What does the hepatitis B virus have for itself, how it is transmitted and which stages of the disease develop.
Acute hepatitis B in most cases (90-95%) ends with recovery, but with an unfavorable coincidence, chronic hepatitis B can develop.
Virus and the environment.
The virus is a spherical and very small (42 nm) particle that consists of a core inside which there is a double-stranded DNA and an enzyme that has the ability to build on the parent DNA sample, a daughter. The virus is surrounded by a shell, which contains antigens, through which the virus can be found in the blood.
The virus is very stable in relation to environmental factors. It maintains its vitality for half a year at a temperature of -30 degrees, and at a temperature of +60 - within 4 hours. Even alcohol does not destroy the shell of the virus, and chloramine kills only when soaked for 6 hours.
Ways of infection.
Infection with hepatitis B occurs when the virus enters the bloodstream. The main ways of transmission of hepatitis B virus are:
- vertical (from the sick mother to the child);
- parenteral (with the use of non-sterile needles for injections and tattoos, piercing, dental instruments, blood transfusion, etc.);
Moreover, in the case of viral hepatitis B, the sexual transmission of transmission is the main.
What happens in the liver?
Two days after the virus penetrated the body, it already reaches the liver, attaches to and penetrates into the liver cells (hepatocytes). Like any virus, the hepatitis B virus tends to reproduce and multiply the amount of viral particles. Therefore, with the help of a special enzyme inside a normal liver cell, the process of creating a foreign DNA-DNA virus of the hepatitis B virus begins. To prevent this, the immune cells begin to "get rid" of the infected cell, destroying hepatocytes and triggering the inflammatory process. Depending on the expression of the host's immune response, the process or passes through all stages of the disease and is safely allowed, or goes into a chronic process with ups and downs of activity.
Diagnosis of viral hepatitis B is presented after conducting the following studies:
- Biochemical blood test (high numbers of indicators of liver tissue damage markers (ALT, AST, bilirubin, alkaline phosphatase)).
- Blood test for the determination of hepatitis markers (positive HBSAg, HBeAg, anti-HBc-IgM).
- Ultrasound of the abdominal cavity (a significant increase in the liver).
Acute viral hepatitis B
The incubation period lasts from 45 days to six months, but despite the fact that there are no symptoms of the disease, the virus can be detected in the blood if you carry out appropriate tests. Then the disease is consistently undergoing pre-jaundice, icteric and restorative period.
Takes from one to seven days and manifests itself in the form of general symptoms of systemic disease - weakness, fatigue, general feeling of being, joint pain. There may be bitterness in the mouth and a feeling of heaviness in the right hypochondrium.
(Present only in one third of patients) lasts two to three weeks. The most characteristic feature of this period is the onset of dark urine and light stool. At the same time there is a coloration of the skin and mucous membranes, itchy skin. Even if no jaundice, common symptoms are jaundice period in all patients: fatigue, loss of appetite, nausea, vomiting, headache, sleep disorders, may experience symptoms associated with increased bleeding (bleeding gums, nosebleeds, bruising of the skin And so on). This is the period of maximum activity of the virus.
Takes up to four months and ends with the normalization of all indicators and a significant improvement in health. However, if this does not happen, viral hepatitis B becomes a chronic disease. This happens in 5-10% of cases.
Chronic viral hepatitis B.
It is believed that about 350 million people worldwide are living with chronic hepatitis B virus from asymptomatic carriers to cases of pronounced chronic inflammation of the threat of a malignant tumor. Course and outcome of liver disease caused by hepatitis B virus, it is determined by the relationship of the immune system and the virus. During chronic hepatitis B there are several phases that periodically change each other:
- Phase immune tolerance (usually diagnosed in patients in childhood and lasts until people reach the age of 20-30 years).
- Phase of immune activity (develops in three scenarios):
- asymptomatic carrier - the most favorable outcome of hepatitis, in which no changes in the liver and in the blood is determined only HBsAg;
- Prolonged for chronic hepatitis with a high risk of cirrhosis of the liver and the presence of viral particles in the blood (in particular, HBeAg);
- Active chronic hepatitis without HBeAg (with mutant HBV particles).
In accordance with the phases of the course of the disease, the prediction of the life of the particular patient and the treatment regimen assigned to him are determined.
Since 1980, vaccines that form immunity against hepatitis B are being practiced at risk for this disease: medical workers, people in need of regular injections (diabetes mellitus, systemic diseases), prisoners, military, etc.
In Ukraine, a recombinant or genetically engineered vaccine is used by different manufacturers.
There are different approaches to planned and emergency vaccination.
1. Emergency prophylaxis. Necessary in the case of suspicion of infection (is carried out not later than 24 hours after the intended contact). Newborn babies are also vaccinated from sick mothers (usually in vaccination mode-one month after vaccination - six months after vaccination - one year after vaccination).
2. Planned prevention. With scheduled vaccination, the scheme is slightly different: the chosen vaccination date - one month after vaccination - six months after vaccination. Side effects of the introduction of the vaccine are few and relatively rare. Usually they are limited to local manifestations (soreness, itching, redness, a small seal at the injection site) and general (headache, slight fever, increased sweating, sleep disturbance).
Acute hepatitis B.
Patients with acute hepatitis B are obliged to be hospitalized in an infectious hospital. Basic therapy includes:
- mode (half-bed or bed depending on the severity of the disease);
- a diet (rich in protein, gentle on culinary processing and eliminates irritating substances and a large amount of fats);
- abundant drinking (up to three liters per day);
- support liver preparations (hepatoprotectors), appointed by the doctor individually. In the case of a severe course of the disease, the affected person may be transferred to a resuscitation unit, in this case, the therapy will depend on the group of symptoms that will be manifested in the patient.
Chronic Hepatitis B
At increased rates of damage to the liver (ALT, bilirubin) and inflammation, antiviral drugs - pegylated interferons (PEG) are prescribed. At their background, one-third of patients are able to achieve normalization of blood tests and reduce the harmful effects of the virus. However, unfortunately, PEG have a lot of side effects ("flu syndrome") and a wide range of contraindications to treatment.