Hepatitis A (Botkin's disease). What is Botkin's disease Botkin's symptoms and their manifestation

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Botkin's disease is an acute infectious disease. It is caused by the hepatitis A virus and infects about ten million people every year. Particularly susceptible to the disease are residents of developing countries, as well as people living in areas with a low level of sanitary conditions.

Typically, in such regions, Botkin's disease is carried in childhood, after which a person remains immune to this virus for life, just like with other "childhood" viral diseases (measles, rubella, chickenpox, mumps). It is noticed that in most cases, children are much easier than adults to endure the disease.

Basically, hepatitis A is successfully cured, because there are a lot of medical techniques and drugs to defeat this virus. A lethal outcome is possible only in the presence of severe complications, and such cases are extremely rare in modern medical practice.

Botkin's disease does not have a chronic form; its symptoms do not cause inevitable changes in the human body. Prevention of malaise is a simple vaccination. This method has been effective in preventing hepatitis A epidemics around the world for many years, although in the past they were quite common.

To a greater extent, the symptoms of Botkin's disease are inherent in residents of hot countries in Africa and Asia, but isolated cases of the disease occur on any of the earth's continents. Therefore, timely diagnosis of the disease and its treatment in the early stages is so important. The only sure way out if you suspect that you or your loved ones are infected with the hepatitis A virus is to consult a doctor.

Unsanitary conditions are the main companion of Botkin's disease.

Its symptoms may appear after eating foods that were manufactured or kept without regard to established sanitary standards, contaminated water, or as a result of poor personal hygiene.

Infection is also sometimes possible due to the use of infected syringes, transfusion of infected blood, unprotected sexual intercourse. Thus, the hepatitis A virus is transmitted in the following ways:

Fecal-oral.
Parenteral.

Research is currently underway on the presence of the hepatitis A virus in ocean water. Curiously, the virus can survive up to several months in both fresh and salt water. It also withstands temperatures up to 60°C.

Manifestations of the disease

Botkin's disease has three stages of development, which are distinguished according to the degree of harm caused by the virus to the body:

At the initial stage of the manifestation of the presence of the virus in the body, the signs coincide with the symptoms of many other diseases, or even just overwork, so it can be difficult to diagnose.

These signs include:

But it happens that the initial stage does not manifest itself at all, and after the apparent period of the state of absolute health of the body, a severe stage of hepatitis A immediately sets in.

It should also be noted that the disease has a rather long incubation period, it can last from two to five weeks. That is, from the moment of infection to the time when at least some symptoms begin to appear, a significant period of time will pass.

But in the later stages of the disease, in its midst, symptoms appear that accurately indicate that we are talking about hepatitis A:

And in severe form, there are the following additional signs:

The most dangerous is the critical (malignant) form of Botkin's disease.

Its manifestations are very serious and require increased attention to themselves, and the cure in this case is not easy and lasts a long period of time. However, it should be noted that the mortality rate from the hepatitis A virus is no more than 0.5%. The main symptoms of the critical stage of the disease:

Such an acute stage may even require a transplant of the liver or part of the liver, as the tissues of the organ gradually die off. But timely diagnosis and treatment will improve the situation.

Remember! The hepatitis virus is easily transmitted in the home, so try to protect uninfected family members from infection.

It is necessary to observe simple precautions, the same as when contacting a person with other infectious diseases (separate dishes for the patient, avoiding close contact, etc.).

Botkin's disease affects both men and women equally. Its symptoms develop equally in both sexes and, accordingly, they will have to undergo an identical treatment procedure. The only thing that doctors specifically recommend to women who have had Botkin's disease is to avoid pregnancy for a year after the disease.

There is also an opinion that if a pregnant woman is sick with the hepatitis A virus, this can adversely affect the health of the unborn child, but this theory has not been proven, and therefore does not necessarily justify itself.

How to overcome the disease?

Since the human immune system has the ability to fight the disease on its own, a mild form of hepatitis A can be cured without taking drastic measures. You just need to follow some simple guidelines:

Since hepatitis A is a viral disease and is transmitted by household means, all people living in the same area with the patient should receive a dose of anti-hepatitis immunoglobulin in order to prevent infection,

After a person has had an illness, and all the troubles seem to be over, because the body produces antibodies that are resistant to the hepatitis A virus, he will still have to follow some of the doctor's recommendations. Your life will never be the same again, because the liver is very weakened after an illness and requires special attention to itself.

To avoid complications, be prepared for a number of the following main contraindications:

Otherwise, complications such as autoimmune hepatitis, liver failure, encephalopathy, or cirrhosis of the liver are possible.

With minor consequences of the disease, you can fight at home.

Drink pumpkin juice as much and as often as possible, eat cereals, dairy products and lean meat. Try to avoid fatty, fried foods in your diet, use a small amount of spices and salt. Also, frequent meals in small portions (eat at least 5 times a day) will help you.

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 fall ill with hepatitis A every year in the world. In early childhood, pathology can be transferred in an erased form.

The incidence rate directly depends on the observance of personal hygiene rules 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 cases are children and adolescents from 4 to 15 years old, as well as young people.

The causative agent of Botkin's disease is an RNA-containing hepatitis A virus (according to the English-language nomenclature - HAV), belonging to the Picornaviridae family. This infectious agent is devoid of a shell. Currently, only one serological type of the virus has been isolated, but there are a number of different genotypes.

The main route of infection is alimentary - through contaminated water, food and utensils used by the infected person. The transmission mechanism of the virus is fecal-oral. Experts do not exclude that mechanical transmission can be carried out by some types of insects (in particular, house flies). There is evidence that parenteral transmission of HAV (with 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 retains virulence upon drying and thermal exposure (up to +60°C). In the aquatic environment (both in sea and fresh water), the virus can remain viable for several months. HAV is susceptible to formalin, and when boiled, it dies in 5 minutes.

Isolation of the infectious agent with feces begins at the end of the incubation period and continues throughout the "preicteric" phase. When a patient develops such a characteristic clinical symptom as jaundice, HAV is no longer detectable in faeces.

Development of the disease

The incubation (hidden) 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 the course. Pathology does not cause permanent damage to the liver. After a disease has been transferred once, the human immune system produces antibodies, thanks to which stable immunity is subsequently provided.

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

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

Symptoms of viral hepatitis

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

The "entrance gate" for the virus is the epithelial cells of the digestive tract. Of these, 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 intestines.

Early clinical symptoms of Botkin's disease:

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

As viral hepatitis A develops, the following are noted:

hepatosplenomegaly (enlargement of the liver and spleen in size);
darkening of urine (to "coffee-colored");
discoloration of feces;
dull pain 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 on the basis of a characteristic clinical picture and data obtained in the course of laboratory tests. The virus is detected in faeces 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 studies 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, monocytosis, relative lymphocytosis, leukopenia and, in some cases, a slowdown in the erythrocyte sedimentation rate can also be determined from the blood side.

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 point on, 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 the infectious departments of hospitals.

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

Patients require a large amount of liquid in the diet for the rapid elimination of toxins. Alkaline mineral waters and natural juices are recommended, 2-3 liters per day.

With a moderate course, intravenous administration of Ringer-Locke solutions and glucose (5%), 250-300 ml each, is indicated. With pronounced intoxication, an intravenous infusion of rheopolyglucin or gemodez 200-400 ml is required.

In severe cases, patients are subject to transfer to the intensive care unit, where they receive intravenous 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 prednisone (intramuscularly or intravenously) 60-90 mg are prescribed per day and kontrikal (10,000-30,000 IU 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, are given gamma globulin for prophylactic purposes in hepatitis A foci.

Botkin's disease, or in other words hepatitis A, refers to infectious forms that cause liver disease. Causes a disease resistant to the influences of the external environment, a virus. It can be detected in the blood of a sick person even in the incubation phase at the very beginning of the damage to the body.

Botkin disease virus it is very vitally stable, it is not afraid of any disinfectants, it can exist with food for about a year, heat treatment partially destroys it. Favorable for its spread are overpopulated countries or places with unfavorable hygienic conditions. Disease control is possible only if the population is vaccinated.

The carrier of Botkin's disease can be a sick person, as well as food or water contaminated during contact with the carrier. Carriers are rodents and flies, but most often this is facilitated by unwashed hands of the person himself. The disease is transmitted by contact with an oral-fecal or household source.

The disease got its name from the name of a well-known Russian in the 19th century. doctor S. Botkin, who was one of the first to investigate the nature of the occurrence of the disease. Hepatitis A became widespread during the Second World War, but now, the disease is more often not of a mass nature, but manifests itself in isolated cases or flares up in small lesions.

Jaundice, this is another name for Botkin's disease, you can get sick at any age, but those who have been ill in infancy receive immunity for life.

Botkin's disease can be caught:

Stages of development of Botkin's disease

The first stage is the entry of the virus into the body. Penetrating into the body by oral route, the virus bypasses the stomach, the acid of which is absolutely safe for it. Through the intestines, by absorption, it penetrates into the blood, and then into the liver.
The second stage is the reproduction of the virus. Having quickly spread through the cells of the liver, the disease comes out through the bile ducts, and through the intestines it leaves the body with feces.
The third stage is the development of immunological protection. This process occurs at the time of manifestation of inflammatory processes in the liver. Special cells, T-lymphocytes, destroy damaged cells, which impairs the functioning of the liver. There is a blockage of the bile ducts.
The fourth stage is to stop the reproduction of the virus. After the immune system is activated, antibodies begin to be produced, which cleanse the body of the virus.

Symptoms of Botkin's disease

Into the aging stage that lasts from 14 to 40 days, Botkin practically does not manifest itself and has a veiled character. After the incubation cycle, the first symptoms appear, indicating the presence of infection. Most often, this is a minor gastric disorder, the presence of bad breath, which does not give rise to serious experiences. The next signal is nausea and vomiting, accompanied by abdominal pain.

Over time, in the course of Botkin's disease, the symptoms are clearly pronounced. Appear:

fever, cough, runny nose (may last about a week);
feeling of heaviness in the liver, its increase in size;
prostration;
irritability;
weakness and drowsiness;
constipation or diarrhea;
urine becomes dark in color, has foaminess;
feces have a light, sometimes even white, shade;
joint pain;
uneven pulse;
low pressure;
decrease in temperature leading to a feverish state.

A clear symptom of Botkin's disease - yellowness of the skin, palate and eye proteins. First, the sclera change color, then the face, torso, hard palate, hands and palms of the hands. This is due to the fact that bilirubin, produced by the liver, begins to enter not into the intestines, but into the blood in large quantities. This is how the virus acts on the liver. In severe cases, yellowness can last for about 3 months, recovery comes slowly.

After the disappearance of yellowness, the liver remains enlarged for a long time. This period lasts from a week to several months. This means only one thing - recovery has not come.

It is worth remembering that yellowness of the skin can appear even after there is a clogged bile duct, so an accurate diagnosis, after the manifestation of this symptom, is established only after all the necessary tests have been carried out.

There are several models for the course of Botkin's disease:

If the immune system is actively working, recovery can even come by itself. The treatment is mainly to alleviate the course of hepatitis A.

Ways to relieve Botkin's disease

At the first sign of jaundice, the patient must be urgently isolated, because he is a carrier of the virus. The patient is hospitalized, creates a favorable atmosphere for rest, recuperation and recovery. In advanced cases, the liver undergoes irreversible processes, there is a risk of liver tissue necrosis, which leads to dystrophy and death of the patient.

Successful prevention methods include vaccination. Now there is no compulsory vaccination against Botkin's disease, but it must be done independently by someone who is at risk. These are children attending a kindergarten, tourists who are going to taste other countries, people who are in contact with a sick person. Vaccination forms the protection of the body up to 10 years, and is carried out in 2 stages, with a break of six months.

Compliance with the daily routine, personal hygiene rules can not only reduce the risk, but also completely prevent Botkin's disease.

One of the least dangerous and favorable types of hepatitis in terms of prognosis is type A or Botkin's disease. Despite the fact that the disease is quite difficult for the patient, it usually does not cause negative consequences for the liver and ends favorably in the complete recovery of the person with the development of lifelong immunity.

How is jaundice or Botkin's disease transmitted?

The ailment in question has a viral infectious nature and is transmitted by the fecal-oral, domestic route. This means that a carrier of hepatitis who does not follow the rules of personal hygiene, for example, does not wash his hands after using the toilet, is potentially dangerous. When sharing dishes, cosmetics with such a person, the risk of infection is very high. In addition, jaundice is transmitted through food and water.

It should be noted that direct contact with a carrier of hepatitis A is not necessary.

Symptoms of Botkin's disease

The incubation period proceeds without any clinical manifestations, this time ranges from 2 weeks to 50 days.

After the specified interval, the first signs of Botkin's disease appear:

heat;
palpable weakness, constant drowsiness and fatigue;
heaviness in the liver area;
pain in the upper epigastric region;
nausea, ;
subsequent decrease in body temperature to subfebrile values;
lack of appetite, anorexia;
enlargement of the liver in size;
dark urine;
the acquisition of fecal masses of a very light color, up to white;
discomfort during flexion and extension of the joints;
yellowing of the skin and whites of the eyes, as well as the palate.

It should be noted that the peak of the disease occurs very quickly and after complete yellowing of the skin and sclera, a person begins to feel much better, the liver decreases in volume. Moreover, from this point on, the patient is no longer contagious.

Infectious hepatitis or Botkin's disease - treatment

In fact, the human body heals on its own and in some cases jaundice is carried "on the legs" without special therapy.

In order to speed up the recovery process, the patient is provided with bed rest, diet (first No. 5a, and then No. 5), detoxification drugs, and vitamins are required. It is also recommended to increase the daily amount of fluid you drink - about 3 liters of water per day. Maintaining the water-salt balance and the protective functions of the body is prescribed intravenous administration of Ringer-Locke solutions, glucose.

Most hepatologists also practice infusions with sorbents (Rheosorbilact) and hepatoprotectors (Glutargin). Symptomatic treatment sometimes includes injections of Papaverine and Vikasol, drugs that relieve spasm of the smooth muscles of the abdominal cavity.

Thus, therapy is aimed mainly at eliminating the signs of hepatitis A and improving the patient's overall well-being. V further can be used for oral administration (Gepabene, Ursosan).

It is important to remember that, despite the absence of complications of Botkin's disease, this is a serious illness that harms all body systems due to poisoning with toxic compounds. Therefore, the duration of treatment is about 1 month, after which the person is granted an exemption from work for another 2 weeks. Moreover, weakness does not go away immediately and persists for another 3-6 months, during which you should continue to follow a diet and try to avoid both physical and emotional stress.

Prevention of Botkin's disease

The only measure that will help prevent infection is to follow the rules of hygiene. It is necessary to monitor the cleanliness of hands, consumed water and food. Try to have less contact with unscrupulous people, do not eat in suspicious places and do not try unwashed berries and fruits in the markets.

Synonyms: Botkin's disease, viral hepatitis A, HAV.

ICD-10 code: B15.0. - hepatitis A with hepatic coma, B15.9. - hepatitis A without hepatic coma.

Diagnostics

The diagnosis is made by an infectious disease specialist.

For diagnosis, it is important to indicate contact with a carrier of Botkin's disease or stay in countries that are dangerous for infection. A detailed examination is necessary to determine the size of the liver and spleen, a series of tests:

Blood chemistry:

Urinalysis with the determination of urobilin and urobilinogen:

the detection of urobilin and bile pigments in the urine is possible already in the preicteric period, these are the first signs of a violation of pigment metabolism.

Blood for antibodies to hepatitis:

the criterion for the acute form of Botkin's disease is the detection of class M antibodies in the blood (IgM),
in chronic course or immunity, class G antibodies (IgG) appear.

Treatment of Botkin's disease

Due to the active work of the immune system to fight viruses, recovery occurs even without treatment. The use of therapy methods is aimed at alleviating the condition and removing the symptoms of intoxication.

Held:

for the duration of the acute period "liver" diet (table No. 5);
creation of peace, isolation of the patient;
removal of intoxication by introducing solutions of glucose and sodium chloride;
the introduction of vitamins to maintain immunity and liver function;
the introduction of drugs that protect liver cells from destruction.

For constipation, laxatives are used (domperidone, metoclopramide, lactulose),
With dysfunctions - enterosorbents (activated carbon, smectite and analogues, hydrolytic lignin).
The duration of the course is 3-5 days.

The diet of table number 5 includes boiled or stewed dishes of the vegetarian table, dairy, cereal dishes, lean meat. Fatty, fried, spicy dishes, spices and excess salt are prohibited. It is important to eat often, at least five times, in small portions.

Read more about nutrition for Botkin's disease in our separate article.

Antiviral therapy is not carried out, as it is not effective. If antibodies are detected in the blood of contact persons, anti-hepatitis immunoglobulin is administered to prevent infection.

Complications

Botkin's disease is severe in children under the age of one year and in the elderly. In adults, hepatitis A is accompanied by severe intoxication.

There may be cases of anicteric mild course of the disease, such a person is a source of infection, especially dangerous for children.

With defects in the immune system or an early age of up to six months, a severe course of Botkin's disease occurs with the development of liver damage up to death.

Hepatitis A is similar in many manifestations to other hepatitis, so any cases of jaundice require examination.

Prevention

Prevention of Botkin's disease is vaccination. To date, it is not included in the mandatory vaccination calendar, but is strongly recommended for children attending kindergartens, people traveling on vacation and people who are at high risk of contact.

domestic inactivated vaccine HEP-A-inVAK (MP "Vector", Novosibirsk),
Havrix (GlaxoSmithKline, UK),
Avaxim (Aventis Pasteur, France),
Vakta (Merc Sharp and Down, USA).

Vaccination is allowed from the first year of life. The vaccination is given intramuscularly and can be combined with any other vaccination, provided that it is done in different parts of the body. The protective effect is achieved after a month, but after 6-12 months a booster dose is necessary. This scheme provides protection against viral hepatitis A for at least 5 years.

With epidemiological risks, the so-called passive immunization is carried out - during the first 10 days from the alleged contact with the patient, 10% commercial immunoglobulin or specific immunoglobulin with a high content of anti-HAV is used (allowed for pregnant women and children from 1 year old). The drug provides protection from 3 to 5 months.