Hepatitis D symptoms and treatment. Hepatitis D Virus, qualitative determination of RNA (blood plasma). Causes of hepatitis D

Methodological instructions for students for practical lesson No. 11.

Subject: Laboratory diagnosis of viral hepatitis.

Target: Study of methods of laboratory diagnostics of viral hepatitis.

Module 3. General and special virology.

Special Virology.

Theme 11 : Laboratory diagnosis of viral hepatitis.

Relevance of the topic: Viral hepatitis in Ukraine accounts for approximately 20% of all viral diseases that lead to prolonged disability: acute liver necrosis, cirrhosis, primary liver cancer. The hepatitis A virus causes epidemic hepatitis (infectious epidemic jaundice, Botkin's disease). For morphological and physico-chemical characteristics similar to enteroviruses. Hepatitis B virus described in 1970 and named Dane particles. It is a complex virus that contains DNA. Causes serum hepatitis. In recent years, there has been an increase in the incidence of this form of hepatitis.

HEPATITIS A VIRUS.

Hepatitis A (Botkin's disease)- an infectious disease with a fecal-oral route of transmission, clinically and morphologically characterized by liver damage with the development of a symptom complex of acute hepatitis. The disease has been known since ancient times, its description is contained in the works of Hippocrates. The virus was first isolated by S. Feystone (1973).

HBsAg. First identified Ar of hepatitis B virus; it was first isolated by B. Blumberg (1965) from the blood of an Australian aborigine, therefore this Ar is also called Australian. HBsAg often forms defective morphological particles of the 1st type, devoid of infectious properties (side metabolites of the replication cycle). In the cytoplasm of infected cells, there is an excess of HBsAg associated with the cell membrane and endoplasmic reticulum. HBsAg appears in the blood 1.5 months after infection; constantly circulates in the serum of infected individuals, and its purified aggregates are part of the hepatitis B vaccine. HBsAg includes two polypeptide fragments: preS 1 has pronounced immunogenic properties (the recombinant product can be used to prepare vaccine preparations); preS 2 is a polyglobulin receptor leading to adsorption of the virus on hepatocytes.

HBcAg. Core HBcAg is represented by a single antigenic type; it is found only in the core of Dane particles. Ar marks viral replication in hepatocytes. It can be detected only during the morphological study of biopsy specimens or autopsy material of the liver. In the blood in a free form, it is not determined. Point mutations in the region encoding the synthesis of the precursor HBcAg HB c Ag producing mutants of the hepatitis B virus, originally isolated in fulminant forms of hepatitis. The transition from HvcAg + to HvcAg - - forms is observed in patients with chronic, relatively mild lesions.

HBeAg. It is not part of the Dane particles, but is associated with them, as it appears in the serum in the incubation period, immediately after the appearance of HBsAg. The formation of HBeAg is translated by RNA containing regions of the core Ar and its precursor. After translation is completed, the resulting HBeAg molecule is expelled from the cell. The functions of HBeAg are unknown, however, HBeAg can be regarded as the most sensitive diagnostic indicator of active infection. The detection of HBeAg in patients with chronic hepatitis indicates the activation of the process, which poses a high epidemic risk. Ar may be absent in infections caused by a mutant strain of the virus.

HBxAg- the least studied Ar. Presumably mediates malignant transformation of liver cells.

DNA appears in serum simultaneously with other Ar virus. Disappears from the bloodstream at the beginning of the second week of acute illness. Prolonged persistence is evidence of a chronic infection. In the diagnosis of acute hepatitis B, DNA determination is rarely used.

Epidemiology. The pathogen reservoir is an infected person. The mechanism of transmission of infection is blood-contact. The main routes of transmission of the hepatitis B virus are injection, blood transfusion and sexual. The possibility of vertical transmission of hepatitis B virus from mother to fetus has also been shown. 7-10% of those infected become chronic carriers. At least 50 people fall ill every year. In Russia, a 10-15% increase in the incidence is noted. The main risk groups are medical workers;

• persons receiving blood transfusions or blood products;
• intravenous drug addicts;
• patients with hemophilia;
• persons on hemodialysis;
• children of HBsAg carrier mothers;
• sexual partners of carriers of the virus.

Pathogenesis. The hepatitis B virus is hematogenously introduced into the liver and multiplies in hepatocytes. In the second half of the incubation period (40-180 days), the virus is isolated from blood, semen, urine, feces and nasopharyngeal secretions. Autoimmune humoral and cellular reactions play an important role in the pathogenesis of lesions, which confirms the relationship between the onset of clinical manifestations and the appearance of specific antibodies. The pathological process begins after recognition of virus-induced Ar on hepatocyte membranes by immunocompetent cells. Complications of the chronic form are caused by chronic inflammation and necrotic processes in the liver parenchyma, the main complications are cirrhosis and primary liver carcinoma.

Cirrhosis is commonly seen in patients with acute chronic hepatitis, with more than 10,000 hepatitis B-related deaths each year.

Liver carcinoma. A clear relationship has been shown between malignant transformation of hepatocytes and past viral hepatitis B. Certain cofactors, many of which remain unknown, are involved in the development of the tumor process.

Principles of microbiological diagnostics. Hepatitis B virus replication markers - HBeAg. AT (IgM) to HBcAg, viral DNA and viral DNA polymerase. To identify HBsAg and HBeAg, ELISA and RNGA are used; studies are supplemented by the detection of hepatitis B virus DNA and viral DNA polymerase. Virus-specific antibodies to HBsAg, HBsAg, HBeAg are determined by ELISA and RNHA. The presence of a “fresh” infection is indicated by high titers of HBsAg, IgM to HBsAg and HBsAg. In patients with clinically manifested hepatitis, the HbsAg titer first increases, and then (as the immune reactions develop) decreases. Anti-HBsAg antibodies can be detected only after a few weeks, which is explained by their active binding into immune complexes. During this period (the so-called “window”), only antibodies to HBcAg can be detected.

AT to HBcAg. An important diagnostic marker of infection, especially when HBsAg is negative.

· IgM to HBsAg. One of the earliest serum markers of viral hepatitis B. In chronic hepatitis, virus replication and process activity in the liver are marked. Their disappearance is an indicator of either sanitation of the body from the pathogen, or the development of the integrative phase of the infection.

· IgG to HBcAg. Stored for many years. Evidence of an existing or previously transferred infection.

AT to HBeAg. Serological marker of virus integration. In combination with IgG, HBsAg and HBsAg indicate the complete completion of the infectious process.

AT to HBsAg. Protective AT; also form after vaccination. In relation to chronic viral hepatitis, they may indicate the end of a viral infection. AT to preS 1 - - preS 2 fragments of HBsAg. They indicate the development of protective immunity at the end of the infectious process. AT to Pre-S 1 is detected simultaneously with AT to HBsAg, and AT to Pre-S 2 .

Treatment. Means of specific therapy are absent, treatment is mainly symptomatic. The use of DNA polymerase inhibitors (for example, lamivudine), α-IFN and its inducers has certain prospects. Despite the fact that less than 50% of patients respond to IFN therapy, a significant disappearance of all markers of infection (DNA of the hepatitis B virus, HBsAg and HBeAg) and an increase in antibody titers to HBsAg are shown.

Immunoprophylaxis. Passive immunization with specific Ig (HBIg) is indicated for persons who have been in contact with infected material and carriers of HBsAg (including sexual partners and children born to HBsAg-positive mothers). Two types of vaccines have been developed for active immunization. The former are prepared from patient plasma containing Ar. Hepatitis B virus in quantities sufficient to create vaccine preparations. The main condition is the complete inactivation of the hepatitis B virus. The second group consists of recombinant vaccines (for example, Recombivax B, Engerix B) obtained by genetic engineering on cultures of baker's yeast (Saccharomyces cerevisiae). Mass immunization is an essential component of infection control. Adults receive 2 doses within a month and a booster immunization 6 months later. Children receive the first dose immediately after birth, the next - after 1-2 months and by the end of the first year of life. If the mother is HBsAg-positive, then the child is given a specific Ig at the same time as the first vaccination.

HEPATITIS D VIRUS (DELTA HEPATITIS)

hepatitis D virus discovered M. Risetto et al. (1977) in hepatocyte nuclei during an unusually severe outbreak of serum hepatitis in Southern Europe. Later, it began to be found everywhere, especially often in North America and the countries of North-Western Europe.

Taxonomy, morphology, antigenic structure. The causative agent of delta hepatitis is a defective RNA-containing virus of the Deltavirus genus of the Togaviridae family. It is isolated only from patients infected with the hepatitis B virus. The defectiveness of the pathogen manifests itself in complete dependence on its transmission, reproduction and the presence of the hepatitis B virus. Accordingly, monoinfection with the hepatitis D virus is absolutely impossible. Hepatitis D virus virions are spherical, 35-37nm in diameter. The genome of the virus forms a single-stranded circular RNA molecule, which brings the hepatitis D virus closer to viroids. Its sequences do not have homology with the DNA of the hepatitis B pathogen, but the supercapsid of the D virus includes a significant amount of HBsAg of the hepatitis B virus. The reservoir of the pathogen is an infected person; the virus is transmitted parenterally. Vertical transmission of hepatitis D virus from mother to fetus is possible.

Pathogenesis and clinical manifestations. Infection of HBsAg-positive individuals is accompanied by active reproduction of the hepatitis D virus in the liver and the development of chronic hepatitis - progressive or fulminant. It is clinically manifested only in persons infected with the hepatitis B virus. It can occur in two ways:

coinfection(simultaneous infection with hepatitis B and D viruses). A short prodromal period with high fever is noted;

• often migrating pain in large joints;
• increase in intoxication in the icteric period;
• often pain syndrome (pain in the projection of the liver or epigastrium);
• occurrence in 2-3 weeks from the onset of the disease or clinical and laboratory exacerbation. The course is relatively benign, but the recovery period takes a long time.

Superinfection infection with the hepatitis D virus in a person infected with the hepatitis B virus). Short incubation and preicteric periods (3-5 days) are noted with high fever, severe intoxication, repeated vomiting, pain syndrome, arthralgia. Characterized by severe jaundice, the development of edematous-ascitic syndrome, severe hepatosplenomegaly, repeated clinical and laboratory exacerbations. With this option, the development of a malignant (fulminant) form of the disease with a fatal outcome is possible.

Principles of microbiological diagnostics. For the diagnosis of acute and chronic viral hepatitis D, ELISA and RIA are widely used. Markers of virus replication - AT (IgM) to Ar of hepatitis D virus and viral RNA. Ar of hepatitis D virus appears in the blood 3 weeks after infection. Virus-specific IgM appear 10-15 days after the development of clinical manifestations. After 2-11 weeks, virus-specific IgG can be identified, constantly circulating in infected individuals.

Treatment and prevention. Means of specific chemotherapy and immunoprophylaxis are absent. Since the reproduction of the hepatitis D virus is impossible in the absence of the causative agent of hepatitis B, the main preventive measures should be aimed at preventing the development of hepatitis B.

HEPATITIS C VIRUS

Hepatitis C usually proceeds chronically and is characterized by the predominant development of chronic forms of hepatitis with an outcome in cirrhosis and primary liver carcinoma.

Hepatitis C virus is included in the genus of the Flaviviridae family. Virions are spherical, 35-50 nm in diameter, surrounded by a supercapsid. The genome is made up of single-stranded RNA. There are 6 serovars, each of which is “tied” to certain countries. For example, hepatitis C virus type 1 is common in the United States, and type 2 in Japan.

- an infected person. The main route of transmission of the virus- parenteral. The main difference from the epidemiology of the hepatitis B virus is the lower ability of the hepatitis C virus to transmit from a pregnant woman to a fetus and through sexual contact. The patient sheds the virus a few weeks before the onset of clinical signs and within 10 weeks after the onset of manifestations. The disease is more often registered in the USA (up to 90% of all transfusion hepatitis) and Africa (up to 25%). The clinical symptoms of viral hepatitis C are characterized by a change in the consistency and size of the liver. With an active process, the liver is usually enlarged and painful on palpation, its consistency is moderately dense. Other manifestations include splenomegaly, dyspeptic and asthenic syndromes, jaundice, arthralgia and myalgia, carditis, vasculitis, pulmonary lesions, anemia, etc. Complications of the chronic process are cirrhosis and primary liver carcinoma.

Principles of microbiological diagnostics. Virus replication markers - AT (IgM) to Ar hepatitis C virus RNA. Markers are detected by ELISA and PCR. An indication for the search for antibodies or RNA of the virus is any inflammatory liver disease. Virus-specific antibodies appear after an average of 3 months and indicate a possible infection with the hepatitis C virus or a past infection. In the seronegative period, hepatitis C virus RNA is detected. To confirm the results of ELISA, as well as when examining patients who do not belong to the main risk groups, the method of recombinant immunoblotting is used, which effectively eliminates false positive ELISA results.

Treatment and prevention. Means of etiotropic therapy are absent; in chronic infections, IFN-alpha can be used. During IFN therapy, 40-70% of patients notice a subsidence of the inflammatory process (as indicated by a decrease in the concentration of aminotransferases in serum), however, at the end of the course, 40-50% of patients experience a relapse of inflammation. Means of specific immunoprophylaxis have not been developed.

HEPATITIS E VIRUS

Hepatitis E- acute infectious liver disease, manifested by symptoms of intoxication and, less often, jaundice.

Pathogenesis and clinical picture. Hepatitis E virus is included in the Calicivirus genus of the Caliciviridae family. Virions are spherical, 27-38 nm in diameter. The genome is formed by a non-segmented +RNA molecule.

Pathogenesis and clinical picture. Exciter reservoir- Human. The epidemiology of the disease is largely similar to hepatitis A; the pathogen causes endemic outbreaks. Incubation period does not exceed 2-6 weeks. The disease is manifested by general malaise; jaundice is observed relatively rarely. In most cases, the prognosis of the disease is favorable, and patients recover completely. Infection of pregnant women, especially in the third trimester, can be fatal (mortality can reach 20%). Chronization of the process is not observed. Recovery is accompanied by the formation of persistent immunity to re-infection.

Principles of microbiological diagnostics. Virus replication markers - AT (IgM) to Ar hepatitis E virus and viral RNA. Virus-specific IgM is detected by ELISA, starting from 10-12 days after infection; diagnostic titers persist for 1-2 months. Abs of the IgG class to Ar of the hepatitis E virus appear one month after the disease. Virus RNA is detected in PCR reactions and molecular hybridization Virus RNA can be detected from the first day of infection; however, it is impossible to detect it in the icteric period.

Treatment. There are no means of etiotropic therapy and specific prophylaxis; carry out symptomatic treatment.

HEPATITIS G VIRUS

Taxonomy, morphology, antigenic structure. taxonomic position virus G remains unexplained. It is conventionally assigned to the Flaviviridae family. The genome is formed by a non-segmented +RNA molecule. The nucleocapsid is organized according to the type of cubic symmetry. Based on the set of Ar virions, it is suggested that there are at least three subtypes of the virus. The hepatitis G virus is presumably a defective virus and requires the presence of the hepatitis C virus in order to reproduce.

Pathogenesis and clinical picture. Exciter reservoir- Patients with acute or chronic hepatitis G and carriers of the hepatitis G virus. Often the registration of the disease is relatively low. In Russia, the detection rate of hepatitis G virus RNA ranges from 2% in Moscow to 8% in Yakutia. At the same time, in the blood serum of donors, the frequency of detection of hepatitis G virus RNA was 1.4%. More often markers of hepatitis G virus infection are detected in individuals receiving multiple transfusions of whole blood or its preparations, as well as among patients with transplants. A special risk group is made up of drug addicts (among those who inject drugs intravenously), the frequency of detection of hepatitis G virus RNA reaches 33-35%. Violations of the immune status contributes to the development of long-term carriage of the virus. The possibility of vertical transmission of the hepatitis G virus from an infected mother to the fetus has been proven. Hepatitis G in most cases proceeds as a mixed infection with viral hepatitis C, not significantly affecting the nature of the development of the underlying process.

Principles of microbiological diagnostics. Virus replication markers - AT(IgM) to Hepatitis G virus Ar and viral RNA. Virus-specific IgM is detected by ELISA, starting from 10-12 days after infection; diagnostic titers persist for 1-2 months. Abs of the IgG class to Ar of the hepatitis E virus appear one month after the disease. Virus RNA is detected in PCR reactions and molecular hybridization. Virus RNA can be detected from the first day of infection; however, it is impossible to detect it in the icteric period.

Viral hepatitis D(delta hepatitis) is an infectious lesion of the liver, coinfection or superinfection of viral hepatitis B, which significantly worsens its course and prognosis. Viral hepatitis D belongs to the group of transfusion hepatitis, a prerequisite for infection with hepatitis D is the presence of an active form of hepatitis B. The detection of hepatitis D virus is carried out by PCR. A study of the liver is mandatory: biochemical tests, ultrasound, MRI, rheohepatography. The treatment of viral hepatitis D is similar to the treatment of hepatitis B, but requires larger doses of drugs and a longer duration of treatment. In most cases, chronic disease is observed with subsequent outcome in cirrhosis of the liver.

General information

Viral hepatitis D(delta hepatitis) is an infectious lesion of the liver, coinfection or superinfection of viral hepatitis B, which significantly worsens its course and prognosis. Viral hepatitis D belongs to the group of transfusion hepatitis.

Exciter characteristic

Hepatitis D is caused by an RNA-containing virus, which is the only currently known representative of the “wandering” genus Deltavirus, which is distinguished by its inability to independently form a protein for replication and uses a protein produced by the hepatitis B virus for this. Thus, the causative agent of hepatitis D is a satellite virus and occurs only in combination with the hepatitis B virus.

The hepatitis D virus is extremely stable in the external environment. Heating, freezing and thawing, exposure to acids, nucleases and glycosidases do not significantly affect its activity. The reservoir and source of infection are patients with a combined form of hepatitis B and D. Contagiousness is especially pronounced in the acute phase of the disease, but patients pose an epidemic danger throughout the entire period of the circulation of the virus in the blood.

The mechanism of transmission of viral hepatitis D is parenteral, a prerequisite for the transmission of the virus is the presence of an active hepatitis B virus. The hepatitis D virus integrates into its genome and enhances the ability to replicate. The disease can be a co-infection, when the hepatitis D virus is transmitted simultaneously with B, or a superinfection, when the pathogen enters the body already infected with the hepatitis B virus. The most significant risk of infection during blood transfusion from infected donors, surgical interventions, traumatic medical manipulation (for example, in dentistry).

The hepatitis D virus is able to overcome the placental barrier, can be sexually transmitted (the spread of this infection among persons prone to promiscuity, homosexuals is high), which in some cases has a familial spread of the virus suggests the possibility of its transmission through household contact. Patients with viral hepatitis B, as well as carriers of the virus, are susceptible to viral hepatitis D. In particular, the susceptibility of persons who are chronic carriers of HBsAg is high.

Symptoms of viral hepatitis D

Viral hepatitis D complements and aggravates the course of hepatitis B. The incubation period of coinfection is significantly reduced, 4-5 days. Superinfection incubation lasts 3-7 weeks. The preicteric period of hepatitis B proceeds similarly to that of hepatitis B, but has a shorter duration and a more rapid course. Superinfection may be characterized by the early development of edematous-ascitic syndrome. The icteric period proceeds in the same way as in hepatitis B, but bilirubinemia is more pronounced, signs of hemorrhage often appear. Intoxication in the icteric period of hepatitis D is significant, prone to progression.

Co-infection proceeds in two phases, the interval between the peaks of clinical symptoms of which is 15-32 days. Superinfection is often difficult to differential diagnosis, since its course is similar to that of hepatitis B. A characteristic difference is the rate of development of the clinical picture, the rapid chronization of the process, hepatosplenomegaly, a disorder of protein synthesis in the liver. Recovery takes much longer than in the case of hepatitis B, residual asthenia may persist for several months.

Diagnosis of viral hepatitis D

In the acute phase of the disease, specific IgM antibodies are noted in the blood, over the next few months only IgG are detected. In wide practice, diagnosis is carried out using the PCR method, which makes it possible to isolate and identify the RNA virus.

To study the state of the liver in viral hepatitis D, ultrasound of the liver, rheohepatography, MRI of the liver and biliary tract are performed. In some cases, to clarify the diagnosis, a puncture biopsy of the liver can be performed. Nonspecific diagnostic measures are similar to those for hepatitis of a different etiology and are aimed at dynamic control of the functional state of the liver.

Treatment of viral hepatitis D

Treatment of hepatitis D is carried out by a gastroenterologist according to the same principles as the treatment of viral hepatitis B. Since the hepatitis D virus is more resistant to interferon, the basic antiviral therapy is adjusted towards increasing dosages, and the duration of the course is 3 months. If there is no effect, the dosages are doubled, the course is extended to 12 months. Since the hepatitis D virus has a direct cytopathic effect, drugs of the corticosteroid hormone group are contraindicated in this infection.

Forecast and prevention of viral hepatitis D

The prognosis in the case of mild to moderate co-infection is more favorable, since a complete cure is observed much more often than with superinfection. However, co-infection with hepatitis B and D viruses often proceeds in a severe form with the development of life-threatening complications. Chronic coinfection develops in 1-3% of cases, while superinfection develops into a chronic form in 70-80% of patients. Chronic viral hepatitis D leads to the development of cirrhosis. Recovery from superinfection is extremely rare.

Prevention of viral hepatitis D is similar to that of viral hepatitis B. Preventive measures are of particular importance for people with hepatitis B who are positive for the presence of the HBsAg antigen. Specific vaccination against viral hepatitis B effectively protects against delta hepatitis.

D is considered a defective microorganism, as it lacks its own coat and the enzymes necessary for reproduction. The main condition for its development in the human body is the presence of the hepatitis B virus, which facilitates the penetration of the delta virus into cells after infection.

The delta virus is a single strand of ribonucleic acid (RNA) with a protein coat on top. Penetrating into hepatocyte cells, the virus loses its capsule and begins to multiply, creating new microorganisms. The vital activity of the virus disrupts the functioning of liver cells and leads to the deposition of fat droplets in them, which ends with necrosis and death of hepatocytes. Having coped with one cell, delta viruses move on to others.

The pathogenesis of hepatitis D is not only in cell death, but also in the response of the immune system. Viral infection and disruption of the body leads to the activation of the immune system, it begins to produce antibodies. The antibodies produced by the body mainly fight the pathogens of type B hepatitis, but if it is completely destroyed, then the conditions conducive to the reproduction and development of the delta virus also disappear.

The causative agent of the hepatitis D virus is significantly different from the more commonly known microorganisms that cause hepatitis. Delta virus is considered the most contagious of them and has several genotypes that are divided along racial lines.

• The genotype of the first type is mostly detected in Europeans.
• The genotype of the second type was found in residents of Taiwan and Japan. In Russia, this genotype affects the population of Yakutia.
• The genotype of the third type is inherent in the inhabitants of Africa and Asia.

People infected with hepatitis B are considered the main group in which hepatitis D can also be detected. You can become infected with the delta virus through blood and unprotected sexual contact.

Causes and methods of infection

Hepatitis D is transmitted from a sick person to a healthy person. The source of infection is patients with acute and chronic forms of infection, as well as carriers, that is, those people who have no signs of the disease, but the delta virus itself is present in the body. If the delta virus enters the body of a person who does not have viral hepatitis D, then the microorganism will not multiply, that is, the disease is excluded. The etiology, that is, the causes of infection, is associated with infection with the blood and body fluids of a sick person, this can happen in several ways:

In rare cases, infection is detected when using some hygiene items by family members. It can be scissors, toothbrushes, razors. The risk of infection in health care workers is increased, since blood from a sick person on healthy skin leads to infection.

Delta virus is not transmitted through sneezing, kissing, dishes or water. Therefore, a person with the D virus does not pose any danger to others during normal communication.

Symptoms

Diet

With viral hepatitis, patients are prescribed diet No. 5. The main purpose of its use is to improve the functioning of the digestive tract and reduce the secretion of digestive juices. The following principles must be followed:

• Meals should be minimum portions of at least 4 times a day.
• Dishes should be warm, cold and hot are excluded.
• Do not eat foods containing a large amount of spices and essential oils.

All fatty fish and meat, smoked meats, chocolate, fresh pastries, pickled preparations, too salty and spicy dishes are excluded from the diet. The emphasis should be on plant and dairy foods, cereals. A sufficient amount of liquid in the form of compotes, rosehip decoctions will help free the body from toxins.

Consequences and prevention

The complications of viral hepatitis D include the development of cirrhosis, liver failure, and malignant neoplasms. With early detection of the disease, complete recovery of the liver is possible, but it can take several months.

There are two main methods for the prevention of hepatitis D. The specific method is to administer a hepatitis B vaccine. Since in this case a person becomes protected from the B virus, the possibility of the delta virus multiplying in the body is excluded.

Non-specific methods of prevention include the use of only disposable instruments during medical and other manipulations, condom-protected sexual intercourse, and abstinence from drugs.

Hepatitis D is a liver disease associated with hepatitis B that gradually causes necrosis or cirrhosis of the liver. But such a terrible disease is typical only for the Mediterranean countries, Japan and Africa. At the moment, in Russia, you can get sick with such an ailment when someone brought this disease into the country. This figure is 0.5%.
HDV is a carrier of the hepatitis Delta virus, which leads to, at times, irreversible consequences,. This is because viral Hepatitis D does not exist as an independent disease. It manifests itself only in tandem with hepatitis B. Therefore, a double effect on a vital organ can adversely affect the human body.

What is hepatitis D?

Hepatitis D is a severe liver disease that spreads through the PA and blood from person to person. This disease can be cured, even the acute form, the main thing is to see a doctor in time, that is, do not miss the time and prevent the infection from spreading throughout the body.

Statistics and prevalence

The RNA of the virus is not able to form a protein on its own, therefore it uses the hepatitis B virus for this purpose. In order for the virus to enter the blood of another person, it is necessary to have direct contact with an infected person or with methods of influencing the blood: transfusion, drug administration, drug addiction. according to medical practice, at the first stage, the disease can be confused with other diseases due to the standard primary symptoms characteristic of most ailments. In 80% of cases, hepatitis D is treatable and curable, but at stages 1 and 2. The consequences of other varieties of this disease can only be slowed down, but not prevented.

Causes

The most common cause of this disease is an infected person. Upon contact with a patient, for example, during PA, or less often, a kiss, infection of reproducing HDV, that is, hepatitis B, occurs. At the same time, this infection is caused in the human body along with hepatitis D and complicates the symptoms of the virus as a whole.

It is worth noting that the reproduction of the virus occurs exclusively in the vital organ, and not outside it.

Symptoms

The most common symptoms of hepatitis D are:

• malaise and lethargy of the whole body,
• gastrointestinal problem,
• lack of appetite,
• body temperature instability
• vomiting urge.

But an infected person may not pay due attention to such symptoms or not feel them at all, since these signs of the disease are characteristic not only for hepatitis D, but also for a number of other diseases, of which there are a huge number. But it is worth noting that these symptoms with hepatitis D do not disappear, but only intensify. Therefore, this should alert the patient.

Concomitant symptoms of infection also include dark urine and feces, bleeding gums, and the appearance of spider veins on the abdomen.

Transmission routes

• blood transfusion - donor blood sometimes does not go through all the stages of testing and purification, so there is a chance that the blood will be infected.
• drug addiction - the use of one syringe by several persons at times increases the percentage of people infected with hepatitis of any type.
• PA - unprotected sexual contact, since the virus is contained in human fluids (any), which easily damage wounded mucous membranes (for example, through cracks, erosion).
• when removing and applying tattoos or piercings, in any contact with the human body, as a result of which the formation of blood is possible. With any of the above manipulations, the devices that carry out the procedures may be unclean.
• during childbirth and lactation, provided that the woman in labor and the mother have cracks in the genital area and nipples. During natural childbirth, the percentage of infection increases than through caesarean.
• manicure scissors / razors. If you use one razor for several people, then the likelihood of a disease increases, since during shaving it is possible to cut off the skin cover, as a result of which blood can flow. The same goes for manicure accessories. If they are not treated properly, then the percentage of infecting a person increases dramatically.

It is worth noting that the hepatitis d virus is not transmitted by airborne droplets. Therefore, you should not be afraid of it in everyday life.

Incubation period

The incubation period in which the patient can infect another person is the first month, in some cases even 3 months. In difficult situations, it can increase up to six months.

if the HDV enters the bloodstream, it travels to the liver, where it stays, settles and multiplies. As a result, the infected person is the first to develop symptoms of the disease, similar to other diseases.

Diagnostics

In order to conduct a comprehensive diagnosis of the body, it is necessary to contact an infectious disease specialist, who will prescribe the following types of examinations to the patient:

• general blood test (from a finger),
• blood biochemistry (from a vein) + blood donation for virus markers,
• general urine analysis,
• abdominal ultrasound,
• anamnesis.

Additionally, in order to obtain a more accurate examination result and prescribe timely and effective treatment, the doctor may send the patient for a biopsy.

Treatment Methods

In order to cure this ailment, you should contact a gastroenterologist who will determine the method of treating the disease. The main types of treatment for hepatitis D include: medication, diet, moderate exercise and proper and healthy sleep.

The medical method is divided into:

• antiviral - the components of the drug are aimed at stopping HBV infection. The course of taking such medicines ranges from six months or more.
• detoxification - to stop the poisoning of the body with toxins, these drugs are used, which help to remove the infection from the human blood in a short time.
• maintaining immunity - promoting health is an important part of any treatment. It is not necessary to use special preparations - it is enough to eat cranberries, lemons and rose hips.
• stopping the reproduction of symptoms of hepatitis D - in order to alleviate the general condition of the patient with this disease, doctors prescribe drugs that alleviate the course of the disease.
• diet - if you do not want to worsen your condition and recover from hepatitis D, then you need to follow diet number 5, which is prescribed to any preoperative person. The basis of this diet included the use of 2-3 liters of fluid per day, the exclusion from the diet of alcohol, fried and fatty foods.
• rest - a properly planned day, in which a special place is given to rest, also helps to maintain a stable general condition of the patient. Do not be stressed and emotionally stressed. It is important to lead a healthy lifestyle, not remembering bad habits and emotional stress.
• physical education - doctors note that with such a disease, the patient should engage in physical education, and not sports. Enough in the morning (after waking up) to do a few breathing exercises. This is necessary in order for the body to be saturated with oxygen. Ideally, do this exercise in nature.

Antiviral therapy

Antiviral therapy is one of the methods of medical treatment of a patient based on blocking HBV infection. This way of dealing with the disease is the most effective and basic, which can later be enhanced by other methods of treatment, for example, folk remedies or diet. In order to completely cure a patient of hepatitis D, it takes about six months. During this period of time, the components of the drug help not only to block the virus, but also to prevent damage to other cells.

Maintenance and restoration of the liver

In order to keep the body in a stable condition, it is necessary to eat right, follow the diet number 5, and follow the instructions of the attending physician. There are many drugs that can stabilize the general condition of the liver. It is also worth remembering the mandatory intake of vitamins and minerals. But it is best to check the dosage with the doctor, since before taking them, you should pass all the necessary tests to establish a deficiency or excess of one or another vitamin in the patient's body.

Detoxification

Detoxification therapy is a complex of measures in which the absorption of the infection and its removal from the blood are noted. Often, with liver poisoning, phenomena such as fever, malaise, the appearance of vomiting and unwillingness to eat are observed.

The most common drugs in this type of treatment are: Enterosgel, Atoxip and Albumin. Some patients are still prescribed a 5% glucose solution.

Immunity

Even if you have had a disease such as hepatitis D, you will still have strong immunity. Once in the body, hepatitis D is able to disappear from the body after treatment after 10 days. In the chronic form, immunity stabilizes, but there is a risk of re-infection, since RNA virus is present in the blood.

Relief of symptoms

When prescribing the course of treatment chosen by the doctor, symptomatic drugs are most often prescribed to patients. To eliminate symptomatic phenomena, such as vomiting, insomnia, nausea and anxiety, include: "Cerukal", "Tenoten" and Valerian extract. All this helps to eliminate the accompanying pain that can distract the patient from the prescribed main treatment for hepatitis D.

Diet and lifestyle

As we said, for any disease or in the preoperative period, the patient is prescribed diet No. 5, in which there is no fried, salty, sweet and starchy food, but there is a balanced diet in the form of steamed vegetables and meat, fruits, fruit drinks and so on.

Also, an important difference between this diet and others is to drink plenty of fluids - about 2-3 liters of fluid per day. Moreover, with hepatitis D and diet No. 5, alcohol, smoking and other bad habits are prohibited. All this is necessary in order not to worsen the general condition of the patient and help the body cope with the disease.

Folk remedies

It is worth noting that some patients try to be treated in the “grandmother's” way, but this is not always effective, because before you start taking some kind of infusion, you need to consult with your doctor to eliminate side effects and other consequences. Only a doctor is able to understand whether this decoction will help in conjunction with the main treatment or not. Traditional medicine is an auxiliary method of treatment for ailments, which in most cases supports the performance of the whole organism.

In order for the cells of a vital organ to recover, it is best to take a herbal collection: mix St. John's wort, calendula, immortelle, chicory, chamomile, knotweed, buckthorn in equal proportions. Then set aside 4 tablespoons of this mixture and pour it with 500 ml of water at room temperature, cover with a lid and leave the mixture until morning. In the morning, the contents must be poured into a saucepan and boiled for 5 minutes, then let the broth cool. Doctors recommend taking this decoction in half a glass 3-4 times a day before meals. It is best to drink this infusion not cold, but warm.

Forecast

If you have been diagnosed with mild or moderate hepatitis D, then it is not as bad as it seems. This disease can be completely cured if it is in the initial stage. More difficult things will be with chronic and acute forms. It is also noted that hepatitis D is accompanied by another disease, such as hepatitis B. All this can lead to cirrhosis, therefore, the chance to recover from a severe form of the disease is a maximum of 30%.

Prevention

The most effective preventive measure for the appearance of the hepatitis D virus is the non-use of common household items with a sick person. And also, if you are already sick with hepatitis B, then you should be vaccinated, which will protect against delta hepatitis already infected organism.

Also, in order not to get hepatitis of any group, it is necessary to give up bad habits, undergo a timely examination and monitor your diet and lifestyle. In no case should one neglect poor health and attribute any symptoms to a cold or poisoning. It is advisable to consult a doctor for any ailment to clarify and interpret the feeling of poor health.

Hepatitis D is a viral anthroponotic infection that causes damage to the liver. A prerequisite for the development of the disease is the presence of a concomitant virus - hepatitis B. Due to this factor, the process of replication of the delta infection occurs. The hepatitis D virus does not have its own membrane, so it needs a cell coating of the B virus. Such coinfection causes serious infections.

The human body is highly susceptible to the hepatitis D virus. You can protect yourself by vaccination. The vaccine provides protection against both hepatitis D and B.

Causes of hepatitis D

The cause of hepatitis D is the causative agent of infection - RNA containing a viral particle. The RNA molecule carries the genetic information of the virus, protected by a protein coat. It contains an antigen that was also found in the hepatitis B virus. This fact allowed specialists to find out that the reproduction of hepatitis D viral particles is impossible without hepatitis B pathogens.

Infection can occur in the following ways:

through blood transfusion. According to statistics, 2% of all donors are carriers of viral hepatitis. In this regard, a thorough blood test is carried out, but this does not exclude the possibility of infection. The risk of transfusion of blood containing the hepatitis D virus is especially high for patients with multiple repetitions of the procedure.

sexually. Thus, the hepatitis B virus most often enters the human body. If there is already a hepatitis D virus in the blood, this will cause it to multiply and develop the disease.

repeated use of the same needle in non-sterile conditions. It is no coincidence that the percentage of patients with hepatitis D among drug addicts is so high. In most cases, the cause of the disease is the use of the same needle by different people. Infection is possible during procedures such as acupuncture, piercing, tattoos. Due to the ingress of the hepatitis D virus into the body while non-compliance with sterile conditions.

infection of children in the womb. This way of appearance of hepatitis D virus in the body is known as vertical. The greatest probability of infection in women suffering from acute hepatitis in the later stages. The risk of the disease increases significantly if it also has. Hepatitis D is transmitted from mother to child only in some cases. For example, the possibility of infection with milk is excluded.

These are the main ways the infection spreads. In many cases, the cause of infection and how the hepatitis D virus enters the human body remains unknown.

Symptoms of hepatitis D

Symptoms of hepatitis D are similar to other types of this disease. Usually, this virus causes a complication in the presence of hepatitis B. The development of coinfection in this case takes from 3 to 5 days, and superinfection - from several weeks to 2 months. The preicteric period is characterized by weakness in patients, lack of appetite, nausea, turning into. There may be pain in the knee joints and liver, fever.

In the icteric period, actively progressive and severe intoxication is observed. With superinfection, edematous-ascitic syndrome appears early. It is very difficult to distinguish it from hepatitis B due to similar symptoms. Superinfection is difficult. Recovery takes much longer than with hepatitis B. In addition, hepatitis D causes complications that negatively affect liver cells. It, like the spleen, increases in size. On the skin, these complications appear in the form of spider veins. Hepatic edema and ascites are also common in hepatitis D.

Based on the fact that the hepatitis D virus is closely related to the causative agent of hepatitis B, the following types of infection are distinguished:

coinfection. It involves the simultaneous entry of hepatitis D and B viruses into the body. Most often in this case, the infection proceeds passively, and the outcome is favorable. Hepatitis does not require treatment and goes away after a while without medical attention. However, sometimes viruses cause an acute form of the disease, which leads to serious consequences. The liver suffers the most.

Superinfection. The hepatitis D virus appears after the B virus enters the body. This form is more severe than co-infection, so in most cases patients need qualified medical care. The percentage of spontaneous elimination of the virus is very low.

Diagnosis and treatment of hepatitis D

Diagnosis of hepatitis D involves a biochemical blood test, as a result of which specific antibodies are usually found in the blood. Since this virus affects the liver cells, an ultrasound scan of this organ, rheohepatography is performed. In some cases, they resort to the help of a puncture biopsy. At the diagnostic stage, it is important to confirm the presence of the hepatitis D virus and to distinguish it from other types.

The main method of treatment of this disease - interferon therapy. This drug is considered the most effective in hepatitis. Depending on the type of disease, the dosage and frequency of taking interferon are individually prescribed. In hepatitis D, treatment with this drug continues until a normal level of serum transaminases in the blood is reached. interferon is taken either daily or several times a week. Depending on this, the dose is determined.

Medical treatment allows you to prevent the development, stop the reproduction of the hepatitis D virus. In most patients, during the first few months of taking interferon, the clinical symptoms of the disease disappear, inflammation decreases. After hepatitis D, it takes a long period of time to restore the normal functioning of the liver. To avoid the development of the disease and the complications it causes, such as cirrhosis or hepatic coma, regular vaccination is necessary.

Education: Diploma in the specialty "Medicine" received at the Military Medical Academy. S. M. Kirova (2007). Voronezh Medical Academy named after N. N. Burdenko graduated from residency in the specialty "Hepatologist" (2012).