Hepatitis A (HAV) Virus

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Hepatitis A (HAV) Virus

Introduction

Hepatitis A is a strain of a severe liver infectious disease, induced by the virus of hepatitis A. This type of infection is regarded as the least dangerous form among the range of other hepatitis viruses as it cannot take a chronic course. Hepatitis A virus is distinguished by ubiquitous, non-uniform intensity in certain regions, and cyclicality in the long-term dynamics. It is aggravated during autumn-winter season, and predominantly involve of preschool children, adolescent and young adults. This virus is clinically manifested by syndrome of intoxication, hepatosplenomegaly and jaundice. The paper will discuss symptoms, causes, and treatment of hepatitis A virus.

Symptoms

A hepatitis A virus is an acute cyclic benign viral infection from the group of the fecal-oral hepatitis, which is accompanied by the necrosis of hepatocytes. Common gateway for the virus is the mucous membranes of the oropharynx and the small intestine. The inflammatory processes that are responsible for the formation of catarrhal syndrome, dyspepsia, and the reaction temperature are developed. The penetration of the pathogen into the blood system leads to viremia, through which it quickly reaches the liver. Patients with viral hepatitis A experience significant damage around the portal areas together with an intensive cellular infiltration and destruction of the border plate, pronounced signs of cholestasis. The antigens of the virus show high immunogenicity. The activation of the immune system and other specific processes of sensitization of lymphocytes start from the introduction of the pathogen.

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The incubation period lasts from three to four weeks. The hepatitis A virus is an acute cyclic disease and is characterized by a succession of several periods – prodromal, height (jaundice), and the period of convalescence. Prodromal stage is characterized by relatively wide diversity of first symptoms, conventionally grouped into several variants of its course. Flu (febrile, catarrhal) option in hepatitis A is the most common symptom. Usually the disease begins quite sharply with the increase in body temperature, weakness, malaise, muscle pain, development of pulmonary catarrhal symptoms (nasal congestion, sore or scratchy throat, coughs) (“Hepatitis A”). However, flu-like symptoms in most cases are accompanied by the dyspeptic disorders of varying severity. In the dyspeptic option, catarrhal symptoms are absent. Patients are concerned about the discomfort in the epigastric region, accompanies by the loss of appetite. The discomfort is characterized by dull pain in the right upper quadrant, bitterness in the mouth, belching, constipation, or loose stools. The asthenovegetative option is characterized by a number of nonspecific symptoms: general weakness, performance loss, irritability or apathy, sleeplessness or, conversely, drowsiness. Viral hepatitis A can clinically manifest itself immediately with the development of jaundice. It should be emphasized that in this term, the clinical symptomatology may be combined in various combinations. The complications after the virus are developed comparatively rare. However, if they are, they include acute inflammatory processes in the biliary tract (cholecystitis, cholangitis, dyskinesia), as well as the development of secondary infections (pneumonia, etc.) (“Hepatitis A”). Acute hepatic encephalopathy in hepatitis A is extremely rare.

Cause

The hepatitis A virus is among the most widespread intestinal infections in the world. The causative agent of this virus is RNA genomic virus Picornaviridae (Lanford et al. 11223). The virions are small and simply organized. The reservoir and source of virus is a person with any signs of disease (icteric, anicteric, asymptomatic inapparent forms). An ill person is dangerous to others starting from the second week of the period of incubation of the disease. The peak of viral shedding occurs in the first week of the illness. Chronic carriage of the virus by one individual has not been established. There are cases of human infection from chimpanzees and other monkey species. The spread of infection is associated with poor sanitation and overcrowded population. Particularly high incidence of hepatitis A is in the developing world.

The mechanism of transmission of hepatitis A is fecal-oral. Sick man ejects the virus in faeces. Then, virus enters the bodies of other people with water or food (Nainan et al. 69). This is the process of fecal-oral contamination. In most cases, children, who are infected with the virus through dirty hands, become sick with hepatitis A (“Hepatitis A”). Because of this tendency, HAV is also known as the “dirty hands” disease. There is also the possibility of sexual transmission of infection, particularly in the gay environment (Nainan et al. 70). In addition, there are cases of the contamination of this disease, described in the parenteral administration of psychotropic substances, transfusion of blood, and its products. The role of each transmission path varies in different conditions. A watercourse usually leads to the outbreaks of the disease among people, who use contaminated water, or swim in contaminated pools and lakes. Because hepatitis A can survive in water for weeks, the infection can occur after the use of various raw clams, or mussels that are collected from areas contaminated by sewage. Infected food outbreaks are most commonly associated with the contamination of food products in the enterprise by personnel with mild disease or poor personal hygiene. The contamination of fruits and berries (especially strawberries and strawberry salad) is possible in the case of their fertilization with human’s faeces. Regularly, the contact-household transmission path takes place in child homes, orphanages, or other similar institutions, especially in terms of their unsatisfactory sanitary conditions. Although this disease is typical mainly for the third-world countries with poor hygiene and sanitation, isolated cases, or outbreaks of hepatitis A disease can be traced even in the most developed countries. Natural person’s susceptibility is high. After the penetration of the infection, persistent stressful immunity is generated. Asymptomatic forms of the disease form less stressful immunity.

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Treatment

To diagnose a hepatitis A, first it is necessary to create an epidemiological history of where the individual was in the last month, what he ate, and what water he drunk, whether he was in contact with infected patients, etc. Then the doctor carefully examines the patient in the daylight and looks for signs of intoxication (general condition, state of health), dyspepsia (indigestion), presence of fever (sweats, chills), jaundice (skin, tongue, eyes). The doctor usually evaluates the condition of various organs and systems by the standard technique.

After establishing the diagnosis of the disease, patient’s treatment can be performed on an outpatient basis. The patients with the severe course of the disease, with the protracted forms in the presence of severe co-morbidities, as well as decreed groups are always hospitalized. Patients are prescribed bed regime for a period of badly expressed intoxication syndromes and nutrition. The diet excludes high-melting fats, fried food, canned food, pickled production, onions, garlic, and spices. What is more, alcohol is strictly forbidden and Lacto-vegetarian food is highly recommended. In addition to the food group, vitamins C and B are added. Due to the lack of funds of causal treatment, pathogenetic treatment is carried out. To remove the intoxication, depending on its extent, excessive drinking or infusion solutions are used. For daily bowel cleansing and the suppression of the anaerobic flora, it is recommended to administer the derivatives of lactulose, which dose is picked individually. To treat cholestatic component, antispasmodics (no-spa, aminophylline), and derivatives of ursodeoxycholic acid are used.

On average, the disease lasts for about a month. The duration largely depends on the age, immune status, presence of concomitant chronic diseases, and strict implementation of the recommendations of the doctor. Some patients suffer from the chronic form of this infection. Deaths from hepatitis A are rare and occur in patients with fulminant (lightning) form of the disease. In these cases, acute liver necrosis that is accompanied by acute liver failure develops very quickly.

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The main preventive measures of the virus are the provision of safe water and the creation of safe conditions. Moreover, it is important to ensure the implementation of sanitary rules that are imposed on the harvesting, storage, preparation, and sale of food products. It is crucial to provide the proper anti-epidemic regime in the organized children and adult teams and communities. Additional measures should be also directed to the active search for sources of infection, increased disinfection modes, and objective health education of children and adults. During the increasing preseason incidence, immunoglobulin prevention is effective. Currently, a vaccine against hepatitis A is provided as another specific preventive mean (“Hepatitis A”). It provides a rapid, but short-term protection. Vaccine creates active immunity, accompanied by a long loop of its own antibodies. However, widespread vaccination against hepatitis A is restrained by its relatively high cost. Nonetheless, the harm that is caused by hepatitis A significantly exceeds the cost of the vaccination. Taking into the account the high susceptibility of children and the fact that they are the main sources of infection for adults, promising direction is the preventive vaccination against the virus among young children and schoolchildren.

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Conclusion

Viral A hepatitis (Botkin’s disease, a dirty hands disease, jaundice) is an acute infectious disease with fecal – oral mechanism of transmission, mainly affecting the liver and the digestive tract. Hepatitis A is a disease of viral origin, which can have mild or severe form. The infection of humans occurs when consuming infected food and water, and sometimes through the contact-household way. The virus is associated mainly with the lack of clean water and poor sanitation. Improved sanitary conditions and Hepatitis A preventive vaccination are the most effective ways to combat the disease.

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