Hepatitis A: symptoms in children, diagnosis, treatment and prevention

In the human body, the liver is a kind of chemical laboratory, where blood is purified from many toxic and harmful substances. If this body works normally, then it copes qualitatively with its tasks, but this does not always happen. There are pathologies that can affect the liver, such as hepatitis A. Symptoms in children and adults are important as soon as possible to recognize in order to begin effective therapy. Let us consider in more detail what the disease is and whether complications can be avoided.

What is Hepatitis A

The forms of this disease can be several, they all have their own characteristics and manifestations. If we consider hepatitis A, then it is an infectious disease that affects the liver cells. The disease is characterized by a cyclic course and manifests itself as symptoms of intoxication and various abnormalities in the work of this organ.

If you look at the international classification, then hepatitis A is divided into several types:

• Hepatitis with hepatic coma.
• Acute hepatitis A.
• Without a hepatic coma.

Clinical manifestations of hepatitis

Each disease proceeds according to its own, hepatitis A periods has the following:

1. Incubation. It begins after the virus enters the intestine through the oral cavity, then it enters the liver, where it starts intensive reproduction. The incubation period of hepatitis A lasts from three to five weeks.
2. The pre-zheltushny period begins with the appearance of the first manifestations of the disease - the appetite decreases, fatigue appears, there may be pain in the abdomen. Often there is an increase in temperature.
3. A vivid manifestation of the disease, which is characterized by yellow skin, dark urine and light feces. The virus of hepatitis A causes an increase in the liver, and sometimes the spleen also increases.
4. At the next stage, the appearance of the disease decreases, the patient's condition improves, the liver returns to its original size.
5. The recovery period, which usually takes about 3 months. At this time the child still feels some malaise, there may be complaints.

How is hepatitis infected

The virus of hepatitis A most often affects the child's body. Pathology can be observed in individual cases or in the form of small epidemics, when a whole group in the kindergarten or class in the school falls ill.

Hepatitis is a disease to which only people are exposed, so only the person can be the spreader of infection. Most often in this role is a patient with an atypical form of hepatitis A, in which the disease is not diagnosed. Man is the carrier of the virus, infecting around the rest.

Infection with hepatitis A occurs in various ways, most often with food, water, you can get infected through feces. Transmission of hepatitis by airborne droplets is not possible, you can get infected during a blood transfusion, but due to the instability of the virus in the blood, this risk is quite small.

The human body is quite susceptible to this infection, usually epidemics break out in children's institutions, when immediately a large number of babies are affected by hepatitis A (the symptoms in children will be considered a little lower). It is worth noting that if a person at least once in life, for example in childhood, has suffered this disease, then immunity is developed for life.

Classification

This question is suitable in terms of the type, severity and course of the disease. The following types of hepatitis A are distinguished:

1. Typical, which manifests itself with all the characteristic symptoms of the disease.
2. Atypical, it has erased signs and refers to a mild form.

Symptoms of the disease depend on the severity of the pathology, doctors singled out:

1. Easy form, which is most common in children. Intoxication is poorly expressed, the liver increases slightly. The disease has a cyclic nature, and recovery comes about a month later.
2. Hepatitis A is of medium severity. There is a smooth course of the disease, jaundice is moderately expressed, not only the liver, but also the spleen can increase. Signs of intoxication may persist for up to 2 weeks. Restore the body is only able for two months.
3. Heavy form is relatively rare. Signs of intoxication are strongly manifested, the child becomes apathetic, inhibited. There are dizziness, heart rhythm disturbance, nosebleeds, rashes on the skin. The liver greatly increases in size, and when palpation there is severe pain.
4. An icteric form is found in 20% of patients. No yellowing of the sclera and skin is observed. There is weakness, loss of appetite, may be vomiting and nausea. The disease can be recognized by enlarged liver.
5. There is also a subclinical form of the disease, in which there are no manifestations at all. Diagnosis can be made only after clinical studies. Such children support the epidemic process in the children's team.
6. Hepatitis A may manifest as a cholestatic form. Symptoms in children are observed in the form of mechanical jaundice. Skin covers can have not only yellow, but also a greenish shade. Appears skin itch, the liver increases slightly. This form lasts for a long time, can stretch for several months, but does not pass into a chronic one.

The course of the disease in children

How is hepatitis A manifested in children, will depend on the course of the pathology. Doctors say:

1. Acute current. It occurs most often, and as a rule, all symptoms disappear within 2-3 weeks. Acute hepatitis A in toddlers can last up to 3 months, but some time after recovery may be some complaints.
2. Prolonged flow is noted if the disease does not recede for more than 3 months. The liver can not come back to normal for a long time, but sooner or later a recovery will come if all the doctor's recommendations are followed.
3. Pathology with exacerbations. With this flow, clinical signs of the disease become worse, liver tests worsen, and the pathological process in the cells of this organ persists for a long time.
4. The course of the disease, which affects the biliary tract. This often happens when the form is moderate. The disease can occur without significant symptoms and is recognized only by the results of laboratory tests.
5. The course of pathology with the addition of intercurrent infections. Diseases that are added, as a rule, do not increase the severity of the symptoms of hepatitis, but can provoke an increase in the liver.

Diagnosis of hepatitis A

The formulation of the correct diagnosis for any disease begins with clinical studies. The recognition of hepatitis A in children is also based on epidemiological, laboratory, clinical data.

If this pathology is suspected, an analysis is made for hepatitis A. Laboratory indicators can be divided into specific ones, they help detect the HAV RNA in the patient's blood with PCR and anti-HAV JgM antibody using ELISA.

With the help of nonspecific indicators it is possible to establish the degree of liver damage, assess the course of the pathology, its severity and make a prediction. When blood is taken for hepatitis A, a test is always performed to determine the activity of hepatic cell enzymes and pigment metabolism parameters.

Only after clarifying the diagnosis can begin to treat the disease.

But already at the initial stage of the development of the disease, parents can pay attention to the symptoms that have appeared and contact the doctor in a timely manner. Let's look at the signs of hepatitis A that parents should know.

Symptoms of the pre-jaundiced period

The duration of this period is from 3 to 7 days. It consists of the infectious stage and secondary toxicosis. The first is characterized by manifestations of intoxication of the child's organism, which are caused by the defeat of the nervous system. The onset of the disease is rather acute, with the following symptoms:

• A sharp rise in temperature.
• General weakness.
• Headache.
• Tachycardia.
• Rarely, but can be vomiting.
• Abdominal pain.

The infectious period lasts a couple of days, and then the temperature decreases, the child's condition improves. The stage of secondary toxicosis and its symptoms signal the development of hepatic insufficiency, signs of hepatitis A in this case develop gradually, most often note:

• Lethargy.
• Apathy.
• Drowsiness.
• There may be dizziness.
• Appetite decreases, there is disgust for fatty foods.
• Nausea and vomiting.

At this stage, the liver becomes denser, noticeably increases in size, the child can feel pain in the right hypochondrium. If you take blood for analysis during this period, then the activity of liver enzymes increases.

The pre-dull period ends with darkening of urine and discoloration of feces.

Symptoms in children in icteric period

If hepatitis A is diagnosed, the symptoms in children in icteric period depend on the stage of the disease. They are distinguished by three: the increase in symptoms, the height of pathology and the decline.

Blood increases the level of bilirubin, usually this process takes 6-8 days, and then the recession begins, if the course of the disease is favorable. The albuminous, fatty, carbohydrate metabolism changes, water-salt balance is violated, liver function suffers.

Typically, the symptoms of hepatitis A in children 6 years old in this period are as follows:

• The temperature can change stepwise. Everything depends on the concomitant pathologies and the presence of complications in the form of inflammatory processes.
• The work of the cardiovascular system is disrupted.
• Pathological changes in the digestive system.

It should be borne in mind that the seriousness of this disease is that hepatitis A introduces changes in the work of the heart, which are explained by a violation of metabolic processes in the heart muscle.

Manifestations in the aftergreen period

The end of icteric period is judged by the amount of bilirubin in the blood. If the indicators dropped to normal values, then it can be argued that the peak of the disease is behind.

The icteric period lasts usually up to two weeks, but it can continue and more. After zheltushny can have a duration of three weeks, but some children - and several months. There are no clear indicators of the end of this period, as a rule, the main criterion is the normalization of liver size, a decrease in the activity of liver enzymes.

How is hepatitis A in infants

The course of the disease in infants has its own characteristics. There is a tendency to flow in a mixed form (viral-bacterial), which is recognized during examination.

Another feature is that at hospitalization, doctors detect not the onset of the disease, but the aggravation of the latent process - congenital or intrauterine.

The disease in children is worse than in adults or older children. Pregnant period takes only a few days and has no pronounced clinical manifestations, therefore pathology is often recognized when jaundice begins.

An acute onset may have the following manifestations in infants:

• Decreased appetite.
• Frequent regurgitation.
• Accession of intestinal infection.
• Heat.
• There may be catarrhal phenomena on the part of the respiratory system.
• Cal and urine change their color literally the day before the icteric period begins.

Treatment of hepatitis should only be carried out under the supervision of a doctor. Depending on the severity of the disease, a doctor may hospitalize a small patient or prescribe a home therapy.

Treatment of hepatitis A

Since the incubation period of hepatitis A is often not manifested by any symptoms, then, as a rule, the disease is diagnosed already in the icteric stage. For the first manifestations in the form of fatigue, loss of appetite, some parents may not pay serious attention. Only a competent specialist can give all the recommendations how to treat hepatitis A, usually the therapy is reduced to the following measures:

1. If the patient's mild form is not hospitalized, bed rest is prescribed, in severe form it should be observed for at least 5 days.
2. A sick child needs proper and adequate nutrition, in which the ratio of proteins, fats and carbohydrates will be 1: 1: 4.
3. Parents should include in the diet more raw vegetables, fruits, herbs and juices.
4. It is necessary to exclude refractory fats, which are usually found in margarine, fat. We will have to exclude canned food, sausages, fatty fish and meat. It will not be useful to use spicy seasonings, sauces, sweets and cakes.
5. Usually doctors do not prescribe special drugs to fight hepatitis, choleretic can be prescribed. In the acute period of the disease, drugs of cholelithic action are recommended, for example, "Magnesium sulfate", "Berberine", and during the reconvalescence of the cholecrossing action: "Allochol", "Holenzyme".
6. Doctors often prescribe to patients a course of vitamins of group B (Kombilipen).
7. If there is cholestasis with a cholestatic form, then the reception of "Ursosan" in the amount of 10-15 mg / kg per day is shown. In severe form, the duration of such therapy can be from 3 to 6 months.
8. If hepatitis is severe, then an infusion therapy is prescribed, which implies the administration of a 1.5% solution of Reamberin in a dose of 10 ml / kg of the body weight of the child.
9. Throughout the treatment, regardless of the form of the disease and its severity, appoint enterosorbents, for example, "Enterosgel", "Enterodesis."
10. One and a half to two months after the onset of the disease, the first examination of the patient is performed, after a 3-month period, a second examination is necessary. If the doctor does not diagnose the clinical manifestations, the child is removed from the register.

It is necessary to take into account: if therapy is carried out at home, a separate room and all personal belongings (dishes, hygiene products) should be allocated for a small patient.

Consequences of hepatitis A

Since the virus of this disease is capable of disrupting the functioning of the liver and the enzymatic system, it can be assumed that this negatively affects the work of the entire child's organism. Each parent must understand the full severity of this pathology and its consequences, so at the first manifestation it is mandatory to contact a specialist.

If therapy is started in a timely manner, all the doctor's recommendations are followed, bed rest, adjustments to nutrition are made, then you can not be afraid of possible complications. If Botkin's disease (also called hepatitis A) is not treated, it will certainly adversely affect the child's health in the future. Among the complications that occur most often, we can name the following:

• Disturbances in the liver.
• Problems with digestion of food.
• The liver decreases in size.
• Encephalopathy develops.
• Ascites.
• It may end in hepatic insufficiency.
• Transition of the disease into a chronic form.

If you start treatment in time, then hepatitis A gradually recedes, all laboratory indicators come back to normal, the liver restores its work.

How to prevent the development of the disease

Prevention of viral hepatitis A plays an important role. Various measures to prevent the spread of the virus involve exposure to the source of the infection, the modes of transmission and the susceptibility of the organism to infection.

It is important to carry out early diagnosis, then it will be possible to isolate the patient from others in order to prevent the spread of the virus. If the child has been in contact with the patient, it is necessary to examine the skin daily, sclera of the eye for the appearance of icteric color, palpation of the liver.

If there is already a focus of hepatitis A, then to determine the atypical form it is necessary to conduct laboratory examinations every 2 weeks, until the outbreak is not extinguished.

Prevent the spread of infection in the following ways:

• Control public catering.
• To monitor the quality of drinking water.
• Observe the norms of public and personal hygiene.
• If a sick child is found, disinfection should be carried out in this center.
• For prevention, a normal immunoglobulin with a high content of antibodies to the hepatitis A virus is administered.

Usually immunoprophylaxis is carried out during the season of activity of the hepatitis virus, it is most often at the end of summer and the beginning of autumn.

But to maximally protect yourself and your children from the disease can only be through vaccination. In Russia, doctors use different types of vaccines, most often the following:

• The vaccine against hepatitis A with polyoxidonium "GEP-A-in-VAK-PO L" is produced in Russia.
• French vaccine "Avaksim".
• "Havrix" is an English-made vaccine.
• Another vaccine against hepatitis A, produced in Russia, is purified concentrated adsorbed inactivated liquid "GEP-A-in-VAK".

These types of vaccines are introduced into the body of a child even before reaching the age of one. Often practiced joint administration against hepatitis A and B, but in different parts of the body. Virtually 95% of vaccinated children form a stable immunity against this virus.

Undesirable manifestations after vaccination, as a rule, are absent. There may be a slight redness, swelling at the injection site, a slight increase in temperature. Such side effects are not all young patients, most of the time the kids are well tolerated.

Without the normal operation of the liver, the effective functioning of all other organ systems is impossible, so any of its pathologies should be timely diagnosed and be effectively treated. This is especially true for young patients. Responsibility for their health falls entirely on the shoulders of parents, so it is important to pay attention to any deviations from the norm in the behavior of the baby, in the laboratory indicators. This is the only way to prevent the development of more serious complications.