal failure, cirrhosis and ends in the death of the patient. According to the international classification, autoimmune hepatitis can occur in the absence of blood transfusions, liver damage from alcohol, toxic poisons, medicinal substances.

The cause of autoimmune liver damage is considered to be a genetic factor. Positive associations of the disease with antigens of the major histocompatibility complex (leukocyte HLA system), in particular, HLA-B8, which is recognized as an antigen of hyperimmunoreactivity, have been identified. However, many may have a predisposition, but not everyone gets sick. Some can provoke autoimmune damage to the liver parenchyma medications(for example, interferon), as well as viruses:

Epstein-Barra; Corey; Herpes types 1 and 6; Gepatitov A, V, S.

It should be noted that about 35% of patients who were overtaken by AIH already had other autoimmune diseases.

The vast majority of cases of autoimmune hepatitis begin as an acute inflammatory process (weakness, loss of appetite, severe jaundice, dark urine). After a few months, signs of an autoimmune nature begin to form.

Sometimes AIT develops gradually with a predominance of symptoms of asthenovegetative disorders, malaise, heaviness in the liver, slight jaundice, rarely the onset is manifested by a significant increase in temperature and signs of other (extrahepatic) pathology.

To expanded clinical picture AIH may indicate the following manifestations:

Severe malaise, loss of performance; Heaviness and pain on the side of the liver; Nausea; Skin reactions (capillaritis, telangiectasia, purpura, etc.) Itching of the skin; Lymphadenopathy; Jaundice (not constant); Hepatomegaly (enlarged liver); Splenomegaly (enlarged spleen); In women – absence of menstruation (amenorrhea); In men – enlargement of the mammary glands (gynecomastia); Systemic manifestations (polyarthritis),

AIH is often a companion to other diseases: diabetes mellitus, blood, heart and kidney diseases, pathological processes localized in the organs of the digestive system. In a word, autoimmune - it is autoimmune and can manifest itself in any pathology that is far from liver.

Any liver “does not like” alcohol...

Alcoholic hepatitis (AH) can be considered as one of the forms of toxic hepatitis, because they have the same cause - Negative influence to the liver irritants, which have a detrimental effect on hepatocytes. Hepatitis of alcoholic origin is characterized by all the typical signs of liver inflammation, which, however, can occur in a rapidly progressive acute form or have a persistent chronic course.

Most often, the onset of an acute process is accompanied by signs:

Intoxication: nausea, vomiting, diarrhea, aversion to food; Weight loss; Jaundice without itching or with itching due to the accumulation of bile acids in the cholestatic form; Significant enlargement of the liver with its thickening and pain in the right hypochondrium; Tremors; Hemorrhagic syndrome, renal failure, hepatic encephalopathy in the fulminant form. Hepatorenal syndrome and hepatic coma may cause the death of the patient.

Sometimes, during the acute course of alcoholic hepatitis, a significant increase in body temperature is observed, bleeding and attachment are possible. bacterial infections, causing inflammation of the respiratory and urinary tract, gastrointestinal tract, etc.

Chronic persistence of hypertension is asymptomatic and often reversible if a person manages to stop in time. Otherwise, the chronic form becomes progressive with transformation into cirrhosis.

...And other toxic substances

For the development of acute toxic hepatitis a single dose of a toxic substrate is sufficient, which has hepatotropic properties, or a large amount of substances that are less aggressive to the liver, for example, alcohol. Acute toxic inflammation of the liver manifests itself by its significant increase and pain in the right hypochondrium. Many people mistakenly believe that the organ itself hurts, but this is not the case. The pain is caused by stretching of the liver capsule due to an increase in its size.

At toxic damage The liver is characterized by symptoms of alcoholic hepatitis, however, depending on the type of toxic substance, they can be more pronounced, for example:

Feverish state; Progressive jaundice; Vomiting with blood; Nose and gum bleeding, hemorrhages on the skin due to damage to the vascular walls by toxins; Mental disorders(excitement, lethargy, disorientation in space and time).

Chronic toxic hepatitis develops over a long period of time when exposed to small but constant doses of toxic substances. If the cause of the toxic effect is not eliminated, then after years (or only months) complications in the form of liver cirrhosis and liver failure can occur.

Markers for early diagnosis. How to understand them?

Markers of viral hepatitis

Many people have heard that the first step in diagnosing inflammatory liver diseases is to test for markers. Having received a piece of paper with the test result for hepatitis, the patient is unable to understand the abbreviation unless he has special education.

Markers of viral hepatitis are determined using enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), inflammatory processes of non-viral origin are diagnosed by other methods, including ELISA. In addition to these methods, biochemical tests, histological analysis (based on biopsy material liver) and instrumental studies.

However, we should return to the markers:

Infectious hepatitis A antigen can be determined only during the incubation period and only in feces. During the phase of clinical manifestations, antibodies begin to be produced and class M immunoglobulins (IgM) appear in the blood. HAV-IgG, synthesized somewhat later, indicates recovery and the formation of lifelong immunity, which these immunoglobulins will provide; The presence or absence of the causative agent of viral hepatitis B determined by what has been revealed since time immemorial (though not modern methods) “Australian antigen” - HBsAg (surface antigen) and inner membrane antigens - HBcAg and HBeAg, which became possible to identify only with the advent of ELISA and PCR in laboratory diagnostics. HBcAg is not detected in blood serum; it is determined using antibodies (anti-HBc). To confirm the diagnosis of HBV and monitor the course of the chronic process and the effectiveness of treatment, it is advisable to use PCR diagnostics (detection of HBV DNA). The patient's recovery is indicated by the circulation of specific antibodies (anti-HBs, total anti-HBs, anti-HBe) in his blood serum in the absence of the HBsAg antigen itself; Diagnosis of C-hepatitis without detection of virus RNA (PCR) is difficult. IgG antibodies, appearing at the initial stage, continue to circulate throughout life. The acute period and the reactivation phase are indicated by class M immunoglobulins (IgM), the titer of which increases. The most reliable criterion for diagnosis, monitoring and control over the treatment of hepatitis C is the determination of the RNA of the virus PCR method. The main marker for diagnosing hepatitis D(delta infection) are considered immunoglobulins of class G (anti-HDV-IgG), which persist throughout life. In addition, to clarify monoinfection, super (association with HBV) or co-infection, an analysis is carried out to detect class M immunoglobulins, which remain forever in case of superinfection, and disappear after about six months in case of co-infection; Main laboratory research hepatitis G is the determination of viral RNA using PCR. In Russia, specially developed ELISA kits that can detect immunoglobulins to the E2 envelope protein, which is a component of the pathogen (anti-HGV E2), help identify antibodies to HGV.

Markers of hepatitis of non-viral etiology

Diagnosis of AIH is based on the identification of serological markers (antibodies):

SMA (tissue to smooth muscle); ANA (antinuclear); Immunoglobulins class G; Anti-LKM-1 (microsomal antibodies).

In addition, the diagnosis uses the determination of biochemical parameters: protein fractions (hypergammaglobulinemia), liver enzymes (significant transaminase activity), as well as the study of histological liver material (biopsy).

Depending on the type and ratio of markers, types of AIH are distinguished:

The first most often manifests itself in adolescents or young adults, or “wait” until 50; The second one most often affects childhood, has high activity and resistance to immunosuppressants, quickly transforms into cirrhosis; The third type was previously identified as a separate form, but now it is no longer considered from this perspective; Atypical AIH, representing cross-hepatic syndromes (primary biliary cirrhosis, primary sclerosing cholangitis, chronic hepatitis of viral origin).

There is no direct evidence of alcoholic origin of liver damage, so there is no specific analysis for hepatitis associated with ethanol consumption, however, certain factors were noted that are very characteristic of this pathology. For example, ethyl alcohol acting on the liver parenchyma promotes the release of alcoholic hyaline, called Mallory bodies, which leads to the appearance of ultrastructural changes in hepatocytes and stellate reticuloepitheliocytes, indicating the degree of negative effects of alcohol on the “long-suffering” organ.

In addition, some biochemical indicators (bilirubin, liver enzymes, gamma fraction) indicate alcoholic hepatitis, but their significant increase is typical for many pathological conditions of the liver when exposed to other toxic poisons.

Clarification of medical history, identification of a toxic substance that has affected the liver, biochemical tests and instrumental study are the main criteria for diagnosing toxic hepatitis.

Can hepatitis be cured?

Treatment for hepatitis depends on etiological factor, which caused an inflammatory process in the liver. Of course, hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment

Viral hepatitis A and E, although of infectious origin, are acute and, as a rule, do not become chronic. In most cases, the human body is able to resist them, so it is not customary to treat them, except that sometimes symptomatic therapy is used to eliminate headaches, nausea, vomiting, and diarrhea.

The situation is more complicated with liver inflammation caused by viruses B, C, D. However, given that delta infection practically does not occur in its own form, but obligately follows HBV, it is necessary to treat B-hepatitis first, but with increased doses and an extended period of time. course.

It is not always possible to cure hepatitis C, although the chances of a cure still appeared with the use of alpha interferons (component immune defense from viruses). In addition, at present, to enhance the effect of the main drug, combination regimens are used, involving combinations of prolonged interferons with antiviral drugs, for example, ribavirin or lamivudine.

It should be noted that not every immune system adequately responds to the interference of immunomodulators introduced from the outside, therefore interferon, for all its advantages, can give undesirable effects. In this regard, interferon therapy is carried out under the close supervision of a doctor with regular laboratory monitoring of the behavior of the virus in the body. If it is possible to completely eliminate the virus, then we can consider this a victory over it. Incomplete elimination, but stopping the replication of the pathogen, is also a good result, allowing you to “lull the enemy’s vigilance” and delay for many years the likelihood of hepatitis turning into cirrhosis or hepatocellular carcinoma.

How to prevent hepatitis?

The expression “It is easier to prevent a disease than to treat it” has long become a hackneyed, but not forgotten, since many troubles can indeed be avoided if preventive measures are not neglected. As for viral hepatitis, special caution will not be superfluous here either. Compliance with personal hygiene rules, use specific means protection in contact with blood (gloves, finger pads, condoms) in other cases are quite capable of becoming an obstacle to the transmission of infection.

In the fight against hepatitis, medical workers specifically develop action plans and follow them to every point. Thus, in order to prevent the incidence of hepatitis and the transmission of HIV infection, as well as reduce the risk of occupational infection, the Sanitary and Epidemiological Service recommends adhering to certain rules of prevention:

Prevent “syringe hepatitis”, common among drug users. For this purpose, organize free syringe distribution points; Prevent any possibility of transmission of viruses during blood transfusions (organization of PCR laboratories at transfusion stations and quarantine storage of drugs and components obtained from donated blood, in conditions of ultra-low temperatures); Reduce to the maximum the likelihood of occupational infection by using all available funds personal protection and fulfilling the requirements of sanitary and epidemiological authorities; Pay special attention to departments with an increased risk of infection (hemodialysis, for example).

We should not forget about precautions when having sexual intercourse with an infected person. The likelihood of sexual transmission of the hepatitis C virus is negligible, but for HBV it increases significantly, especially in cases associated with the presence of blood, for example, menstruation in women or genital trauma in one of the partners. If you really can’t do without sex, then... at least, at least you shouldn’t forget about the condom.

There is a higher chance of becoming infected in the acute phase of the disease, when the concentration of the virus is especially high, so for such a period it would be better to abstain from sexual relations altogether. Otherwise, human carriers live normal lives, give birth to children, remembering their peculiarity, and be sure to warn doctors (ambulance, dentist, when registering with antenatal clinic and in other situations requiring increased attention) that they are at risk for hepatitis.

Increased immunity to hepatitis

Prevention of hepatitis also includes vaccination against viral infection. Unfortunately, a vaccine against hepatitis C has not yet been developed, but available vaccines against hepatitis A and B have significantly reduced the incidence of these types.

The hepatitis A vaccine is given to children aged 6-7 years (usually before entering school). A single use provides immunity for a year and a half, revaccination (re-vaccination) extends the period of protection to 20 years or more.

The HBV vaccine is mandatory for newborns in the maternity hospital; there are no age restrictions for children who have not been vaccinated for any reason, or for adults. To ensure a full immune response, the vaccine is administered three times over several months. The vaccine is developed based on the surface (“Australian”) antigen of HBs.

The liver is a delicate organ

Treating hepatitis yourself means taking full responsibility for the outcome of the inflammatory process in such an important organ, therefore, in the acute period or in the chronic course, it is better to coordinate any of your actions with a doctor. After all, anyone understands: if the residual effects of alcoholic or toxic hepatitis can be neutralized by folk remedies, then they are unlikely to cope with the rampant virus in the acute phase (meaning HBV and HCV). The liver is a delicate organ, albeit patient, so treatment at home should be thoughtful and reasonable.

Hepatitis A, for example, does not require anything other than following a diet, which is necessary, in general, in the acute phase of any inflammatory process. Nutrition should be as gentle as possible, since the liver passes everything through itself. In the hospital, the diet is called the fifth table (No. 5), which is followed at home for up to six months after the acute period.

With chronic hepatitis, of course, it is not advisable to offer strict adherence to a diet for years, but it would be correct to remind the patient that it is still not necessary to irritate the organ again. It is advisable to try to consume boiled foods, exclude fried, fatty, pickled foods, and limit salty and sweet foods. The liver also does not accept strong broths, strong and weak alcoholic and carbonated drinks.

Can folk remedies save?

In other cases, folk remedies help the liver cope with the load that has fallen on it, increase natural immunity, and strengthen the body. However They can't cure hepatitis, therefore, it is unlikely to be correct to engage in amateur activities and treat liver inflammation without a doctor, because each type has its own characteristics that must be taken into account in the fight against it.

"Blind" probing

Often the attending physician himself, when discharging a convalescent patient from the hospital, recommends simple home procedures. For example, “blind” probing, which is done on an empty stomach in the morning. The patient drinks 2 chicken yolks, discarding the whites or using them for other purposes, after 5 minutes he washes it all down with a glass of still mineral water (or clean from the tap) and lies on his right side, placing a warm heating pad under it. The procedure lasts an hour. You should not be surprised if after it a person runs to the toilet to give away everything unnecessary. Some people use magnesium sulfate instead of yolks, however, this is a saline laxative, which does not always provide the same comfort to the intestines as, say, eggs.

Horseradish?

Yes, some people use finely grated horseradish (4 tablespoons) as a treatment, diluting it with a glass of milk. It is not recommended to drink the mixture right away, so it is first heated (almost to a boil, but not boiling), and left for 15 minutes for a reaction to occur in the solution. Take the medicine several times a day. It is clear that such a remedy will have to be prepared every day if a person tolerates a product such as horseradish well.

Soda with lemon

They say that some people lose weight in the same way. But still, we have a different goal - to treat the disease. Squeeze the juice of one lemon and pour a teaspoon of baking soda into it. After five minutes, the soda will extinguish and the medicine is ready. They drink three times a day for 3 days, then rest for 3 days and repeat the treatment again. We do not undertake to judge the mechanism of action of the medicine, but people do so.

Herbs: sage, mint, milk thistle

Some say that milk thistle, known in such cases, which helps not only with hepatitis, but also with cirrhosis, is absolutely ineffective against hepatitis C, but instead people offer other recipes:

1 tablespoon peppermint; Half a liter of boiling water; Leave for a day; Strained; Used throughout the day.

Or another recipe:

Sage - tablespoon; 200 - 250 grams of boiling water; Tablespoon natural honey; Honey is dissolved in sage with water and infused for an hour; The mixture should be drunk on an empty stomach.

However, not everyone shares a similar point of view regarding milk thistle and offers a recipe that helps with all inflammatory liver diseases, including hepatitis C:

The fresh plant (root, stem, leaves, flowers) is crushed; Place in the oven for a quarter of an hour to dry; Remove from the oven, lay out on paper and place in a dark place to complete the drying process; Take 2 tablespoons of dry product; Add half a liter of boiling water; Leave for 8-12 hours (preferably at night); Drink 50 ml 3 times a day for 40 days; Take a break for two weeks and repeat the treatment.

Video: viral hepatitis at the School of Doctor Komarovsky

Hepatitis B infection can occur when the virus enters the blood. Also, any fluid that is released from the body of an infected person and contains the virus can cause the onset of the disease. To avoid getting infected, you need to know the main routes of transmission and be sure to get vaccinated against this disease. What symptoms indicate that hepatitis infection has occurred?

What are the signs of illness?

Symptoms of hepatitis usually do not appear immediately, but after a period of 2-6 months. At this time, the person is a carrier of the virus, but does not feel a deterioration in health, and therefore does not know about his condition.

Depending on the form of the disease, various symptoms are distinguished.

Acute viral hepatitis B in its initial manifestations resembles the flu, body temperature rises, aches and weakness appear. When a patient's skin begins to turn yellow, this is an accurate symptom of hepatitis.

In addition, a person experiences the following symptoms:

joint pain; allergic skin reaction; loss of appetite; abdominal pain; nausea and vomiting.

Clinical manifestations include darkening of urine and lightening of stool. The patient's liver is enlarged. After taking blood tests, a more complete picture emerges: the level of bilirubin and liver enzymes is elevated. If the disease does not become chronic, two weeks after the yellowing of the skin the patient feels an improvement, because all the symptoms subside.

Important! With a poorly developed immune system response to the virus, the disease can be asymptomatic and become chronic.

Viral hepatitis B chronic form the most dangerous for humans, because it is not only difficult to treat, but also has severe symptoms and leads to complications. A person constantly experiences weakness and general malaise. These are the primary symptoms that very often go unattended. The patient may experience nausea and vomiting, stool upset, pain in the abdomen, muscles and joints.

In advanced cases of the disease, jaundice appears, venous mesh, skin itching, exhaustion, the liver and spleen increase in size.

Transmission routes

Viral hepatitis B is the type that is transmitted only through direct contact of a healthy person with the blood, saliva or seminal fluid of a sick person.

This virus is not transmitted through the fecal-oral route.

You can become infected from a patient with chronic or acute form hepatitis A. In newborns, the main mechanism of transmission of the virus is blood during childbirth. Children can also become infected with viral hepatitis from their sick siblings.

Important! Viral hepatitis is 50 times more contagious than HIV, but it is not transmitted through breast milk.

There are the following routes of infection:

Through blood. In this way, you can become infected by using a single syringe, for example, when injecting drugs, or by using unsterile instruments that have blood on them, for example, in tattoo parlors or operating rooms. Infection through infusion of donor blood is possible; of course, this mechanism of transmission of the virus is quite rare, about 2% of cases have been reported. The risk of infection increases with repeated transfusions of blood or its components. Sexually. The probability of infection through sexual contact is very high and reaches 30%, because the virus is found in the seminal fluid and secretions from the genital tract of women. A person may not even know about his illness, so unprotected sex should be avoided. Route of transmission from mother to child. It is worth noting that intrauterine infection of the fetus cannot occur (if the placenta maintains its integrity); the risk of infection increases during childbirth. Children born to mothers with hepatitis are vaccinated against hepatitis B immediately in the maternity hospital, this reduces the risk of developing a chronic form of this disease. By everyday means. There is minimal risk of infection this way. The thing is that the mechanism of transmission of the virus is not only hematogenous, but also through saliva, urine or sweat. If this biological fluid gets even on the damaged skin of a healthy person in a small amount, then infection will not occur. If the concentration of the virus in the liquid contents is high, then infection cannot be avoided.

Important! In the absence of damage to the skin by everyday means it is impossible to get infected.

The likelihood of infection through household methods is influenced by factors such as the integrity of the skin and the concentration of the virus in biological fluid.

In 30% of cases, the mechanism of transmission of the virus cannot be determined. After all, the disease can exist for a long time asymptomatically, especially in a chronic form.

It is worth noting that the disease can only be transmitted if the blood, saliva or sweat of the patient enters the blood of a healthy person, unless, of course, he has immunity from the disease.

After infection, a patient becomes a carrier of the virus long before the first symptoms of the disease appear. In this case, there is a risk of infecting loved ones.

What is the most common form of transmission of the virus?

Most likely, you can catch the virus through casual sexual contact, less often from mother to child during childbirth. Since the transmission mechanism is not only through blood, but also through saliva, you can get hepatitis B by kissing. You should also not use the patient’s toothbrush, washcloth or towel, because biological fluid, such as sweat or saliva, may remain on them, which is a source of infection.

The likelihood of becoming infected when infused with donor blood is small, because recently all blood is tested for the presence of various viruses before infusion.

In rare cases, infection can occur through the germinal route when a healthy egg is infected with an infected sperm, in which case the child is born with congenital hepatitis B.

What to do if you come into contact with an infected person. How do you know if there is a risk of contracting hepatitis B?

How to determine the likelihood of infection?

Each person can find out their risk of contracting viral hepatitis. He needs to be tested for the presence of the virus antigen and antibodies to it. If the result is negative, then such a person must be vaccinated. Otherwise, if you come into contact with an infected person, there is a 100% chance of becoming infected.

If the HBsAg virus is detected in the blood after testing, this indicates that infection has already occurred and the person can infect others. Antibodies to the virus in the blood are a good sign; in this case, you don’t have to get vaccinated, because hepatitis B is not scary in this case.

How to find out if you have been exposed to the virus?

In people who have had viral hepatitis, antibodies to the virus can be detected, so re-infection is impossible.

Many people are concerned about the question of whether it is possible not to become infected after contact with a sick person. What factors influence this process? Infection can be avoided only after vaccination; also, communicating with a sick person is not scary for people who have previously suffered from viral hepatitis, because antibodies are produced in their blood. Also, children born from infected mothers are protected from infection for life, because at birth they are given immunoglobulin against hepatitis B.

If an unprotected person, for example, a health care worker, has had direct contact with patients, then in order to reduce the risk of infection, he can be given immunoglobulin, which will protect against the disease.

The following groups can be identified with a high probability of developing hepatitis:

injection drug addicts; persons of unconventional orientation; people who have multiple sexual partners; sexual partners of patients; members of families where there are infected people; persons who are on hemodialysis or require frequent blood transfusions;

health workers; people with hemophilia or organ transplants; children born from infected mothers.

There are certain factors that contribute to an increased risk of infection, namely:

contact with the patient’s blood or its components; intravenous administration of drugs or drugs with reusable syringes; acupuncture; the use of non-sterile instruments for various manipulations on the body (ear piercing, piercing or tattoos).

Individuals who are at risk should take steps towards prevention. First of all, you need to get vaccinated and adhere to personal hygiene rules.

Members of families where there is a patient with chronic hepatitis should be examined for the presence of the virus and antibodies to it and, if necessary, be vaccinated.

By knowing how the hepatitis virus is transmitted, you can protect yourself from serious illness. To protect yourself 100% you need to undergo a vaccination course.

– this is Botkin’s disease or jaundice, which is known to many because the disease occurs among patients of all ages.

Scientists were able to establish that approximately 1.5 million infected people are recorded in hospitals every year, but this is not the final number.

It is known that the disease can occur without obvious signs and complications for the patient, which is why some people do not even know that an infection has occurred and do not seek help from a doctor.

The common audience for hepatitis A is children aged three to ten years. It is necessary to pay close attention to the disease to avoid complications.

In the article you will find information about who is most susceptible to infection, the likelihood and routes of transmission, as well as ways to protect yourself from hepatitis A.

Who is susceptible to infection?

Hepatitis A is called a childhood infection. In most cases, this concerns countries that are developing and still have a reduced level of social and economic development. Many children suffer from the disease before the age of 10 and have a strong immunity to it for life.

Studies have shown that the number of patients who showed symptoms of hepatitis A is much less than the number of people who have antibodies to this virus. This fact suggests that the disease often does not manifest itself in any way and has no obvious signs.

In well-developed and stable countries, the “disease of dirty hands” is not so common, because personal hygiene is maintained at a high level there, and public utilities do an excellent job of their tasks.

What is the risk of getting infected?

To find out the likelihood of the risk of infection itself, a special blood test is carried out to check for the slightest presence in the body of antibodies to hepatitis A of the class designated immunoglobulin group G. If these particles are detected in the blood, we can talk about the presence of strong immunity to infection, that is, the possibility of infection is close to zero, and vaccination not required to protect the body. If there are no antibodies, then the risk increases, and therefore you need to go to the hospital for vaccination.

Experts identify several groups of people who need vaccination due to high risk infections:

1. Household members who live with a person with hepatitis.
2. Persons who have sexual contact with a sick person.
3. Children who live in areas where the virus is widespread.
4. People who travel for a specified period to a country with an increased incidence of hepatitis A.
5. Men who have a practice of homosexual relations.
6. Drug addicts.

It is possible to come into contact with someone who has hepatitis A as long as you follow normal hygiene rules. It is better for children to be isolated from infected people. If you take into account all the simple rules, you can easily live in the same area with a family member who has already received the infection.

Routes of transmission

Fecal-oral infection

This method of transmission is the most famous and widespread. Hepatitis A virus is excreted in fairly large quantities along with feces during the entire asymptomatic period of the disease, and sometimes in the early stages of the development of the disease, when there are primary clinical manifestations. An infected patient may not even suspect that the disease is already actively developing in the body. Personal hygiene also plays a huge role in all this, which many simply do not observe.

Contacts with people

Transmission of hepatitis viral infection can also occur after close contact with a previously infected person. This is possible if you are caring for a patient who suffers from fecal or urinary incontinence. Sometimes you have to care for people who cannot independently apply personal hygiene measures, which contributes to infection with the hepatitis A virus.

Outbreaks of hepatitis are often recorded in kindergartens, schools, hospitals, and nursing homes. In these areas, staff are constantly in close contact with the people they need to care for. At home, contacts also carry the threat of infection, which is sometimes simply impossible to avoid.

During sexual intercourse, especially in the case of its oral-anal form, frequent infection with hepatitis A occurs, therefore it is recommended to use condoms.

Parenteral route of infection

During primary development diseases, it is not worth donating because the risk of plasma infection increases. This type of virus does not have an envelope, so it cannot be stopped by the use of solvents and detergents.

Routine blood products that are not properly and pre-processed can quickly lead to an active hepatitis A outbreak in hemophiliacs. But still, the frequency of infection with a dangerous virus in the case of blood transfusion is not as high as with other methods of transmitting a viral infection.

How to avoid infection

You can avoid getting this hepatitis after infection with viral cells only if you have previously received a special vaccination against this infection and the body has formed immunity to it.

If there are no bodies for protection, and the virus has already entered the blood, then hepatitis itself cannot be avoided. There is a specialized drug - immunoglobulin, which is introduced into the body immediately before a possible infection or in the near future after the resulting infection. This makes it possible to protect yourself for a certain period from infection or the active development of the disease if infection has already occurred.

Remember that hepatitis type A cannot be re-infected.

If there is already a patient in your family, you need to examine absolutely all family members for the spread of antibodies in the body that work against hepatitis. When there are no antibodies in the body, vaccination is recommended. It is carried out on the direction of a doctor who checked your health.

Always follow the hygiene rules indicated everywhere, which will help you avoid illness when in contact with a sick person:

• After each visit to the toilet and even using the bathroom, you should wash your hands.
• Wash your hands thoroughly after routinely caring for a newborn or older child and before doing anything that touches them.
• It is also recommended to wash your hands before eating and preparing food.

It is worth paying attention to what you eat, never take food with dirty hands, which can carry not only hepatitis A, but also other dangerous ailments.

It is necessary from early childhood to teach children to wash their hands after going outside or having contact with animals. Food should be heat treated so that it does not contain any dangerous viral infections and their pathogens, which cause great harm to the body.

Conclusion

The ways in which hepatitis A infection enters the body are quite different and require attention among adults, parents and children. Always pay attention to what you eat so that you do not come into contact with dirty food or dishes that were not properly cooked before serving.

For timely treatment it is necessary immediately after contact with the patient or increased risk infection, contact a specialist who can diagnose your infection by conducting the necessary detailed tests and examining the patient. If there is already a person infected with hepatitis type A in the family, you should also apply for medical care in the form of vaccination.

Correct observance simple tips will help avoid jaundice and infection of family members. Also recommended in countries with reduced level development to improve people's awareness of the disease, its spread and control methods. Information will help people not to be afraid of this disease, but to be able to stop it and protect themselves from hepatitis A, as well as their family and children.

Alexey has been practicing medicine since 1996. Provides therapy for all diseases of the liver, gall bladder and gastrointestinal tract as a whole. Among them: hepatitis, pancreatitis, duodenal ulcer, colitis.