Botkin’s Disease (Hepatitis A)

Hepatitis A

General Information:
Hepatitis A remains one of the most common types of viral diseases. It presents only in acute form with no chronic stage and rarely requires treatment in hospital settings. The source of the disease is RNA-containing enteroviruses, with the causative agent being highly resistant in the external environment, tolerating negative temperatures and persisting in household conditions for up to 2 weeks. The hepatitis A virus rapidly dies when exposed to direct sunlight or during boiling but remains intact when entering the acidic gastric environment. This resilience contributes to the widespread distribution of the disease globally.

Classification:
Specialists distinguish two forms of Botkin’s disease: subclinical, which proceeds asymptomatically, and clinically pronounced, characterized by jaundice, anicteric, or erased manifestations. Two types of hepatitis A are distinguished based on the duration of the disease: acute cyclic (lasting no more than 3 months) and acute protracted (lasting longer than 3 months). According to the accepted classification, hepatitis A can be mild, moderate, severe, as well as fulminant or lightning-fast depending on the severity of the clinical picture.

Causes of Botkin’s Disease (Hepatitis A)

The primary cause of hepatitis A is contact with the primary source of the disease, namely an infected person or contaminated substances. Specialists identify three main ways of virus transmission:

1. Fecal-oral (the most common method), where the infectious agent enters the body of a healthy person through food, drink, or contact with household items.
2. Sexual, where transmission occurs during sexual intercourse and other forms of sexual contact, including oral sex.
3. Parenteral (the rarest type), where the disease is transmitted through blood during plasma transfusion or other invasive medical procedures.

Susceptibility to the hepatitis A virus is quite broad. Factors that worsen the unhealthy epidemiological situation include:

• High population density.
• Low sanitary standards.
• Poor water quality.
• Violation of rules for storing, handling, and preparing food supplies and food products.

People at risk include those who:

• Travel extensively across different regions of the country and other countries/continents.
• Have frequent contact with human bodily fluids and biological fluids due to their professional activities (doctors, laboratory technicians, nurses, sanitation workers, etc.).
• Consume alcohol and narcotics.
• Practice homosexual relationships.
• Lack a permanent residence.
• Reside in areas with low infrastructure development and poor epidemiological conditions.

Hepatitis A is characterized by well-tracked seasonality, with the highest number of reported cases occurring during summer and autumn months. Outbreaks are most commonly observed in southern regions with warm and humid climates.

Symptoms of Hepatitis A

Botkin’s disease develops gradually and systematically. The incubation period lasts from 7 days to 1.5 months.

During the typical course of the disease, infection passes through three stages. The first, pre-jaundice stage, lasts from 2 to 15 days. Depending on the symptoms, it can be characterized by several syndromes.

The flu-like variant of the disease in adult patients is accompanied by:

• Abrupt fever of 38 degrees Celsius or higher.
• Painful, dry cough.
• Runny nose.
• Headaches, joint, and muscle pain.
• Feeling of weakness, fatigue, tiredness.
• Smokers with this form of pathology often note a significant decrease in nicotine cravings.

Symptoms of hepatitis A in men and women with dyspeptic syndrome include:

• Abdominal pain.
• Heaviness and discomfort in the right hypochondrium.
• Nausea, sometimes with vomiting.
• Flatulence.
• Decreased appetite.
• Stool disturbances.

Signs of asthenovegetative form of pathology include:

• Increasing weakness.
• Dull headache without clear localization.
• Increased irritability.
• Drowsiness.
• Dizziness.

In this type of disease, the body temperature is almost not elevated or reaches subfebrile values.

Specialists also identify a so-called mixed syndrome, when a patient exhibits signs of several variants of the pre-jaundice stage of viral hepatitis A simultaneously.

In some patients at this stage of the disease’s development, nosebleeds, darkening of urine, lightening of stool, and a decrease in heart rate are also observed. Significant enlargement of the liver and slight enlargement of the spleen can be noticed during examination of the abdominal organs.

The next phase is the jaundice period. It lasts from 5-7 days to two weeks. Typically, during this stage, the patient’s general condition improves, and the unpleasant symptoms of hepatitis A weaken. The following symptoms come to the forefront:

• Yellowing of the skin.
• Appearance of jaundice on the mucous membranes of the mouth, nose, and sclera of the eyes.
• Severe itching of the skin.
• Dark, concentrated urine.
• Light-colored stools.

Weakness, drowsiness, decreased appetite, and other signs of asthenovegetative disorder may persist. In some patients, joint and muscle pains intensify, while others complain of swelling of the lower extremities, and some experience a drop in blood pressure.

With a favorable course, the symptoms gradually subside, the patient’s condition stabilizes, the color of the skin, sclera of the eyes, and mucous membranes of the oral cavity normalizes, and the recovery phase begins.

During atypical progression of the pathology, classical clinical signs of the disease may be absent altogether or be weakly expressed. The most rare atypical variant of hepatitis A is the fulminant form, characterized by the development of acute liver failure. The condition is accompanied by:

• Rapid decrease in liver size.
• Unpleasant “liver” odor from the mouth.
• Frequent vomiting.
• Coordination, hearing, and vision disturbances.
• Inappropriate behavior.

With this form of the disease, there is a real threat to the patient’s life: if urgent measures are not taken, coma occurs, which in most cases ends in death. Specialists note that the development of such a variant of the disease is higher in people suffering from prolonged or chronic liver diseases and HIV.

Diagnosis of Hepatitis A

During the initial examination, the hepatologist conducts a patient interview, collects historical data, and performs palpation of the liver and abdominal organs.

The next stage is laboratory and instrumental diagnostics. The complex of studies may include:

• General clinical blood and urine tests.
• Biochemical blood analysis.
• Serological specific tests (RIA, ELISA, PCR).
• Ultrasound scanning of the liver and abdominal organs.

As part of the differential diagnosis, tests and assays are conducted to distinguish the symptoms of viral hepatitis A from other diseases with similar features. For example, differentiation from influenza and other respiratory infections in the pre-jaundice period, and from infectious mononucleosis, leptospirosis in the jaundice stage of the disease.

Treatment of Hepatitis A

In most cases, therapy for Botkin’s disease is carried out on an outpatient basis, hospitalization is only required for severe cases, and when the patient is infected with the fulminant form of the disease. Sometimes, patients are admitted to the hospital based on epidemiological indications.

The basis of treatment for hepatitis caused by the A virus includes:

• Strict bed rest.
• Diet, excluding any fatty, smoked, and heavy foods for the liver, alcohol, and dishes that have a choleretic effect.
• Intake of vitamins and mineral complexes.
• Adequate hydration.
• Normalization of digestion and maintenance of gastrointestinal tract function with the help of medications.

Specific etiotropic therapy for hepatitis A is not provided. It is important to monitor the patient’s condition, preventing possible complications.

Prevention

Systemic preventive measures include:

• Providing sources of quality drinking water.
• Prevention of wastewater discharge into public reservoirs and rivers.
• Increasing the level of medical care.
• Control over the organization of public catering.
• Conducting population immunization.

To protect oneself and loved ones from hepatitis A infection, every person should:

• Thoroughly wash hands after using the toilet, contact with animals, visiting stores, and other crowded places, and working in the garden.
• Teach children personal hygiene rules.
• Not eat or drink with unfamiliar people from the same dishes and not use the same utensils.
• Regularly perform wet cleaning at home using disinfectants, especially if there are pets in the premises.
• Undergo regular preventive examinations.
• Control existing chronic liver diseases and other systemic conditions.

It is very important to observe quarantine measures to prevent the spread of Botkin’s disease in case of suspected or confirmed diagnosis.