Viral hepatitis A and E - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Viral hepatitis A (or disease Botkin) - a special type of viral hepatitis;it does not have, and chronic forms of fecal-oral transmission mechanism.The same properties have a less common form of viral hepatitis - hepatitis E .

viruses hepatitis A and E not have a direct damaging effect on the liver. Hepatitis - liver inflammation - occurs because the virus enters the cells of the liver, causing the blood cells of protective reaction to the change of liver tissue.

Hepatitis A - one of the most common infections in the world.Many perebolevayut the disease in childhood, which is associated with a higher prevalence of hepatitis A in child care, in a closed group.Children carry the infection is much easier than adults, many suffer asymptomatic hepatitis A and acquire lifelong immunity.In adults, the most severe form of hepatitis occur, requiring hospitalization, most likely associated with various comorbidities.

most widespread hepatitis A acquired in countries with warm climates and poor sanit

ation.Therefore, the probability increases to catch hepatitis A when traveling to tropical countries: Egypt, Tunisia, Turkey, Central Asia, India and other

Hepatitis E is common in Southeast Asia, Africa, Central America..In our latitudes, hepatitis E is much rarer.

Hepatitis A virus

Hepatitis A virus is very resistant to external influences and can persist long in the environment.

  • withstand boiling for 5 minutes.
  • Chlorination - 30min.Processing
  • formalin - 3 h.
  • Braves processing 20% ​​ethyl alcohol.
  • withstand acidic environment (pH 3.0).
  • in water at 20 ° C 3 days lives.
  • The dishes of meat and shellfish at a temperature of 80 ° C is active for 20 minutes.

How do you get hepatitis A

source of infection is a sick person who excrete the virus into the environment with faeces.Viruses falling into the water, food, penetrate into the body of a healthy person and can cause disease.Especially dangerous are the dishes prepared from insufficiently cooked seafood.In addition, often the infection occurs by eating fruits and vegetables, which themselves may contain viruses or hepatitis A can be washed contaminated water.

less common mechanism of transmission - through infected blood.This occurs when a blood transfusion, the use of drug addicts sharing syringes, as well as through homosexual contact.

Development hepatitis A and E hepatitis viruses

penetrate through the mouth into the intestine, from there, soaked in blood, penetrate into the cells of the liver, causing inflammation through their own immune cells attack the body.Then the viruses enter the bile duct, and thence into the intestine and the environment.

sick person is dangerous to others in the last week of the incubation period and the first week of the disease.The incubation period - the period from infection to the first symptoms of the disease.In the case of hepatitis A, he is 14-28 days.And in the case of hepatitis E up to 60 days (average 40 days).

While the virus is in the blood, there is no jaundice, there are common signs of intoxication, infection occurs under the guise of SARS.

occurrence of jaundice indicates that the virus is no longer in the blood, the immune response is completely formed.However viral hepatitis A often occurs without jaundice.

occurrence of jaundice indicates liver lesions of 70%, so all patients with jaundice treatment is indicated in the hospital.However, in most cases, adherence and adequate treatment of the structure and operation of the liver is completely restored.

anicteric period when the virus of hepatitis A and E

anicteric period may last for 1-2 weeks.At the same time there are common symptoms that are very similar to the symptoms of flu and colds.

  • Decreased appetite.
  • Fatigue.
  • Malaise.
  • Fever (usually 38-39ºS rarely the temperature rises to 40 ° C).
  • pain in muscles and joints.
  • Headache.
  • Cough.
  • Rhinitis.
  • Sore throat.
  • Nausea and vomiting.
  • Abdominal pain.

jaundice period when the virus of hepatitis A and E

The first symptom that causes the alert - it darkening of the urine.The urine becomes dark brown, "the color of dark beer."Then the yellow eye sclera and conjunctiva of eyes, mouth, which can be determined by lifting the tongue to the palate;yellowing is also more noticeable on the palms.Later, yellow skin.

Since the beginning of the period of the common symptoms of jaundice are reduced, the patient usually becomes easier.However, in addition to the yellowing of the skin and mucous membranes, there is heaviness and pain in the right upper quadrant.Sometimes there is discoloration of feces, due to blockage of the bile ducts.

Full recovery occurs in 1-2 months.

Severe forms when the virus of hepatitis A and E

Severe forms of the disease include the so-called cholestatic form , when there is a stagnation of bile, which is caused by inflammation of the bile duct wall.Thus there is a lightening of feces, there is itching, which is caused by irritation of the skin component of bile.

particularly dangerous fulminant hepatitis, in which developed massive liver necrosis, acute liver failure and often death of the patient.When hepatitis A fulminant form occurs rarely, and if hepatitis E - its rate of 1-2%.However, a particular danger hepatitis E is for pregnant women - the frequency of lightning forms 25%

Mortality in hepatitis A ranges from 1 to 30%.The mortality rate increases with age, as well as in other chronic carriers of hepatitis B virus.

who often ill with hepatitis A and E

  • People who travel to countries where the incidence of the above (endemic areas)
  • Children attending kindergartens
  • Workers
  • kindergartens Workers in catering
  • Workerssewer services and water supply
  • Those family members who are sick with hepatitis a
  • Gay
  • Addicts

should be noted that in countries with a high prevalence hepatitis a , as well as in rural areas, many people perebolevayut hepatitis and inchildhood, most often mild or asymptomatic forms, getting in this lifetime immunity.While people living in the cities suffer from hepatitis A is much less, therefore, have a greater risk of getting in contact with the sick person, as well as when traveling to endemic areas.

Prevention of hepatitis A and E

general prevention measures are reduced to the elementary principles of hygiene.It is necessary to wash hands before eating, wash fruits and vegetables with water, clean which is no doubt.Not enough to eat processed meat, fish, especially seafood.


With the so-called passive immunization using normal human immunoglobolina achieved, ie,man introduced ready-made antibodies (protective proteins) against the hepatitis A virus .Duration of action of these antibodies is 2 months.With the drug at the beginning of the incubation period it prevents the development of disease.

immunoglobulin can be used in people who have close contact with the patient, not later than 2 weeks after the alleged contamination;as well as in people in endemic region.

immunoglobulin is safe, well tolerated;HIV infection through it impossible because the inactivated virus in the manufacture of the drug.


In Russia, available vaccines, which are grown in cell culture and formalin-inactivated virus.There are several vaccines of this type: "Hep-A-in-vac" (Russia), "AWACS" (France), "Havrix" (Belgium), "Waqt" (USA).

Vaccination can be done to children, starting from 2 years old.After a single inoculation immunity is formed after 1-4 weeks (depending on the type of vaccine), so it can be used for 1-4 weeks or more prior to traveling to the high spread of hepatitis country A. After a single immunization, immune formed at 2 years;after twice - more than 20 years.

adult vaccine is administered intramuscularly - 2 doses with an interval of 6-12 months.Children aged 2-18 years intramuscularly administered 2 doses with an interval of half a month, and the third - 6-12 months.

Complications of hepatitis A and E

Hepatitis A , emerged against the background of overall health, almost always ends in recovery.In elderly patients with concomitant diseases, particularly in chronic carriers of other viral hepatitis, the prognosis worsens, often observed during prolonged illness.

A small number of patients after weeks and months of a relapse may occur after the disease, ie,Returns all the symptoms: intoxication, jaundice.But even in these cases, not hepatitis becomes chronic.

addition, viral hepatitis E can cause hemolysis - the destruction of blood cells - red blood cells, which can lead to kidney damage and acute renal failure.

Violations of the liver after suffering hepatitis A are rare, mostly in the age of patients.However, there are cases where hepatitis A occurs in anicteric form, under the guise of SARS when a patient fails to comply with bed rest;it can lead to the formation of scar tissue in the liver - liver fibrosis, which is dangerous development of dyskinesia of the bile ducts - disturbance of the normal passage of bile.

Hepatitis E in 5% of cases of cirrhosis of the liver occurs.

diagnosis of hepatitis A

Diagnosis is primarily based on clinical data - that is,manifestations of the disease.

To confirm the diagnosis of viral hepatitis carried out a number of laboratory tests.The biochemical blood tests can detect a significant increase in bilirubin and liver enzymes, which supports liver damage.

then carried out differential diagnosis of viral hepatitis.A specific diagnosis of hepatitis B based on the determination of antibodies to the virus in the blood, thus have specific antibodies that are specific for acute hepatitis.

regime and diet in acute hepatitis

During acute hepatitis better comply with bed rest.In the supine position improves blood flow to internal organs, including the liver, which helps restore normal liver cells.

In acute hepatitis shows a special kind of diet - a diet №5.

Food should be consumed 5-6 times a day, in the form of heat.


  • dried bread or bread baking yesterday.
  • soups, vegetables, cereals, pasta in the vegetable broth and milk soups.
  • dishes from lean beef, poultry, boiled or fried after boiling.
  • Low-fat varieties of fish (cod, perch, saffron cod, pike, carp, silver hake) boiled or vapor form.
  • Various types of vegetables and herbs, non-acidic sauerkraut, ripe tomatoes.
  • Crumbly semi-viscous cereals, puddings, casseroles, especially recommended dishes of oatmeal, buckwheat porridge.
  • Eggs - no more than one per day in the form of adding to meals, protein omelet.
  • Fruits and berries except very acidic, compotes, jelly, lemon (with tea).
  • Sugar, jam, honey.
  • milk tea, condensed, dry, low-fat cottage cheese, sour cream in a small amount, not sharp cheese (Dutch, etc.).Especially recommended for cheese and cheese products.
  • Butter, vegetable oil (50 g per day).
  • rather weak tea and coffee with milk, sour fruit and berry juices, tomato juice, broth hips.


  • all alcoholic beverages.
  • Fresh bakery products, pastry products.
  • soups on meat, fish, mushroom broth.
  • Fatty meats, poultry, fish (sturgeon, sturgeon, sturgeon, catfish).
  • mushrooms, spinach, sorrel, radishes, radish, green onion, pickled vegetables.
  • Canned meats, eggs.
  • cream, cream products, chocolate.
  • legumes, mustard, pepper, horseradish.
  • Black coffee, cocoa, cold drinks.
  • Cooking fats lard.
  • cranberry, sour fruits and berries.
  • Hard-boiled eggs and fried.

In severe vomiting spend parenteral nutrition, ie,nutrients are administered intravenously.High-grade high-calorie diet is an important factor in the treatment of these patients.

Treatment of Viral Hepatitis A and E

Typically, hepatitis A treatment is not required, except for severe forms of the disease.In these cases, drug therapy is performed in detoxification therapy, i.e.reducing the level of toxins that accumulate in the blood due to liver disease.Usually it is the intravenous administration of various detoxification solutions.