Contents
More than thirty years ago, infectious disease specialists used a single name for human viral hepatitis – Botkin’s disease or jaundice. After the typification of the virus, human hepatitis began to be denoted by the letters of the Latin alphabet from “A” and further in order to “F”.
What is hepatitis C?
New, modern, varieties of the virus are designated by the initials of the first patients with GB, TTV. Scientists do not exclude the further detection of forms of the virus of this group. For now, we will focus on the most common and dangerous form of hepatitis, which has the letter “C”.
Hepatitis C – a human viral disease, the pathogen belongs to the Flaviviridae family, the Hepavirus genus, the type of HCV (hepatitis C virus) or HCV (English). First identified in 1989.
In an electron microscope, it is a small, spherical formation covered with a shell. Genetic information is contained in one gene that carries information about six to eleven genotypes.
Features of the HCV virus:
Human infection with HCV occurs mainly parenterally (bypassing the digestive tract), when the virus enters the bloodstream, then into the liver parenchyma. The main route of infection is intravenous injection of narcotic substances with a dirty syringe, infection is possible when the virus penetrates through the mucous membranes during unprotected sexual contact.
Liver damage in HCV is accompanied by concomitant diseases of the internal organs, a variety of metabolic disorders, as well as the immune system.
The high variability of the immune receptors of the virus envelope is characteristic. The virus easily deceives the human immune system and is regularly modified. As a result, scientists periodically discover new forms, types, subtypes of the virus.
Approximately 15% of patients have a chance for a complete recovery in the acute form of hepatitis, in the rest it passes into an asymptomatic chronic form, which ends with cirrhosis, sometimes with liver cancer.
The development of pathogenesis according to the type of chronic disease is one of the features of hepatitis C. Icteric staining of the integument in patients may be absent or appear for a short time.
A small bonus. For this form of hepatitis, intrauterine infection is possible, but not typical (transmission of the virus from a pregnant woman to her fetus).
Since 2004, hepatitis C has been included in the list of socially significant infectious diseases in the Russian Federation. The disease refers to predominantly chronic infections (decrease in the working capacity of people of active age), difficult to control the spread, since there is no vaccine. Up to 90% of people who inject drugs of the heroin series are carriers of the virus. Asymptomatic carriers of hepatitis C are the reservoir and carriers of the disease.
A distinctive feature of the chronic form of hepatitis is that the virus is in the human body in an active and inactive state. In this case, the activity states repeatedly change.
The trick is that antibodies in the blood (traces of the virus) are detected, but the virus in the blood (pathogen) is absent, that is, it is in a non-replicating phase and therefore cannot be treated.
Confirmation of the disease and control of the effectiveness of treatment is carried out on the basis of a comprehensive diagnosis:
laboratory methods, including determining the concentration of the virus (RNA), the amount of specific antibodies;
instrumental methods of visualization of the liver, puncture of the parenchyma of the organ and further laboratory research in order to determine the nature of damage to liver cells.
How long does the hepatitis C virus live?
The stability of the virus has been tested in the laboratory. It has been experimentally proven that the virulence of the hepatitis C pathogen persists on different surfaces, including in the syringe needle, for more than four days at room temperature.
Boiling is inactivated in two minutes. When heated up to 600C loses virulence within two minutes. Direct irradiation with ultraviolet light will inactivate it within about 10 minutes.
Meanwhile, the probability of a virus getting into the bloodstream is quite high in various everyday situations or medical care errors (see below).
How long do people with hepatitis C live?
On average, after ten to thirty years, a chronic disease ends with severe, irreversible liver damage – cirrhosis. Since the main risk group is young people under 30 years old, the prospect of getting fatal consequences at 40-60 years old and even earlier is relevant. This outcome is expected by approximately 20% of chronic patients with this form of viral hepatitis.
In an infected person, the quality of life decreases due to damage to liver functions. Its important function is reduced – detoxification of metabolites, especially after eating fatty foods, alcohol. Blood stasis is potentially dangerous due to a decrease in the filtration function of the liver.
The premature death of a person affected by the hepatitis C virus is possible, caused by indirect causes. One of the probable causes of death is a decrease in the functional competence of the liver, which leads to a trail of pathologies (disturbance of the cardiovascular system, kidneys, lungs).
The end of the disease – cirrhosis of the liver is manifested by a total violation of the functions of the organ, the desolation of small vessels and the formation of large blood flow pathways. Cirrhosis of the liver is an irreversible process, it is almost impossible to cure it with modern methods. As a result of compaction of the parenchyma, congestion develops in the abdominal cavity (ascites). Stagnation of blood is accompanied by the expansion of the walls of the arteries of the liver. This is a potential threat of rupture of blood vessels and bleeding. In exceptional cases, liver cancer develops.
Symptoms of Hepatitis C
The main group of patients who complain of general malaise, weakness, do not associate complaints with liver damage.
One of the features of hepatitis C is the absence or short-term yellowness of the integument. Jaundice (icterus) of the sclera of the eyes and skin is a symptom of liver damage, or rather a symptom of an increase in the concentration of bile pigment in the blood. Bilirubin, as this pigment is called, can enter the bloodstream in one of the forms of pathology of the bile ducts or liver parenchyma.
General clinical symptoms accompanied by hepatitis C:
general weakness, apathy;
decrease in activity during work;
disgust, often loss of appetite;
pain, discomfort in the right hypochondrium associated with dyskinesia (bile stasis) or inflammation of the gallbladder, damage to the liver parenchyma is not manifested by pain;
on palpation, the doctor feels an increase in the size of the liver and spleen, the patient feels an increase in the liver by a feeling of fullness in the right hypochondrium;
persistent fever is possible.
A feature of the pathogenesis of hepatitis C, as well as hepatitis B (similar pathogenesis) is the possible presence of extrahepatic symptoms. The absence of a visible connection between symptoms and liver damage, with a deep analysis, nevertheless confirms this connection.
Main extrahepatic symptoms:
damage to the joints and heart muscle – rheumatoid inflammation;
damage to the organs of vision of a different nature;
papular rash on the skin or mucous membranes, possibly as a separate disease – lichen planus;
damage to the excretory organs (kidneys, bladder).
Unfortunately, none of the above symptoms is pathognomonic (main, defining), but always confirms damage to the liver or other organs that have a close connection with it.
The main symptoms confirming the connection of the disease with hepatitis C are detected by laboratory and instrumental methods.
Signs of hepatitis in women and men
Hepatitis C does not have gender differences, it manifests itself equally in men and women. Often this form of hepatitis has no symptoms at all, except for general and extrahepatic symptoms (see above).
The consequences of hepatitis C appear imperceptibly, a long time after infection. Adults should increase epidemic alertness, stop using drugs, unprotected, casual sex.
It is sad if a baby is at risk of contracting hepatitis C as a result of carelessness of parents.
Hepatitis C in pregnant women
It is always associated with huge loads on the body of a pregnant woman. The acute form of hepatitis in the active stage can be dangerous for the fetus. Meanwhile, modern ideas about the chronic pathogenesis of this form of the disease give reason to consider it possible to successfully bear a fetus in the absence of signs of liver degeneration.
In some cases, complications are possible. Their features are diverse and cannot be classified within the framework of this text. Observation of the course of pregnancy in this case is carried out in a hospital or outpatient setting.
Severe consequences associated with the degeneration of the liver in the form of cirrhosis are incompatible with pregnancy and gestation. Women with cirrhosis are advised not to become pregnant.
Hepatitis C in infants
Here are answers to current questions about the possibility of intrauterine infection, as well as infection during breastfeeding.
No more than 6% of cases of infection of the fetus during pregnancy and childbirth have been registered, while the transmission of the virus is possible only in the active (replicative) phase of pathogenesis.
The breast milk of an infected mother is safe for the baby in the absence of damage to the nipples of the nursing, infected woman and the oral cavity of the newborn.
Antibodies to the virus penetrate the placental barrier, therefore, in an infant born to an infected mother, antibodies to the C virus are found in the blood until the age of one.
Intrauterine infection is excluded in a child born from an infected mother with a decrease in titers, the disappearance of antibodies at the age of one. For about 5% of children, this statement is not true.
Infants born from women infected with hepatitis C are under special supervision of infectious disease specialists.
How is hepatitis C transmitted?
In about 25% of adults and 46% of children, the exact cause of the infection is unknown. The most significant route of transmission of virus C is intravenous administration of narcotic drugs using non-sterile (virus-contaminated) injection needles. A possible, uncontrolled route of infection is sexual contact in the presence of lesions on the mucous membranes of the external male or female genital organs.
Possible ways of parenteral accidental infection in medical institutions and public service offices:
intravenous administration of drugs, transfusion of infected blood;
dental procedures of a surgical or therapeutic nature;
shaving with general razors;
some procedures in beauty parlors associated with the risk of accidental bleeding;
there is a hypothesis about the transmissible transmission of virus C during the bite of blood-sucking synanthropic insects (bugs), forest bloodsuckers (mosquitoes, mosquitoes)
Can you get hepatitis C?
The oral-fecal route of infection, characteristic of the A, E forms, is not excluded in the transmission of the C virus, but with a low degree of probability. Oral (through the mouth) infection is possible when the mucous membrane of the gastrointestinal tract is damaged.
In addition to the C form, the parenteral route is characteristic of viruses (B, D, F), as well as relatively new forms (GB, TTV).
Is hepatitis C sexually transmitted?
Infection in this way is possible, however, due to the nature of the virus, genital infection is not the main one, just like the household route of infection. The main condition for the transmission of virus C is damage to the skin or mucous membranes of their bleeding or microbleeding.
Genotypes of hepatitis C
According to modern concepts of virologists, hepatitis C has six genotypes. The term “genotype” means the differences of the virus at the molecular (genetic) level.
Most scientists recognize the existence of six genotypes. As a scientific hypothesis, the presence of three more genotypes is considered.
Since the genetic differences of the virus are indifferent to the average reader, let us dwell on the description of the six main genotypes.
Knowledge of the genotypes of their quasi-types is important for infectious disease doctors with:
choice of methods of treatment of the disease;
determining the epidemic situation of hepatitis C.
Genotypes have a specific territorial distribution. In relation to the same genotypes of different territories, the same principles of treatment apply.
Genotypes are denoted by Arabic numerals (from one to six), and quasitypes or subtypes are denoted by Latin letters (a, b, c, d, e) and so on:
First genotype. It is ubiquitous, three quasi-types (1a, 1b, 1c) have been identified. If this genotype is confirmed, long-term treatment should be expected, for one year or more.
Second genotype. The ubiquitous distribution of the genotype and four quasitypes (2 a, b, c, d) are characteristic. The duration of treatment is usually no more than six months.
Third genotype. Distributed everywhere. The presence of six quasitypes (3 a, b, c, d, e, f) is proved. This genotype is characterized by fatty degeneration (infiltration) of the liver parenchyma – steatosis. The treatment time depends on the quality of the diagnosis. The average treatment time is limited to six months.
Fourth genotype. Widespread in the Middle East and Central Africa. In the conditions of Russia it is little studied. Ten quasitypes (4a, b, c, d, e, f, g, h, i, j) have been identified.
Fifth genotype. First registered in South Africa. Has one quasitype. In the conditions of our country, it remains a little-studied pathology.
Sixth genotype. Registered in Asian countries, has one quasi-type. In the conditions of Russia it is little studied.
Other types of hepatitis
Different human hepatitis have ambiguous epidemic significance for the human body, differ in methods of treatment, the possibility of specific prevention.
Hepatitis A
The name remained behind the disease – Botkin’s Disease. A common infection, registered in approximately 40% of patients with hepatitis. It is transmitted by the oral-fecal route, when eating contaminated food, water, or accidentally swallowing other objects into the digestive tract. Very rarely parenteral route of infection is possible.
Typical symptoms:
Inflammatory, necrotic changes in the liver;
Organ enlargement;
Jaundice (icteric staining) of the integument;
dark urine;
Colorless feces (no pigment).
The stage of jaundice is characterized by the absence of contagiousness. The pathogenesis is characterized by an acute course for up to three to four weeks.
Hepatitis B
It has the designation VGV or in the English-language literature HBV. parenteral infection. The causative agent is found in urine, semen, and also in the discharge of female genital organs. As well as for hepatitis C, a chronic course of the disease is characteristic.
The main difference from hepatitis C similar to it is the high risk of intrauterine transmission of the pathogen from mother to fetus. Clinical signs resemble hepatitis C. It is also characterized by an undulating course, a chronic form of the disease. Accompanied by cirrhosis, malignant degeneration of liver epithelial cells is possible.
For hepatitis B, a vaccine has been developed and introduced into everyday practice, which is also effective against hepatitis D. Newborns from women infected with this hepatitis must be vaccinated. The first dose in the delivery room, booster after a month and a year. The decision on further vaccination is made by doctors based on the results of laboratory diagnostics.
Hepatitis D
It is a delta infection of hepatitis B. Only in the presence of the B virus, the development of the D form of the disease is possible. Characterized by parenteral infection and chronic course.
Clinical signs resemble hepatitis B. It is distinguished by a severe course of the acute form of the disease. Often observe a joint course with a closely related B pathogen.
Prevention is based on the use of hepatitis B vaccine and non-specific methods. Treatment is similar to that for acute and chronic pathogenesis of other herpes.
Hepatitis E
Infection through the digestive tract is characteristic, as well as an exceptionally acute course of the disease. It is characterized by a severe course in pregnant women. Otherwise, it resembles the acute forms of other hepatitis with the oral-fecal route of infection. In particular, it is similar to hepatitis A.
Hepatitis G
The independent existence of the virus is discussed, not recognized by all researchers. Sometimes they are called by the first letters of the diseased – GB. Often, the detection of the G virus directly correlates with the detection of hepatitis C. Parenteral infection and a chronic course of pathogenesis are characteristic. The clinical picture resembles other forms of hepatitis with parenteral infection. The picture of the disease is similar to hepatitis C.
Therapies
Therapy of acute and chronic forms of hepatitis has a fundamental difference. Treatment of the acute form is aimed at eliminating the main symptoms, protecting the liver from further damage, and protecting the main functions of the organ.
Intravenous administration of saline solutions stimulating the elimination of toxins from the body, vitamins are prescribed, choleretic drugs are prescribed inside.
A feature of the treatment of acute hepatitis C is the mandatory appointment of immunocorrectors. This measure is related to the peculiarity of the pathogen. For other hepatitis, correction of immunity in the acute course of the disease is not appropriate.
Sometimes patients are surprised at the lack of intensive care in acute forms of hepatitis. The fact is that an additional drug load, excluding symptomatic treatment, is potentially dangerous for a damaged liver.
In addition to symptomatic treatment, proper dietary nutrition is important.
In case of acute liver damage, a dietary therapeutic diet is prescribed, which is usually indicated by table number 5, which includes:
Bakery products (slightly dried);
Soups with vegetables, cereals, milk;
Lean meat (beef, chicken, rabbit);
Low-fat fish (cod, pike perch);
Dairy products (fermented milk, hard cheese, egg omelet, butter);
Drinking (tea, compote, homemade juices, still mineral water);
Dessert (jam except for strawberry varieties, honey, sweets, sugar, marshmallows, fruit marshmallow)
Fruits (green apples, persimmon, watermelon, bananas)
It is forbidden fried, smoked, pickled, pickled, carbonated, canned, as well as products that have a salty, sour, sharp, spicy taste.
Some popular products are banned:
fruits, vegetables and berries (kiwi, melon, rose hips, strawberries);
products (jelly, mushrooms in any form, processed cheese, sour cream, cream, milk).
More relevant is the treatment of the chronic form of hepatitis C. Mandatory appointment of immunomodulators of different pharmacological groups:
interferons or interferon stimulants (RoferonA, Reaferon, Intron A, others)
correctors of humoral or cellular immunity (cycloferon, amixin, others);
Periodically, doctors change correctors. During the period of fever, the appointment of antipyretic drugs or physical methods (rubbing) of the regulation of body temperature is indicated.
In relation to chronic hepatitis C, which has a complex relationship with the immune system, antiviral drugs are prescribed (Remantadin, Ribavirin).
The diet for chronic hepatitis C is less strict. It is believed that the products prohibited in the acute phase of the disease are limited, it is possible to use once a week.