Update: October 2018 When the doctor begins to meet with
the patient, practically the first thing he asks: “Botkin
were you sick? “So the specialist asks if you
infectious hepatitis, rightly believing that the above
The wording of the question will sound clearer.
In fact, inflammation of the liver (namely, this is called
hepatitis) can cause 9 specific viruses: A, B, C, D, E, D,
TT, G and SEN. Botkin’s disease – what kind of hepatitis? So official
called only a disease caused by the hepatitis A. All
the remaining viral hepatitis is called “viral hepatitis B”,
�”Viral hepatitis C” and so on.
Viral hepatitis A is relatively the easiest of all the others.
similar diseases. They are usually ill in childhood, and
he often does not cause complications. But from any rule there are
exceptions. Therefore, let’s talk about Botkin’s disease in more detail.
A bit about the virus itself
Hepatitis A virus belongs to the genus Enterovirus – to the very same
in which viruses are “made up” that cause hand-foot-mouth disease,
herpangina, “summer” viral meningitis. Like all of his “brothers”,
the microbe can be killed by heating to as low as 50 ° C, ultraviolet
radiation, formalin. But at + 4 ° it is saved somewhat
months, at – 20 ° C – a few years. In addition, it is resistant to
chlorine, so it can easily get into tap water or
Unlike other enteroviruses, the hepatitis A virus (its doctors
designated as HAV – hepatitis A virus) has many
nonspecific receptors. Therefore, it can multiply not only
inside the liver cells, but also in the intestinal cells, and in the bile-excreting
ways. Embedded in cellular DNA, HAV can form
mutant viruses that are “poorly visible” to the immune system.
How get infected with hepatitis A virus
How is hepatitis A transmitted? Feces sick person virus
gets into the water, with it – into the local reservoir, from where it reaches again
water systems (as you remember, the microbe is not inactivated
chlorine, but only by boiling). Also можно заразиться от больного
a family member or employee if he has washed his hands badly after using the toilet
and touched items, towels and door handles that
after you touched and without washing your hands, let’s go eat. Infection
It is also possible when eating food for a sick person.
There is also a food route of infection – through seed
microbial foods that have been washed with infected water and not
subjected to heat treatment.
The person who got HAV, becomes dangerous to others
before he even knows about his illness: 10-14 days before
the onset of jaundice (that is, during the incubation period). Virus
at least 2 weeks after the onset of jaundice.
Virus содержится в кале и моче. With other biological
microbes are not excreted with liquids, although
blood transfusions taken from a patient donor in the last days
incubation period. In a person infected in this way
the incubation period is shortened, and hepatitis itself is leaking
Transmission of virus A through the placenta is not proven.
In our country, hepatitis A is a disease of predominantly children and
young people, although anyone can get sick
immunity. After the virus leaves a persistent life
immunity, so the second time almost never get sick.
At risk are:
- travelers, especially those visiting other countries with
low sanitary standards;
- drug addicts;
The maximum incidence is observed in the summer and in
Symptoms of the disease
Virusный гепатит A обычно протекает остро, но крайне редко
there are cases of chronic infection and even carriage (when
there are no symptoms of botkin’s disease, and the virus is out to the environment
The incubation period for hepatitis A lasts from 7 to 40 days. After
it follows the preicter period. Its symptoms often resemble
- temperature rises to 38 ° C. She lasts 1-4 days, then
- body aches;
At the same time there is no cough and runny nose, but the throat does not blush.
Signs appear a little later or simultaneously with the above.
Botkin’s disease, which suggest this diagnosis. it
lack of appetite, pain in the “under the spoon”, nausea.
The preicteric period lasts 3-7 days. If such symptoms
continue more, it most likely speaks of addition
hepatitis other diseases: allergies, exacerbation of chronic
inflammation, the addition of another acute pathology.
After безжелтушного периода наступает период желтушный: желтеют
skin and whites of the eyes, dark urine, calories lightens. it
usually occurs after 2-3 days of normal temperature, several
days of lack of appetite and pain in the stomach. If the disease
the symptoms described above will be easy with the appearance of jaundice
hepatitis A are declining.
It happens that Botkin’s disease occurs without jaundice. it бывает
rarely 3 times less than icteric form.
With Botkin’s disease fulminant (fulminant) forms are possible.
They are characterized by nausea and frequent vomiting, which
accompanied by progressive drowsiness and bleeding.
Acute liver failure develops rapidly, which in
most cases end in death.
Even if the disease is easy, the person does not get
treatment, breaks diet or takes alcohol, after 1-2.5 months
there may be a recurrence of the disease. It looks like a refund all
or almost all of the symptoms described above. Hepatitis A relapses
there are extremely rare, but still it happens.
Hepatitis A is often exacerbated after such hepatitis.
chronic diseases like:
- peptic ulcer disease.
As a result of being infected with the hepatitis A virus, these diseases can
appear for the first time as acute forms.
Against the background of Botkin’s disease, the syndrome often appears for the first time.
Gilbert is a hereditary disease in which intermittently,
due to disturbances in the enzyme system, metabolism is disturbed
bilirubin – substances whose excess stains the skin yellow
Rare complications of hepatitis A are associated with over-activation.
the immune system that produces antibodies
against their own bodies. It:
- arthritis – inflammation of the joints;
- cryoglobulinemia – the appearance of special proteins in the blood,
cryoglobulins that are able to affect internal organs
precipitating in them;
- vasculitis – inflammation of the walls of blood vessels in many
- nephrotic syndrome.
In 90% of cases, the disease is mild, leading to a rapid,
within 2-3 weeks of recovery. 10% of patients recover
Little is known about the chronic disease of Botkin, so here
statistics not accumulated. Chronization develops, according to scientists
due to autoimmune processes. The carrier of the virus, too, really
not learned. It is believed that it is observed in some people.
shortly after suffering hepatitis.
Hepatitis A mortality is 0.05%.
Hepatitis A is diagnosed by blood tests:
- Class M immunoglobulins (the analysis is called viral markers
hepatitis, is given in the serological laboratory, and if IgM –
positive, this is – Botkin’s disease). If the blood is positive
both IgM and IgG, it means that this is the height of the disease – it is being created
active antiviral immunity. If IgM is negative and IgG is
positive, it suggests that a person suffered from hepatitis A in
the past, but now he is not sick of them.
- Detection of RNA virus HAV by PCR in the blood or in the feces.
In the feces of the virus can be found 1-2 weeks before the onset of the disease and
first 2 weeks of jaundice. In the blood, RNA is found from the end
incubation period, as well as for 1-3 weeks of illness.
In the presence of confirmed markers of viral hepatitis A gene
virus in the blood is not found in all patients.
During the course of the disease a number of other
studies to judge the severity of the disease and the affected
virus organs. It:
- liver function tests: bilirubin is common and one of two is straight or
indirect, ALT, AST, alkaline phosphatase,
- coagulogram – indicators of blood coagulation system;
- proteinogram: because the liver is responsible for the formation
proteins, with hepatitis this function may suffer, for this and
need this analysis;
- Ultrasound of the liver, pancreas, spleen. For hepatitis A
characterized by an increase in the liver, its decrease is a bad sign,
talking about the risk of developing acute liver failure. Also
spleen enlargement or pancreatic inflammation may be noticed
glands. In these cases, you need to take additional measures.
Therapy for viral hepatitis A consists of simple
- diets with the obligatory exception of fatty foods, alcohol,
coffee, fried foods, raw vegetables, berries and fruits, juices, sausages,
fatty dairy products, borscht, soups in broth;
- compulsory drink at least 2 l / day non-carbonated
- sorbent administration (Enterosgel, Polysorb) 4 times a day,
1.5 hours after meal or 1 hour before the next intake
- the use of drugs that reduce acidity (“Omeprazole”,
�”Rabeprazol”) every day 30 minutes before breakfast and before
- taking enzymes (“Mezim”, “Pancreatin”) three times a day during
- use of lactulose drugs (“Dufalak”, “Normase”) – according to
20-30 ml three times a day until soft stools appear.
No antiviral agents for this disease.
In severe cases, with severe intoxication, need
infusion therapy (droppers). In solutions add drugs from
essential amino acids: “Glutargin”, “Ornitox” (“Hepa-Mertz”),
injected glucocorticoid hormones (“Dexamethasone”), proteolytic
enzymes (“Contrycal”, “Gordoks”), hepatoprotectors
Hospitalization and discharge from hospital
Treatment болезни Боткина в нашей стране проводят пока только в
inpatient, although in other countries, in the case of a mild course,
are treated on home.
The length of stay in the infectious diseases hospital depends on
general condition, but lasts at least 21 days. Write out
when a person has:
- good general well-being;
- normal sleep, no nightmares;
- no bleeding gums or menstruation in women
- total bilirubin – no higher than 30 mmol / l;
- ALT – not higher than 1.5 mmol / l * h.
After discharge, you must immediately visit the Infectious Diseases (IDT) in
clinic, and come to him every 10-14 days to complete
recovery. As soon as all tests are normal, he writes
person to work. But if there are any signs of exacerbation
– hospitalization is again necessary.
Even if the person wrote out with completely normal analyzes,
he is usually allowed to start work no earlier than after 2
of the week.
General prevention is to wash your hands, drink boiled
water, using their own dishes.
There is also a specific prevention – the introduction of one of
vaccines: plasma or recombinant. After a single injection
immunity plasma vaccine is formed in a month and
lasts up to a year. Re-vaccination (if provided
the vaccine itself) prolongs the existence of antibodies up to 10 years.
Inoculate not everyone, but only those who live in the regions
adverse for viral hepatitis A, or goes there
If there was a contact with a person who was not viral
Hepatitis, with the patient, you can passive immunization – enter
specific donor immunoglobulin G (IgG). Such a manipulation
can be done even to a pregnant woman.
Passive immunization is especially effective in the first days after
contact, but entered after 2 weeks or later, is not at all
protect from disease. It can be performed to facilitate the flow.
diseases, especially in people whose liver is already affected by chronic
process, or who has autoimmune diseases.
Автор: Кривега Мария Салаватовна врач-реаниматолог