Infectious disease in the Botkin department what is happening. What is Botkin's disease and what are its symptoms? Botkin's disease: treatment

Botkin's disease is a disease whose pathomorphological manifestations are localized exclusively in the liver, characterized by a favorable course and viral origin. Not only every adult, but also a child should know how Botkin’s disease is transmitted and how to avoid infection, since this category belongs to a risk group for infection. The causative agent of Botkin's disease is prone to rapid spread through contaminated food and household items, therefore the most favorable conditions for its life are inadequate sanitation and lack of personal hygiene.

The fundamental difference between Botkin's disease and other viral diseases is that this pathology is not prone to chronicity due to the absence of a degenerative effect on the liver parenchyma. The development of a fatal outcome in Botkin's disease is possible only in the case of a complicated course, which is extremely rare and is rather an exception to the rule.

Cases of Botkin's disease have recently been observed in the form of outbreaks, although previously there were entire epidemics of this infectious pathology throughout the world, which developed with some cyclicity.

Among all toxic infections, Botkin's disease makes up the overwhelming majority. The causative agent of Botkin's disease exists for a long time in environmental conditions and is resistant to most food production processes that are routinely used to inhibit bacterial pathogens.

Botkin's disease leads to economic and social losses, due to the fact that treatment and recovery of patients usually take a long period of time, so the issue of preventing this infectious pathology is an extremely important link.

Causes of Botkin's disease

The main source of the spread of infection in Botkin's disease is a person who has a clinical picture of this pathology and, along with infected feces, releases virions into the environment. The causative agent of Botkin's disease is pathogenic in humans and is extremely resistant to environmental factors. It should be taken into account that not only the sick person, but also the virus carrier can act as a source of spread of the virus in Botkin’s disease.

In addition to the presence of the virus in the stool of patients with Botkin's disease, the pathogen is concentrated in large quantities in the blood. Infection with Botkin's disease can be carried out by almost any method, however, the predominant ones are fecal-oral and water. The maximum danger in relation to the epidemiology of the spread of the Botkin disease virus is hidden virus carriers, which include patients with a latent course of the clinical picture.

The pathogenesis of the development of Botkin's disease is that the virus spreads hematogenously throughout the body and concentrates in the liver, provoking inflammatory changes in its parenchyma. Botkin's disease leads to disruption of the bilirubin-excreting function of hepatocytes, which is accompanied by excessive accumulation of bilirubin in the circulating blood, provoking the development of jaundice. In Botkin's disease, viral particles multiply in the cytoplasm of hepatocytes, after which they enter the intestine en masse with bile, moving along the bile ducts. Persons who have recovered from this disease acquire a lifelong immune response, which does not protect convalescents from infection with other types of viral hepatitis.

Botkin's disease can be confidently classified as a childhood infection, although most cases of this pathology in children are not registered, as they occur in an asymptomatic form.

Symptoms and signs of Botkin's disease

Botkin develops in stages. This pathology is characterized by the presence of a long prodromal period, which is manifested by febrile and dyspeptic syndrome, which are manifested by malaise, a feeling of weakness, decreased appetite, belching, nausea and vomiting of eaten food, pain in the right hypochondrium, and an increase in body temperature to 38.5 ° C.

The development of clinical manifestations of the icteric period in Botkin's disease is very rapid and is accompanied by an improvement in the general condition of the patient. First of all, jaundice appears on the mucous membranes and sclera, and later spreads to the skin of the entire body. The increase in jaundice occurs gradually, in contrast to the manifestations of the incubation period, and takes about a week. Jaundice in Botkin's disease is most often accompanied by the development of adynamia, headache, insomnia, skin itching, and irritability.

Objective signs of Botkin's disease are considered to be a slight or significant increase in the size of the liver, the edge of which is somewhat compacted and sensitive to palpation. In some situations, hepatomegaly is combined with an enlarged spleen. Darkening of urine in Botkin's disease is caused by the concentration of urobilin in the urine, and due to insufficiency of bilirubin in the intestines, stool becomes discolored. Laboratory criteria for the icteric period in Botkin's disease are leukopenia and a slight increase in the concentration of bilirubin in the blood serum to 8 - 10 mg%. With a protracted course of Botkin's disease, an increase in the icteric period to several months is noted.

The duration and intensity of clinical manifestations in Botkin's disease can vary significantly. The incubation period of Botkin's disease, as well as jaundice, with a mild course, is short-lived. In this situation, a good help is the use of laboratory diagnostic methods in the form of determining aldolase activity, which increases several times.

The severe course of Botkin's disease is characterized by the development of neuropsychic disorders in the form of lethargy, drowsiness, as well as pronounced intensity of jaundice, and the appearance of a diffuse petechial rash on the skin. Laboratory signs of severe Botkin's disease are an increase in the level of bilirubin in the circulating blood to 20 mg%, the thymol test to 20 - 24 units and a simultaneous decrease in the mercuric test to 1.4 - 1.1 units.

The malignant course of Botkin's disease, which is called “acute liver dystrophy,” is accompanied by the development of diffuse massive necrosis of the liver and the formation of irreversible dystrophic changes in its parenchyma. Clinical markers of this form of Botkin's disease are progressive liver shrinkage, jaundice, general severe intoxication syndrome, profound disturbances in the activity of the structures of the central nervous system with the development of hepatic coma.

Signs of toxic liver necrosis, which is one of the forms of Botkin’s disease, are the development of persistent anorexia, nausea, repeated episodes of “coffee grounds” vomiting, increasing general weakness, lethargy, apathy, drowsiness during the day and insomnia at night. Hepatomegaly gives way to sclerotic changes in the liver, and the consistency of the parenchyma becomes soft. Pathognomonic signs of the development of neurological changes are the appearance of patient agitation, increased tendon reflexes and tremor, and with progression, coma develops.

Botkin's disease in children

Botkin's disease develops equally often in children of different ages. The incubation period of Botkin's disease in children ranges from 15 to 40 days, and the duration of the prodromal period is much shorter than in adults. It is characterized by general malaise, dyspeptic disorders in the form of loss of appetite, nausea, vomiting, belching, constipation, pain in the epigastric region, as well as signs of catarrh.

The development of jaundice in Botkin's disease in children is gradual and manifests itself in the form of a icteric coloration, first of all, of the mucous membranes, and then of the skin, which is accompanied by mild skin itching. Botkin's disease in children is always accompanied by the development of hepatosplenomegaly, and the liver with this pathology is not only enlarged, but also painful. A decrease in the intensity of clinical manifestations occurs after the jaundice is relieved. How Botkin's disease is transmitted in children, which manifests itself as acute liver dystrophy, is not reliably known and, fortunately, this pathology is extremely rare in this category of people.

Early diagnosis in children is possible in the presence of pathognomonic clinical symptoms and verification of contact with an adult or child suffering from this pathology within 15-45 days, since the incubation period of Botkin's disease is precisely this period of time. For early verification of Botkin's disease, routine laboratory examination of children is important for the concentration of bilirubin in the blood serum, the content of bile pigments, urobilin in the urine, as well as determining the activity of enzymes such as aldolase and transaminase. Before prescribing treatment for children with Botkin's disease, it should be taken into account that the clinical picture of this disease can be simulated by influenza, obstructive jaundice, and food poisoning.

Treatment of Botkin's disease in children should be carried out exclusively in an infectious diseases hospital, subject to bed rest during the entire icteric period. A diet for Botkin's disease in children involves eating high-calorie foods with limited animal fats and enriching the daily diet with cottage cheese, vegetables and raw fruits. With this infectious pathology, there is an increased need for vitamins, which cannot be met by rationalizing eating behavior, and therefore it is recommended to use oral administration of vitamin complexes in the form of vitamin C in a daily dose of 0.1-0.3 g, Nicotinic acid in a daily dose of 0. 04 g, B vitamins 0.003 g per day.

Children suffering from Botkin's disease are advised to use a 25% solution of Magnesium Sulfate in a volume of 5-10 ml depending on age, and Borjomi mineral water 100 ml before meals at room temperature. The severe course of Botkin's disease, accompanied by the development of intoxication syndrome, is the basis for parenteral therapy with a 20% glucose solution.

Prevention of Botkin's disease in childhood is carried out only if the child has reliable contact with a person suffering from this pathology and involves intramuscular administration of gamma globulin in a dose appropriate to the child's age.

Treatment of Botkin's disease

Botkin's disease belongs to the category of infectious pathologies for which antiviral therapy is not a fundamental element in treatment. The primary treatment measure for Botkin's disease is the use of symptomatic drug therapy, which involves the administration of infusions of crystalloid solutions, vitamin complexes, hepatoprotectors, which contribute to the rapid restoration of all liver functions.

Bed rest should only be observed by children in the active icteric period, while adult patients should only limit physical activity. A diet for Botkin's disease involves enriching the patient's daily menu with high-calorie foods with the obligatory consumption of raw vegetables and fruits, as well as herbs in sufficient quantities. Treatment of Botkin's disease, even if it is mild, should be carried out in an infectious diseases hospital with an emergency notification sent to the local sanitary and epidemiological station.

Prevention of Botkin's disease in a medical institution consists of treating household items, as well as the patient's natural excrement, by boiling, mechanical cleaning and soaking in chlorine-containing disinfectants.

Severe intoxication in Botkin's disease is an indication for prescribing an intravenous infusion of Glucose solution in a volume of 250 ml, hemodez, oxygen therapy, as well as taking glucocorticosteroid drugs. The absolute indication for the use of steroid hormones in a dose of 30 mg for Prednisolone is Botkin's disease, which occurs in the form of acute liver dystrophy. Hormone therapy for Botkin's disease must be carried out under the control of blood clotting indicators, and at the first signs of increased bleeding, it is necessary to prescribe a 1% Vikasol solution intramuscularly in a dose of 2 ml for a course of 2-3 days.

The complicated course of Botkin's disease, in which the formation of inflammatory infiltrates of the liver and liver abscesses is observed, must necessarily be supplemented with drug therapy with antibacterial agents in the form of Penicillin in a daily dose of 100,000,000 units, Erythromycin, 200,000 units four times a day orally.

Specific prevention of Botkin's disease is used only when indicated using gamma globulin in a dose of 2 ml. A protective reaction after immunization is observed in 100% of cases within one month. Even when the causative agent of Botkin's disease enters the human body, a sufficient immune response develops within two weeks after vaccination. In order to ensure the development of long-term immune protection against the Botkin disease virus, double vaccination is recommended. The administration of the vaccine against the Botkin disease virus is well tolerated by patients of all ages.

Consequences of Botkin's disease

The vast majority of patients with a history of Botkin's disease are absolutely healthy, even in the case of a severe clinical period of the disease. A recurrent course of Botkin's disease is not observed, however, in 30% of cases, patients can develop a protracted chronic course. This course of Botkin’s disease is observed when the patient fails to timely seek medical help from an infectious disease specialist, as well as non-compliance with the recommendations of the attending physician regarding compliance with the work and nutrition regime.

The result of Botkin's disease in the acute period is a violation of the functional abilities of the liver parenchyma and accompanying enzymatic failures, which negatively affect the functioning of the whole organism, and, fortunately, are transient. In the absence of timely diagnosis and compliance with the conditions of drug treatment, Botkin's disease can provoke the development of complications in the form of liver cirrhosis, ascites, liver failure and encephalopathy. A lethal outcome can be observed only in the case of Botkin's disease, which occurs in an acute dystrophic form in persons suffering from immunodeficiency.

The convalescence period for Botkin's disease is 2-3 months and in 70% of cases ends with complete recovery. Botkin's disease is characterized by a severe course in newborns, as well as in the elderly, so the prevention of complications in this category of patients must be approached with special attention. Nonspecific prevention of Botkin's disease is of primary importance and consists of maintaining cleanliness of food and tap water, and personal hygiene rules.

Botkin's disease - which doctor will help? If you have or suspect the development of Botkin's disease, you should immediately seek advice from doctors such as an infectious disease specialist or a therapist.

Infectious in origin, accompanied by the death of hepatocytes. It is included in the group of intestinal pathologies, which is due to the mechanism of infection: the disease is transmitted by the fecal-oral route. Airborne transmission is not possible.

Characteristics of the pathogen

The hepatitis A virus belongs to the Hepatovirus group, the genome is RNA. Stable outside the wearer's body. At room temperature it dies within a few weeks, at +4 it can survive for several months, at -20 it remains active for years.

The pathogen is killed by boiling after 5 minutes and may remain active for a short time in chlorinated tap water. It is transmitted by the fecal-oral route, mainly through food and water. Infection through contact and household contact cannot be ruled out: transmission occurs through the use of shared utensils or household items.

Reasons for development

The source of infection is a sick person. It becomes infectious from the last few days of the incubation period and continues to be a carrier of the disease throughout the illness. The most dangerous for others is the first week and the prodromal period (the time period from the completion of the incubation stage to the appearance of the first symptoms of the disease).

You can get the virus through contact with a sick person. Infection occurs through food and household contact. The virus gets from the patient's hands to work surfaces. Hepatitis A is commonly called “the disease of dirty hands.” This explains outbreaks of the disease in kindergartens, schools, pioneer camps and other organized groups.

We can talk about an isolated outbreak if pathology occurs in a single family.

Symptoms of viral hepatitis

The duration of the incubation period is three to four weeks, after which the first signs of hepatitis A appear. An acute onset is typical for the disease. Pathology passes through several successive periods:

• pre-icteric or prodromal – can occur in febrile, dyspeptic and asthenovegetative forms;
• icteric;
• convalescence.

Symptoms of the disease depend on the severity of the disease

Symptoms of a febrile period are as follows:

• a sharp increase in body temperature;
• signs of intoxication of the body appear - general weakness, muscle pain and headaches;
• dry cough;
• runny nose;
• redness of the throat.

In some cases, dyspeptic symptoms are added - belching, attacks of nausea, loss of appetite. For the dyspeptic variant, the signs will be somewhat different - catarrhal symptoms and intoxication are slightly expressed. The main complaints are:

• indigestion;
• attacks of nausea ending in vomiting;
• belching;
• violation of defecation - constipation replacing diarrhea.

A minor pain syndrome in the area of ​​the right hypochondrium with spread to the epigastric area cannot be ruled out.

The pre-icteric period, which takes place in an asthenovegetative format, does not have specific symptoms. The complaints are standard: apathetic state, general weakness, sleep disorders - problems falling asleep. In rare cases, the prodromal period is asymptomatic and the disease immediately begins with jaundice.

The duration of the pre-icteric period is 2–10 days, but most often it is a week. The transition to the next phase of hepatitis A occurs gradually. During the icteric period, the symptoms of hepatitis A in adults change. Typical for him are: complete disappearance of signs of intoxication, normalization of body temperature, improvement of general well-being.

Symptoms of dyspepsia persist and even intensify. The formation of jaundice is slow. Initially, the patient experiences a change in the color of the urine: it becomes darker. Then the sclera of the eyes become yellowish. Then the mucous membranes of the mouth and soft palate turn yellow. The last thing to change is the color of the skin: it becomes an intense yellow-saffron hue.

Significant enlargement of the liver and spleen indicates a severe course of the disease

Severe hepatitis A is characterized by the following symptoms:

• the formation of petechiae, precise hemorrhages on the mucous membranes and surface of the skin;
• formation of a characteristic yellowish coating on the surface of the tongue and teeth;
• enlarged liver and spleen;
• slight pain upon palpation;
• bradycardia;
• decrease in blood pressure;
• discoloration of stool.

The duration of the icteric period is no more than a month. Most often it is limited to 2 weeks. This is followed by a period of convalescence (recovery). The condition returns to normal, the signs of jaundice disappear. The phase takes 3–6 months.

In most diagnosed cases, hepatitis A is mild or moderate. Severe course is rare. The patient, after complete recovery, is not a virus carrier.

Forms of hepatitis A

Depending on the course, hepatitis A occurs in three forms - mild, moderate and severe. Signs of a mild form of pathology are the almost complete absence of jaundice. Its maximum duration does not exceed two to three days. It does not affect the patient’s well-being in any way.

Sometimes Botkin's disease is completely asymptomatic. Diagnosis in this case is based on determining the activity of a specific aldolase enzyme. With moderate severity, the patient experiences the following symptoms:

• drowsiness;
• lethargy;
• severe jaundice;
• Petechiae (point hemorrhages) form on the surface of the skin;
• the heart is enlarged;
• myocardial tones are weak;
• tachycardia.

The malignant form of hepatitis A (liver dystrophy) is accompanied by massive death of hepatocytes. The condition is typical: the development of severe jaundice, a rapid decrease in the size of the liver as a result of the death of the parenchyma, bleeding, fever, liver failure, symptoms of central nervous system damage.

In the absence of adequate therapy, hepatic coma may develop.

Possible complications

Exacerbations of viral hepatitis A are not typical. Sometimes the infection can cause the development of cholangitis, cholecystitis, impaired bile outflow, and inflammation of the gallbladder. It is possible that a secondary infection may occur. Severe consequences from the liver, in particular acute hepatic encephalopathy, are extremely rare.

Hepatitis A almost never causes serious damage to liver tissue

Diagnosis of pathology

The diagnosis is made based on characteristic symptoms, as well as physical examinations and laboratory tests. Patients must donate blood. Biochemistry shows the following changes:

• increased bilirubin levels (bilirubinemia);
• increase in the activity of liver enzymes - AST, ALT;
• decrease in prothrombin index;
• decrease in albumin levels;
• decrease in thymol and increase in sublimate test.

Changes are also recorded in the general blood test. There is an increase in the erythrocyte sedimentation rate, as well as leukopenia and lymphocytosis. There is also a specific diagnosis based on the detection of antibodies. The ELISA and RIA techniques are used. A more accurate method is serodiagnosis, which allows one to detect viral RNA in the blood.

Treatment of hepatitis A in children and adults

Treatment of hepatitis A is possible at home. Hospitalization of the patient is necessary only in severe cases of the disease, and also if the patient needs to be quarantined. How long does a person stay in the hospital? The duration of stay in the infectious diseases department is at least 4 weeks.

If signs of intoxication are evident, the patient is advised to remain in bed. The patient is prescribed diet No. 5, which completely excludes fatty foods, dishes that stimulate the production of bile, and alcohol. The diet should include dairy and plant products.

Treatment with antibiotics is practiced in cases of complex disease, as well as in the case of associated pathologies.

There is no specific therapy for hepatitis A. The development of a clinical protocol is aimed at eliminating and alleviating current symptoms. To relieve signs of intoxication, the patient is recommended to drink plenty of fluids. If the need arises, intravenous administration of crystalloid solutions is prescribed.

In order to prevent the development of cholestasis - stagnation of bile - drugs from the group of antispasmodics can be prescribed. After recovery, the patient must be observed by a gastroenterologist for three to six months.

Treatment of hepatitis in childhood

The disease in children is diagnosed when the first symptoms have already been missed, i.e. at the stage of development of jaundice. During this period, the child does not pose a danger to other people and does not need to be quarantined. Undergoing therapy in a hospital setting is stressful for a child.

In addition, immunity weakened by the disease increases its susceptibility to various hospital infections. If hepatitis A is mild, then treatment at home is the best option.

Pathology therapy includes the following measures:

• Observe strict bed rest for the first 10 days from the development of jaundice.
• Following the principles of dietary nutrition is a complete rejection of fatty/spicy/fried foods. Fermented milk products, lean meat and fish, cereals, pasta, potatoes, compotes, salads with vegetable oil dressing, and jelly are allowed. The child is advised to drink plenty of fluids.
• Taking plant-based choleretic drinks.
• Vitamin therapy.

The child may be prescribed plant-based hepatoprotectors. Decoctions of choleretic herbs, in particular knotweed, show good results. After clinical recovery, clinical observation is necessary for three to six months.

Treatment at home

Mild forms of hepatitis A can be successfully treated at home. To exclude infection of family members, it is necessary to follow certain recommendations: tests and regular visits to the doctor are necessary, the course of the disease is not complicated, the sick person should be in a separate room, adherence to the principles of dietary nutrition and semi-bed rest.

Mild hepatitis A can be treated at home

After the formation of jaundice, the patient does not pose a danger to others, so he can eat at a common table and use sanitary facilities. The patient must be protected from the cooking process. Family members are advised to strictly adhere to the rules of personal hygiene, in particular, it is necessary to wash their hands with soap every time after visiting the toilet.

During the pre-icteric period, the patient is recommended to adhere to strict bed rest. A typical symptom is severe weakness; additional stress on the body will be unnecessary and may negatively affect the condition of the liver. During the icteric period, strict adherence to bed rest may result.

As the condition improves, it is allowed to increase physical activity.

Prevention

There is no specific prevention of infection. General measures to prevent infection are:

• high-quality purification of drinking water supply sources;
• compliance with sanitary and hygienic requirements;
• epidemiological control at enterprises involved in the production, storage and transportation of food products.

In the event of an outbreak of hepatitis A in organized groups, anti-epidemic quarantine measures are mandatory. Sick people are isolated for a period of 2 weeks. Patients cease to pose a danger to others after the onset of the icteric period.

They are allowed to work and study only after clinical recovery, i.e. when test results return to normal. Persons who have had direct contact with infected people need to be monitored for 35 days. Quarantine is declared in kindergartens and schools for this period. All surfaces in the room are thoroughly sanitized.

It is easier to prevent the development of pathology than to engage in long-term treatment

Vaccination

Vaccination against hepatitis A in Russia is not included in the compulsory vaccination calendar, although in other countries it is actively practiced and is mandatory. The Havrix 720 vaccine from the Belgian manufacturer has proven itself well. It is a suspended virus inactivated by formaldehyde.

Vaccination is carried out in advance: approximately 10–14 days before potential contact with the virus carrier. It is advisable to get vaccinated before going to a children's camp in another country where frequent outbreaks of Botkin's disease are recorded.

Administration of the vaccine is justified after direct contact between a person and an infected person. Deadline: first week after communication. Children tolerate the vaccine quite well. In rare cases, a slight deterioration in general health may occur. This is considered an acceptable physiological norm.

The drug is administered twice with an interval of 6–12 months, which provides stable immunity to the disease for at least 6 years. The prognosis for viral hepatitis A is favorable. The disease is characterized by a successful recovery 3–6 months after infection. Virus carriage and the transition of the disease to a chronic form are atypical.

A (HAV infection). It can occur either as a moderate illness lasting several weeks or as a severe illness lasting several months.

Causes of Botkin's disease

The cause of Botkin's disease is a virus transmitted through feces, dirty hands, food and water.

Once the infection enters the intestines, it is absorbed through the bloodstream, reaching the liver. The virus develops in liver cells, damaging them, which causes the main symptoms of the disease. The human body uses the immune system to recognize damaged cells in order to destroy them.

The risk of contracting the disease increases significantly if a person:

• uses drugs;
• visits foreign countries where the incidence of the HAV virus is high;
• has unprotected sex;
• violates hygiene rules;
• has close contact with patients with this disease.

How does the disease spread?

The virus leaves the body of an infected person in the stool. Infection of others occurs due to contact with the mucous membrane of the oral cavity of hands, food or objects that have previously been in contact with infected feces. For infection to spread, a very small amount of infecting material is required, invisible to the naked eye.

Conditions for the spread of Botkin's disease:

• Ignoring by an infected person the need to thoroughly wash their hands after using the toilet.
• Consuming water or seafood contaminated with the virus.
• As a result of sexual intercourse that involves contact of hands or mouth with feces or with parts of the body contaminated with feces.

The patient is most contagious 2 weeks before and 1 week after the onset of symptoms.

Botkin's disease is not transmitted by kissing, sneezing, or spread by saliva.

Signs and symptoms of Botkin's disease

Symptoms usually appear 2-6 weeks after infection. The duration of the disease varies; Patients usually recover from the disease within 3 weeks. The severity of the disease increases with age; in rare cases, the disease can cause serious complications and.

In adults at an early stage of the disease, the following symptoms are observed:

• nausea and vomiting;
• fatigue;
• temperature increase;
• pain in the abdomen or sides in the side.

In some cases, the following characteristic signs of the disease may be observed:

• dark yellow or brown urine;
• pale or white stool (excrement);
• jaundice (yellow skin and sclera of the eyes).

Patients may experience all or some of the symptoms of the disease.

In some cases, particularly in young children, the course of the disease may resemble a moderately severe flu-like illness without jaundice; in some cases, symptoms may be completely absent.

Epidemiological situation

Geographical distribution areas can be classified into areas with high, medium or low infection rates. However, infection does not mean illness because infected young children do not experience any significant symptoms.

Areas with high infection rates

In low- and middle-income countries where sanitation and hygiene standards are inadequate, infection is widespread and the majority of children (90%) become infected with hepatitis A virus before the age of 10 years, most often without symptoms. Epidemics are uncommon because older children and adults are generally immune. In these areas, rates of symptomatic illness are low and outbreaks are rare.

Areas with low infection rates

In high-income countries with good sanitation and hygiene, infection rates are low. The disease can occur among adolescents and adults from high-risk groups, such as injecting drug users, men who have sex with men, travelers to areas of high endemicity, and among isolated populations such as closed religious communities. In Russia, large outbreaks of diseases are recorded among homeless people.

Areas with medium infection rates

In middle-income countries and areas with varying health conditions, many individuals are not exposed to infection in early childhood and reach adulthood without immunity. Thus, improvements in economic and sanitary conditions sometimes lead to an increase in the number of adults who have never been infected and are not immune. Thus, in such areas, increased susceptibility in older age groups may lead to higher incidence rates and large outbreaks.

Diagnostics

Cases of Botkin's disease are clinically no different from other types of acute viral hepatitis. A specific diagnosis is made by detecting immunoglobulin G (IgM) antibodies in the blood that are specific for hepatitis A virus. Additional tests include reverse transcription-polymerase chain reaction (RT-PCR) to detect hepatitis A virus RNA and may require specialized laboratories.

Treatment of Botkin's disease

There is no special treatment for Botkin's disease. Recovery from infection symptoms may be slow and take several weeks or months. The main thing is to avoid unjustified prescription of medications. Acetaminophen/paracetamol and anti-vomiting medications are not indicated.

If not, hospitalization is not required. Treatment is aimed at maintaining comfort and proper nutritional balance, including replacing fluid losses caused by vomiting and diarrhea.

Nutrition when sick

The patient is recommended to follow special diet No. 5. This diet was developed in the USSR in the fifties of the last century by a leading specialist - nutritionist A.A. Pokrovsky for patients with chronic hepatitis. It provides complete nutrition, while being as gentle as possible for a diseased liver.

• The dietary list includes boiled, stewed and baked dishes made from lean meats and fish, lactic acid products, cereals and legumes, eggs and bread.
• A set of vegetables and fruits containing fiber allow for a sufficient choleretic effect of proteins and fats.
• Avoid the consumption of fatty, refractory foods, fried foods, spicy and smoked foods.
• Avoid the consumption of canned foods, including pickled and salted foods, and carbonated drinks.
• Limited.

Powerful stimulants for the secretion of gastric juice and pancreas are excluded. Favorable conditions are created for the normal functioning of the liver with the activation of restorative and compensatory processes. The amount of digestible proteins and fats in the diet corresponds to the physiological needs of fractional meals.

Prevention of Botkin's disease

• The most effective way to prevent the disease is vaccination, which will provide protection against the virus for many years. Vaccination is recommended:
  • All children aged 1 to 18 years.
  • Men who have sexual relations with other men.
  • Persons who use drugs (injecting and non-injecting).
  • Persons traveling to countries where Botkin's disease is common (all countries of the world except Canada, Western Europe and Scandinavia, Japan, New Zealand and Australia).
  • Persons with chronic liver diseases, including chronic and.
  • Persons with blood clotting factor disorders, in particular those suffering from hemophilia.
  • Persons who need protection from hepatitis A.
• Wash your hands thoroughly with soap and warm water after using the toilet, changing diapers, and before preparing or eating food.
• Drink water only from proven sources. Water chlorination, as practiced in Russia, prevents water contamination by the hepatitis A virus. Boiling or cooking food (including seafood) at 185°F (85°C) for at least one minute will also neutralize HAV infection.
• If you have been exposed to the HAV virus:
  • If you have been in contact with someone who has hepatitis A at any time during the 2 weeks before that person started showing active symptoms and one week after they stop showing symptoms, and have not been vaccinated or not previously, you may be at risk of contracting hepatitis A virus A.
  • An effective remedy against Botkin's disease can be preventive treatment, the course of which is completed within 14 days after contact with the virus. Preventative treatment is recommended if you:
    • They ate food or placed objects in the oral cavity that were prepared/with which the patient had contact.
    • Have entered into sexual or other intimate relationships with a patient with Botkin's disease.
    • Are caring for a child or working in a child care program in a setting/environment where a person with hepatitis A (another child/worker) is present.

Prognosis for Botkin's disease

Approximately 85% of people infected with hepatitis A virus (HAV) have complete clinical and biochemical recovery within a 3-month period, with almost all people recovering within 6 months and developing lifelong immunity. Approximately 10–20% of symptomatic patients may experience a prolonged and relapsing course lasting several months with persistent fever, itching, diarrhea, jaundice, weight loss, and

Botkin's disease is a disease that occurs as a result of a virus, is accompanied by an inflammatory process and affects the liver. Another name for the disease is Hepatitis A.

This disease is quite well known in Africa, Asian countries and other tourist regions where hot climatic conditions prevail (Turkey, Tunisia, Egypt, India). Such data are due to the fact that it is in hot countries that it is easier for viruses to survive, and in cold countries located in the north, the risk of getting the disease is much lower. More often those people who neglect the rules of personal hygiene and rarely wash their hands after going outside suffer from Botkin's disease. But the infection can also be contracted through food and water contaminated with the virus, especially if the immune system of a potential patient is reduced.

Classification of Botkin's disease

In medical practice, it is customary to distinguish two types of Botkin’s disease:

• Typical view. In this case, the disease is recognized by a change in the color of the white of the eye and the color of the skin, which becomes distinctly yellow, followed by other signs and symptoms of the disease (described below).
• Atypical appearance. This case does not involve a change in skin color, and the disease may go unnoticed for some time. However, if a child has an atypical type of Botkin's disease, then at the beginning only the stool will change, namely its disorder.

The disease is also characterized by several forms of progression:

• easy or simple (common);
• moderate severity (occurs in approximately 30% of cases);
• severe form (occurs extremely rarely, in approximately 1-3% of patients)

Treatment of hepatitis A is successful in most cases, and the patient makes a full recovery. Besides. All changes that occurred to the liver during the illness return to normal, and the functionality of the liver is restored. In some cases, the patient's liver enlarges and remains this size throughout his life, but usually this does not manifest itself as symptoms and is only detected during an ultrasound.

Causes of the disease

You can become infected with Botkin's disease from another person infected with this virus. This does not mean airborne droplets, but non-compliance with hygiene rules: eating food from the same container, using the same hygiene items, etc. This does not mean that the disease will be transmitted in a 100% ratio, but the risk of the disease is the case described above is great.

The process of development of the disease is as follows: viruses enter the intestinal cavity, after which they enter the blood, and from there follow to the liver.

In this process, the liver cells suffer the most, since an infection develops in them, which contributes to their damage and causes the main manifestations of Botkin’s disease. The disease is accompanied by an inflammatory process, but this is only a protective reaction of the body. The human body is designed in such a way that it can recognize infectious processes and thus respond. In this case, the body recognizes the patient’s affected liver cells and then begins to destroy them.

Let's look at the main factors leading to hepatitis A:

1. close contact with infected people;
2. failure to comply with hygiene rules;
3. kissing, sexual intercourse;
4. tourist trips to countries with hot and exotic climates;
5. drug use

How to recognize Botkin's disease

Signs of the disease: Yellow eyes, itching, digestive problems

The disease begins with an incubation period that can last from 15 to 50 days after infection. Then the patient develops a feeling of lethargy and constant unjustified fatigue. Due to fatigue, the body temperature may rise, and the person may experience a feeling of nausea that turns into vomiting. Often there is a violation of the stool, which is manifested by diarrhea and flatulence. And, of course, one of the main symptoms that distinguishes hepatitis A from ordinary fever is pain in the liver. However, the described manifestations may not exist at the initial stage, and the patient himself may not be aware of the presence of Botkin’s disease and refer to an ordinary ARVI.

To confirm or rule out Botkin's disease, a blood test for antibodies is required. In this way, the presence or absence of immunity to the anti-HAV IgG virus is checked. If the test results reveal antibodies to hepatitis A, this will mean that the person has already had this disease and will no longer face it. But, if antibodies are not detected in the blood, then the person is still susceptible to infection.

It is worth noting that even if a person has already had Botkin’s disease and has completely recovered, the virus still remains in his blood, and those who use the same hygiene items risk becoming infected.

Thus, let us highlight the main symptoms of hepatitis A:

• the occurrence of fever;
• pain in the lateral area on the right;
• sleep is disturbed;
• feeling of general weakness and fatigue;
• feeling of heaviness in the abdomen (especially in the stomach area);

After the disease begins to progress, the following symptoms are added:

• urinary fluid becomes foamy and dark in color;
• appetite becomes very weak or completely absent;
• the appearance of jaundice (yellow skin, whites of the eyes and mucous membranes);
• stool becomes discolored

It should be noted that it is the manifestation of jaundice at its height that promises an improvement in the patient’s condition. The yellow tint to the skin lasts an average of a month and a half, but if the patient is too weakened by the disease or suffers from any additional ailments, then hepatitis A can become chronic. In the latter case, it is often necessary to heal the disease for six months.

How to diagnose hepatitis A

At the very beginning, if the above-described signs have been noticed in yourself or your loved ones, the potential patient should urgently consult a gastroenterologist, who will be able to make a preliminary diagnosis based on the manifestations and refer further to the right doctor (if necessary).

If the patient has all the signs and symptoms of Botkin’s disease, the gastroenterologist issues a referral to an infectious disease doctor, who will conduct a diagnosis.

First, you need an anamnesis of the disease, thanks to which the doctor will be able to find out the exact cause of the disease, since the course of treatment will differ depending on the cause.

In addition, if a person does not live alone, then it is necessary to conduct an examination of all family members, and especially if there are children, since their body is more vulnerable to various infections.

Diagnosis of Botkin's disease consists of the following procedures:

• palpation by the doctor of the patient’s liver area;
• blood test to detect bilirubin;
• liver tests to detect liver enzymes;
• blood test to check for antibodies to hepatitis A;
• blood clotting test

Methods of treating the disease

Food is healing

During an illness with Botkin's disease, a person's immune system devotes all its strength to overcoming the disease. It is precisely because of the activity of the immune system that the body is able to cope on its own, unless it is severe. Hepatitis A is treated only with a conservative method, but this course of treatment is not aimed at exterminating the disease itself, but at improving the patient’s well-being (pain relief, reducing nausea and vomiting, etc.).

Let's consider the standard course of treatment for Botkin's disease:

• Diet No. The patient must strictly adhere to the diet, especially during an exacerbation, so as not to worsen his condition;
• the patient must be isolated from healthy people;
• the patient must remain in bed and remain at rest;
• administering solutions of sodium chloride and glucose to the patient (to relieve symptoms of poisoning);
• administering drugs to the patient that protect liver cells from destruction

What complications can occur with hepatitis A?

Usually the disease is cured and proceeds in a mild form, and less often in a moderate form. However, if the patients are children under one year old or people aged 60+, their disease may become severe due to age-related weakness of the body. In this case, signs of intoxication of the body will appear especially pronounced.

A particularly dangerous type of Botkin's disease is atypical, in which there are no manifestations of jaundice. This species is especially dangerous for babies under one year old, since their immunity is not very developed, and the disease can be fatal for them.

Botkin's disease is the most benign disease of the hepatitis family, but since the symptoms of all hepatitis are similar, you need to be sure of your diagnosis by consulting a doctor in a timely manner.

How to prevent Botkin's disease

You can prevent the disease if you protect yourself as much as possible from the factors leading to it. For example, it is necessary to observe the rules of personal hygiene, especially in hot countries, if you come there on a tourist visit. Next, you need to protect yourself from contact with infected people, and if they are relatives, then urgently get vaccinated.

Vaccination is the most reliable preventive measure and is carried out 2 times with a break of six months. It is worth noting that the vaccine can be administered to children only from the age of 3, so up to this age it is necessary to especially closely monitor your children and protect them as much as possible from the sources of the disease. For people who are at risk, vaccination is mandatory.

In comparison with other hepatitis, the pathology is considered the most favorable and has a good prognosis for life. The incidence of deaths does not exceed 0.4%. In addition, the disease is not accompanied by a chronic infectious-inflammatory process, which reduces the risk of developing complications such as cirrhosis and cancer.

With proper treatment and a mild course, there are no consequences of Botkin's disease, and jaundice and other symptoms disappear after two weeks. To restore hepatocytes (liver cells), 2 months are usually enough.

A newborn suffers a pathology much more severely, which is why serious health consequences are observed. Complications are also diagnosed in older people. As for children over one year old and adults, they are characterized by a rapid cure for Botkin’s disease.

Both men and women are equally likely to become infected. After suffering a viral liver injury, a strong immunity develops, which prevents you from getting sick again.

According to statistics, about one and a half million people suffer from Botkin's disease every year. In reality, this figure is much higher, since asymptomatic forms of the pathology are not taken into account.

What is Botkin's disease?

The highest incidence of viral liver damage is recorded in developing countries with hot climates. The disease is otherwise called “dirty hands disease”, which is due to the fecal-oral mechanism of transmission of infection. In some territories, children under 10 years of age already have developed immunity, as they have had hepatitis A. The peak incidence occurs at the end of summer and September.

Previously, it was believed that the pathology was a consequence of unsanitary conditions, but in the 70s of the 20th century a virus was discovered. This made it possible to develop a vaccine against the infection and reduce the risk of developing the disease.

A sick person releases a huge number of pathogens into the environment with feces, as a result of which they enter the soil, water and food. Infection occurs by eating contaminated food.

The virus in a healthy body begins to multiply intensively, increasing the number of individuals and provoking an increase in intoxication. With the bloodstream, the pathogen penetrates the liver, where it infects hepatocytes and disrupts the functioning of the gland.

Causes

The disease is of infectious origin. It is caused by a virus that, upon entering the body, affects the liver and leads to the death of hepatocytes. Infection can occur:

The risk of infection increases when traveling to hot countries, as well as when hygiene rules are not followed.

The virus is an RNA pathogen and has good resistance to unfavorable conditions.

Symptoms

After infection of the body, the first signs of intoxication appear, similar to the symptoms of ARVI:

1. fever up to 40 degrees;
2. joint, muscle pain;
3. chills;
4. decreased appetite;
5. headache.

The duration of this period is 10 days, after which dyspeptic disorders in the form of nausea, vomiting and intestinal dysfunction are noted. Jaundice is considered a confirmation of hepatocyte damage. It is manifested by a specific clinical picture and changes in laboratory parameters.

Jaundice syndrome involves discoloration of feces and darkening of urine, which is caused by impaired production and movement of bile. As for the color of the skin, it can be either lemon or more saturated. It is especially important during the height of the disease to adhere to a diet and not drink alcohol, as the consequences can be quite serious. In most cases, the disease is not complicated, but this does not mean that medical recommendations can be neglected.

Over time, hyperthermia recedes, itching sensations on the skin and pain in the liver area are disturbing. Discomfort is caused by stretching of the fibrous capsule of the gland by swollen tissues, which leads to irritation of the nerve endings.

Swelling of the organ is observed starting from the pre-icteric period, when intensive reproduction of viruses is noted. When palpating (feeling) the area of ​​the right hypochondrium, hepatomegaly (increased liver volume) can be detected. At this time, cell destruction occurs, resulting in the release of enzymes. In the laboratory, this is manifested by an increase in the level of ALT and AST.

The duration of the acute period is one and a half months. During this time it is prohibited to drink alcohol.

When alcohol breaks down, toxic products affect hepatocytes, resulting in a serious consequence of Botkin liver failure. Its development is caused by massive death of hepatocytes.

Complications can manifest as encephalopathy and severe intoxication of the body. Note that hepatomegaly persists after recovery for several months.

Serious consequences of jaundice are observed in infants. Complications of hepatitis A can occur against the background of dehydration and are manifested by convulsions and impaired consciousness of the infant. Treatment of a newborn is carried out exclusively in a hospital under the supervision of a doctor.

Treatment

To minimize the consequences of jaundice, it is necessary to begin treatment for hepatitis in a timely manner. The main goal of therapy is to reduce intoxication, protect gland cells and restore organ function. To date, there is no specific treatment for the disease. To reduce the severity of clinical symptoms, medications and a dietary diet are prescribed.

Medication method

Drug therapy includes:

• enterosorbents, the purpose of which is to prevent absorption and accelerate the elimination of toxic products from the gastrointestinal tract;
• immunomodulators;
• vitamins;
• enzyme preparations necessary to facilitate the digestion process;
• hepatoprotectors. Medicines are used to protect liver cells and restore their structure;
• choleretic drugs are used in the absence of a block in the biliary ducts.

To prevent the undesirable consequences of viral liver damage, in severe cases of the disease, hormonal agents and detoxification solutions are prescribed for intravenous administration.

Usually, in case of pathology of the hepatobiliary tract (liver, bladder, biliary tract), table No. 5 is prescribed. This diet is recommended throughout the illness, as well as for six months after recovery.

The diet allows you to reduce the load on affected hepatocytes, regulate bile flow and normalize metabolic processes. The following nutritional principles are distinguished:

Why is jaundice dangerous?

Complications of Botkin's disease for newborns are extremely severe, and therefore require immediate hospitalization and intensive care. In older age, the disease occurs in a milder form, but the risk of undesirable consequences is still present. They are expressed:

• inflammation of the pancreas;
• joint damage (arthritis);
• inflammation of the mucous membrane of the digestive tract;
• vasculitis;
• renal dysfunction, which is expressed by nephrotic syndrome;
• inflammation of the organs of the hepatobiliary system.

Sometimes secondary infection, development of liver failure and encephalopathy are observed.

Consequences of jaundice in men

There is an opinion that Botkin's disease can cause infertility, but convincing evidence of this theory has not yet been provided. The pathogenesis of the development of this complication has not yet been established, therefore, in case of unsuccessful attempts to conceive, the cause should not be sought in viral liver damage.

Jaundice is just as dangerous for men as it is for women. The severity of complications depends on concomitant diseases and lifestyle.

Given the prevalence of alcoholism among the stronger sex, Botkin's disease can quickly lead to liver failure. The fact is that the breakdown products of alcohol have a toxic effect on hepatocytes, which is why they gradually die. Viral infection due to alcoholism can lead to decompensation of the gland, up to complete failure. Note that cirrhosis develops faster in men.

The stronger sex is less inclined to follow a dietary diet, as a result of which the affected hepatocytes in Botkin's disease experience additional stress (fatty, spicy foods). This can result in liver failure due to irreversible cell death.

Consequences of Botkin's disease in women

According to statistics, the weaker sex more often suffers from cholecystitis, cholangitis and bile duct dyskinesia. From this it follows that hepatitis A can provoke an exacerbation of chronic diseases of the biliary tract.

On the other hand, women are more susceptible to hormonal fluctuations. They can be caused by endocrine pathology, taking oral contraceptives, stress and pregnancy. All this affects metabolic processes, resulting in an increased risk of obesity and the progression of related diseases.

To avoid Botkin's disease or reduce the risk of developing it, it is recommended to adhere to the following tips:

1. wash your hands before eating and after visiting public places;
2. observe precautions when living with a patient with hepatitis A in the same area;
3. drink water only from proven sources;
4. have one sexual partner or use barrier protection (condoms) during casual intimacy;
5. follow food preparation technology without reducing the time of exposure to high temperatures;

Hepatitis A is a disease with a favorable prognosis, but treatment should not be neglected. Thanks to timely diagnosis and therapeutic measures, it is possible to reduce the area of ​​liver damage and quickly restore its functioning.