Symptoms of Botkin's disease and the main methods of treating the disease

Hepatitis A (also known as Botkin's disease ) is an intestinal infection that is common in children. During its development, general intoxication of the body , but the human liver is mainly affected.

As a rule, hepatitis A develops not in one child, but in a whole group of children who are in close contact with each other. The disease most often affects children aged three to seven years. However, adults also suffer from hepatitis A. As a percentage, more than 60% of cases of the disease occur in children.

The disease is very rare in infants, who are reliably protected by antibodies .

Hepatitis A virus

Hepatitis A is an acute infectious disease that develops under the influence of a virus.

The hepatitis A virus is resistant to a number of substances - acids , ether , chlorine . At the same time, it shows sensitivity to formaldehyde , and when boiled it dies after 5 minutes.

The virus is excreted from the human body along with feces, and a person is contagious from the end of the incubation period and during the pre-icteric period. The virus is not detected in the stool of a person with already developed jaundice. The virus enters the body through the mucous membranes of the gastrointestinal tract.

Reproduction of viral particles occurs in the cytoplasm of liver cells. After they leave the liver cells, they immediately enter the bile ducts and then, together with bile, end up in the intestines.

Hepatocytes (liver cells) are damaged due to inflammation that develops in the liver. In turn, the inflammatory process is a consequence of an attack by the body’s immune system on liver cells affected by the virus. As a result, infected hepatocytes die, Botkin's disease manifests itself and the functioning of the liver is disrupted.

How does infection occur?

Thus, the mode of transmission of the hepatitis A virus is fecal-oral . Very often, infection with the disease occurs in countries with hot climates on different continents.

Hepatitis is also called the “disease of dirty hands.” In civilized countries, due to the normal functioning of sanitary and communal services, as well as due to the observance of hygiene rules by the population, people rarely suffer from hepatitis.

Consequently, very few people develop antibodies to this disease. When in contact with a carrier of the virus, people who do not have antibodies run the risk of becoming infected.

Therefore, during trips to Asian and African countries, cases of infection among our fellow citizens are relatively common.

A healthy person can have contact with a sick person without risking infection. It is more important to strictly follow all hygiene rules. But it is best to isolate children from patients with hepatitis A.

To determine the degree of risk of contracting the disease in order to decide on the advisability of vaccination, a special blood test can be performed to determine whether there are antibodies to the hepatitis A virus in the human body.

If they are detected, this means that the person has immunity to the virus, and vaccination is not needed. People practically never get sick with hepatitis A again.

In the absence of antibodies, the risk of infection exists, which means vaccination is needed.

Before a possible infection or after it, a person can be given immunoglobulin , which during this period will protect against infection or the development of an illness in the body.

Classification of hepatitis A

There is a division of hepatitis A into several types according to different criteria.

Depending on the manifestations of the disease, a typical variant (the patient has jaundice) and an atypical variant (there is no jaundice).

If the latter option occurs, then sometimes the disease goes unnoticed, since the child in this case suffers only from a short-term bowel disorder.

When assessing the course of Botkin's disease in a child, doctors distinguish between a mild form (most cases), a moderate form (about 30% of cases), and a severe form (rarely, about 1-3% of cases).

Symptoms of hepatitis A

During the incubation period, Botkin's disease gradually begins to manifest itself with some characteristic signs. A person may be bothered by fever , as well as dyspeptic symptoms (vomiting, nausea, heaviness in the stomach and right hypochondrium). The child's body temperature may increase slightly in the first few days. In addition, symptoms of Botkin's disease include weakness and darkening of the urine. Later, the patient develops jaundice - the sclera and skin acquire a characteristic yellow color, and at the same time the feces become discolored. Jaundice appears on the body very quickly, almost overnight. This condition lasts for three to six weeks. Moreover, after the onset of jaundice, the patient begins to feel a little better. On average, the illness lasts approximately 40 days. At this time, adequate treatment is carried out. But the duration of the illness can be influenced by various factors, for example, age, the correct approach to therapy, and the presence of other chronic diseases.

In approximately 15% of people affected by the hepatitis virus, the disease becomes chronic and can last up to 9 months. In most cases, hepatitis A exhibits typical symptoms, and the patient recovers completely if the doctor's recommendations are followed, as well as an appropriate diet .

Hepatitis A is most severely affected by children under one year of age, adult patients, and elderly people. In preschool children, viral hepatitis A occurs in a milder form, while in adult patients, the symptoms of hepatitis A are severe, with severe intoxication. The illness can last up to three months, despite treatment.

It should also be taken into account that all hepatitis, of any origin, manifests itself with similar symptoms. Therefore, it is very important to consult a doctor in a timely manner and undergo a comprehensive examination.

Diagnosis of hepatitis A

To diagnose hepatitis A in a patient, the doctor must carefully study the patient's epidemiological history.

In this case, we are talking about which countries the person visited, what he ate, whether he had contact with patients, etc.

The main criterion for diagnosing the acute form of Botkin's disease is the isolation of antibodies to hepatitis A from a person's blood. They can be detected in the blood only during the acute period of the disease.

Treatment of hepatitis A

If a person is diagnosed with hepatitis A, then specific therapy is not practiced, since the patient recovers without treatment.

In modern medicine, the efforts of specialists are concentrated on reducing the content of harmful substances in the human body and removing them.

Such substances begin to appear in the human body at a time when the liver is damaged and its basic functions are disrupted. Consequently, patients are administered detoxification solutions, as well as glucose.

They are advised to take vitamins and hepatoprotective drugs (these drugs protect liver cells). With Botkin's disease, there is no need for antiviral therapy. If doctors are dealing with a severe case of the disease, the principle of treatment does not change, but the volume of prescribed medications increases.

During the treatment process, it is important to adhere to a certain dietary diet. Food should be high in calories and balanced. It is necessary to include proteins in the daily diet in the form of lean meat and fish, eggs, and low-fat cheese. Carbohydrates should be consumed in the form of cereals, potatoes, bread, sugar.

Fats should be chosen from vegetable sources, and butter should also be consumed periodically. In addition, it is important for the child to eat a lot of vegetables, fruits, and drink juices.

At the same time, it is prohibited to introduce refractory fats, fatty meats, fish, sausage, spicy foods, legumes, chocolate, smoked meats, etc. into the diet.

After recovery, children are required to remain under medical supervision. If, after two examinations, no health problems are found in the child, then he is removed from the register.

With hepatitis A, the prognosis is favorable; a person experiences complete restoration of liver function. In rare cases, the liver remains enlarged, but its function is not affected.

The doctors

Medicines

Prevention of hepatitis A

The main preventive measure is vaccination against Botkin's disease. Modern vaccines are highly effective and highly immunogenic. The vaccine must be administered twice, with an interval of six months to one year. After administration of the vaccine, a person is protected from infection by the virus for up to 10 years.

Vaccinations are given to children over three years of age, as well as to adults who have never had hepatitis A. It is also important to vaccinate those people who are at increased risk of infection.

Several categories of people are identified who need to be vaccinated against hepatitis A. First of all, these are family members of a patient with hepatitis A and people in close contact with him.

Persons who have had sexual contact with patients should receive vaccinations.

Vaccination is also necessary for those who live in regions where many cases of the disease are recorded; people planning to visit countries where hepatitis A is common; homosexuals; those who use drugs.

Hepatitis vaccinations should also be given to workers in infectious diseases departments of hospitals, all staff of children's institutions, employees of the water supply and public catering sectors, and people suffering from chronic liver diseases.

If someone in the family has contracted Botkin's disease, it is recommended that all family members be examined for the presence of antibodies to hepatitis A. In addition, as a preventive measure for the disease, everyone should follow the simplest rules of hygiene: wash your hands as often as possible, and always use soap. It is very important to teach children to follow the rules of prevention from a very early age.

Hepatitis A and pregnancy

If a woman is planning a pregnancy , she needs to be vaccinated against hepatitis A, as the disease can cause pregnancy complications and even premature birth. If vaccination has not been carried out, then the pregnant woman should clearly know how Botkin’s disease is transmitted, since prevention in this case is a very important point.

Diet, nutrition for Botkin's disease

Diet for hepatitis A

• Efficacy: therapeutic effect after 10 days
• Duration: from 3 months or more
• Cost of products: 1200-1400 rubles. in Week

List of sources

• Infectious diseases. National leadership. Ed. N.D. Yushchuka, Yu.Ya. Vengerova. M.: GEOTAR-Media. 2009;
• Uchaikin V.F., Nisevich N.I., Cherednichenko T.V. Viral hepatitis from A to TTU. - M., 2003;
• Esaulenko E.V., Gorchakova O.V., Chernov M.Yu. Clinical course of hepatitis A during periods of varying intensity of the epidemic process. Medline Express. 2004;
• Mayer K-P. Hepatitis and consequences of hepatitis. Practical guide. Per. with him. / Ed. A.A. Sheptulina. - M.: Geotar Medicine, 1999;
• Treatment of viral hepatitis. A.A. Klyuchareva, N.V. Goloborodko, L.S. Zhmurovskaya and others / Ed. A.A. Klyucharevoy – Minsk: Doctor Design LLC, 2003.

Source: https://medside.ru/gepatit-a-bolezn-botkina

What does hepatitis A mean and how to avoid becoming infected with Botkin's disease

Botkin's disease is a disease that occurs as a result of a virus, is accompanied by an inflammatory process and affects the liver. Another name for the disease is Hepatitis A.

This disease is quite well known in Africa, Asian countries and other tourist regions where hot climatic conditions prevail (Turkey, Tunisia, Egypt, India).

Such data are due to the fact that it is in hot countries that it is easier for viruses to survive, and in cold countries located in the north, the risk of getting the disease is much lower. More often those people who neglect the rules of personal hygiene and rarely wash their hands after going outside suffer from Botkin's disease.

But the infection can also be contracted through food and water contaminated with the virus, especially if the immune system of a potential patient is reduced.

Classification of Botkin's disease

In medical practice, it is customary to distinguish two types of Botkin’s disease:

• Typical view. In this case, the disease is recognized by a change in the color of the white of the eye and the color of the skin, which becomes distinctly yellow, followed by other signs and symptoms of the disease (described below).
• Atypical appearance. This case does not involve a change in skin color, and the disease may go unnoticed for some time. However, if a child has an atypical type of Botkin’s disease, then at the beginning only the stool will change, namely its disorder.

The disease is also characterized by several forms of progression:

• easy or simple (common);
• moderate severity (occurs in approximately 30% of cases);
• severe form (occurs extremely rarely, in approximately 1-3% of patients)

Treatment of hepatitis A is successful in most cases, and the patient makes a full recovery. Besides.

All changes that occurred to the liver during the illness return to normal, and the functionality of the liver is restored.

In some cases, the patient's liver enlarges and remains this size throughout his life, but usually this does not manifest itself as symptoms and is only detected during an ultrasound.

Causes of the disease

You can become infected with Botkin's disease from another person infected with this virus.

This does not mean airborne droplets, but non-compliance with hygiene rules: eating food from the same container, using the same hygiene items, etc.

This does not mean that the disease will be transmitted 100%, but the risk of the disease in the case described above is high.

The process of development of the disease is as follows: viruses enter the intestinal cavity, after which they enter the blood, and from there follow to the liver.

In this process, the liver cells suffer the most, since an infection develops in them, which contributes to their damage and causes the main manifestations of Botkin’s disease.

The disease is accompanied by an inflammatory process, but this is only a protective reaction of the body. The human body is designed in such a way that it can recognize infectious processes and thus respond.

In this case, the body recognizes the patient’s affected liver cells and then begins to destroy them.

Let's look at the main factors leading to hepatitis A:

1. close contact with infected people;
2. failure to comply with hygiene rules;
3. kissing, sexual intercourse;
4. tourist trips to countries with hot and exotic climates;
5. drug use

How to recognize Botkin's disease

Signs of the disease: Yellow eyes, itching, digestive problems

The disease begins with an incubation period that can last from 15 to 50 days after infection. Then the patient develops a feeling of lethargy and constant unjustified fatigue. Due to fatigue, the body temperature may rise, and the person may experience a feeling of nausea that turns into vomiting. Often there is a violation of the stool, which is manifested by diarrhea and flatulence. And, of course, one of the main symptoms that distinguishes hepatitis A from ordinary fever is pain in the liver. However, the described manifestations may not exist at the initial stage, and the patient himself may not be aware of the presence of Botkin’s disease and refer to an ordinary ARVI.

To confirm or rule out Botkin's disease, a blood test for antibodies is required. In this way, the presence or absence of immunity to the anti-HAV IgG virus is checked.

If the test results reveal antibodies to hepatitis A, this will mean that the person has already had this disease and will no longer face it.

But, if antibodies are not detected in the blood, then the person is still susceptible to infection.

It is worth noting that even if a person has already had Botkin’s disease and has completely recovered, the virus still remains in his blood, and those who use the same hygiene items risk becoming infected.

Thus, let us highlight the main symptoms of hepatitis A:

• the occurrence of fever;
• pain in the lateral area on the right;
• sleep is disturbed;
• feeling of general weakness and fatigue;
• feeling of heaviness in the abdomen (especially in the stomach area);

After the disease begins to progress, the following symptoms are added:

• urinary fluid becomes foamy and dark in color;
• appetite becomes very weak or completely absent;
• the appearance of jaundice (yellow skin, whites of the eyes and mucous membranes);
• stool becomes discolored

It should be noted that it is the manifestation of jaundice at its height that promises an improvement in the patient’s condition. The yellow tint to the skin lasts an average of a month and a half, but if the patient is too weakened by the disease or suffers from any additional ailments, then hepatitis A can become chronic. In the latter case, it is often necessary to heal the disease for six months.

How to diagnose hepatitis A

At the very beginning, if the above-described signs have been noticed in yourself or your loved ones, the potential patient should urgently consult a gastroenterologist, who will be able to make a preliminary diagnosis based on the manifestations and refer further to the right doctor (if necessary).

If the patient has all the signs and symptoms of Botkin’s disease, the gastroenterologist issues a referral to an infectious disease doctor, who will conduct a diagnosis.

First, you need an anamnesis of the disease, thanks to which the doctor will be able to find out the exact cause of the disease, since the course of treatment will differ depending on the cause.

In addition, if a person does not live alone, then it is necessary to conduct an examination of all family members, and especially if there are children, since their body is more vulnerable to various infections.

Diagnosis of Botkin's disease consists of the following procedures:

• palpation by the doctor of the patient’s liver area;
• blood test to detect bilirubin;
• liver tests to detect liver enzymes;
• blood test to check for antibodies to hepatitis A;
• blood clotting test

Methods of treating the disease

Food is healing

During an illness with Botkin's disease, a person's immune system devotes all its strength to overcoming the disease. It is precisely because of the activity of the immune system that the body is able to cope on its own, unless it is severe. Hepatitis A is treated only with a conservative method, but this course of treatment is not aimed at exterminating the disease itself, but at improving the patient’s well-being (pain relief, reducing nausea and vomiting, etc.).

Let's consider the standard course of treatment for Botkin's disease:

• Diet No. The patient must strictly adhere to the diet, especially during an exacerbation, so as not to worsen his condition;
• the patient must be isolated from healthy people;
• the patient must remain in bed and remain at rest;
• administering solutions of sodium chloride and glucose to the patient (to relieve symptoms of poisoning);
• administering drugs to the patient that protect liver cells from destruction

What complications can occur with hepatitis A?

Usually the disease is cured and proceeds in a mild form, and less often in a moderate form. However, if the patients are children under one year old or people aged 60+, their disease may become severe due to age-related weakness of the body. In this case, signs of intoxication of the body will appear especially pronounced.

A particularly dangerous type of Botkin's disease is atypical, in which there are no manifestations of jaundice. This species is especially dangerous for babies under one year old, since their immunity is not very developed, and the disease can be fatal for them.

Botkin's disease is the most benign disease of the hepatitis family, but since the symptoms of all hepatitis are similar, you need to be sure of your diagnosis by consulting a doctor in a timely manner.

How to prevent Botkin's disease

You can prevent the disease if you protect yourself as much as possible from the factors leading to it. For example, it is necessary to observe the rules of personal hygiene, especially in hot countries, if you come there on a tourist visit. Next, you need to protect yourself from contact with infected people, and if they are relatives, then urgently get vaccinated.

Vaccination is the most reliable preventive measure and is carried out 2 times with a break of six months. It is worth noting that the vaccine can be administered to children only from the age of 3, so up to this age it is necessary to especially closely monitor your children and protect them as much as possible from the sources of the disease. For people who are at risk, vaccination is mandatory.

 

Source: http://puzyrya.ru/zabolevaniya/gepatit-i-bolezn-botkina.html

Botkin's disease

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

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

Andriyanov G.Yu., doctor - health care organizer
Editor: Smirnova I.G.

December, 2019

Hepatitis A (Botkin's disease) is a viral infection of the liver that occurs as a result of violation of personal hygiene rules, consumption of food or water contaminated with viruses. This infection belongs to the category of “diseases of dirty hands”. Most common in hot countries.

Botkin's disease is widespread in Asian and African countries, including traditional tourist countries - Tunisia, Egypt, Turkey, India. Children under 5–6 years of age are most often affected; many suffer from a mild form of hepatitis.

Outbreaks are common in children's groups; after illness, lifelong immunity remains.

Causes

Botkin's disease is caused by a virus that is transmitted through water, food and dirty hands.

When viruses enter the intestines, they are absorbed and enter the liver through the blood. The development of infection occurs in liver cells, damaging them and causing the main symptoms of the disease. The inflammatory process has an immune mechanism; the body recognizes damaged cells and destroys them.

Who is at risk of getting sick?

There is a high risk of developing Botkin's disease if:

• close contacts with patients, violation of hygiene rules;
• during kissing, sexual intercourse;
• when traveling abroad to countries with high incidence rates (Africa, Asia, South America);
• when using drugs.

How to find out about infection

If Botkin's disease is suspected or to determine the presence of immunity, blood is tested to detect antibodies to the anti-HAV IgG virus.

If they are present in the blood, this indicates that there has already been contact with the virus (as a result of vaccination or illness). In this case, re-infection is impossible; vaccination is not necessary.

If there are no antibodies, it means there is no immunity to Botkin’s disease and routine or emergency vaccination and the administration of immunoglobulin are necessary (it can prevent infection or stop the infection within two weeks).

All family members of the sick person and contact persons, if this is a child, are subject to examination.

Symptoms of Botkin's disease

Botkin's disease occurs in stages, the incubation period from the moment of infection lasts from 15 to 50 days.

After its completion, the stage of prodromal phenomena (i.e. general symptoms) begins - symptoms of general intoxication of the body arise:

• fever;
• nausea and vomiting;
• appetite disorders;
• heaviness in the stomach;
• pain in the right side;
• weakness, sleep disturbances.

At the height of Botkin's disease, the following appear:

• foamy and dark urine;
• jaundice, manifested on the skin, mucous membranes and whites of the eyes;
• discoloration of stool.

 

Against the background of jaundice, the patient's general health improves. Jaundice lasts about a month, gradually decreasing in intensity.

Depending on the age and state of immunity, the disease lasts from 30 to 40 days; in weakened patients, it can become chronic, lasting up to six months.

Most cases of Botkin's disease lead to complete recovery, without any consequences.

Important! In children under 6 years of age, in 70% of cases, hepatitis A infection is asymptomatic; in symptomatic cases, jaundice rarely occurs1.

Diagnostics

• The diagnosis is made by an infectious disease doctor.
• To make a diagnosis, it is important to indicate contact with a carrier of Botkin’s disease or stay in countries that are dangerous for infection. A detailed examination is required to determine the size of the liver and spleen, and a number of tests:
• Blood chemistry:

• AlT,
• AsT,
• bilirubin and its fractions,
• alkaline phosphate,
• GGTP, 
• cholesterol2.

General urine analysis with determination of urobilin and urobilinogen:

• detection of urobilin and bile pigments in the urine is possible already in the pre-icteric period; these are the first signs of a violation of pigment metabolism. 

Blood for antibodies to hepatitis:

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

Treatment of Botkin's disease

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

Held:

• during the acute period, a “liver” diet (table No. 5);
• creating peace, isolating the patient;
• removal of intoxication by administering solutions of glucose and sodium chloride;
• administration of vitamins to maintain immunity and liver function;
• administration of drugs that protect liver cells from destruction.

All patients with Botkin's disease are recommended to take medications that normalize the function of the gastrointestinal tract - both to prevent constipation and to combat dysfunction.

• For constipation, use laxatives (domperidone, metoclopramide, lactulose),
• For dysfunctions, enterosorbents (activated carbon, smecta and analogues, hydrolytic lignin).
• Course duration is 3-5 days.

The diet of table No. 5 includes boiled or stewed vegetarian dishes, dairy, cereal dishes, and lean meat. Fatty, fried, spicy foods, spices and excess salt are prohibited. It is important to eat often, at least five times, in small portions.

More information about nutrition for Botkin's disease is written in our separate article.

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

Complications

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

1. There may be cases of anicteric mild course of the disease; such a person is a source of infection, especially dangerous for children.
2. With defects in the immune system or at an early age of up to six months, a severe course of Botkin's disease occurs with the development of liver damage, including death.
3. Hepatitis A is similar in many manifestations to other hepatitis, so any cases of jaundice require examination.

Prevention

Prevention of Botkin's disease is vaccination. Today it is not included in the compulsory vaccination schedule, but is strongly recommended for children attending kindergartens, people traveling on vacation and people at high risk of contact.

Vaccines recommended by the Russian Ministry of Health:

• domestic inactivated vaccine GEP-A-inVAK (MP “Vector”, Novosibirsk),
• Havrix (GlaxoSmithKline, UK),
• Avaxim (“Aventis Pasteur”, France),
• Waqta (“Merc Sharp and Down”, USA).

Vaccination is allowed starting from the first year of life. The vaccination is done intramuscularly and can be combined with any other vaccination, provided that it is done in different parts of the body. The protective effect is achieved after a month, but after 6-12 months a booster dose is required. This regimen provides protection against viral hepatitis A for at least 5 years3.

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

Source: https://www.diagnos.ru/diseases/jekat/virgepa

Symptoms of Botkin - All about the liver

Hepatitis A, also known as Botkin's disease, is an acute infectious disease that affects the liver. The source of the pathogen is a sick person. According to the World Health Organization, up to 10 million people worldwide become ill with hepatitis A every year. In early childhood, pathology can be tolerated in an erased form.

The level of morbidity directly depends on compliance with the rules of personal hygiene in certain areas, institutions and teams.

Characteristics of the pathogen Development of the disease Symptoms of viral hepatitis Diagnosis Treatment of viral hepatitis A Prevention of viral hepatitis A

Characteristics of the pathogen

Please note: Botkin's disease is characterized by seasonality. The peak incidence occurs in the summer-autumn period. Most of the sick are children and adolescents from 4 to 15 years old, as well as young people.

The causative agent of Botkin's disease is the RNA-containing hepatitis A virus (HAV), which belongs to the Picornaviridae family. This infectious agent lacks an envelope. Currently, only one serological type of the virus has been identified, but there are a number of different genotypes.

The main route of infection is nutritional - through contaminated water, food and utensils used by the infected person. The mechanism of transmission of the virus is fecal-oral.

Experts do not rule out that mechanical transmission may be carried out by certain types of insects (in particular, house flies).

There is evidence that parenteral transmission of HAV (through whole blood, plasma or red blood cells) is possible in rare cases.

The release of the infectious agent in feces begins at the end of the incubation period and continues throughout the “pre-icteric” phase. Once a patient develops the characteristic clinical symptom of jaundice, HAV is no longer detectable in feces.

Development of the disease

The incubation (latent) period of this disease ranges from 1 week to 50 days (on average - from 2 to 4 weeks).

Botkin's disease is characterized by the absence of a chronic form of its course. The pathology does not cause permanent liver damage. After one illness, the human immune system produces antibodies, which subsequently provide lasting immunity.

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

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

Symptoms of viral hepatitis

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

The “entry gate” for the virus is the epithelial cells of the digestive tract. From them, the pathogen enters the bloodstream and migrates to the liver, where it actively multiplies in “Kupffer cells” (macrophages) and hepatocytes. HAV then enters the bile and is excreted through the intestine.

Early clinical symptoms of Botkin's disease:

• loss of appetite;
• general malaise;
• muscle and joint pain;
• nausea;
• vomit;
• loose stools (not always);
• febrile reaction (temperature rises to 38.5°C).

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

As viral hepatitis A develops, the following are noted:

• hepatosplenomegaly (enlarged liver and spleen);
• darkening of urine (to “coffee color);
• stool discoloration;
• dull painful sensations in the liver area (in the right hypochondrium);
• yellowing of the sclera of the eyes and skin.

Diagnostics

The diagnosis of viral hepatitis A is made by a specialist based on the characteristic clinical picture and data obtained during laboratory tests. The virus is detected in feces only at the end of the “latent” period, and at earlier stages (already 1-2 weeks after the infectious agent enters the body) specific anti-HAV immunoglobulins (IgM) can be detected in the blood.

In the acute phase, laboratory tests reveal an increase in the activity of serum enzymes, in particular aldolase, AST (aspartate aminotransferase) and ALT (alanine aminotransferase). ALT appears due to the destruction of liver cells by the virus.

Another diagnostic sign of Botkin’s disease is an increase in the level of bilirubin in the blood. During the period of jaundice, the blood can also detect monocytosis, relative lymphocytosis, leukopenia and, in some cases, a slowdown in the erythrocyte sedimentation rate.

The end of the acute phase of Botkin's disease is indicated by the appearance of specific IgG in the patient's blood. From this moment we can talk about the formation of stable immunity to the hepatitis A virus.

Treatment of viral hepatitis A

There is no etiotropic treatment for Botkin's disease. Patients with suspected viral hepatitis are placed in infectious diseases departments of hospitals.

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

Patients require plenty of fluid in their diet to quickly eliminate toxins. Alkaline mineral waters and natural juices are recommended, 2-3 liters per day.

In cases of moderate severity, intravenous administration of Ringer-Locke and glucose solutions (5%) 250-300 ml is indicated. In case of pronounced intoxication, an intravenous infusion of rheopolyglucin or hemodez of 200-400 ml is required.

In severe cases, patients must be transferred to the intensive care unit, where they receive IV up to 1 liter of 10% glucose per day, as well as Lobari solution (up to 1.5 liters per day).

If the disease is complicated by acute liver failure, for the treatment of Botkin's disease, solutions of albumin (15%, 200-300 ml per day) and sorbitol (20%, 250-500 ml per day), as well as prednisolone (intramuscular or intravenous) 60- 90 mg per day and contrical (10,000-30,000 units per day).

In some situations, blood transfusion may be chosen. Hyperbaric oxygen therapy is considered a promising treatment for viral hepatitis A.  

Prevention of viral hepatitis A

A vaccine has been developed against the virus, thanks to which outbreaks of Botkin's disease are successfully contained. Children, as well as pregnant women who have been in contact with infected people in areas of hepatitis A, are given gamma globulin for preventive purposes.

Vaccination is recommended for tourists and military personnel traveling to areas with high incidence rates.

You will receive more detailed information about the symptoms of Botkin’s disease, methods of diagnosis and treatment of this disease by watching this video review:

• Konev Alexander, therapist
• 10,149  11 
• (55 voice., 4,70

Source: https://pechenb.ru/simptomy-botkina.html

Botkin's disease: what it is, how it is transmitted, symptoms and treatment

Botkin's disease (hepatitis A) is an inflammatory infectious process in the liver. The pathology has a favorable course and does not become chronic, since there is no degenerative effect on the parenchyma.

Complications are possible, but these are exceptional cases. Nevertheless, Botkin’s disease provokes socio-economic losses, because recovery is a long process, dragging on for six months.

Therefore, it is important to carry out prevention, and if infected, immediately recognize the alarming symptoms.

The causative agent of Botkin's disease

The causative agent of Botkin's disease is an RNA-containing virus from the genus of enteroviruses, lacking an envelope. The serological type is the same, but it has different genotypes.

The virus itself is extremely small - 28-32 nm. It contains no fats or carbohydrates.

Outside the human body, the virus is viable, remains active for months at above-zero temperatures, and can withstand freezing at -20 degrees.

The virus can be destroyed only by boiling for five minutes, exposure to formaldehyde, or chlorine solution. To destroy it by sterilizing steam at a temperature of 120 degrees, it takes 20 minutes.

How is Botkin's disease transmitted?

The only source of infection is a sick person, but there are several ways the virus is transmitted. Main mechanisms of infection:

1. Contact household - through shared towels, dishes, any household items. The stool of an infected person contains a high concentration of the virus. Microparticles settle on objects in the house and products. Health workers and relatives caring for the patient are at risk of becoming infected. The risks increase when changing incontinence diapers.
2. Water – when using water contaminated with the virus for drinking, washing dishes, brushing teeth, or bathing in it. When the pathogen enters natural bodies of water or public water reservoirs, hepatitis A outbreaks occur.
3. Nutritional – due to consumption of contaminated products. The most dangerous are shellfish, oysters and fish, since the virus can migrate into them from contaminated water. At the same time, they filter large volumes of water, increasing the concentration of the pathogen in their bodies.

A large amount of the virus is contained in the patient's blood. Therefore, parenteral transmission is possible, although it is less common. This refers to infection through blood during dental treatment at the dentist, unsterile intravenous injections.

This is interesting: What is the main route of infection with viral hepatitis A?

The greatest danger is posed by hidden carriers of the virus – those who have Botkin’s disease asymptomatically. Without feeling sick, they infect others. This is associated with the high prevalence of Botkin's disease - 10 million people are infected annually.

In general, hepatitis A is predominantly a childhood infection. However, it often remains undetected due to absent symptoms.

At-risk groups

Botkin's disease is a seasonal pathology; outbreaks usually occur in summer and autumn. Most often it spreads among groups of children from 3 to 12 years old. The risk group also includes people who:

• do not maintain personal hygiene (do not wash hands after going outside or visiting the toilet);
• are in close contact with infected people (relatives living together, doctors);
• work in the field of catering;
• visit countries where the incidence rate is high (usually Africa, Southeast Asia);
• use drugs.

Homosexual men are also included in the risk group, although the cause-and-effect relationship with the incidence of hepatitis A is not explained.

Symptoms of the disease

If susceptible to the disease, symptoms in adults appear 15-50 days after infection, when the incubation period ends. Common symptoms are:

• fever;
• fatigue;
• nausea, vomiting;
• pain on the right under the ribs;
• loss of appetite;
• heaviness in the stomach;
• insomnia.

At the height of the disease, new signs are added:

• jaundice (yellowing of the skin, mucous membranes, and whites of the eyes);
• discolored stool;
• darkened urine with foam.

During the icteric period, you feel better. Jaundice persists for a month, then its intensity decreases.

The duration of Botkin's disease is 30-40 days, it depends on age and immunity. If a person is weakened, the process may become chronic, when it drags on for six months. However, the patient usually recovers and the liver is completely restored.

Treatment of Botkin's disease

Hepatitis A is diagnosed by an infectious disease doctor. He must know whether there was contact with the patient, whether the person visited countries where the risk of infection is increased. Blood tests are also carried out - it reveals increased bilirubin, antibodies M, and when the process is chronic - G. Ultrasound is used to determine the size of the liver and spleen, which also often increases.

Based on the test results, treatment is prescribed. It is performed on an outpatient basis. Hospitalized in severe cases, according to epidemic indications.

Patients are prescribed bed rest. Table No. 5 according to Pevzner is prescribed, drinking plenty of fluids. There is no specific treatment, and drug therapy is used to reduce the severity of symptoms. The following drugs are prescribed:

1. Intravenous infusion solutions relieve symptoms of intoxication.
2. Lactulose preparations restore digestion.
3. Antispasmodics – prevent cholestasis.
4. Hemostatic agents infused into the stomach through a tube treat hemorrhagic syndrome.
5. Antibiotics – fight bacterial infection.

When the symptoms pass, the patient should remain under medical supervision for another 3-6 months. Specific IgG in the blood indicates recovery and the development of stable immunity.

Diet

In case of Botkin's disease, it is necessary to follow a diet and drink plenty of fluids. Table No. 5 according to Pevzner is assigned. Basic principles of the diet:

1. Meals 5-6 times a day in small portions. This helps stimulate appetite - it is weak in Botkin's disease, and the load on the liver is also reduced, due to which it begins to work better.
2. The consumption of boiled and stewed vegetarian dishes, cereals, lean meat, and milk is allowed.
3. Fatty foods, fried foods, and spices are prohibited.
4. Food is recommended to be warm, at a temperature of 15-60 degrees. Such food is the most gentle for the liver, does not cause stomach irritation, and normalizes pancreatic functions.
5. Salt should be limited to 4 g per day. It retains fluid, causing swelling. Detoxification is also difficult because toxins and viral breakdown products are excreted in the urine.
6. You need to drink 2-2.5 liters of liquid daily. Rosehip decoction, medicinal herbs, berry fruit drinks are useful, weak tea is allowed. A large amount of fluid stimulates urination, and toxins are washed out with urine. At the same time, appetite improves.
7. Alcohol is completely avoided for at least six months. Even if the symptoms subside, the liver cannot yet function fully. All resources are directed towards restoring damaged cells. Alcohol will worsen the course of the disease.

The daily diet should contain:

• 90-100 g of proteins;
• 80-100 g fat;
• 350-400 g carbohydrates.

It is important to reduce the consumption of animal fats, as they double the load on the liver and bile ducts. The daily calorie intake should be 2800-3000 Kcal.

The main purpose of table No. 5 is to create favorable conditions for the functioning of the liver and stimulate bile secretion. As a result, the work of other gastrointestinal organs, which also suffer from Botkin’s disease, is facilitated and stabilized. At the same time, the metabolism of fats and cholesterol is regulated, and the accumulation of glycogen in the liver is normalized.

Complications

After recovery from Botkin's disease, even if it was severe, most people become absolutely healthy. Relapses do not occur. However, in 30% of cases, a chronic course is possible if the patient did not go to the doctor on time or ignored the doctor’s instructions regarding work schedule and diet.

Complications and consequences of the acute period - dysfunction of the liver parenchyma, malfunction of the organ. This negatively affects the functioning of the entire organism, but is transitory.

The consequences of Botkin’s disease being detected untimely, or the patient violating the medication regimen can be severe:

• cirrhosis;
• ascites;
• liver failure;
• encephalopathy.

Botkin's disease is fatal if it occurs in an acute dystrophic form and the person suffers from immunodeficiency.

Prevention of infection

General preventive measures aimed at preventing the development of the disease:

• control of sewage discharge;
• providing people with clean drinking water and quality products;
• organization of quarantine in kindergartens, schools, boarding schools, adult groups during outbreaks of the disease.

Persons in contact with the patient should be observed for 1 month. In areas of infection, disinfection is mandatory.

To reduce the risk of infection you need to:

• maintain personal hygiene;
• refuse food of questionable quality;
• Do not drink unboiled or untreated water.

The most effective prevention of hepatitis A is vaccination. In Russia it is optional. However, vaccinations are recommended:

• children who go to kindergarten;
• adults traveling to countries with high incidence rates;
• in contact with infected people.

The vaccine is administered twice at six-month intervals. This allows the body to develop lasting immunity for up to 10 years.

Source: https://progepatity.ru/gepatit-a/bolezn-botkina