Viral hepatitis of B

Description:

Viral hepatitis In - the antroponozny viral infection from conditional group of transfusion hepatitises which is characterized immunological by the mediated damage of hepatocytes and proceeding in various clinical forms (from a carriage of virus to cirrhosis).

Long time a viral hepatitis In called serumal, parenteral, iatrogenic, posttransfusion, spray. It emphasized a parenteral way of transfer of the activator through the damaged integuments and mucous membranes (unlike a virus of a viral hepatitis And, transferred fecal orally).

In 1963 B. Blamberg for the first time emitted the special "Australian antigen" which began to be considered afterwards a marker of serumal hepatitis from blood of the Australian natives. Later D. Dane (1970) for the first time allocated a new virus of hepatitis, thereby having proved existence of a new nosological form - a viral hepatitis of Century.
Infection source - persons with manifest or subclinical forms of a disease (patients acute and chronic hepatitises, with cirrhosis and so-called "healthy" virus carriers).
Mechanism of transfer of a viral hepatitis of Century. Allocation of a virus with various biological secrets (blood, saliva, urine, bile, tears, breast milk, sperm, etc.) defines plurality of ways of transmission of infection. However only blood, sperm and, perhaps, saliva constitute real epidemiological danger as in other liquids concentration of a virus is very small. The disease is transmitted mainly in the parenteral way at hemotransfusions and blood substitutes, when using medical tools without their rather effective sterilization.

Symptoms of the Viral hepatitis In:

Incubation interval. At an acute cyclic form of a viral hepatitis In its duration it is subject to big fluctuations and varies from 30 to 180 days and more.

Dozheltushny period. Can proceed in the same options, as at a viral hepatitis In, but meet artralgichesky, astenovegetativny and dispeptic options more often. At dispeptic option persistent anorexia, constant feeling of nausea, periodic vomiting without any visible reasons are expressed. It is necessary to notice that at grippopodobny option of the dozheltushny period at a viral hepatitis In the catarral phenomena are uncharacteristic and only at a small part of patients it is possible to observe fervescence. At the same time patients quite often complain of joint pains; at the same time externally joints, as a rule, do not change. Arthralgias more often happen in night and morning time, and at the movements in joints for a while disappear. An enanthesis like small tortoiseshell can accompany them. The combination of an arthralgia and a dieback usually foretells more severe disease. In such cases the clinical picture is supplemented by fervescence, sometimes to high figures.

Already during the dozheltushny period it is possible to observe dizziness, persistent drowsiness and manifestations of a hemorrhagic syndrome in the form of bleedings from a nose and gums.

Icteric period. The health of patients, as a rule, does not improve, and in most cases worsens. Arthralgias and a dieback disappear, but dispeptic symptoms accrue.

The Ikterichnost of integuments and mucous membranes slowly progresses, reaching the maximum not earlier than the 7-10th day from the moment of its emergence. Jaundice is usually intensive, is followed by a skin itch. On skin quite often reveal hemorrhages in the form of petechias or large bruises. At heavier current note nasal bleedings, bleeding of gums, and women have an early arrival of plentiful periods. Urine gains dark color, from the majority of sick kcal ахоличен.

The liver, as a rule, increases in sizes; it clearly is painful at a palpation, rather soft on a consistence. It is necessary to pay attention that against the background of intensive jaundice quite often the liver does not increase that indicates heavier course of hepatitis. In 50-60% of cases observe a splenomegaly. Pulse урежен, however at heavier current it is possible to observe tachycardia. Cardiac sounds are muffled, note small hypotonia. Patients are usually apathetic, test dizziness, frustration of a dream.

The current of the icteric period long, drags on up to 1 month and more.

The period of reconvalescence begins with the moment of reduction or disappearance of a complex of dispeptic symptoms then there is a slow decrease in a bilirubinemia. As for change of the sizes of a liver, this process is sometimes dragged out for several months.

At accession of a cholestatic component (5-15% of patients) the disease gets a torpid current. In these cases not expressed intoxication, long cholestatic manifestations (high "monotonous" rates of a bilirubinemia and a fermentemiya, the dark urine, an akholichny chair increased, which is not reduced in sizes a liver, subfebrile condition) are characteristic.

In addition to an acute cyclic form of a disease of a viral hepatitis In it can be shown in the form of a chronic form (synchronization in 5-10% of cases) and cirrhoses of a virus etiology.

The reasons of the Viral hepatitis In:

The causative agent of a viral hepatitis With - DNA-genomic virus of the family Orthohepadnavirus of the Hepadnaviridae family. In blood of patients with a viral hepatitis In particles of three morphological types circulate. Most often find spherical particles, is more rare - threadlike forms. Virus particles of these types do not show infectious properties. Only 7% of particles are presented by the complex two-layer spherical educations with full structure (so-called particles of Dane) showing the expressed infectivity. Their upper layer forms a supercapsid. The genome is presented incomplete (one thread shorter) by dvukhnitevy ring molecule DNA and the DNA polymerase associated with it. At virions emit four antigens - superficial (HBsAg) and three internal (HBeAg, HBcAg and HBxAg).

Treatment of the Viral hepatitis In:

Patients with the acute cyclic course of a viral hepatitis In are hospitalized. In mild and medium-weight cases treatment is similar to that at a viral hepatitis And. At a heavy current resolve an issue of purpose of Prednisolonum on 40-60 mg/days inside. Decrease in doses is made gradually from the moment of stopping of symptoms of intoxication. At the same time sick intensify disintoxication therapy (crystalloids and реополиглюкин in the ratio 1:3), carry out correction of disturbances of water and electrolytic balance (Pananginum, an asparkam at a hypopotassemia), apply lactulose (normaza), spasmolytic drugs (Nospanum, an Euphyllinum), appoint antibiotics with a low resorption from intestines (Neomycinum). In cases of the expressed cholestasia drugs of ursodeoksikholevy acid are recommended (уросан, урсофальк). At development of acute hepatic encephalopathy appoint glucocorticoids (intravenously 240-480 mg and more Prednisolonum in days) though their efficiency is doubtful.