Hepatitis A

Causes of the Disease

Hepatitis A, also known as Botkin’s disease, is an acute infectious disease that affects liver cells (hepatocytes). It falls largely under gastrointestinal disorders, with the main route of transmission being the oral-fecal route. The disease is characterized by a mild course; however, under certain conditions, it can pose a significant threat to human health. Diagnosis, treatment, and prevention of hepatitis A in adults are managed by hepatologists in collaboration with infectious disease specialists, gastroenterologists, and other experts as needed.

General Information
Hepatitis A remains one of the most common types of viral diseases, without a chronic stage, as it always presents acutely and rarely requires hospital treatment. The source of the disease is RNA-containing viruses, which cause various types of infections in the digestive system. The causative agent of Botkin’s disease remains highly resilient in the external environment, tolerating negative temperatures and can persist in household conditions for up to 2 weeks. Hepatitis A virus quickly dies when exposed to direct sunlight or boiling, but remains intact upon entering the acidic stomach environment. This resilience of the infectious agent contributes to the widespread global spread of the disease.

Based on the size and nature of clinical symptoms, experts distinguish two types of Botkin’s disease: subclinical, which progresses without symptoms, and clinical, which is characterized by jaundice or anicteric manifestations.
Regarding the duration of the disease, two types of hepatitis A are distinguished:

  • Acute recurrent type – lasting no more than 3 months;
  • Prolonged acute type – lasting more than 3 months.
    According to the severity of the clinical picture, hepatitis A can be mild, moderate, severe, or fulminant, as well as excellent or rapidly progressive.

Causes of Hepatitis A (Botkin’s Disease)
The main cause of hepatitis A is contact with the primary source of the disease, which is the infected person or contaminated materials. Experts identify three main ways of virus transmission:

  1. Oral-fecal (the most common method), where the infectious agent enters the healthy person’s body through food, drink, or contact with household objects.
  2. Sexual transmission, which occurs during sexual intercourse and other forms of sexual contact, including oral sex.
  3. Parenteral (the least common type), where the disease is transmitted through blood during plasma transfusions or other medical procedures.

Exposure to hepatitis A virus is significantly widespread. Factors worsening the unhealthy epidemic situation include:

  • High population density.
  • Low health standards.
  • Poor water quality.
  • Violation of rules for storing, processing, and preparing food supplies and food products.
    At-risk individuals include those who:
  • Travel extensively across different regions/countries/continents.
  • Frequently handle human body fluids and biological fluids due to their professional activities (doctors, laboratory technicians, nurses, cleaners, etc.).
  • Consume alcohol and drugs.
  • Engage in homosexual relationships.
  • Lack permanent shelter.
  • Reside in areas with low infrastructure development and poor epidemic conditions.

Hepatitis A is characterized by a well-defined seasonality, with the highest number of reported cases occurring during the summer and fall months. The viral outbreaks are most common in warm and humid southern regions.

Symptoms of Hepatitis A

Botkin’s disease progresses gradually and systematically. The incubation period lasts from 7 days to 1.5 months.
During the typical course of the disease, the infection passes through three stages. The first stage, preceding jaundice, lasts from 2 to 15 days. Depending on the symptoms, it can be distinguished by several syndromes.
The flu-like type of the disease in adult patients is accompanied by:

  • Sudden rise in temperature to 38 degrees Celsius or higher.
  • Painful dry cough.
  • Runny nose.
  • Headache, joint, and muscle pain.
  • Feeling of weakness, fatigue, and exhaustion.
  • Smokers with this type of disease notably experience a significant decrease in the desire to smoke.
    Symptoms of hepatitis A with digestive syndrome in men and women include:
  • Abdominal pain.
  • Heaviness and discomfort on the right side of the pelvis.
  • Nausea, sometimes with vomiting.
  • Swelling.
  • Decreased appetite.
  • Digestive disturbances.

Signs of the neurovegetative asthenic type include:

  • Increased weakness.
  • Bloody headache without clear localization.
  • Increased irritability.
  • Drowsiness.
  • Dizziness.
    In this type of disease, body temperature is either almost normal or reaches hyperpyretic values.
    Experts also identify what is known as mixed syndrome when the patient exhibits signs of several types of hepatitis A stages before jaundice simultaneously.
    In some patients at this stage of disease progression, nosebleeds, darkening of urine, lightening of stools, and a slight decrease in heart rate may be observed. Significant enlargement of the liver and slight enlargement of the spleen can be noted during abdominal organ examination.
    The next stage is the jaundice period. It lasts from 5-7 days to two weeks. Usually, during this stage, the patient’s general condition improves, and the unpleasant symptoms of hepatitis A diminish.

The following symptoms become prominent:

  • Skin discoloration with yellow tint.
  • Appearance of jaundice on the mucous membranes of the mouth, nose, and eye sclera.
  • Severe itching of the skin.
  • Dark and concentrated urine.
  • Pale stools.
    Weakness, drowsiness, decreased appetite, and signs of neurovegetative asthenic disorder may persist. In some patients, joint and muscle pains worsen, while others complain of swelling in the lower limbs, and some may experience low blood pressure.
    With a favorable course, the symptoms gradually fade away, the patient’s condition stabilizes, and the skin color, eye membranes, and mouth mucous membranes return to normal, marking the beginning of the recovery phase.
    During the non-traditional progression of the disease, the classic clinical signs of the disease may not be present at all or may be poorly expressed.

The rarest atypical forms of hepatitis A include the form known as non-viral, which can manifest with symptoms resembling hepatitis, but without the presence of viral agents in the body. Additionally, cases of relapsing hepatitis A have been reported, where symptoms improve and then recur after a period of apparent recovery.

It’s important to note that while hepatitis A typically follows a predictable course, individual experiences may vary, and some patients may exhibit unique or atypical symptoms. Therefore, healthcare professionals must remain vigilant and consider a wide range of presentations when diagnosing and managing cases of hepatitis A. Early detection, supportive care, and appropriate management can significantly contribute to the patient’s recovery and prevent complications associated with the disease.

Diagnosis and Treatment of Hepatitis A

Hepatitis A is a viral liver infection that can cause acute illness. Prompt diagnosis and treatment are crucial for managing the disease effectively.

Initial Evaluation:
During the initial assessment, a hepatologist conducts a patient interview, gathers historical data, and performs a clinical examination of the liver and abdominal organs.

Laboratory and Diagnostic Testing:
Laboratory tests may include general blood and urine tests, biochemical blood analysis, and serum-specific tests (such as RIA, ELISA, PCR). Additionally, ultrasound imaging of the liver and abdominal organs may be performed.

Differential Diagnosis:
Distinguishing hepatitis A symptoms from other diseases with similar characteristics is essential. This may involve differentiating between influenza and other respiratory infections in the pre-jaundice period, as well as distinguishing from infectious mononucleosis and leptospirosis during the jaundice phase.

Treatment of Hepatitis A:

In most cases, hepatitis A treatment is outpatient-based, with hospitalization required only in severe cases or when the patient presents with fulminant disease. Hospital admission may sometimes be based on epidemiological indicators.

Basic treatment for hepatitis A includes:

  • Bed rest.
  • Dietary modifications, avoiding fatty, smoked, heavy foods for the liver, alcohol, and dishes with biliary solubility effects.
  • Vitamin and mineral supplementation.
  • Adequate hydration.
  • Improvement of digestion and maintenance of gastrointestinal function with medications.

There is no specific treatment for hepatitis A. Monitoring the patient’s condition and preventing potential complications are important.

Regular preventive measures include:

  • Providing high-quality drinking water sources.
  • Preventing the discharge of wastewater into public tanks and rivers.
  • Increasing access to medical care.
  • Monitoring general nutrition regulation.
  • Implementing population vaccination.

Individual protective measures to prevent hepatitis A infection include:

  • Thorough handwashing after using the toilet, contact with animals, visiting crowded places, and working in the garden.
  • Teaching children personal hygiene rules.
  • Avoiding sharing food or drinks with strangers from the same dishes and avoiding using the same utensils.
  • Regularly conducting wet cleaning at home using disinfectants, especially if there are pets in the room.
  • Undergoing regular preventive examinations.
  • Monitoring chronic liver diseases and other existing systemic conditions.

Strict adherence to quarantine measures is essential to prevent the spread of hepatitis A in cases of suspected or confirmed diagnosis.

Early diagnosis and proper management are essential for hepatitis A patients. Understanding the diagnostic process, treatment options, and preventive measures is crucial for healthcare professionals and individuals alike in effectively combating this viral liver infection.