How long does treatment for Botkin's disease take? What is Botkin's disease and what are its symptoms? What it is

Botkin's disease (viral hepatitis A) is an infectious liver lesion, which is one of the most favorable forms of hepatitis, as it is not prone to becoming chronic. Botkin's disease is one of the most common intestinal infections. All categories of the population are susceptible to the disease; hepatitis A is most often diagnosed in children, but in recent years there has been an increase in incidence in adults.

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The prevalence of this form of hepatitis is directly related to poor sanitation and hot climates, so this rate is especially high in developing countries.

With timely and properly selected treatment, the prognosis is favorable. Complete restoration of liver function occurs in approximately 90% of cases.

Causes and risk factors

The hepatitis A virus belongs to the RNA viruses of the Hepatovirus genus. It is quite stable in the environment: at a temperature of 4 °C it persists for several months, at -20 °C it persists for years, at room temperature for several weeks. Withstands boiling for up to 5 minutes; when exposed to ultraviolet radiation, inactivation occurs within a minute; is able to remain viable for some time in chlorinated tap water. It has an acid-resistant shell, which allows it to pass through the acidic gastric environment without damage. The hepatitis A virus is characterized by high immunogenicity; after suffering from the disease, a person develops stable lifelong immunity.

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The source of infection is a sick person. Infection occurs mainly through household contact (through dishes and other household items) and through nutrition (by eating contaminated foods). When the hepatitis A virus gets into public water reservoirs, outbreaks occur. The parenteral route of transmission is less common - through blood when the rules for intravenous injections, blood transfusions, and dental procedures are violated.

The spread of Botkin's disease most often occurs in children's groups. At risk are employees of the catering sector, medical and sanatorium-resort institutions, and people leading an antisocial lifestyle.

Most often, Botkin's disease affects children 3–12 years old and young adults. The incidence is seasonal, with an increase observed in the summer-autumn period.

Forms of the disease

Botkin's disease can have a typical (with the presence of symptoms characteristic of hepatitis) and atypical (absence of specific symptoms) course.

Depending on the clinical picture, the following forms of the disease are distinguished:

• icteric;
• anicteric;
• erased;
• subclinical.

Depending on the duration of its course, Botkin's disease can be acute or protracted. Depending on the severity: mild, moderate and severe.

The prodromal period of Botkin's disease can occur in febrile, dyspeptic, asthenovegetative and mixed forms.

Stages of the disease

In the clinical course of a typical variant of Botkin’s disease, three stages are distinguished:

1. Prodromal (pre-icteric) period.
2. Jaundice period.
3. Convalescence.

After the end of the icteric period, convalescence begins, i.e. recovery. There is a regression of intoxication and jaundice, the size of the liver is normalized. This stage can last 3–6 months.

Symptoms of Botkin's disease

In some cases (usually in children under 6 years of age), the disease is asymptomatic.

The incubation period for Botkin's disease is 3–4 weeks. The onset is usually acute.

The febrile variant of the prodromal period of Botkin's disease is characterized by an increase in temperature to high numbers, accompanied by pronounced signs of intoxication of the body (weakness, headache, pain in the joints and muscles, decreased appetite), nausea, belching, discomfort in the stomach and liver, as well as symptoms of catarrhal inflammation of the upper respiratory tract - sore throat, rhinitis, dry cough.

In the dyspeptic variant of the prodromal period of the disease, catarrhal symptoms are usually absent. Patients complain of nausea, vomiting, belching, bitterness in the mouth, dull pain in the right hypochondrium and epigastric region, as well as stool disorder (diarrhea or constipation, or their alternation).

The asthenovegetative variant of the pre-icteric period is not very specific. There is general weakness, lethargy, increased fatigue, decreased performance, sleep disturbances, and loss of appetite. In some cases, the disease may begin with the development of jaundice in the absence of any signs of a prodromal period.

The mixed version of the prodromal period is characterized by a combination of several clinical syndromes.

The prodromal period usually lasts from two to ten days, gradually turning into the icteric stage. Signs of general intoxication disappear, body temperature normalizes, and the patient’s general condition improves. However, dyspeptic symptoms, as a rule, not only persist, but also become more pronounced. Other symptoms of Botkin's disease in the icteric period include darkening of the urine, icterus of the sclera, the mucous membranes of the soft palate and frenulum of the tongue, and then the skin, turn yellow. A yellowish coating is found on the tongue and teeth. The feces lighten up to complete discoloration.

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In severe cases of Botkin's disease, hemorrhagic syndrome develops (hemorrhages, petechiae on the skin and mucous membranes, nosebleeds, etc.). The liver is enlarged, painful on palpation, and in 10–20% of cases the spleen is enlarged. Bradycardia and hypotension are observed, astheno-vegetative symptoms and disorders of the central nervous system may develop.

The duration of the icteric period ranges from several weeks to a month, after which convalescence begins, i.e. recovery. There is a regression of intoxication and jaundice, the size of the liver is normalized. This stage can last 3–6 months.

Botkin's disease usually occurs in a mild or moderate form. The disease does not transform into a chronic form or viral carriage (latent form).

In rare cases, cholangitis, biliary dyskinesia and gall bladder, and cholecystitis may develop against the background of Botkin's disease.

Diagnostics

To make a diagnosis, a collection of complaints and anamnesis, a physical examination, and laboratory tests of blood and urine are carried out. In order to determine the morphological and functional state of the liver, instrumental diagnostic methods are used.

A general blood test reveals a decrease in the number of leukocytes, lymphocytosis, and an increase in ESR. A biochemical blood test reveals a sharp (8-10 times) increase in the activity of liver transaminases, an increase in the concentration of bilirubin (mainly due to direct bilirubin), and a decrease in albumin levels. The prothrombin index is usually below normal.

Specific diagnosis of Botkin's disease, i.e. identification of the pathogen, is carried out using enzyme immunoassays and radioimmunoassays. In the icteric period, there is an increase in the IgM titer, and at the stage of convalescence - IgG. In addition, the detection of hepatitis A virus RNA is carried out using the polymerase chain reaction method.

Treatment

Treatment of Botkin's disease in most cases is carried out on an outpatient basis. Hospitalization is required only in severe forms of the disease, according to epidemiological indications. If there are severe signs of general intoxication, bed rest is indicated. An important component of therapy is adherence to the diet (table No. 5 according to Pevzner) and drinking regimen (drinking plenty of fluids).

Causal therapy for hepatitis A has not been developed; treatment is aimed at reducing symptoms and pathogenetic correction. To reduce signs of severe intoxication, intravenous infusion of crystalloid solutions is performed. In order to normalize digestive processes, lactulose preparations are used. To prevent the development of cholestasis, antispasmodics are prescribed. In some cases, there is a need to use corticosteroid drugs. With the development of hemorrhagic syndrome, the use of hemostatic drugs may be required, which are infused into the stomach using a tube. In case of bacterial infection, antibacterial drugs are used. and death.

Forecast

With timely and properly selected treatment, the prognosis is favorable. Complete restoration of liver function occurs in approximately 90% of cases; residual effects are observed in the remaining patients. The mortality rate for Botkin's disease is no more than 0.04%.

The prevalence of this form of hepatitis is directly related to poor sanitation and hot climates, so this rate is especially high in developing countries.

Prevention

General preventive measures aimed at preventing the development of Botkin's disease include control over the discharge of wastewater, ensuring high-quality purification of drinking water, providing food to the population in accordance with sanitary and hygienic requirements, ensuring the necessary quarantine measures in case of outbreaks of Botkin's disease in organized children's and adult institutions. teams. Contact persons are subject to observation for a month from the moment of contact with the patient. In areas of infection, disinfection measures must be carried out.

Vaccination against hepatitis A is recommended for children starting from the second year of life, as well as adults who do not have a history of Botkin’s disease and who have an increased risk of infection (medical workers in infectious diseases departments, workers in water supply and public catering enterprises, people traveling to areas , epidemically dangerous for viral hepatitis A, staff of preschool institutions, social workers in contact with injection drug addicts, etc.).

In order to reduce the risk of infection with the hepatitis A virus, it is recommended to observe the rules of personal hygiene, not to consume food products of questionable quality, to avoid drinking water from questionable sources and open water bodies, and to avoid contact with patients with Botkin's disease.

Video from YouTube on the topic of the article:

Today the world knows a million different diseases, most of which people have learned to successfully fight. Of course, in our lives we encounter only some diseases. One of these is How this disease is transmitted, how to treat and prevent it, every mother should know. After all, the infection often affects the child’s body.

What types of hepatitis are there?

The liver is one of the main human organs. It synthesizes proteins and carries out the accumulation and breakdown of glucose. The main function of the liver is to filter all incoming substances. Of course, if the liver’s function is impaired, the entire human body suffers.

There may be several causes of disease in this organ:

1. Infections (hepatitis A, B, C, E, D).
2. Diabetes.
3. Long-term use of antibacterial drugs and other medications.
4. Alcohol abuse.
5. Heredity.
6. Ecology.
7. Lifestyle and unacceptable working conditions.

Liver diseases include:

1. Viral hepatitis (A, B, C, etc.). Each form has its own developmental characteristics, treatment methods and consequences. All forms of viral hepatitis are transmitted through household contact, through semen, and also from mother to child.
2. Toxic hepatitis is a reaction to taking medications.
3. Alcoholic hepatitis occurs as a result of alcohol abuse.

All hepatitis, except form C, are treatable. Hepatitis C is cirrhosis of the liver. There is no cure for this disease. The disease always ends in death.

Hepatitis A

Or as it is also called - Botkin's disease (in honor of the doctor who discovered the disease) - an acute viral disease that primarily affects the liver. The nervous system, digestive system and kidneys are also affected.

The disease can be called an epidemic, outbreaks of which are typical for countries in Africa, Asia, and South America.

A large percentage of hepatitis A patients are children, adolescents and elderly people. The main symptoms of Botkin's disease are icteric complexion, headaches, diarrhea. Hepatitis A is a curable disease. It is enough to go to the hospital for help in a timely manner. There are, of course, deaths - 0.1 - 0.3%.

Causes of the disease

The virus that causes hepatitis A is very resistant to the external environment. It has an acid-resistant shell, as a result of which the protective barrier of the stomach is not afraid of it. Hepatitis bacteria persist in water for a long time. Therefore, the main cause of epidemics is contaminated drinking water sources. Botkin's disease is also transmitted through contact and household contact, sometimes by airborne droplets, and also through blood. The virus can be carried by flies. Bacteria, entering the body, are absorbed through the intestines into the blood, after which they spread throughout the body and affect the liver.

The incubation period ranges from 10 to 40 days, after which the first symptoms of the disease begin. Having had jaundice once, a person receives stable immunity for life. Such people can no longer be blood donors.

Symptoms of Botkin's disease

Hepatitis A can occur in the body in several forms: mild (most cases), moderate (about 30%) and severe (1-3%).

Depending on the form of the disease, symptoms may also be different. Mainly:

1. Increased body temperature, lethargy, fatigue.
2. Nausea, vomiting, upset.
3. Pain in the liver area. When palpated, this organ is noticeably enlarged.
4. Disturbed sleep, lack of appetite.
5. A runny nose and cough may occur.
6. The skin and membranes of the eyes acquire a characteristic yellowish color. The icteric period lasts from three to six weeks.
7. Urine becomes dark, feces, on the contrary, become discolored.

Often the signs of the disease are perceived as a common cold (flu, ARVI), and not as Botkin’s disease. Symptoms worsen, jaundice appears, and only then do patients consult a doctor.

On average, the disease lasts about forty days. The course of the disease depends on age, immunity, concomitant diseases and treatment methods.

One-year-old children and the elderly are more susceptible to infection. Therefore, everyone should know what Botkin’s disease is, how it is transmitted and what its symptoms are. After all, the disease often affects entire families. Timely diagnosis can protect against severe forms of the disease.

Complications after hepatitis A

Hepatitis A, unlike its other forms, is completely curable. After therapy, liver function is restored. People gain lifelong immunity.

In rare cases, Botkin's disease causes health problems. The causes and symptoms of complications can only be associated with non-compliance with doctor’s instructions, violation of bed rest and poor diet.

Patients may complain of continued pain and vomiting for another two months after therapy. This is normal, no need to panic.

You can minimize the complications and consequences of hepatitis with the help of proper dietary nutrition.

1. Food should be consumed in small portions, but often.
2. During illness, a person loses a large amount of vitamins, so it is imperative to replenish them. The diet should include fresh vegetables, fruits, juices, and dairy products.
3. The consumption of fatty, salty, smoked, pickled and spicy foods is prohibited.
4. “Fasting” days are welcome. Dairy products, vegetables and fruits are good for this.
5. Fans of alcoholic beverages will have to give them up for a while.
6. All food products must be thoroughly processed.

How to treat Botkin's disease?

First of all, to establish an accurate diagnosis, you should go to the hospital. Only a doctor, after examining and passing all the tests, can give an opinion to the patient. Considering that Botkin’s disease does not always have pronounced symptoms, it is impossible to talk about the presence of infection in the body without additional diagnostics. For research you need: blood (general and biochemical analysis is performed), urine and feces. If class M antibodies were detected in biomaterials, this indicates the presence of infection in the body. Antibodies of class G - immunity to the disease.

Determine how to treat Botkin's disease and symptoms. Treatment of mild and moderate forms of the disease can be done at home. The main thing is bed rest and dietary nutrition. Drinking plays an important role, which is necessary to reduce intoxication. Treatment of severe forms of hepatitis A is carried out inpatiently, in infectious diseases departments.

To improve liver function, in addition to vitamins, specific drugs such as Gepabene and Essentiale can be prescribed.

Diet No. 5 for liver diseases

It's no secret that proper and healthy food is the best assistant in the fight against diseases and infections. For each type of disease there are therapeutic nutrition schemes developed by Soviet nutritionist Mikhail Pevzner.

Diet No. 5 is designed specifically to improve liver function. The essence of the diet is to limit the consumption of fatty and unhealthy foods. So, during illness you need to exclude:

1. Smoked, fatty, marinades, pickles and offal.
2. Fresh baked goods and confectionery.
3. Hot herbs and spices.
4. Carbonated drinks, strong coffee and alcohol.

Allowed:

1. Yesterday bread, dried flour products.
2. Cereals, soups, porridges.
3. Vegetables fruits.
4. Low-fat dairy products.
5. Lean meat and broths.
6. Teas, juices, coffee with milk.
7. Vitamins.

It is better to cook food by steaming. This preserves a large number of useful microelements.

Symptoms of Botkin's disease in children

Botkin's disease refers to acute intestinal infections. You can become infected with the disease through food, water, and also from infected patients.

The incubation period averages 28 days, after which the disease itself begins, which consists of three stages: pre-icteric, icteric and convalescent. Each period has its own symptoms.

At the first stage of the disease, the child becomes very capricious and loses appetite. Sleep may be disturbed and the temperature may rise. Nausea, vomiting, and diarrhea appear. This period is also characterized by the appearance of cough and runny nose.

The symptoms of Botkin's disease in adults and children are initially the same and can often be mistaken for another disease (for example, influenza). When the icteric period begins, the patient's condition improves. However, yellowness appears on the eye membranes and skin. Pain in the liver may also occur. At this time, the patient begins to perceive the symptoms of Botkin’s disease correctly and seeks help from a doctor.

The recovery period is characterized by the gradual extinction of all symptoms. Liver functions are restored, the patient's condition is stabilized. Sometimes nausea and pain can persist for a month or two after recovery.

Considering how complex Botkin’s disease can be and how the pathogen is transmitted, it is better to treat in hospitals. This applies in particular to families with young children or elderly people.

Botkin's disease and pregnancy

Botkin's disease is a very dangerous disease for expectant mothers. While most people suffering from hepatitis A suffer from mild to moderate forms of the disease, pregnant women almost always suffer from a severe form.

Botkin's disease during pregnancy causes liver dystrophy. The infection also penetrates through the placenta to the baby. Children born from infected mothers often have various defects and pathologies. The woman herself may die during childbirth. This is because the disease affects blood clotting. Caesarean section is also contraindicated.

At all stages of pregnancy, the cause of miscarriages and premature births is Botkin's disease. Every woman should know the symptoms, treatment and signs of Botkin's disease. Proper preventive measures will help her protect herself from the sad consequences of this disease during pregnancy.

Prevention of hepatitis A

Of all types of hepatitis, the easiest to prevent is hepatitis A (Botkin's disease), which is transmitted by the fecal-oral route. To do this, it is enough to observe the rules of personal hygiene, as well as educate people about this disease.

Symptoms of Botkin's disease can be different, but the main ones are jaundice, vomiting, headaches and diarrhea. If people sought help in a timely manner, perhaps the number of patients would be significantly reduced. After all, the incubation period of hepatitis A lasts quite a long time, and all this time the person is already a carrier of the pathogen.

To protect yourself and your loved ones from this disease, you should follow these simple rules:

1. Always and everywhere you need to wash your hands with soap.
2. Handle food carefully. Vegetables and fruits should only be washed under running water.
3. It is better to boil tap water. The pathogenic bacteria are resistant to the aquatic environment, and boiling kills them in a matter of minutes.
4. Food products should be purchased in specialized stores, and not in spontaneous markets.
5. If possible, it's better to do it

Be healthy!

“Botkin’s disease, symptoms, treatment, complications” is a topic that everyone should become familiar with. The cause of many diseases and infections is ignorance!

When a person is aware and consults a doctor in a timely manner, there will be fewer complications. It should be remembered that severe forms of hepatitis A can cause cirrhosis and liver cancer, although this happens very rarely.

Botkin's disease is much less common today than it was several decades ago. But if sanitary standards are violated, a source of disease may occur. It is important to know what Botkin's disease is and how to cure jaundice.

Basic information

Botkin's disease (hepatitis A) is an acute viral disease that occurs due to the ingestion of contaminated water or food, or dirt from hands. The digestive system is mainly affected, the liver is especially sensitive. The disease was first described by the Russian therapist Sergei Botkin in 1888; it was he who pointed out the viral nature of the disease, which was subsequently confirmed by other studies. It is unknown where this disease first appeared.

The causative agent of hepatitis A is a virus belonging to the genus hepatotropic, most often affecting the liver tissue. It is characterized by its small size and high stability in the environment. The microorganism dies at temperatures above 60C, and at 100C death occurs no earlier than after 5 minutes. The causative agent of acute viral hepatitis A survives well in water and persists on food products.

Botkin's disease is common on all continents. The incidence rate depends on compliance with the rules of personal and public hygiene. The main source of infection is a sick person in the incubation or pre-icteric period. This pathology is characterized by virus carriage, in which there are no signs of the disease, but the virus is present in the body in a latent form.

Hepatitis A is most often transmitted through:

• Contaminated water.
• Food containing the virus.
• Dirty hands.
• Injections. This path is the rarest and is found only among drug addicts.

Large outbreaks of jaundice (hepatitis A) occur when the causative agent of viral hepatitis enters a water supply. Much smaller outbreaks arise when sanitary standards are not observed at public catering establishments, which requires immediate notification of the anti-epidemic service.

At-risk groups

Children aged 2 years and older and adults under 30 are most susceptible to the virus.
It is known that infants cannot become infected with hepatitis due to the presence of maternal antibodies, which protect them from many infectious diseases.

The number of cases depends on the time of year. The largest number is observed in spring and summer, which is associated with the establishment of a temperature that is comfortable for the life of the virus. Botkin's disease, called viral hepatitis A, leaves behind lifelong immunity; re-infection is impossible.

How the disease develops

The causative agent of viral hepatitis A, entering the human digestive system, spreads through blood vessels and penetrates into liver cells, where the virus multiplies.

In response, the immune system releases special enzymes that cause inflammation and destruction of affected liver cells. Damage to these cells is accompanied by disruption of all liver functions, such as the synthesis of vitamins, bilirubin, protein, and hemostatic substances.

With inflammation of the liver cells, swelling of the liver and compression of its blood vessels develop, and the transport of bilirubin through the liver cells is disrupted. It enters the bloodstream, causing bilirubinemia - the appearance of bilirubin in the urine.

Damage to hepatocytes is temporary and cyclical. Dystrophy occurs, necrosis of some parts of the liver cells occurs, but at the same time regenerative processes take place aimed at restoring the liver. 2–3 months after treatment for hepatitis A, the structure and functions of the liver are completely restored.

Symptoms

It is important to know what symptoms appear with hepatitis A. This will help you see a doctor on time. The incubation period for hepatitis A ranges from 7 to 50 days. On average, the duration of this period ranges from 14 to 35 days. Basically, the incubation of the infection occurs silently without pronounced clinical symptoms and can only be detected by laboratory tests.

There are just as many symptoms of hepatitis A in adults as in children. The first signs of jaundice in adults:

• Weakness.
• Loose stools.
• Loss of appetite.
• Headache.

The manifest icteric form of the disease has a benign and cyclical course. There are three periods of the disease:

• Pre-icteric period.
• Jaundice period.
• The period of convalescence.

The pre-icteric period begins acutely without clear warning signs of the disease, allowing one to immediately suspect something is wrong. Symptoms can be disguised as signs of various diseases, such as ARVI, intestinal infections, food poisoning. Observed:

1. Dyspeptic syndrome, characterized by decreased appetite, diarrhea and vomiting, intolerance to heavy foods, belching with a bitter taste, a feeling of heaviness and attacks of dull pain in the epigastrium.
2. Flu-like syndrome: chills, weakness, discomfort in the muscles, fever up to 40 degrees, mild nasal congestion, slight sore throat.
3. Asthenovegetative syndrome is manifested by severe weakness, decreased performance, increased sweating, a drop in blood pressure, and a sharp change in mood.

Rarely, the pre-icteric period may be absent. Botkin's disease can begin with changes in the color of various parts of the body.

On examination, there is pronounced swelling of the tongue and plaque on it. The liver and spleen become enlarged; after 2–4 days, the urine becomes dark in color, while the feces are poorly pigmented. The duration of the pre-icteric period is from 4 to 7 days.

Hepatitis A and jaundice

You need to understand that jaundice and hepatitis are not the same disease. Classification of jaundice according to the mechanism of occurrence:

With hepatitis A, it is parenchymal jaundice that develops. Types of jaundice:

• Hepatocellular. Clinically manifested by yellowing of the skin, absence of skin itching, the presence of spider veins on the face and body is visible, the patient has so-called hepatic palms and enlarged mammary glands. Causes: hepatitis of various etiologies, drug-induced injuries and chronic liver diseases.
• Cholestatic. The reasons for the development of symptoms of jaundice are: long-term use of antibacterial drugs, benign tumors, primary biliary cirrhosis, cholestatic hepatosis of pregnant women.
• Enzymopathic. The reason is a violation of intracellular bilirubin metabolism due to a deficiency of a number of enzymes. This type of jaundice is quite rare. Most often it is hereditary.

The incubation period for jaundice is 1–2 days. As already mentioned, jaundice is not hepatitis. Many people want to know how jaundice usually manifests itself in adults and children. This question is asked by everyone who felt the first signs of the disease.

Symptoms in adults begin in the same way as in children: with the appearance of a icteric coloration of the sclera. They acquire a bright yellow color; this condition lasts about 3–4 weeks after the pathological process subsides. With jaundice during Botkin's disease, the skin of the face, palms and feet turns yellow, and lastly the torso. The skin color acquires lemon-yellow shades. There is a table that determines the degree of coloring. Symptoms of jaundice last approximately 7–10 days.

During laboratory tests, antibodies to the hepatitis A virus are detected, an increase in the number of liver enzymes - alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT), a decrease in the number of leukocytes, the erythrocyte sedimentation rate (ESR) may be normal or reduced, upon examination an enlarged liver edge is determined dense consistency. Symptoms and treatment of hepatitis A should be strictly monitored by an infectious disease physician.

Severe jaundice in adults is extremely rare and is characterized by the development of damage to the central nervous system. There is a refusal to eat, there is nausea, vomiting and weakness, pathological tendon reflexes and tremors of the limbs appear.

In general, jaundice in type A hepatitis occurs with mild or moderate severity; cases of transition to a chronic form are not observed.

In rare cases, exacerbation is possible; it is accompanied by an increase in liver enzymes and is called an enzyme crisis.

During the period of convalescence (clinical recovery), health improves, malaise passes, the activity of liver enzymes (ALAT and AST) and the amount of bilirubin decreases. A decrease in the icteric color of the skin and the size of the liver is observed 1–2 months after the signs of hepatitis A and symptoms of intoxication subside.

Diagnosis of viral hepatitis A (Botkin's disease)

Treatment of jaundice in adults is characterized by large doses of drugs taken. Men receive the same treatment as women. Previously, people were treated by removing bile from the body.

The patient must undergo a course of nutritional therapy with limited fat and spicy foods. It is necessary to understand that jaundice can be eliminated only under the supervision of a doctor. Hepatitis A is treated with the use of vitamins and hepatoprotectors that improve liver function. The consumption of beer and any strong alcohol is strictly prohibited.

To relieve intoxication syndrome, drink plenty of fluids and infusion therapy. Lactulose-based drugs are used to cleanse the gastrointestinal tract. To eliminate jaundice syndrome, ursodeoxycholic acid and antispasmodics are used. Choleretic and detoxifying medications help get rid of skin itching, resulting in a subsidence of the pathological process.

Identification and treatment of carriers is the basis for the prevention of Botkin's disease (hepatitis A). As a result, the peak incidence passes and the number of victims decreases. It is important to understand that following the rules of personal hygiene helps to avoid Botkin's disease.

Hepatitis A, also known as Botkin's disease, is an acute infectious disease that affects the liver. The source of the pathogen is a sick person. According to the World Health Organization, up to 10 million people worldwide become ill with hepatitis A every year. In early childhood, pathology can be tolerated in an erased form.

The level of morbidity directly depends on compliance with the rules of personal hygiene in certain areas, institutions and teams.

Note:Botkin's disease is characterized by seasonality. The peak incidence occurs in the summer-autumn period. Most of the sick are children and adolescents from 4 to 15 years old, as well as young people.

The causative agent of Botkin's disease is the RNA-containing hepatitis A virus (HAV), which belongs to the Picornaviridae family. This infectious agent lacks an envelope. Currently, only one serological type of the virus has been identified, but there are a number of different genotypes.

The main route of infection is nutritional - through contaminated water, food and utensils used by the infected person. The mechanism of transmission of the virus is fecal-oral. Experts do not rule out that mechanical transmission may be carried out by certain types of insects (in particular, house flies). There is evidence that parenteral transmission of HAV (through whole blood, plasma or red blood cells) is possible in rare cases.

The causative agent of Botkin's disease is very resistant to detergents, acid solutions, ether and chlorine. It remains virulent when dried and exposed to heat (up to +60°C). In the aquatic environment (both sea and fresh water), the virus can remain viable for several months. HAV is susceptible to formaldehyde and is killed in 5 minutes when boiled.

The release of the infectious agent in feces begins at the end of the incubation period and continues throughout the “pre-icteric” phase. Once a patient develops the characteristic clinical symptom of jaundice, HAV is no longer detectable in feces.

Development of the disease

The incubation (latent) period of this disease ranges from 1 week to 50 days (on average - from 2 to 4 weeks).

Botkin's disease is characterized by the absence of a chronic form of its course. The pathology does not cause permanent liver damage. After one illness, the human immune system produces antibodies, which subsequently provide lasting immunity.

The icteric period, caused by the vivid manifestation of clinical symptoms, lasts from a week to a month and a half.

The period of convalescence begins with a general improvement in well-being and a decrease in jaundice. Subictericity (slight jaundice) of the sclera, a feeling of heaviness in the right hypochondrium, slight hepatomegaly and asthenia may persist for quite a long time.

Symptoms of viral hepatitis

The pathogen has a damaging effect on liver cells. Organ tissues undergo inflammatory and necrotic changes, which is accompanied by general intoxication of the body.

The “entry gate” for the virus is the epithelial cells of the digestive tract. From them, the pathogen enters the bloodstream and migrates to the liver, where it actively multiplies in “Kupffer cells” (macrophages) and hepatocytes. HAV then enters the bile and is excreted through the intestine.

Early clinical symptoms of Botkin's disease:

Important:in many patients, especially children, early symptoms (signs of intoxication and fever) of Botkin’s disease may not appear at all.

As viral hepatitis A develops, the following are noted:

• hepatosplenomegaly (enlarged liver and spleen);
• darkening of urine (to “coffee color);
• stool discoloration;
• dull painful sensations in the liver area (in the right hypochondrium);
• yellowing of the sclera of the eyes and skin.

The diagnosis of viral hepatitis A is made by a specialist based on the characteristic clinical picture and data obtained during laboratory tests. The virus is detected in feces only at the end of the “latent” period, and at earlier stages (already 1-2 weeks after the infectious agent enters the body) specific anti-HAV immunoglobulins (IgM) can be detected in the blood.

In the acute phase, laboratory tests reveal an increase in the activity of serum enzymes, in particular aldolase, AST (aspartate aminotransferase) and ALT (alanine aminotransferase). ALT appears due to the destruction of liver cells by the virus.

Another diagnostic sign of Botkin’s disease is an increase in blood levels. During the period of jaundice, the blood can also detect monocytosis, relative lymphocytosis, leukopenia and, in some cases, a slowdown in the erythrocyte sedimentation rate.

The end of the acute phase of Botkin's disease is indicated by the appearance of specific IgG in the patient's blood. From this moment we can talk about the formation of stable immunity to the hepatitis A virus.

There is no etiotropic treatment for Botkin's disease. Patients with suspected viral hepatitis are placed in infectious diseases departments of hospitals.

The basis of therapy is diet (table No. 5 with limited salt intake) and a gentle regimen.

Patients require plenty of fluid in their diet to quickly eliminate toxins. Alkaline mineral waters and natural juices are recommended, 2-3 liters per day.

In cases of moderate severity, intravenous administration of Ringer-Locke and glucose solutions (5%) 250-300 ml is indicated. In case of pronounced intoxication, an intravenous infusion of rheopolyglucin or hemodez of 200-400 ml is required.

In severe cases, patients must be transferred to the intensive care unit, where they receive IV up to 1 liter of 10% glucose per day, as well as Lobari solution (up to 1.5 liters per day).

If the disease is complicated by acute, for the treatment of Botkin's disease, solutions of albumin (15%, 200-300 ml per day) and sorbitol (20%, 250-500 ml per day), as well as prednisolone (intramuscular or intravenous) 60-90 mg are prescribed per day and kontrikal (10,000-30,000 units per day).

In some situations, blood transfusion may be chosen. Hyperbaric oxygen therapy is considered a promising treatment for viral hepatitis A.

Prevention of viral hepatitis A

A vaccine has been developed against the virus, thanks to which outbreaks of Botkin's disease are successfully contained. Children, as well as pregnant women who have been in contact with infected people in areas of hepatitis A, are given gamma globulin for preventive purposes.

Hepatitis A (Botkin's disease) is a viral infectious disease with an acute course that affects people of various age categories. In case of progression of this pathology, the development of an inflammatory process in the liver tissues is observed. Such pathological changes lead to disruption of its functioning. Previously, this disease was considered fatal, but now it is possible to prevent it - a special vaccine has been developed that can be administered to both adults and children.

Transmission path

In order not to become infected, it is necessary to know exactly how hepatitis A is transmitted. This disease is more often diagnosed in countries where there is an insufficient level of hygiene. Because of this, it is sometimes called “dirty hands disease.” The main route of transmission is fecal-oral. Viral hepatitis A is transmitted through food and water. The virus that provokes the development of pathology is not resistant to elevated temperatures, so it quickly dies when boiling and heat treatment of products.

Viral hepatitis A is often diagnosed in children. This is due to the fact that their immune system is not yet fully developed. It is also worth noting that it is children who love to put unprocessed foods (berries, vegetables, etc.) into their mouths. Therefore, it is important to get vaccinated as a child to prevent possible infection. It is worth noting that most patients in early childhood suffer from the disease in an erased form, which is not typical. After recovery, a person develops immunity.

Risk group (people who must be vaccinated):

• persons who frequently travel to countries where the incidence of viral hepatitis A is quite high;
• residents of Latin America, Asia, Africa;
• people who are in close contact with a patient with Botkin's disease.

Mechanism of infection

The source of infection is a sick person. Viruses enter the environment along with excrement (they contaminate the soil). From there they end up on food and in water. When they are consumed, pathogenic microorganisms enter the body, where they begin to actively multiply. They then enter the bloodstream and are transported to the liver, where they infect hepatocytes.

As a result, these cells cease to perform their basic functions and cause an autoimmune reaction. As a result, the body begins to attack its own cells. Inflammation develops in the organ, which causes the death of hepatocytes.

Symptoms

The first symptoms of hepatitis A in children and adults are very similar to the symptoms. The pathological process begins with the appearance of fever, which lasts for 10 days. As Botkin's disease progresses, nausea and vomiting, weakness and pain in the muscles appear.

As soon as the virus penetrates the liver and damage to hepatocytes begins, icteric lesions of the skin and sclera will appear. During this period, the patient's excrement becomes discolored and the urine becomes dark in color. These symptoms indicate that autoimmune reactions have begun in the body. Also during this period, the patient’s condition stabilizes, his temperature approaches normal values, and nausea stops. But these symptoms are replaced by itchy skin and the appearance of pain in the abdominal area.

The incubation period of Botkin's disease ranges from two weeks to 50 days. During this period, the patient begins to show the first symptoms of the pathology:

• weakness;
• nausea;
• temperature increase.

Often, when these symptoms appear, the patient does not consult a doctor, because he does not suspect that he is developing a dangerous illness. Symptoms are similar to respiratory infections. But it is worth noting that if the process is diagnosed just during the incubation period, then the effectiveness of the treatment will be much higher.

After the incubation period, pre-icterus begins. Signs of intoxication syndrome are increasing, the temperature rises to 40 degrees. This period is characterized by liver damage. The pathogenic virus begins to multiply in hepatocytes, which leads to the development of inflammation and edema in the organ. Hepatomegaly and changes in the structure of the organ are noted. If you palpate the right hypochondrium, you will notice that the liver is enlarged and protrudes from under the rib by 2 cm.

Symptoms of the pre-icteric period:

• darkening of urine;
• discoloration of excrement;
• jaundice of the skin increases (mild jaundice can be observed during the incubation period);
• destruction of hepatocytes occurs, as a result of which liver enzymes are released;
• the liver is painful on palpation.

The next stage in the progression of the pathology is the icteric period. Its duration is up to 6 weeks. Often after this there is a complete recovery. It is worth noting that the total duration of viral hepatitis A is 3 months. Even during the recovery period, hepatomegaly is noted. If you do a blood test, it can reveal elevated levels of liver enzymes.

The acute form of hepatitis A can become chronic. Medical statistics are such that a chronic course is observed in 15% of the total number of patients. The prognosis of this form is favorable - the disease ends with complete recovery of the patient and the formation of lifelong immunity.

Botkin's disease occurs in severe form in children under one year of age. Therefore, it is important to vaccinate them in a timely manner to protect them from possible infection. In infants, all symptoms are more pronounced. The disease is characterized by a rapid course. Severe dehydration develops. This symptom must be eliminated as soon as possible with intensive therapy (correction of water and electrolyte composition). If treatment for the pathology is not started in a timely manner, a coma may develop.

In adult patients, intoxication syndrome is pronounced. A characteristic symptom is prolonged jaundice. Doctors assess the condition of such patients as serious. Symptoms may persist for several months. Against the background of viral hepatitis A, other liver diseases may begin to progress. The clinical picture of Botkin's disease will be supplemented by their symptoms.

Treatment

At this time, there is no specific treatment for Botkin's disease. The main goal of therapy is to eliminate the symptoms of the pathology, relieve intoxication syndrome, and normalize the functioning of the liver.

Drug treatment is based on the use of the following groups of drugs:

• enterosorbents;
• vitamin therapy;
• hepatoprotectors;
• immunomodulators;
• enzyme preparations. They complement the basic treatment plan for severe forms of the disease;
• treatment with glucocorticoids is resorted to in case of a sharp deterioration in the patient’s condition;
• introduction of detoxification sterile solutions;
• choleretic.

Diet therapy plays a special role in the treatment of Botkin's disease. The patient is prescribed diet No. 5. With its help you can reduce the load on the liver. Food is taken in small portions and 6 times a day.