Viral hepatitis: causes, symptoms and treatment in an article by infectious disease specialist Aleksandrov P. A.

Description of the hepatitis virus

Hepatotropic viruses that cause viral hepatitis are transmitted only from one person to another, since they retain viability and the ability to replicate (reproduce) in one single environment - in liver cells (hepatocytes).
Viruses use cells as “factories” to maintain the ability to reproduce and spread, including outside the “native” human body. The immune system performs protective functions, therefore, immediately after detecting a foreign infection, it starts the process of destroying the identified infected cells. The main destructive role is played by cytotoxic substances aimed at destroying hepatocytes affected by viral infection. The more actively the immune system fights, the more liver cells die from cytotoxic substances, the more obvious the clinical picture of hepatitis. The most dangerous form of hepatitis is considered to be the fulminant (fulminant) form of hepatitis, which most often develops so quickly that the most likely prognosis is the death of the patient.

Diagnosis and treatment

Verification of the disease is based on the analysis of the patient’s complaints and collection of anamnesis. The doctor palpates the abdomen, feels the liver, and assesses its condition using tactile sensations. Accurate diagnosis involves the use of specific laboratory tests that detect pathogen-specific antibodies in the blood.

Doctors at the Profimedica clinic carry out a comprehensive diagnosis of liver damage. For this purpose, we use laboratory tests (detection of specific antibodies and antigens of the pathogen, PCR), instrumental procedures (ultrasound, fibroscan). Based on the information received, our doctors select the best option to combat the disease.

Treatment of hepatitis is aimed at stimulating the body’s own forces to resist the virus. Complete recovery is typical for types A, E. Options B and C are characterized by a tendency towards chronicity of the process, which can cause the pathology to degenerate into a malignant tumor. However, now there is antiviral therapy against hepatitis C. Doctors individually develop therapeutic regimens for each patient.

How do I know if I have hepatitis?

All forms of viral hepatitis have their own characteristics, but the first symptoms of hepatitis are similar:

pain in the right hypochondrium (where the liver is located), general malaise,
enlargement of the spleen and liver,
urine is dark colored
feces lose color, become lighter,
The whites of the eyes and skin turn yellow.

The symptoms are presented in chronological order, which means that yellowness appears last, when the inflammatory process has already affected most of the liver cells. The sooner you recognize hepatitis and contact a hepatologist, the less consequences the infection will leave in your body.

Specific symptoms of different types of hepatitis

Varieties of hepatitis are determined by viruses that provoke inflammation of the liver tissue. The incubation period of infections varies (for example, hepatitis A requires only 2-4 weeks, while a patient with hepatitis B may not notice symptoms for six months), therefore the symptoms of each disease have their own characteristics. The incubation period is the time it takes for a viral infection to adapt to a new environment (the body of an infected person) and begin to reproduce. Only after the end of the incubation period does the virus begin to use liver cells, and only from this moment does a person discover the first symptoms of hepatitis.

Reasons for development

There is no generally accepted classification of all types of hepatitis. Depending on the reasons that caused the inflammation, there are:

Infectious hepatitis: viral hepatitis A, B, C, D, E and others; hepatitis developing with yellow fever, cytomegalovirus infection, rubella, mumps, infection with the Epstein-Barr virus, herpes viruses, Lassa fever, HIV infection, etc.; bacterial hepatitis (for example, with syphilis, leptospirosis).
Toxic hepatitis: alcoholic, drug-induced, and hepatitis caused by poisoning with other chemicals.
Autoimmune hepatitis.
Non-alcoholic steatohepatitis.
Other types of hepatitis.

The first symptoms of hepatitis A:

headache, fever, chills, feeling of weakness, joint pain. It is important not to confuse hepatitis with the flu.
Appetite disappears, food seems tasteless, functional stomach disorders (diarrhea) and vomiting occur.
urine darkens (to the color of beer), feces lightens (becomes colorless).
yellowness of the skin and mucous membranes. This symptom of the icteric phase of hepatitis indicates that the bile produced by the liver as a protective reaction enters the blood and spreads throughout the body. Hence the characteristic yellowish tint of the skin and whites of the eyes.

Our phone numbers:

Human viral hepatitis represents a traditionally difficult global problem that is still far from being resolved. According to WHO estimates, hundreds of millions of people are infected with viral hepatitis in different countries of the world. This significantly exceeds the prevalence of HIV infection but, at the same time, has not attracted due attention. At the present stage, as in an earlier period, the high epidemic potential of all known viral hepatitis - A, B, C, D, E, G - remains high.

A completely unfavorable epidemiological situation regarding viral hepatitis has developed in the former Soviet Union. The number of patients with acute viral hepatitis reaches 1 million per year.

In the light of modern knowledge, the group of human viral hepatitis, called hepatitis A, B, C, D, E, G, includes nosologically independent infectious diseases, the characteristics of which are very diverse. The unifying principle is the hepatotropic nature of the pathogens, which determines the development of selective liver damage. Viral hepatitis A, B, C, D, E, G differ in all aspects - taxonomic affiliation of viruses, mechanism of infection and routes of transmission, pathogenesis and immunogenesis, clinical manifestations, severity and outcomes, likelihood of chronicity and malignancy, specific diagnostic criteria, different therapy and prevention programs.

The current stage is called the “golden era” of studying the problem of viral hepatitis. Thanks to the use of methods of virology, molecular biology, genetic engineering, in particular recombinant technology, new horizons for understanding the problem and its further study have opened up.

The Nobel Prize-winning discovery of the “Australian antigen” was the first in a chain of brilliant research that made the unknown known.

The causative agents of viral hepatitis - A, B, C, D, E, G - were discovered. The long-standing dream of clinicians about the separate specific diagnosis of viral hepatitis of different etiologies was realized not by exclusion or indirect signs, but on the basis of direct studies using highly specific and highly sensitive test systems . The use of new research methods has shown that the “hepatitis alphabet” is far from being exhausted. There remains a niche of viral hepatitis, neither A, nor B, nor C, nor D, nor E, nor G, caused by other pathogens.

Types of hepatitis viruses.

Hepatitis A

Of all the fairly numerous forms of viral hepatitis, hepatitis A is the most common. Although this disease is characteristic mainly of third world countries with poor hygiene and sanitation, isolated cases or outbreaks of hepatitis A can occur even in the most developed countries.

Hepatitis A virus is transmitted by the fecal-oral route. The most common route of transmission of hepatitis A virus is through close household contact between people and consumption of food or water contaminated with fecal material.

One of the most important factors on which the clinical manifestations of hepatitis A depend is age. Unlike adults, children do not have the “classic” picture of hepatitis A. Moreover, in young children, hepatitis A can be asymptomatic. The frequency of occurrence and severity of symptoms of the disease increases with age, so the icteric form of hepatitis A is characteristic of almost all adult patients. Elderly patients are more likely to develop a severe form of the disease, and they are more likely to develop severe complications of hepatitis A. Patients over 40 years of age are more likely to require hospitalization, and the mortality rate among them, compared to other age groups, is also higher. In typical cases, the clinical course of hepatitis A has four stages: the incubation period, the prodromal phase, the icteric phase and the convalescent period. An infected patient releases the virus in the initial stages of the disease, and the infection is transmitted to others long before the development of clinical symptoms. After the most contagious incubation period of 15 to 50 days, most patients with hepatitis A begin to experience prodromal symptoms of the disease. This is followed by the clinical manifestation of the disease, which is characterized by great variability of symptoms. As with other viral infections, the prodromal symptoms of hepatitis A are usually nonspecific, with patients experiencing weakness, gastrointestinal distress (including food aversions, diarrhea, and vomiting), and flu-like symptoms such as headache, chills, and fever. In addition, respiratory problems, muscle weakness, skin rashes and joint pain may often occur. The appearance of dark urine and uncolored feces at the end of the prodromal period are important signs indicating infection with the hepatitis A virus and usually cause the patient to seek medical help. At the end of the acute period of the disease, which usually lasts several weeks, most patients recover. However, in some cases, a relapse of the disease, the development of cholestatic jaundice or fulminant hepatitis may occur26. Patients who have recovered from the disease have long-term, possibly lifelong, immunity to hepatitis A. Long-term and persistent immunity to the disease is developed only after hepatitis.

Hepatitis B

This rather severe and common form of hepatitis is also called serum hepatitis. This name is due to the fact that infection with the hepatitis B virus can occur through the blood, and in an extremely small dose. The hepatitis B virus can be transmitted sexually, through injections with non-sterile syringes from drug addicts, or from mother to fetus. Hepatitis B is characterized by liver damage and occurs in different forms: from carriage to acute liver failure, cirrhosis and liver cancer. From the moment of infection to the onset of the disease, 50-180 days pass. In typical cases, the disease begins with fever, weakness, joint pain, nausea and vomiting. Sometimes rashes appear. The liver and spleen become enlarged. There may also be darkening of the urine and discoloration of the stool.

A specific reaction for diagnosing hepatitis B, or its carriage, is the detection of HbsAg. Treatment requires an integrated approach and depends on the stage and severity of the disease. The main drug was the immune drug - Interferon and its analogues. Hormones, hepatoprotectors, and antibiotics are also used. Various types of vaccines are used to prevent hepatitis B virus infection. To build immunity, the vaccination is repeated one month and six months after the first injection.

Hepatitis C

Hepatitis C is the most severe form of viral hepatitis, which is also called post-transfusion hepatitis. This means that they contracted it after a blood transfusion. This is due to the fact that testing of donor blood for the hepatitis C virus began only a few years ago. Quite often, infection occurs through syringes among drug addicts. Sexual transmission is possible from mother to fetus.

The greatest danger is the chronic form of this disease, which often develops into cirrhosis and liver cancer.

A chronic course develops in approximately 70-80% of patients. The combination of hepatitis C with other forms of viral hepatitis dramatically worsens the disease and can lead to death.

Hepatitis D

The causative agent of delta hepatitis has a defect, which means that the virus cannot reproduce independently in the human body; it requires the participation of a helper virus. This helper is the hepatitis B virus. This tandem gives rise to a rather serious disease. Doctors call this “union” a superinfection. Most often, infection occurs through blood transfusions, through syringes from drug addicts. Sexual transmission is possible from mother to fetus. All persons infected with the hepatitis B virus are susceptible to hepatitis D. The risk group includes hemophiliacs, drug addicts, and homosexuals.

Often, infection with hepatitis B and D viruses occurs simultaneously. From the moment of infection to the development of the disease, it takes 1.5-6 months, as with hepatitis B. The clinical picture and laboratory data are the same as for hepatitis B.

However, with mixed infection, severe forms of the disease predominate, often leading to liver cirrhosis. Doctors agree that the prognosis for this disease is often unfavorable. Treatment is the same as for hepatitis B.

Hepatitis E

Previously (before the detection of the hepatitis E virus), the disease, together with hepatitis C, D, G, was included in the group of so-called “neither A nor B” hepatitis. The mechanism of infection, like hepatitis A, is fecal-oral. That is, the disease is transmitted from a sick person who excretes the virus in their feces. Infection often occurs through water. As with hepatitis A, the prognosis is favorable in most cases. The exception is women in the last three months of pregnancy, in whom mortality reaches 9-40% of cases. Susceptibility to viral hepatitis E is universal. Mostly young people aged 15-29 years old become ill. The disease is especially common in countries with hot climates and extremely poor water supplies.

From the moment of infection to the onset of the disease, 14 to 50 days pass. Hepatitis E begins gradually with indigestion, deterioration in general health, and less often with a short rise in temperature. Unlike hepatitis A, the appearance of jaundice does not improve the health of patients.

After 2-4 weeks from the onset of the disease, a reverse development of symptoms and recovery is observed. Unlike other types of viral hepatitis, severe liver and kidney damage is observed in severe forms of hepatitis E. With hepatitis E, more often than with hepatitis A, moderate and severe forms of the disease are observed. Hepatitis E is characterized by a severe course in pregnant women in the second half of pregnancy with a high number of deaths. Fetal death occurs in almost all cases. Hepatitis E is not characterized by a chronic course and viral carriage. Treatment and prevention as for hepatitis A.

HepatitisG

Hepatitis G (Hepatitis G) is widespread. In Russia, the frequency of detection of the pathogen ranges from 2% in Moscow to 8% in Yakutia. According to the figurative expression of English doctors, hepatitis G is the younger brother of hepatitis C. Indeed, they have a lot in common. Hepatitis G is transmitted in the same way: through blood. This is reflected in the widespread prevalence of the disease among drug addicts. Infection also occurs during blood transfusions and parenteral interventions. Sexual transmission and vertical transmission from an infected mother to a child are possible.

In terms of clinical manifestations, hepatitis G also resembles hepatitis C. However, it is not characterized by the progression of the infectious process inherent in hepatitis C with the development of cirrhosis and cancer. As a rule, the acute infectious process is mild and asymptomatic. The main marker for diagnosing hepatitis G is the PCR (polymerase chain reaction) method.

The outcomes of acute hepatitis G can be: recovery, the formation of chronic hepatitis or prolonged carriage of the virus. Combination with hepatitis C can lead to cirrhosis.

Routes of infection, diagnosis and symptoms of hepatitis.

Hepatitis viruses enter the human body in two main ways.

A sick person can excrete the virus in their feces, after which it enters the intestines of other people with water or food. Doctors call this mechanism of infection fecal-oral. It is characteristic of the hepatitis A and E viruses. Thus, hepatitis A and hepatitis E arise mainly due to poor personal hygiene, as well as imperfect water supply systems.

This explains the greatest prevalence of these viruses in underdeveloped countries.

The second route of infection is human contact with infected blood. It is characteristic of hepatitis B, C, D, G viruses.

The greatest danger, due to the prevalence and severe consequences of infection, are the hepatitis B and C viruses.

Here are the situations in which infection most often occurs: - Donor blood transfusion. Worldwide, on average, 0.01 - 2% of donors are carriers of hepatitis viruses, so currently donor blood is tested for the presence of hepatitis B and C viruses before transfusion to the recipient. The risk of infection increases in persons who require repeated transfusions of blood or its products.

Using the same needle by different people greatly increases the risk of contracting hepatitis B, C, D, G. This is the most common route of infection among drug addicts.
Viruses B, C, D, G can be transmitted through sexual contact. Hepatitis B is most often transmitted sexually. It is believed that the likelihood of contracting hepatitis C in spouses is low.
The route of infection from mother to child (doctors call it “vertical”) is not observed so often. The risk increases if a woman has an active form of the virus or suffered acute hepatitis in the last months of pregnancy. The likelihood of infection of the fetus increases sharply if the mother, in addition to the hepatitis virus, has HIV infection. The hepatitis virus is not transmitted through mother's milk.

Hepatitis B, C D, G viruses are transmitted through tattooing, acupuncture, and ear piercing with unsterile needles. In 40% of cases, the source of infection remains unknown.

Complications of viral hepatitis can include functional and inflammatory diseases of the biliary tract and hepatic coma, and if the disruption of the biliary tract is treatable, then hepatic coma is a formidable sign of the fulminant form of hepatitis, ending in death in almost 90% of cases. In 80% of cases, the fulminant course is caused by the combined effect of hepatitis B and D viruses.

Hepatic coma occurs due to massive necrosis (necrosis) of liver cells. The breakdown products of the liver tissue enter the blood, causing damage to the central nervous system and the extinction of all vital functions.

Recovery from viral hepatitis is long-term. Often, the disease takes on protracted forms. Some patients infected with the hepatitis B, C, D virus do not get sick themselves, but being carriers, they pose a danger in terms of infecting others. A very unfavorable outcome of acute hepatitis is its transition to the chronic stage, mainly with hepatitis C.

Chronic hepatitis is dangerous because the lack of adequate treatment inevitably leads to cirrhosis and sometimes liver cancer. In this regard, doctors consider hepatitis C to be the most serious disease: In 70-80% of cases, its acute form becomes chronic, although there may be no external signs of the disease. Moreover, the majority of patients with acute hepatitis C experience the phenomenon of “imaginary recovery”, in which the data of biochemical blood tests return to normal. This phenomenon lasts from several weeks to several months or even years, and patients may mistake this period for recovery. This dictates the need for long-term and regular monitoring of patients and mandatory specific therapy. Hepatitis C is not unreasonably compared in severity to AIDS.

But the most severe course of hepatitis is caused by a combination of two or more viruses, for example B and D or B and C. Even B+D+C is found. In this case, the prognosis is extremely unfavorable. Often, the signs of chronic viral hepatitis are mild, which allows a person to ignore the disease for the time being. Often, obvious clinical manifestations of the disease are detected already at the stage of cirrhosis.

Cirrhosis occurs in approximately 20% of people with hepatitis C. Hepatitis B with or without hepatitis D can also cause this complication. The presence of cirrhosis creates obstacles to normal blood flow in the liver. The blood is forced to find additional bypass routes, which leads to dilation of blood vessels in the esophagus and stomach.

These dilated blood vessels are called varicose veins; they stretch and can become a source of bleeding, requiring emergency medical attention. Another problem associated with the development of liver cirrhosis is ascites (accumulation of fluid in the abdominal cavity), which is externally manifested by an increase in the size of the abdomen. Sometimes, patients with cirrhosis develop liver cancer, which in the early stages can be treated with medications or surgery. If cirrhosis of the liver has formed, it cannot be eliminated, even if the inflammation of the liver has already passed. Therefore, treatment for viral hepatitis should be started as early as possible!

Treatment and prevention of hepatitis.

To protect yourself from hepatitis infection, you must follow simple rules.

You should not drink unboiled water, always wash fruits and vegetables, and do not neglect heat treatment of products. This way you can prevent infection with hepatitis A, the transmission of which is associated with food contamination from the feces of a sick person. The great rule “Wash your hands before eating” is a guarantee of health in this case as well.

In general, contact with other people's body fluids should be avoided. To protect against hepatitis B and C - primarily with blood.

Blood in microscopic quantities can remain on razors, toothbrushes, and nail scissors. You should not share these items with other people.

Medical institutions take measures to prevent hepatitis infection. However, if you had an endoscopy or dental treatment ten to fifteen years ago, when the fight against hepatitis was not yet carefully organized, you need to get checked. There is still a small risk of infection today.

Never share syringes and needles when taking drugs. Never perform piercings or tattoos with non-sterile equipment. Remember - the hepatitis virus is very tenacious and, in contrast to the AIDS virus, persists in the external environment for a long time (sometimes up to several weeks). Invisible traces of blood can even remain on straws used when using cocaine, so in this case, you should be wary of contamination.

Hepatitis B is most often transmitted through sexual contact, but infection with hepatitis C is also possible. It is especially necessary to take precautions during sex during menstruation and anal intercourse, however, oral sex can also be dangerous.

Hepatitis is also transmitted in the so-called “vertical” way - from mother to child during pregnancy, childbirth, and breastfeeding. With proper medical support, you can try to avoid infection of the baby - this will require careful adherence to hygiene rules and taking medications.

However, the route of hepatitis infection very often remains unknown. To be completely calm, you need to get vaccinated.

Currently, healthcare practice has effective vaccines only against hepatitis A and B. Intensive research is underway to develop a vaccine against hepatitis C, but it is at an early stage, because The high variability of the virus and the lack of an effective protective antibody response after hepatitis C infection make these studies difficult. In this regard, timely treatment of hepatitis C can prevent the development of severe progressive changes in liver tissue, which will certainly improve the patient’s quality of life.

It is not difficult to protect yourself from hepatitis A - one vaccination provides protection for more than 1 year. Second dose after 6 - 12 months. after primary provides long-term protection. For adults, the vaccine is administered in a dose of 0.5 ml into the deltoid muscle. Course - 3 vaccinations according to the schedule of 0, 1 and 6 months. Children are injected with 0.25 ml into the deltoid muscle twice with an interval of 1 month. As planned, medical workers, staff of preschool institutions, and service sector workers (primarily those employed in public catering establishments, water supply and sewerage facilities) are vaccinated against hepatitis A; traveling to regions and countries hyperendemic for hepatitis A (Middle East, Africa, Latin America, Indonesia); In the event of accidents at water supply and sewerage facilities (wastewater entering the water supply network), the population that used this water main is subject to vaccination against hepatitis A.

Since 1981, more than 1 billion doses of hepatitis B vaccines have been used worldwide with excellent safety and efficacy indicators; the vaccine is 95% effective in preventing the development of chronic carriage of the hepatitis B virus. The hepatitis B vaccine is the first anti-cancer vaccine, since chronic carriers of the hepatitis B virus are at high risk of mortality due to cirrhosis and liver cancer. Because of the critical importance of hepatitis B vaccine, the World Health Assembly recommended in 1992 that all countries should include hepatitis B virus vaccination in their national immunization schedules. To date, 100 countries have introduced hepatitis B vaccination into their national immunization schedules. In addition, adolescents are vaccinated in many industrialized countries. In some US states, newborns are vaccinated without exception.

The hepatitis B vaccine has been included in the national calendar of preventive vaccinations since 1996.

According to the National Preventive Vaccination Calendar, the first vaccination against viral hepatitis B is given to newborns in the first 12 hours of life, the second at the age of 1 month, and the third at 6 months.

Children born to mothers who are carriers of the hepatitis B virus or who are sick with viral hepatitis B in the third trimester of pregnancy are vaccinated against viral hepatitis B according to the schedule of 0-1-2-12 months.

Post-vaccination reactions when using the vaccine are rare. In 3.5-5% of cases, slight passing local pain, erythema and induration at the injection site are possible, as well as a slight increase in temperature, complaints of malaise, fatigue, joint pain, muscle pain, headache, dizziness, nausea. These reactions develop mainly after the first two injections and disappear after 2-3 days. Particularly sensitive people may develop immediate allergic reactions, so the vaccinated person requires medical supervision for 30 minutes.

Contraindications: hypersensitivity to yeast and other components of the drug, acute infectious and non-infectious diseases, chronic diseases in the acute stage (immunization is carried out no earlier than a month after recovery (remission)), decompensated forms of diseases of the cardiovascular system and lungs, pregnancy.

Conclusion.

Viral hepatitis is a common and dangerous infectious disease.

They can manifest themselves differently, but among the main symptoms are jaundice and pain in the right hypochondrium.

To diagnose hepatitis, you need to do a blood test, urine test, and in difficult cases, a liver biopsy.

Of all forms of viral hepatitis A is the most common. From the moment of infection to the appearance of the first signs of the disease, 7 to 50 days pass. Most often, the onset of the disease is accompanied by a rise in temperature, and may resemble the flu.

Most cases result in spontaneous recovery and do not require active treatment. In severe cases, droppers are prescribed to eliminate the toxic effect of the virus on the liver.

The hepatitis B virus is transmitted sexually, through injections with non-sterile syringes from drug addicts, and from mother to fetus.

In typical cases, the disease begins with fever, weakness, joint pain, nausea and vomiting.

Sometimes rashes appear. The liver and spleen become enlarged. There may also be darkening of the urine and discoloration of the stool.

The greatest danger is the chronic form of this disease, which often develops into cirrhosis and liver cancer.

A chronic course develops in approximately 70-80% of patients. The combination of hepatitis C with other forms of viral hepatitis dramatically worsens the disease and can lead to death. Hepatitis D is a “companion disease” that complicates the course of hepatitis B.

Hepatitis E is similar to hepatitis A, but it starts gradually and is more dangerous for pregnant women. The last in the hepatitis family, G, is similar to C, but less dangerous.