Viral hepatitis E in children. Acute viral hepatitis B

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FEATURES OF VIRAL HEPATITIS IN CHILDREN

Definition, types, etiology, epidemiology, pathogenesis, clinical picture, outcomes, laboratory diagnostics, treatment, care, prevention, measures in the outbreak

Viral hepatitis (VH) is a group of diseases characterized by liver damage, general toxic syndrome, hepatosplenomegaly and often jaundice.

There are at least seven independent forms of the disease. From an epidemiological point of view, they form two main groups of hepatitis - with a fecal-oral transmission mechanism (A, E) and parenteral (B, C, D, G). However, some hepatitis still remains etiologically unrecognized.

Etiology. The causative agents of hepatitis belong to different families of viruses and are characterized by resistance to high and low temperatures, as well as to the action of many disinfectants.

Pathogenesis. With hepatitis A and E, the pathogen enters the blood from the intestines, causing the development of a general toxic syndrome in the initial period of the disease. Penetrating through the portal vein system into the liver, viruses have a direct damaging effect on liver cells, resulting in their necrosis. The breakdown of necrotic hepatocytes leads to the release of protein complexes that act as autoantigens.

The pathogenesis of hepatitis B has a number of differences: the pathogen, as a rule, is introduced into the body by the parenteral route, which ensures its direct hematogenous introduction into the liver. Another significant difference is the mechanism of damage to hepatocytes. The hepatitis B virus does not have a direct damaging effect on liver cells. A decisive role in the development of the disease is played by immunological reactions leading to liver damage. The hepatitis B virus has the ability to persist for a long time, many years, and often lifelong in hepatocytes.

The mechanisms of development of hepatitis E, C, D and G have not been fully studied. It is known that the causative agent of hepatitis D has a direct damaging effect on liver cells.

Viral hepatitis C with fecal-oral transmission

ViralhepatitisA.Epidemiology. The source of infection is patients and convalescents who excrete the virus in their feces. Patients in the pre-icteric period, as well as with anicteric and subclinical forms of the disease are of greatest epidemiological importance. The virus is transmitted through contaminated water, food and personal contact. Hepatitis A is considered primarily a “childhood infection”, in which the main contingent consists of primary school students. In the first year of life, the disease practically does not occur. Hepatitis A is characterized by epidemiological signs of intestinal infection. The incidence may be limited to sporadic cases, but epidemic outbreaks are also possible. Hepatitis has a clear seasonality, with the peak incidence observed in the fall (October, November).

Clinicalpainting. The incubation period ranges from 10 to 50 days, but usually does not exceed a month. The disease begins acutely. Body temperature rises to 38-39 °C, nausea, persistent infrequent vomiting, unstable stools, a feeling of heaviness and pain in the right hypochondrium appear. Sometimes catarrhal symptoms from the upper respiratory tract are observed. Signs of general intoxication gradually increase. The liver enlarges, it becomes dense and painful on palpation. Towards the end preicteric period Dark colored urine and discolored feces appear. At this time, a new short-term rise in temperature is often observed. The duration of the pre-icteric period is on average 5-7 days.

Icteric period characterized by the appearance of jaundice with a gradual increase in its intensity. First, the sclera and mucous membranes are stained, primarily the soft palate. As the jaundice intensifies, the color spreads to the skin of the face, torso and limbs. The liver is enlarged. In young children, the spleen enlarges. With the appearance of jaundice in mild forms of the disease, the child’s well-being improves, intoxication and dyspeptic symptoms decrease. The icteric period usually lasts 7-15 days.

Period convalescence long-term, usually more protracted in young children, lasts on average three months and is characterized by the gradual disappearance of clinical and laboratory manifestations of the disease.

The main features of hepatitis A are the predominantly mild course of the disease and the almost complete absence of a threat of chronicity of the process.

ViralhepatitisE. Hepatitis E is more common in tropical and hot countries. Young and middle-aged individuals are usually affected. Children under 15 years of age rarely get sick; their infection is latent. The incubation period and clinical manifestations of the disease are close to those of hepatitis A. A feature of the infection is increased sensitivity to the virus in pregnant women with high mortality, especially in the 3rd trimester.

Viral hepatitis with parenteral transmission mechanism

ViralhepatitisIN.Epidemiology. The hepatitis B virus is transmitted parenterally through violation of the integrity of the skin or transfusion of blood and its preparations. Infection occurs in various ways: 1) during medical procedures: blood transfusions, hemodialysis, injections, instrumental diagnostics, dental interventions; 2) household infection is possible: when applying tattoos, performing cosmetic procedures (manicure, pedicure, shaving, etc.), using shared toiletries - toothbrushes, washcloths, razors; 3) during sexual intercourse through microtraumas of the mucous membrane or infected sperm (vaginal secretion); 4) transplacental transmission of the virus from pregnant women to the fetus is possible, but infection more often occurs during childbirth and in the neonatal period (through microtrauma of the skin during breastfeeding and breast milk).

The high incidence of hepatitis is determined by the widespread circulation of the virus; a large number of carriers who remain unrecognized for a long time, often for life; high sensitivity to the pathogen, allowing the possibility of infection with insignificant doses of the virus (10" 7 ml of infected blood is enough for infection); high concentration of the virus in the blood and its presence in semen and other biological fluids; high resistance of the pathogen in the external environment, to disinfectants and methods sterilization; many ways of transmission.

Clinicalpainting. Contact with the virus usually leads to an asymptomatic course of the disease. Some infected people develop acute hepatitis. The incubation period lasts from 6 weeks to 6 months. The disease begins gradually without a clearly defined onset. Preicteric period long. Dyspeptic and asthenovegetative symptoms are more pronounced and occur more often than with hepatitis A. From the first days of the disease, the liver enlarges and becomes significantly denser. Extrahepatic manifestations of the disease often develop: polymorphic rash, pain in muscles, bones and joints. In severe and moderate forms, signs of hemorrhagic syndrome are revealed. In the icteric period, intoxication and dyspeptic symptoms, unlike hepatitis A, increase. Jaundice is long lasting and reaches great intensity. The spleen may become enlarged.

Hepatitis B, unlike hepatitis A, is characterized by a moderate to severe course, and chronic forms of the disease often develop. The peculiarity of the chronicity of the process is that it occurs mainly in mild forms of the disease.

Peculiaritiescurrentshepatitisatchildrenbreastage. The disease often begins acutely with increased body temperature, lethargy, drowsiness, breast refusal, regurgitation and vomiting. The duration of the pre-icteric period is shortened, and dark, diaper-staining urine and discolored feces appear early. The jaundice of the sclera and skin is usually milder than in sick older children. There is often a discrepancy between the severity of the disease and the intensity of jaundice. Hepatolienal syndrome is more pronounced. More often than in older children, manifestations of hemorrhagic syndrome are observed, and complications associated with the accumulation of bacterial infection often occur.

Congenital hepatitis B develops in the first days after birth or 2-3 months later in the form of a manifest or latent form with prolonged release of the hepatitis virus antigen. Manifest forms are difficult, with high mortality.

ViralhepatitisD. The disease occurs mainly in children over one year of age. The peculiarity of this infection is that it cannot exist without hepatitis B. Its implementation is possible only in an organism infected with the hepatitis B virus, since the delta agent uses the hepatitis B virus antigen as its outer shell.

The clinical picture of the initial period depends on the type of delta infection. When infected with hepatitis B and hepatitis D viruses at the same time, the disease manifests itself with the same symptoms as hepatitis B, but is more violent and severe. There is a tendency to develop malignant forms with acute hepatic encephalopathy. The disease has a high mortality rate.

Superinfection is characterized by a sharp exacerbation of latent or sluggish chronic hepatitis B.

Viral hepatitis C. The contagiousness of the blood and the likelihood of spreading the virus through sexual, transplacental and other routes is lower than with hepatitis B. The disease is characterized by a delayed appearance of antibodies - on average 15 weeks after the onset of hepatitis. The level of serum transaminases often does not change. Despite the favorable course of the acute period, the virus lingers in the liver for a long time and leads to the formation of chronic hepatitis with a high risk of developing cirrhosis and primary hepatoma. It occurs in the first 10 years of the disease and at a later date. Extrahepatic manifestations of infection are possible (vasculitis, glomerulonephritis, autoimmune thyroiditis).

Viral hepatitis F. The term “hepatitis F” was used to refer to etiologically unrecognized cases of hepatitis with a parenteral and enteral mechanism of infection. However, numerous studies have not detected the hepatitis F virus.

ViralhepatitisG. According to its clinical characteristics, hepatitis G resembles hepatitis C. However, it is not characterized by the development of chronic hepatitis and complications such as cirrhosis and hepatoma.

Outcomesviralhepatitis. Usually hepatitis A, E and G result in complete recovery. Residual effects of an incomplete process are possible in the form of an increase in liver size, dysproteinemia, an increase in the level of thymol test, and sometimes enzyme activity. In some cases, long-term consequences of viral hepatitis are observed in the form of hyperbilirubinemia, hepatomegaly (residual liver fibrosis), and damage to the biliary tract. With hepatitis B, D and C, chronic hepatitis often develops.

Laboratory diagnostics. The main specific markers of hepatitis are viral antigens (HAAg, HBsAg, HBeAg, etc.) and IgM and IgG antibodies to them (anti-HAAg, anti-HBs, anti-HBc (cor), etc.).

Nonspecific markers are transaminases (AST and ALT). They increase in the pre-icteric period (normally AST is 0.1-0.45 mmol/chl, ALT is 0.1-0.68 mmol/chl). At the end of the pre-icteric period, bile pigments and urobilin appear in the urine, and stercobilin disappears in the feces. During a biochemical blood test, an increase in bilirubin is observed, mainly in the direct fraction (normally 2.1-5.1 µmol/l).

Treatment. In case of viral hepatitis, the patient must be hospitalized. Separate placement of patients with enteral and parenteral mechanisms of infection is necessary. For hepatitis A and E, the filling of wards should be carried out taking into account the period of illness (the degree of contagiousness of patients).

Treatment of the disease includes a protective regimen, diet, antiviral and pathogenetic therapy.

In the acute period, for mild and moderate forms of hepatitis, semi-bed rest is indicated, for severe forms - bed rest. Food should be complete, easily digestible with a sufficient amount of protein (table No. 5). Spicy, salty, fried foods, pork, canned food, refractory fats, marinades, chocolate, and cakes are prohibited. For detoxification purposes, increase the amount of fluid consumed. For drinking, weak tea, fruit and berry juices, compotes, rosehip decoction, alkaline mineral waters, and 5% glucose solution are recommended. It is not advisable to use canned drinks.

Antiviral treatment is prescribed depending on the severity of the condition and the etiology of the disease. For hepatitis A and E, antiviral therapy is not indicated. It is carried out in severe and protracted cases of hepatitis B and D and in all cases of hepatitis C, taking into account the high probability of developing a chronic process. The main antiviral agent is os-interferon and its preparations - reaferon, realdin, intron A, roferon A, Viferon, human leukocyte interferon, wellferon. Etiotropic treatment also includes the use of synthetic nucleosides - famciclovir (fsshvira, lamivu-dina (epivir), zidovudine (retrovira, thymoside), didanosine (Videxa), ribavirin and other protease inhibitor drugs - saquinavir (invirases), indinavir (krssivana); interferon inducers - neovira (cycloferon), amiksina.

Pathogenetic therapy should be as gentle as possible, since almost all drugs are inactivated in the liver. It consists of prescribing a complex of vitamins ("Aerovit" " Vitalux", "Vitrum", "Centrum" etc.); enterosorbents (polyphepane, bigignin, granulated carbon sorbents), enzyme preparations (pancreatin, Creon, me-zim-forte, festal, panzinorm etc.).

In case of development of cholestatic syndrome, it is recommended fat-soluble vitamins A And E, bile acid adsorbents (cholestyramine, bilignin); bile acid derivatives (ursofalk, ursonane). When signs of bile discharge appear, choleretic agents are indicated (allohol, hofitil, ode-ston, holagol, nikodin).

In patients with moderate and severe disease, infusion detoxification therapy is performed 5% solution glucose With riboxin, ascorbic acid acid, solution Ringer, hemodesis etc. The introduction of amino acid mixtures is indicated (aminosteril, hepasteril, hepatamine). For severe forms of hepatitis, glucocorticosteroids are prescribed. A course of hyperbaric oxygen therapy is carried out. Immunosuppressants are used according to indications - delagil, azathioprine (imuran). During the period of reverse development of the disease, hepatoprotectors are prescribed (LIV-52, legalol, karsil), During the period of convalescence, physiotherapy (electrotherapy), tubing according to Demyanov, and physical therapy are indicated.

Care. The nurse must ensure that patients comply with the protective regime, diet, and receive a sufficient amount of fluid. An essential component of care is monitoring bowel regularity. To prevent the accumulation of toxins in the intestines, it is necessary to have regular bowel movements. This is essential from the first days of the disease, but is especially important during the height of the disease, when the disruption of all functions of hepatocytes, including detoxification, reaches its greatest degree of severity. In the absence of daily bowel movements, the nurse, as prescribed by the doctor, performs cleansing enemas. Children with severe forms of the disease require constant monitoring due to the possibility of developing hepatic coma. Any changes in the patient's condition should be reported to the doctor immediately. viral hepatitis children transmission

Prevention. To prevent hepatitis A and B, active immunization is carried out. The fight against hepatitis A, along with vaccination, includes early diagnosis and timely isolation of patients, interruption of transmission routes. Those who have had hepatitis A are admitted to the children's team after clinical recovery and normalization of biochemical parameters.

Measures to prevent hepatitis B include a thorough examination of donors, the organization of centralized sterilization facilities in medical institutions, and the provision of syringes and disposable instruments. All manipulations involving blood should be carried out wearing rubber gloves, oversleeves, and an apron. Mask and goggles required. When washing your hands, it is necessary to avoid hard brushes that cause maceration of the skin. Damage to the hands should be covered with adhesive tape or finger pads.

Medical workers in burn centers, surgical, intensive care units, hematology and oncology departments are at increased risk of infection.

EventsVhearth. Before hospitalization of the patient, current disinfection is carried out, after hospitalization - final. Subsequently, routine disinfection is carried out daily. Used dishes are soaked in a disinfectant solution.

Children who have been in contact with the patient are separated for 35 days. School classes for contact persons are held in the same class. They dine last in the canteen and are not allowed to be on duty in the canteen. They are subject to medical supervision (thermometry, questioning, examination of skin and stool). Children of preschool institutions are observed daily, schoolchildren - weekly. Passive immunization with immunoglobulin is carried out in the outbreak: at the age of 6 months to 10 years, 1 ml of the drug is administered, for older children - 1.5 ml. If there are clinical indications, laboratory tests (ALT and AST) are performed.

Security questions

1. What diseases belong to the group of viral hepatitis? Name the mechanism of infection transmission. 2. What periods are distinguished during the course of the disease? Describe the features of the course of hepatitis A and B. 3. What laboratory tests are performed for VH? 4. Name the basic principles of treating patients. Tell us about the features of care. 5. What is the prevention of hepatitis diseases with fecal-oral and parenteral transmission mechanisms? 6. What activities are being carried out at the source of infection?”

HIV infection

* Definition * Etiology * Epidemiology * Pathogenesis * Clinical picture * Diagnostics * Treatment * Prevention ® Actions in the outbreak * Medical and psychological features of the work of a nurse with infectious patients

HIV infection is an infectious process characterized by a slow course, damage to the immune and nervous systems, and the development of progressive secondary infections and neoplasms, ending in death.

AIDS is the terminal phase of HIV infection, in most cases occurring after a long period of time from the moment of infection.

Etiology. The disease is caused by the human immunodeficiency retrovirus - HIV 1, 2, 3. The causative agent is heterogeneous and genetically has a high degree of variability. Stability in the external environment is relatively low. In its native state in the blood on environmental objects, the virus retains its infectious ability for up to 14 days, and in dried form for up to 7 days. The pathogen quickly dies when boiled and exposed to disinfectants. Resistant to UV and y-radiation in doses usually used for sterilization.

Epidemiology. The reservoir and source of the pathogen is a sick or HIV-infected person. The highest concentrations of the virus are found in blood, semen, female genital secretions, and cerebrospinal fluid. HIV is found in lower concentrations in amniotic fluid, breast milk, saliva, sweat, tears, feces, and urine.

Infection of children with HIV can occur from an infected mother during pregnancy, childbirth, and breastfeeding. The probability of a child becoming infected from an HIV-infected mother is 25-50%. Infection is possible through blood transfusions containing the virus, when blood and biological fluids from HIV-infected people come into contact with unprotected skin and mucous membranes, in the case of using “contaminated” (insufficiently processed or reused) medical instruments, syringes, catheters. Infection can occur through sexual contact with someone infected or sick with HIV.

Homosexuals, drug addicts, people who are promiscuous, and patients with hemophilia are at risk of infection. The risk group also includes medical workers who, due to the nature of their work, are constantly in contact with the blood and biological fluids of patients.

Pathogenesis. The immunodeficiency virus enters the human body through damaged skin or blood. The virus shows particular selectivity for T-lymphocytes. Viral proteins are synthesized inside the infected cell, the virus penetrates the cell nucleus and integrates into the DNA, remaining latent for a long time. Rapid reproduction of the virus begins after immune stimulation of T-lymphocytes due to reinfection, under the influence of diseases, intoxication, and chemotherapy drugs. Disturbances in the system of cellular regulation of the immune response make an HIV patient vulnerable to infection and the development of tumors.

Clinicalpainting. The incubation period ranges from 3 days to 3 months. It often extends for up to 1-3 years. The body's primary reaction to the introduction of HIV is the production of antibodies. The clinical course of HIV infection is divided into three stages: / stage - asymptomatic. It includes periods of initial manifestations (acute infection), asymptomatic infection and persistent generalized lymphadenopathy.

Acute infection is detected in 50-90% of infected individuals. The duration of clinical manifestations varies from several days to several months. The clinical picture is manifested by sore throat, generalized enlargement of lymph nodes, enlargement of the liver and spleen, periodic fever, sometimes rash and diarrhea. Aseptic meningitis may develop.

Asymptomatic infection (virus carriage) is characterized by the absence of clinical manifestations of HIV infection. There may be a moderate enlargement of the lymph nodes. Diagnosis of this stage is based on epidemiological history and laboratory tests.

Persistent generalized lymphadenopathy is manifested by persistent, more than 3 months, enlargement of two groups of lymph nodes in the absence of objective reasons for their damage.

Lymph nodes are moderately enlarged (more than 0.5 cm in diameter), sometimes painful, not fused with the surrounding tissues and with each other, they can decrease and increase in size again. The duration of stage I can vary from 2-3 to 10-15 years. // stage -- pre-AIDS. Patients begin to exhibit clinical symptoms indicating deep damage to the immune system. Characterized by weight loss of more than 10%, unexplained fever for more than 3 months, unexplained diarrhea lasting more than 1 month, profuse night sweats, chronic fatigue syndrome. Bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the respiratory tract, which acquire a protracted course, are typical. The nervous system and internal organs are affected. Kaposi's sarcoma may be detected.

/// stage - AIDS. It is characterized by the development of severe, life-threatening secondary diseases and their generalized nature. Damage to the central nervous system and other organs and systems is irreversible. The death of the patient occurs within a few months.

HIV infection is characterized by a long course. In some cases, the disease develops more quickly and after 2-3 years it enters the terminal stage.

There are features of the course of HIV infection in young children. The disease is characterized by faster progression of the process compared to adults. The course of the disease is determined by the properties of the virus strain and the timing of perinatal infection of the child. The most common clinical signs are encephalopathy and delayed psychomotor and physical development. Thrombocytopenia is common, clinically manifested by hemorrhagic syndrome, which can cause death in children. More often than in adults, recurrent bacterial infections, enlarged pulmonary lymph nodes, and interstitial lymphoid pneumonitis occur. Kaposi's sarcoma is rare.

Laboratory diagnostics. Methods used to diagnose the disease are divided into three groups: 1) methods aimed at identifying specific viral antibodies - enzyme-linked immunosorbent assay (ELISA) reactions and immunoblotting (IB). In children born to seropositive mothers, maternal antibodies circulate in the blood during the first year of life. Therefore, detection of HIV antibodies is not sufficient to diagnose HIV infection; 2) methods that detect viral particles and other components of HIV in blood cells, saliva, tear and seminal fluid, as well as those obtained from the study of biopsies of organs and tissues. They are determined by the molecular biological method using polymerase chain reaction (PCR), DNA hybridization and DNA amplification; 3) methods based on identifying an immunodeficiency state. In general and biochemical blood tests, lympho- and thrombocytopenia, dysproteinemia, changes in the number and ratio of T-helpers and T-suppressors are determined (normally 1.6-2.2; in patients - less than 1).

The diagnosis of HIV infection in children is considered confirmed if: 1) an HIV-seropositive child or a child born to an HIV-infected mother under 18 months has a positive HIV test result in two blood samples taken at different times; 2) a child over 18 months has repeatedly detected anti-HIV antibodies in ELISA and IB or immunofluorescence reactions; 3) the child has an AIDS-indicating disease (candida cytomegalovirus, herpes, pneumocystis infections, cerebral toxoplasmosis, etc.).

Treatment. Modern therapy helps delay the development of the disease at intermediate stages, delaying the terminal phase. Basic etiotropic therapy includes antiviral therapy (aimed at containing the multiplication of the virus in cells) and chemoprophylaxis of secondary diseases.

The main antiviral drug is azidoti-midine (timazide, retrovir, zidovudine). To slow down the progression of the disease, combination therapy is used. It includes the prescription of three drugs: invirase (kriksivan etc.), azidothymidine, lamivudine (zalcitabine etc.). Sulfonamide drugs are used to prevent secondary diseases (biseptol, septrin, dapsoi), antifungal drugs (nystatin, fluconazole, ketoconazole), antituberculosis drugs (isoniazid, rifampicin). According to indications (in case of contact with chickenpox, measles), multicomponent immunoglobulin drugs are administered intravenously or intramuscularly. Lymphocyte transfusions and bone marrow transplants are performed. Symptomatic and restorative therapy is carried out according to an individual program.

Prevention. The World Health Organization (WHO) identifies four main areas of prevention.

HIV infection: 1) prevention of perinatal transmission of HIV during family planning; 2) prevention of transmission of infection through blood; 3) prevention of sexual transmission of infection; 4) organization of medical care and social support for patients, their families and others.

Prevention of nosocomial infection includes the use of single-use medical instruments, conducting research to detect HIV in donated blood, its preparations and other biological materials, strict adherence to the requirements of the anti-epidemic regime, and rules for sterilization of medical instruments.

Professionalinfectionhealth workers can be prevented by observing precautions when providing medical care and serving patients, transporting and working with blood and other biomaterials, and carrying out emergency measures in case of injuries.

When performing manipulations that violate the integrity of the skin and mucous membranes, conducting laboratory tests, processing instruments, linen, and cleaning, it is necessary to use personal protective equipment (surgical gown, cap, mask, goggles or shield, gloves, waterproof apron and oversleeves). Medical workers with injuries (wounds) on their hands, exudative skin lesions, and weeping dermatitis are excluded from medical care for patients and contact with items used to care for them during their illness. Medical instruments, equipment, linen, dishes contaminated with blood and biological fluids that come into contact with mucous membranes must be disinfected immediately after use. Disinfection regimes are similar to those used to prevent infection with hepatitis B, C, D.

Health care workers must take precautions when handling cutting and piercing instruments. To prevent injury from needles, they should not be reinserted into the sheath or removed from the syringe after injection. Used instruments, syringes with needles must be immediately placed in a container for disinfection (sterilizer, bin). Before immersing the syringe with a needle in the disinfectant solution, only the plunger is removed.

When collecting blood and other biological fluids, the use of glass objects with broken edges is not allowed. You cannot draw blood from a vein through a needle directly into a test tube (unless this is stipulated by the research technology). Any containers with blood and other biological fluids, tissues, or pieces of organs must be closed with plastic stoppers immediately at the collection site.

Transportation of blood samples and other biomaterials should be carried out in racks placed in containers (boxes or pencil cases) that prevent the opening of the lids along the way. It is prohibited to use cardboard boxes, wooden boxes, plastic bags for this purpose, or to place forms, directions or other documentation inside the container. To disinfect leaked liquid in the event of overturning or breaking of dishes, a 4-layer dry napkin or one soaked in one of the disinfectant solutions is placed on the bottom of the container. When sending blood for HIV testing, it is unacceptable to soak a napkin with chlorine-containing drugs.

Workplaces are provided with first aid kits for emergency prevention in emergency situations. Any damage to the skin, mucous membranes, or contamination with biological fluids of patients is regarded as possible contact with materials containing HIV and requires immediate implementation of measures to prevent infection.

Events V hearth. Anti-epidemic work begins from the moment positive test results for HIV infection are detected in at least two blood samples. Information is anonymously transmitted to the district and Republican AIDS centers (f. 264/u-88, 60/u-88), as well as to the donor center with a prohibition on the collection of donor blood. The HIV-infected person and his parents are informed in writing about the presence of the immunodeficiency virus in the body.

Among contacts, persons who could be infected are identified. The following are subject to medical supervision: 1) children born from an HIV-infected mother. They are followed for 18 months. HIV testing is carried out at 12 and 18 months; 2) contact persons from the source of HIV infection. They are observed for 1 year after cessation of contact with the infected person; 3) medical and other workers in the event of an accident - within 6 months. The examination is carried out immediately after the accident and after 6 months.

The importance of treatment with antiviral drugs is explained to children and parents. The duration of the latent phase and the risk of developing secondary infections depend on the state of the immune system. Therefore, a healthy lifestyle, balanced nutrition, adherence to a daily routine, and timely vaccination play a significant role in preventing an immunodeficiency state. Vaccinations for children with suspected perinatal HIV infection and HIV-infected people in the latent stage of the disease are carried out according to general rules.

The HIV-infected person and his parents are introduced to the essence of the disease, routes of transmission of infection and prevention of infection when caring for the patient. The importance of regular primary care is emphasized, the need to keep a diary recording symptoms of the disease and taking medications.

HIV-infected women are advised to avoid or terminate pregnancy, and pregnant women are advised to take antiviral medications throughout pregnancy and during childbirth. Delivery is carried out by caesarean section. It is recommended to feed the newborn with adapted milk formulas.

Security questions

1. Characterize the causative agent of HIV disease. 2. How does HIV infection occur? 3. Describe the clinical picture of the disease, features of manifestation in young children. 4. List the methods for diagnosing HIV infection. 5. What medications form the basis of treatment? 6. How is HIV infection prevented?"

Medical and psychological features of a nurse’s work with infectious patients

The psychology of an infectious patient differs markedly from that of somatic patients. This is due to the contagiousness of the infectious disease, the need to isolate the patient from family members and a change in the usual environment. Children often develop fear, and adolescents develop shyness and a feeling of unreasonable guilt before loved ones and relatives. Children try to hide the disease, harming the health of themselves and those around them, since those who continue to communicate with them are at risk of infection.

Hospitalization in the infectious diseases department is accompanied by fear of children and their parents of becoming infected with other infectious diseases. All this obliges the nurse to conduct individual health-educational and psychotherapeutic conversations with the sick child and his parents; explain the essence of infectious diseases, routes of infection and preventive measures; explain that isolation is temporary and is not caused by the severity of the condition, but by a real danger to others. The patient's relatives should be sufficiently informed about the degree of contagiousness or sanitization of the ill child, which will ensure the establishment of correct relationships between the former patient in the family and with others.

Parents and children should be convinced of the reliability of the preventive measures carried out in the department to ensure the prevention of nosocomial infections. Strict adherence by the medical staff of the department to the sanitary-hygienic and anti-epidemic regime will have a great psychotherapeutic effect. Reliability and demonstrativeness of disinfection measures calm the psyche of the patient and parents, make them more contactable, and instill confidence in recovery.

When working with HIV patients, deontological aspects are especially important. Due to the predetermined fatal outcome of the disease, the attitude towards the patient, regardless of the route of infection, should be imbued not with condemnation and fear, but with pain and compassion. The patient must have complete confidence in maintaining medical confidentiality. Only with this indispensable condition can one count on the patient’s frankness, which is so important when making a diagnosis and for specifying preventive measures.

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Signs and symptoms of hepatitis in children

A child can be infected with hepatitis while no one is aware of it, since in most infected children the disease has virtually no symptoms. In some children, the only signs of illness are general malaise and fatigue for several days. Some children may experience a high temperature, after which signs of jaundice will appear (the sclera or the whites of the eyes and skin become yellow). Jaundice is explained by a pathological increase in bilirubin (yellow pigment) in the blood, which occurs due to inflammation of the liver.

With hepatitis B, a child is less likely to develop a high fever, although in addition to jaundice itself, the child may lose appetite, experience nausea, vomiting, abdominal pain and general malaise.

If you suspect that your baby has jaundice, be sure to tell your pediatrician. Your doctor will ask you to take blood tests to determine whether hepatitis is the actual cause of your health problems or whether there are other causes. Be sure to tell your pediatrician if your child has vomiting and/or abdominal pain that continues for several hours, or for several days or longer, has no appetite, is nauseated, or has general lethargy. All these signs may indicate the presence of the hepatitis virus in his body.

Treatment of hepatitis in a child

In most cases, there is no specific treatment for hepatitis. As with most viral diseases, the body’s defense reaction, as a rule, copes with the infectious agent itself. You likely won't have to restrict your baby's diet or exercise too much, although you may need to make some changes depending on your baby's appetite and general activity level. Do not give your child medications that contain aspirin or acetaminophen, as there is a risk of toxic effects on the body due to liver dysfunction. In addition, the pediatrician should review medication dosages for young children who are receiving long-term treatment for other conditions to avoid the risk of toxicity resulting from the liver's inability to handle the usual dose of the medication.

There are only a small number of drugs available to treat hepatitis B and C. But most are not approved for use in children. If a child's hepatitis becomes chronic, the pediatrician will advise you on the specialist to whom you should contact to determine further care for the child and decide whether to use any medications.

In most cases, hospitalization for children with hepatitis is not required. However, if lack of appetite or vomiting affects the amount of fluid a child consumes and there is a risk of dehydration, the pediatrician may recommend hospitalization. If you notice that your child is very lethargic, unresponsive or delirious, contact your pediatrician immediately - this may mean that he has become worse and needs to be hospitalized. In many young children, hepatitis B develops into chronic hepatitis. After recovery, some of these children may develop cirrhosis (scarring of the liver). However, deaths are extremely rare. The hepatitis A virus does not cause any chronic disease consequences (for comparison, about ten out of every 100 carriers of the hepatitis B virus develop a chronic disease). Many more infants born to mothers with acute or chronic hepatitis B become chronic carriers of the virus if they do not receive a vaccine designed specifically to combat the hepatitis B virus. These children are chronic carriers of hepatitis B, which increases their risk of developing hepatitis B. further liver cancer.

There is now a vaccine that can protect your child from getting hepatitis A. This vaccine, first approved for use in 1995, is advised for use by some interstate travelers; adults whose occupation is associated with a risk of disease; as well as all children who live in states where the risk of disease is highest. Ask your pediatrician if the state you live in is eligible.

Treatment of viral hepatitis B and C is generally no different from the treatment of other hepatitis. Interferon preparations are widely used in treatment.

Prevention of hepatitis in a newborn baby

Using disposable syringes and needles, an individual toothbrush, trusted sexual partners, etc.
Vaccination. There are vaccinations, but, unfortunately, so far only against hepatitis B. The first vaccination is given to all healthy children while still in the maternity hospital. Vaccination is included, however, relatively recently, in the compulsory vaccination calendar for all children in our country. Older children are gradually being covered and are being vaccinated centrally in schools. You can read more about vaccination in the “Vaccinations” section. A vaccine against hepatitis C has not yet been developed.
Emergency prevention. Children who have been exposed to hepatitis B can receive passive immunization. Carried out no later than 4 days after contact. The child is injected with immunoglobulin, a protein that neutralizes the hepatitis B virus. Newborn children of hepatitis B-infected mothers are given immunoglobulin immediately after birth.

Hepatitis prevention

The most important measure to prevent hepatitis is washing your hands before eating and after using the toilet. If your child is staying in child care for any length of time, ensure that child care staff wash their hands after changing diapers and before feeding the child.

It is impossible to become infected with hepatitis if you are simply in the same room or children's day hospital with an infected person, while talking with him, by shaking hands or while playing. Hepatitis A is only transmitted when you come into direct contact with food or water contaminated with human feces. It can be spread through kissing, mouthing toys or eating from the same plate, or using the same toilet. Hepatitis B is only transmitted through direct contact with the blood or body fluids of an infected person.

If your child has been exposed to someone with hepatitis, tell your pediatrician right away, who can help determine whether your child is at risk for the disease. If you are at risk of infection, your doctor may give you a gamma globulin injection or a hepatitis vaccine, depending on the type of hepatitis you have been exposed to.
Before you take your child on a long trip, consult your doctor about the risk of hepatitis in the countries you are traveling to. In some cases, gamma globulin vaccine and/or hepatitis A vaccine may be prescribed.

Hepatitis A in a newborn baby

Epidemiology: Cases of prenatal infection are unknown. Even against the background of active hepatitis of the mother during childbirth, fecal-oral transmission of infection from her to the child is relatively rare. Cases of epidemics in departments due to improper sanitary and hygienic measures have been described.

Clinic and course: Jaundice and increased transaminase levels. Due to the long incubation period, the onset of the disease in most cases occurs after the neonatal period (>44 weeks).

Diagnostics: IgM in a child, transaminase levels. IgG circulates in the blood throughout life and can be passed on to a child from the mother.

Treatment: symptomatic.

Prevention: The standard dose of immunoglobulin is 0.2 ml/kg IM in the postnatal period. Change of gown and gloves when working with feces.

Forecast: Favorable. In some cases, a protracted course is noted. The mortality rate for fulminant hepatitis is about 40%.

Viral hepatitis B and C in children

Viral hepatitis B and C are liver diseases that are caused by the hepatitis B and C viruses (respectively). For more complete information about hepatitis, it is recommended that you read the chapter “Hepatitis”.

Viral hepatitis B and C share a common mechanism of infection transmission - parenteral.

Parenteral route of transmission of infection. This route of transmission can be described as “blood to blood.” In order to become infected, the blood of a sick person must enter the bloodstream. However, most doctors are inclined to believe that transmission of the virus through other biological fluids (sperm, saliva, breast milk, etc.) is quite possible.

So, the virus enters the blood:

When using poorly disinfected medical instruments: through infected syringes and needles (mainly among drug addicts, because now in medicine, as a rule, everything is disposable), during surgical operations, when visiting a dentist.
During sexual intercourse.
When transfusion of donor blood. Those children who, for health reasons, need constant blood transfusions, for example, patients with hemophilia, are especially affected.
During hemodialysis (artificial kidney machine).
During childbirth and breastfeeding from an infected mother to an infant.
When using combs, toothbrushes, nail scissors, etc., shared with the patient.

It is believed that when living together with a carrier of the hepatitis B or C virus, sooner or later the person becomes infected. Therefore, a special risk group consists of children from families where there is a carrier of the virus, as well as children from orphanages and boarding schools, where contacts between children are close and constant.

It happens when the same person is diagnosed with both hepatitis B virus and hepatitis C virus at the same time.

There are other hepatitis that are transmitted through blood: hepatitis D, hepatitis G. Hepatitis D develops only if the child has hepatitis B, making its course more severe. Hepatitis G is still poorly understood. Science is moving forward, and perhaps soon scientists will discover other hepatitis viruses.

What are the dangers of viral hepatitis B and C?

There are acute and chronic courses of the disease. In an acute case, a person recovers quickly and soon forgets about this unpleasant fact of his biography, since his health does not suffer subsequently. But if the disease becomes chronic, the virus remains living in the liver cells, which is fraught with serious damage to it, including the development of cirrhosis. What is cirrhosis? This is the progressive death of liver cells, the replacement of working cells capable of performing the functions of purifying the blood of toxins, producing bile, proteins, etc., with connective tissue that does not possess these properties. Moreover, this process cannot be stopped.

Hepatitis B and C is a very insidious infection. The likelihood of contracting the chronic form of hepatitis is high. Moreover, the disease often occurs in a chronic form immediately, bypassing the acute one. In medicine this is called primary chronic hepatitis. A person may not even know for years that he has been infected, but meanwhile the virus does its dirty work: it destroys liver tissue, and its cells gradually turn into useless connective tissue. Viral hepatitis C is especially aggressive in this regard.

Acute course. The incubation period (see) of hepatitis B is 2-6 months, hepatitis C is 6-12 weeks. Variants of the course of acute hepatitis:

1. Typical icteric form. The onset of the disease is gradual. First, your health worsens, your temperature rises moderately (may remain normal), muscle and joint pain, and headache appear. Nausea, vomiting. After some time, the urine darkens (becomes the color of beer) and the feces become discolored. This condition lasts 7-14 days. Then jaundice appears. With its appearance, the patient’s condition does not change or may worsen. In severe cases, nasal and uterine bleeding occurs, increased bleeding of the gums, and bruises on the skin. The disease ends either in recovery or in transition to a chronic form.

2. Anicteric form. The disease is limited to deterioration of the general condition. There is no jaundice.

3. Lightning form. Occurs in approximately 1% of cases of acute hepatitis in children with good strong immunity. The response to the infection is so violent, and the body wants to get rid of the infection so much that it begins to destroy liver cells along with the virus. Over the course of 1-2 days, the patient's condition progressively worsens with the gradual development of depression of consciousness and coma. The prognosis is usually unfavorable. Treatment in the intensive care unit of the hospital.
Diagnosis of viral hepatitis is carried out by determining hepatitis markers in the blood. This method can determine what kind of hepatitis a person has been sick with, for how long and what form it has, acute or chronic.

Chronic course. Causes of development of chronic hepatitis B and C:

Primary chronic hepatitis.
Transition of acute hepatitis to chronic. For hepatitis B, the transition from acute to chronic form is rare, according to various sources, from 1 to 10% of cases. As a rule, the chronic form develops immediately.

On the other hand, acute hepatitis C becomes chronic in 50% of cases. An interesting fact: the more severe acute viral hepatitis C is, the more pronounced the jaundice, the less likely it is to become chronic. Doctors explain this by saying that the immunity of children who vigorously resist infection is strong and is capable of completely suppressing and eliminating the virus.

The following variants of the course of chronic hepatitis are possible:

Chronic carriage. An infected person is a carrier of the virus, but this does not affect his health in any way. It is dangerous because it can infect others. Chronic carriage can result in the transition to disease, and the longer a person is a carrier, the less likely this is.

Chronic inactive hepatitis. This is a benign course of chronic hepatitis. Although the liver tissue is affected, the process is not active. There is no transition to liver cirrhosis with this course.

Symptoms. Typically, children complain of increased fatigue, abdominal pain that appears during physical activity or poor diet, a feeling of heaviness in the right hypochondrium, and nausea. The child's liver and spleen are enlarged. There is no jaundice.

Chronic active hepatitis- the most severe course of chronic viral hepatitis. The virus behaves very aggressively towards the liver, and the disease often ends in cirrhosis. Chronic hepatitis C takes on this course especially often.

Symptoms. Children get tired quickly, have decreased attention, increased excitability and irritability, and often experience abdominal pain. During exacerbations, jaundice, nosebleeds, and bruises on the body may appear. The child's liver is significantly enlarged and dense, and the spleen is also enlarged. The condition is progressively worsening.

Hepatitis A in children is a form of viral disease of the liver tissue, also known as infectious hepatitis. It is a highly contagious disease due to its ability to spread through personal contact. It is a milder liver disease than hepatitis B. The disease very often occurs with absolutely no external symptoms or deterioration in health, especially in children. Hepatitis A does not cause liver failure or chronic liver disease. Once the infection is completely sanitized, all symptoms disappear and no destructive consequences remain.

It should be taken into account that relapses of the disease often occur in medical practice. Their symptoms appear mainly 1 month after the sick child has completely healed.

Routes of transmission of hepatitis A virus

From the onset of the disease, the hepatitis A virus is found in large quantities in the stool (feces) of persons infected with this pathogen. It is usually spread from person to person when objects or particles of substances contaminated with fecal fragments from an infected person enter the mouth. This route of transmission is called the fecal-oral route. Thus, it spreads more easily in areas where there are poor sanitation conditions or where personal hygiene is not observed. Most viral hepatitis infections occur in children as a result of contact with another family member who is infected with the disease. Transmission of the virus through blood is possible, but extremely rare.

Common routes of transmission of hepatitis:

consuming food that has been produced by a person who has come into contact with contaminated excrement;
through drinking water contaminated with infected feces (the problem is more common in areas with poor sewage treatment facilities);
contact with the stool of an infected person, which can occur due to poor hand washing;
overcrowding of children in children's institutions; kindergartens in which there are children who are not potty trained are especially susceptible to the spread of infection.

Hepatitis A has a uniform distribution in children throughout the world and is endemic in most countries. However, the incidence is declining in developed countries. There is a very high risk of infection and morbidity in developing countries and rural areas. For example, in rural South Africa, the infection rate is 100 percent.

According to the Medical Centers for Disease Control, hepatitis affects up to 200,000 young Russians every year. The highest incidence of viral hepatitis A is observed among children aged 5 to 14 years. Almost 30% of reported infections occur in children under 15 years of age, mainly because they are often in close contact with other children at school and daycare. About 15 percent of registered cases of disease are recorded among children and staff in kindergartens.

In our country, hepatitis among children is most common in the central regions and the Volga Federal District. To a lesser extent, the virus is found in Siberia and the Far East. There is a high probability of infection in the southern regions and regions of the North Caucasus.

Symptoms of hepatitis A in children

Hepatitis A is caused by an enterovirus that was identified in 1973. It has an incubation period of three to five weeks. After entering the body through the oral cavity and intestines, it multiplies in the gastrointestinal tract and spreads to the liver parenchyma, where its vital activity and further reproduction occur. Hepatitis A virus is shed in a child's stool for two weeks before the onset of clinical symptoms.

People with hepatitis A may not have any signs or symptoms of the disease. A full-fledged clinical picture often develops in elderly or weakened people. Symptoms are nonspecific in many cases and usually include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and (yellowing of the skin and eyes). Viral hepatitis A produces symptoms in children after the end of the incubation period. In some cases, the clinical picture may develop 6 months after infection.

What signs of hepatitis A require immediate medical attention?

Parents should consult a doctor immediately if they experience at least one of the following symptoms:

the child shows changes in his behavior, becomes absent-minded, has difficulty waking up in the morning, becomes lethargic or irritable;
the child begins to drink a lot of fluids;
the sclera of the eyes and skin of the child are yellow;
the child has signs of dehydration, such as no urine for eight hours or dry mouth;
the child begins to look very bad;
appetite is impaired;
the child's urine turns red;
vomiting and refusal to eat are periodically observed;
The baby complains of itchy skin.

Diagnosis and testing for hepatitis A

To establish an accurate diagnosis of viral hepatitis type A in children, a combination of medical history, clinical symptoms and specific tests is required.

Biochemical tests for hepatitis A, which include elevated liver tests and transaminases, allow one to suspect the disease. There is also a special blood test that allows you to determine antibodies to the hepatitis virus in a child’s blood. According to laboratory data, the diagnosis is finally established and the patient is sent to the infectious diseases department. Complete isolation from other children is necessary to prevent transmission of the infection to others.

It is not always possible to establish a diagnosis based on complaints and clinical symptoms due to the blurred picture of the manifestation of the disease in children. Yellowness of the sclera and skin can be caused by mechanical reasons. Redness of urine can also be observed when the baby's diet changes. For example, red urine may be associated with eating beets.

Hepatitis A is one of the types of viral hepatitis, which is an acute, cyclical disease with damage to liver tissue and impaired liver function. Only people get hepatitis A. Over 60% of all patients with hepatitis A are children. The infection is common throughout the world, but in developed countries the incidence is much lower.

The disease can occur in sporadic cases and in the form of outbreaks (usually in children's groups). In the Russian Federation, about 200,000 children become ill with viral hepatitis A every year. Mostly children in the age group 3-14 years old are affected, which is associated with closer contact in kindergartens and schools. Babies under one year old rarely get sick (they are protected by transplacental immunity).

Hepatitis A differs from other viral hepatitis in its milder course. In many cases, it can occur (especially in children) in an atypical form (without external manifestations).

Reasons

Hepatitis A virus is an RNA virus related to enteroviruses.

Liver damage in hepatitis A is caused by an RNA virus belonging to the group of enteroviruses. It dies under the influence of chlorine-containing disinfectants, formaldehyde, and ultraviolet rays. In the first minute, the virus dies even when heated to 85 °C.

Susceptibility to the virus is high: the vast majority of adults have antibodies to it. The incidence prevails in the autumn-winter period. After the disease, a strong immunity is formed that protects against its re-development.

The source of infection is a person who has hepatitis A in a typical or atypical form, and a virus carrier. Patients with an atypical form of the disease pose the greatest epidemiological danger, since their infection is not diagnosed, they are not isolated and continue to spread the virus.

The virus is excreted from the body of an infected patient in urine and feces. The mechanism of infection is fecal-oral. The virus also enters the blood, but does not remain there for long, so infection through the blood is possible, but in very rare cases.

Hepatitis A virus infection can occur:

food;
water;
contact and household ways.

The occurrence of epidemics in a populated area is usually associated with waterborne infection.

Family foci of the disease arise from contact-household infection or food spread of infection (a sick family member who did not follow the rules of personal hygiene prepared food).

The spread of infection is facilitated by unsanitary conditions, and in children's groups - by overcrowding of children. The airborne route of infection has not been confirmed. The virus also does not penetrate the placenta.

Viruses enter the body of healthy children through the mouth if hygiene rules are not followed. Waterborne spread is possible if water treatment facilities are in poor condition. That is why viral hepatitis A is included in the group of intestinal infections. When the virus enters the intestine, it is absorbed into the blood and then penetrates the liver, where it infects hepatocytes (liver cells).

As a result, all types of metabolism (carbohydrate, fat, pigment, protein, etc.) are disrupted. This leads to a decrease in the synthesis of albumin, vitamins, blood clotting factors, and glucose absorption suffers.

Due to impaired membrane permeability, cytolysis develops in liver cells, the cells die, but massive tissue necrosis does not occur in hepatitis A. During the period of convalescence, the process stabilizes, the liver tissue is restored, and no destructive changes remain. This hepatitis is not characterized by a chronic course.

Classification

Hepatitis A is classified by type, course and severity.

They are classified according to the type of hepatitis:

Typical (icteric) forms:

mild (50% of cases);
moderate (about 30%);
heavy (1-3%).

Atypical forms (all mild) account for about 20% of cases:

anicteric;
erased;
subclinical.

The severity is determined by the severity of jaundice and intoxication, and the results of a biochemical blood test.

With mild hepatitis A, there are mild manifestations of intoxication, a moderately enlarged liver, jaundice lasts 7-10 days, and the size of the liver returns to normal after 25-35 days. In 5% of cases, a protracted course is observed.
In the moderate form, the intoxication syndrome is more pronounced and persists for up to 2 weeks, jaundice can be significant, lasting up to 2-3 weeks, the enlarged liver size normalizes only after 40 days. In 3% of cases, a protracted course is observed.
In severe forms, both jaundice and intoxication are pronounced. With the appearance of jaundice, the intensity of intoxication not only does not decrease, but even increases. Characterized by bleeding, slow pulse, and decreased urine output per day. There is a significant increase and soreness not only of the liver, but also of the spleen.
With icteric hepatitis A, a cholestatic form can develop as a result of impaired outflow of bile and its stagnation in the intrahepatic bile ducts. Intense jaundice lasts up to 40 days or longer. The skin takes on a saffron (greenish) tint. Characterized by severe itching of the skin, dark color of urine and gray,. However, intoxication is not pronounced, the liver is slightly enlarged. Despite the long course, the cholestatic form of hepatitis A has a favorable outcome.

The course of hepatitis A is:

sharp;
protracted;
smooth with and without exacerbations;
unsmooth, with complications and relapses.

Acute hepatitis A lasts 2-3 months. A protracted course is diagnosed when the duration of the disease is from 3 to 6 months or more, but hepatitis ends in recovery in this case.

An exacerbation of hepatitis A is called a deterioration in biochemical analysis against the background of an ongoing process. Relapse of hepatitis A is the return of manifestations of the disease after recovery.

A complication of hepatitis can be damage to the bile ducts, diagnosed during laboratory examination and ultrasound.

Symptoms

One of the manifestations of the pre-icteric period of hepatitis A is abdominal pain.

The cyclical nature of hepatitis A consists in the presence in cases of a typical course of such periods of the disease:

incubation (hidden);
preicteric;
icteric, or the height of the disease;
post-icteric;
restorative, or convalescence stage.

The incubation period can last 7-50 days (usually 2-4 weeks). During this period, it is already possible to detect the virus antigen in the blood of infected children. The virus is excreted from the child’s body in feces 2 weeks before clinical manifestations.

The prodromal, that is, pre-icteric period (sometimes called the initial period), can manifest itself in different ways. Its variants are the following syndromes:

Catarrhal, or flu-like: has an acute onset, the temperature rises, catarrhal symptoms appear in the form of a sore throat, runny nose, cough, and loss of appetite. Possible nosebleeds. The child may even be diagnosed when visiting a clinic.
The dyspeptic, or gastric, variant is manifested by abdominal pain (in the stomach or right hypochondrium), nausea, vomiting,. There may be a bowel disorder. Parents often associate these manifestations with the food they eat and consider them food poisoning.
The asthenovegetative variant is characterized by manifestations in the form of headache, severe weakness, drowsiness, increased fatigue, and decreased appetite. The child is capricious and not interested in games.

In mild forms, hepatitis A may begin with dark-colored urine. Upon examination, already in the initial period, one can detect enlargement and tenderness of the liver. At the end of the period, urine becomes the color of strongly brewed tea. The pre-icteric period lasts 3-8 days.

During the peak period, the main symptom is jaundice. With the appearance of jaundice, the patient's well-being improves. The yellow color first appears on the sclera, oral mucosa, and then on the skin of the face, quickly spreading throughout the body and limbs. During this period, urine remains a rich dark color, and feces are discolored, gray, like clay.

At the height of the disease, the liver is at its maximum size and is painful to touch. Jaundice lasts 1-2 weeks in mild cases, up to a month in moderate cases, and up to 6 weeks in severe hepatitis. The order in which jaundice disappears is the reverse of its appearance, that is, jaundice persists longest on the sclera.

In the post-icteric period, the child’s health is good, but the liver remains enlarged, and the increased activity of liver enzymes (transaminases) also persists.

During the recovery period of hepatitis, you feel good, but you may experience fatigue, and possible abdominal pain after physical activity. The size of the liver is normalized, its functions are restored. The recovery or rehabilitation period lasts on average 3 months.

Hepatitis A in children can occur in one of the atypical forms:

Anicteric form: clinical signs are limited to symptoms characteristic of the pre-icteric period. Jaundice does not occur, although the liver is enlarged and the activity of liver enzymes (transaminases) is increased. This form is diagnosed in children most often during outbreaks in children's groups. In sporadic cases, as a rule, other diseases are diagnosed (acute respiratory infections, etc.). Children with the anicteric form are contagious to others.
In the erased form of hepatitis A, the typical symptoms of hepatitis are present, but are mild. There are usually no signs of intoxication. The liver is slightly enlarged. This form of hepatitis A is also not always diagnosed.
In the subclinical form of hepatitis, the child’s health does not suffer and there are no manifestations of the disease. This form can only be diagnosed in children who have been in contact with someone with hepatitis. The diagnosis is established by the results of a blood test using ELISA (detection of specific class M antibodies to the hepatitis A virus).

Diagnostics

When making a diagnosis of hepatitis A, information on the epidemiological situation, the presence of obvious contact with a person with viral hepatitis, complaints and clinical signs of the disease are taken into account. Laboratory diagnostic tests are of primary importance.

The following methods can be used:

Biochemical analysis of blood serum: in the case of the icteric form of hepatitis, there is an increased level of bilirubin (due to its direct fraction), changes in sedimentary protein samples (sulem and thymol), an increase in the globulin fraction and a decrease in albumin. In all forms, the activity of the enzymes AlAt and AsAt (transaminases) will increase.

This is a nonspecific analysis, but the level of bilirubin and enzyme activity is necessary to assess the severity of the process in the liver and monitor the dynamics of the disease. By determining enzyme activity, early diagnosis of hepatitis is possible.

In an enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIM), specific antibodies (class M and class G) are determined, which make it possible to establish the exact cause of hepatitis and track the dynamics of the disease.
The PCR blood test is also specific: hepatitis A virus RNA can be detected already in the initial period.
A blood coagulogram test is used in severe cases of hepatitis and the risk of bleeding to assess the coagulation system.
A general blood test makes it possible to diagnose the presence of an inflammatory process in the body.
Urinalysis: in the case of the icteric form of hepatitis, urobilin and bile pigments are detected.

Of the hardware diagnostic methods, ultrasound is prescribed: the size and structure of the liver and spleen are determined.

Treatment

Milk and dairy products can be a source of protein for a child suffering from hepatitis A.

Treatment of children with a mild form of hepatitis A is carried out at home with semi-bed rest. Moderate and severe forms of hepatitis are treated in an infectious diseases department. Such children are prescribed bed rest for 3-5 days. After the symptoms of intoxication disappear, the patient is transferred to semi-bed rest.

An important point in treatment is adherence to diet No. 5. The child's nutrition should be high-calorie and complete, proteins, fats and carbohydrates in a ratio of 1:1:5, respectively.

The patient can obtain proteins from the following products:

lean fish;
lean meat;
protein omelet.

Vegetable oil and butter will provide the supply of fats, and margarine, shortening, and lard should be excluded.

The intake of carbohydrates into the body will be ensured by the following foods in the diet:

wheat bread (slightly dried);
(buckwheat, semolina, rice, oatmeal);
pasta;
sugar and (in the absence of allergies).

The diet should include sufficient quantities of fruits and dried fruits (dried apricots, raisins, prunes), and vegetables. Dishes can be cooked boiled or steamed, but fried ones are completely excluded.;

pastries and cakes;

halva.

Food should be consumed warm. The child should be fed in divided portions 5-6 times a day.

Drug treatment includes drip injection of the necessary solutions into a vein (Reamberin, 10% glucose solution, Reopoliglyukin, etc.) for severe forms of hepatitis to relieve intoxication. Enterosorbents (Enterosgel, Polysorb, Enterodes) and vitamin complexes are prescribed for the entire period of the disease.

During the recovery period, hepatoprotectors (Enerliv, Essentiale-Forte, etc.), choleretic drugs are used - first, the doctor may prescribe cholekinetics that improve the outflow of bile (Flamin, magnesium sulfate, etc.), and then choleretics during the rehabilitation period, promoting bile secretion (Cholenzim , Allohol, etc.). For cholestatic hepatitis A, Ursosan or Phosphogliv can be used.

The question of a child’s admission to the children’s group and school is decided by the attending physician. Children are exempt from physical education classes for a period of 3-6 months, depending on the severity of the illness. You can play sports after six months to a year (the doctor decides the issue individually for each patient).

After completion of treatment, the child should be monitored over time. An examination and blood test (biochemical) is carried out a month later by a doctor at a hospital or a specially organized office for those who have recovered from hepatitis. If there is no such office, a pediatrician observes. A repeat examination with a biochemical blood test is carried out after 3 months. If there are no clinical manifestations and the analysis is without deviations from the norm, the patient is removed from the register.

The outcome of viral hepatitis A in most cases is favorable - the child recovers completely, the liver structure is restored.

Some children are left with lifelong enlarged livers. A complication in the form of inflammation in the bile ducts is also possible. It can occur due to activation of microflora and appear 2-3 months after recovery. The child will feel pain in the liver area and nausea.

Prevention

Preventive measures include impact on:

Source of infection:

isolation of patients for a period of 3 weeks from the onset of jaundice;
monitoring contacts in foci of infection for the purpose of early detection of the disease;
laboratory examination of contacts to identify atypical forms of hepatitis A.

Transmission routes:

teaching children from an early age hygiene rules;
ensuring high-quality water purification in the water supply system;
disinfection in the outbreak (current and final).

Body sensitivity:

increasing immunity in the child’s body;
vaccination against hepatitis A for children after one year of age.

Summary for parents

Despite the fact that hepatitis A most often occurs in a mild form with a favorable outcome, it is better to prevent this infection in children by using vaccination against hepatitis A.

If a child does not have this vaccination and if contact with a patient occurs, one should carefully monitor the behavior and condition of the children and carry out the recommended examinations so as not to miss the development of an erased, anicteric form. Lack of diet and restriction of physical activity if these forms of hepatitis are not detected leads to damage to the child’s biliary system.

Pediatrician E. O. Komarovsky talks about viral hepatitis:

Hepatitis A is called the disease of unwashed hands. Due to its spread through poor hygiene, viral hepatitis A occurs much more often in children than in adults. The disease is a food infection that affects the liver. Despite its similarity to ordinary poisoning, the disease poses a serious danger to the life and health of the child.

What is a disease?

Hepatitis A (Botkin's disease) is a disease that is accompanied by intoxication of the body and impaired liver function. Botkin's disease belongs to viral hepatitis. It is less dangerous than other types of disease, but the most common. It occurs only in acute form and is well treated with timely diagnosis. After recovery, you need to monitor the child’s condition, because a relapse of the disease often occurs.

Epidemiology

The causative agent of Botkin's disease is a virus that belongs to the Picornaviridae family. It tolerates exposure to the external environment and freezing well (at a temperature of 20 degrees it can live for a long time). The virus can be destroyed by sterilization at 120 degrees, ultraviolet light, formalin and disinfectants.

The source of the disease can only be an infected person. From the second half of the incubation period, a virus is detected in human secretions, which, when it enters another organism, infects it. Children under 12 years of age, groups on camping trips, and children attending childcare centers are most susceptible to the disease. Most patients occur in the summer - autumn period.

The causative agent of hepatitis A enters the body through the fecal-oral route. The virus is found in feces, urine, menstrual fluid and semen. When these substances get into water and food, the virus retains its properties. Eating contaminated foods leads to infection in the child's intestines. There it begins to have a detrimental effect on the liver and digestive system.

There is another method of infection - through household contact. It is less common than fecal-oral. In the case of this route of infection, the disease in children occurs as a result of using the patient’s personal belongings. Most often, the disease affects children living in regions with unsanitary conditions.

Incubation period and pathogenesis

Botkin's disease develops gradually and includes 5 stages. In a typical icteric form, the following stages of the disease are distinguished:

The incubation period lasts 3−5 weeks. The virus enters the gastrointestinal tract, and from there into the liver. In the largest gland, it multiplies and disrupts the normal functioning of the organ. During the incubation period, no symptoms of the disease are observed.
Pre-icteric stage. The period of the first signs of intoxication: fatigue, loss of appetite, constant nausea, pain in the right hypochondrium, elevated temperature up to 38.5 degrees.
Jaundice period. A week after the first signs, symptoms characteristic of hepatitis appear - yellowing of the skin and whites of the eyes, itching of the skin, darkening of urine, discoloration of feces. The child has an enlarged liver. The most severe period of the disease lasts about 10 days.
The patient's condition improves - the jaundice goes away, the liver stops hurting, its size returns to normal.
Regression of hepatitis occurs 3 months after the onset of the disease.

In addition to the typical icteric form, there are the following types of hepatitis A:

Atypical jaundice is a rare type that occurs mostly in adolescents. It is characterized by mild intoxication, but pronounced itching and jaundice.
Anicteric. It is characterized by mild symptoms, which are often not given importance. As a result, the disease starts.
Hardware and subclinical - the child does not have most of the signs of the disease. There is only an enlargement of the liver.

Symptoms of hepatitis A in children

Symptoms of hepatitis A in children depend on the form of the disease. It can occur in 3 forms: mild, moderate and severe. The mild form is the most common, occurring in 50% of cases. It is characterized by the following manifestations:

mild intoxication (diarrhea, nausea);
slight increase in temperature;
slight enlargement of the liver;
jaundice, which goes away quickly.

Moderate form of hepatitis is typical for 30% of patients. The illness lasts longer than with mild severity. In the case of such a course of the disease, the following signs of hepatitis are observed:

significant yellowing of the skin and mucous membranes;
painful sensations in the right side;
When examining the liver, a dense edge is detected;
decrease in the amount of urine.

Severe severity is less common than others - up to 10% of cases. Patients experience the following phenomena:

severe intoxication;
sudden weight loss;
apathy and fatigue;
nosebleeds;
sharp enlargement of the liver and spleen;
prolonged jaundice.

Features in children under one year old

More than 60% of those infected with hepatitis A are children. Children aged 3 to 8 years are most often affected. The disease does not occur in babies under one year of age, because they are protected by transplacental immunity - antibodies transmitted from the mother. If the mother has hepatitis, problems during pregnancy, miscarriage and premature birth are possible. To avoid all complications, the woman is hospitalized. Hepatitis A is not transmitted during childbirth or breastfeeding. If you adhere to the rules of hygiene, then Botkin’s disease is not scary for your baby.

Diagnostics

When symptoms characteristic of Botkin's disease appear, you need to undergo the necessary tests to confirm the diagnosis. Diagnosis of hepatitis A in children includes the following examinations:

The hepatitis A test determines the presence of antibodies to the virus in the blood serum. This analysis is the most common in the process of identifying the disease and makes it possible to detect the virus 5-10 days before the appearance of the first symptoms.
Ultrasound of the liver and spleen reveals enlargement of organs and may indicate Botkin's disease.
Urinalysis. With hepatitis A, the urine becomes dark, and protein and blood are also possible.
Coagulogram - test for blood clotting. Deviation from the norm in the direction of decrease indicates disorders in the functioning of the liver.

To diagnose hepatitis A, in addition to clinical signs, laboratory results are necessary.

A rapid test for determining the antigen of the hepatitis A virus can independently detect the disease. The test detects the disease in the blood and stool. The pharmacy sells special kits “Vegal” and “Vitrotest HAV-IgM”. Their reliability according to the manufacturer is 99%. To make an accurate diagnosis if the test result is positive, it is advisable to undergo laboratory tests in the hospital

Treatment of the disease

Treatment of hepatitis A in children requires medication and special measures. Measures aimed at combating the virus include:

hospital regime;
special diet;
the use of special drugs - hepatoprotectors, choleretic and anti-intoxication agents;
consumption of vitamins.

Sick children are placed in separate rooms in the hospital. The duration of stay in a medical institution is 15-30 days, subject to recovery. Then the infected person is registered at the dispensary. On the 45-60th day from the onset of the disease, the child is examined, and after 90 days - again. Based on the examination data, the patient is removed from the register or the disease continues to be treated.

A special diet aimed at nutritious and high-calorie nutrition is very important in the process of combating hepatitis A in children. During it, fatty, smoked, pickled foods, fried foods, canned food, meat broths, sour cream, coffee and all types of alcohol are excluded. It is recommended to consume low-fat cheese, vegetarian and dairy soups, cereals, kefir, yogurt, pasta, low-fat meat and fish. It is also important to drink a lot of water during illness.

Prescribing diet and hepatoprotectors has an important role in the treatment of hepatitis A.

To protect the liver during treatment, the child is given Phosphogliv or Liv 52. Choleretic drugs are very important in the treatment process. Children can be given cholecestic drugs - “Flamin”, “Berberine”. Sorbents will help overcome body intoxication. For this purpose, Enterosgel and Enterodes are prescribed. If a child has liver cell damage, the doctor prescribes antiviral drugs - Interferon, Viferon, Intron-A. The use of vitamins is no less important during the therapy process. Doctors recommend taking B vitamins (BP B2, B6), C and PP. The course of admission is from 10 to 15 days.