Symptoms and treatment of hepatitis in children

Liver damage in a child can develop for a variety of reasons. The danger of this condition is that it can lead to the development of numerous complications.

What it is?

Disruption of the liver cells or hepatocytes as a result of various provoking factors is called hepatitis. In most cases, different subtypes of viruses lead to the development of this condition in babies. These forms of the disease are called viral hepatitis. They are most common in children's practice.

The number of babies suffering from hepatitis is growing every year. In America, the incidence is rising to 400,000 new cases each year. Among the most common variants registered in children in Russia is hepatitis B and A. They are found in the overwhelming majority of cases. Hepatitis C is much less common.

Scientists have identified several types of viruses that have a destructive effect on liver cells. They are called using Latin letters - A, B, C, D, E, F, G, SEN, TTV. They differ not only in special differences in cellular structure, but also have different properties.

Once in the child's body, hepatitis viruses, along with the blood, penetrate the liver cells, where they begin to actively multiply and exert their destructive and toxic effects.

The liver has over 40 different functions in the body. It is the main organ in which detoxification (neutralization) of toxic metabolic products occurs. It also performs a barrier function, protecting the internal environment of the body from the penetration of foreign microorganisms. The liver also synthesizes important hormones and biologically active substances that are involved in most chemical reactions that are very necessary for life.

Once in a child's body, hepatitis viruses have a damaging effect on liver cells. In acute course - the child has very vivid clinical symptoms. In the chronic form, the manifestations of the disease can be erased or slightly expressed. In this case, additional diagnostic methods are required to establish the correct diagnosis.

How is it transmitted?

Hepatitis viruses persist very well in the external environment. For a long time, they can be in cold temperatures, and they die only with a sufficiently long treatment, which is carried out when heated above 60 degrees.

It is important to note that most subtypes of the hepatitis virus are quite sensitive to ultraviolet radiation.

A child can get infected in various ways:

Direct contact with body fluids containing viruses. These include: urine, saliva, blood. Viruses enter the bloodstream through various microdamages. They are small in size and spread well throughout the bloodstream.

Congenital. This method of infection is also called fetal. In this case, hepatitis viruses are transmitted to the baby from the mother. Also, a child can become infected from the father, if he was already sick before conception. Microorganisms pass through the placenta in different ways. For example, hepatitis C viruses have a much more difficult time crossing the blood-placental barrier than subtype B.

Through breastfeeding. Research worldwide confirms the fact that some types of hepatitis viruses very easily reach the mammary glands. They are able to penetrate into breast milk. If a nursing mother suffers from hepatitis, especially in an active form, then her baby can become infected.

Through drinking. In this case, the source of infection is poor quality water. It usually contains a huge concentration of viruses. This method is most likely for hepatitis A. This form is also called Botkin's disease. A baby can also become infected with hepatitis A when swimming in a pond, when he accidentally swallows water from it while swimming.

Due to violation of the rules of personal hygiene. Using someone else's personal hygiene products increases the chances of infection many times over. Another person's toothbrush, towel, or washcloth can cause a child to become infected with hepatitis.

During medical interventions. Of course, this is quite rare. However, all the same, cases of infection through the blood are still recorded every year after surgical interventions or even when performing simple injection measures. Most often, this variant of infection leads to the appearance of viral hepatitis B or C in the child.

After liver transplant. In some situations, with various severe congenital or acquired diseases, it is required to replace the damaged tissue with a new one. For this, doctors use a liver transplant from a donor. Before carrying out this procedure, the entire necessary range of tests is carried out, which should prevent possible hepatitis infection. However, there are cases when viruses are found in the child's blood after a liver transplant.

After poisoning with toxic substances. The liver, performing a detoxifying function, must eliminate all hazardous components from the body. Some toxic substances have a detrimental and destructive effect on liver cells. Usually, these acute conditions develop quite rapidly. This leads to an almost complete blockage of the liver and significant disruptions in its work.

As a result of unprotected sex. This form of infection is quite often recorded in adolescents. Lack of information and neglect of the simplest means of contraception leads to a huge number of cases of hepatitis B or C.

Through dirty hands. After playing outside, kids often forget to wash their hands. Particles of dirt or soil can contain a huge variety of viruses, including hepatitis viruses. While eating, the child introduces an infection into his body. Viruses very quickly enter the saliva, and then into the blood.

It is important to note that any person who has hepatitis viruses in their blood can be a carrier of the infection.

In some cases, the diagnosis fails to detect them. However, this does not mean at all that there are no more viruses in the body. Often, an extended set of diagnostic measures is required to identify chronic forms of the disease.

The risk of hepatitis transmission is quite high. Hepatitis A is more often recorded in babies aged 3 - 12 years. Congenital variants of the disease are most often caused by viruses of the subtype C. In school-age children, as well as adolescents, hepatitis B is detected in the vast majority of cases. It occurs in about 80% of cases. Other subtypes of viruses cause hepatitis in babies quite rarely.

Kinds

Each hepatitis occurs with varying degrees of severity of symptoms. This largely depends on what subtype of viruses caused the disease. This circumstance also determines how difficult the disease will be in a particular baby.

The most severe variant of the disease is fulminant. It is characterized by complete death of liver cells (necrosis). This condition is irreversible and worsens the prognosis. It can occur at every stage of the course of the disease. With a fulminant course, a large number of antibodies can be detected, which is a consequence of autoimmune damage to the liver tissue.

Most often, such a dangerous form of hepatitis is recorded in children during the first months of life.

This is due to the imperfection of the structure and functioning of the immune system in such babies. Immunity in infants is not able to cope with the toxic and destructive effect of viruses on liver cells. With the development of a fulminant course of hepatitis, doctors usually reveal a large number of rather massive foci of a destroyed liver.

For nonspecific reactive hepatitis, diffuse degenerative changes in the liver tissue are characteristic. This form of the disease appears, as a rule, due to chronic diseases of internal organs. Usually, such variants of the course of the disease are manifested by the appearance of minor symptoms. The most common of them: fatigue, impaired taste and appetite, some dryness of the skin. In severe cases, jaundice may develop.

Different clinical forms of the disease require special treatment. It is different for each form of the disease. In some cases, the therapy of the disease is still imperfect. This can be said mainly about hepatitis C. Scientists around the world are working every day to create new effective drugs that would lead to a complete recovery from this disease. Such difficulty in choosing a treatment makes hepatitis C close to herpes type 6, for which no specific therapy has yet been found.

Incubation period

The time from the beginning of the pathogen entering the bloodstream to the onset of the first clinical symptoms may vary. This largely depends on the virus subtype and its infectious properties.

Different types of hepatitis are characterized by different duration of the incubation period:

Option A - from 8 to 49 days. In most cases, two weeks.
Option B - from 51 to 180 days. In the vast majority of children, the first signs of hepatitis B appear, on average, 3 months after the pathogen enters the bloodstream.
Option C - from 1.5 to 2 months. In some situations, the incubation period can be from two weeks to six months.
Option D - usually in the first week after the penetration of the pathogen into the blood. In some cases, the onset of the first symptoms may develop after 2–3 months after the initial infection.
Option E - from 20 days to 1.5 months.
Option F - never occurs separately. Babies can become infected with them only when infected with viruses A, B and C. When combined with infection with these viruses, their incubation periods can be shortened several times.
Option G - mainly from two weeks to a month. In some babies, the first symptoms appear only after 35-45 days.

Symptoms

These diseases are characterized by a gradual appearance of clinical signs.

The severity of symptoms in a baby will directly depend on his initial data. In more weakened children with concomitant diseases, the course of the disease can be quite severe, and the symptoms manifest themselves quite brightly.

In the development of the disease, several stages are successively replaced:

Preicteric period. It can manifest itself in several forms: catarrhal, gastritic, asthenovegetative or rheumatological. For hepatitis A, it is usually about a week. The rest of the forms, which are characterized by hematogenous infection, proceed with the development of symptoms for 2-3 weeks.
Jaundice period. It is characterized by the appearance of the most specific marker of liver diseases - yellowing of the visible mucous membranes and skin. Botkin's disease is characterized by a gradual increase in jaundice and its rapid disappearance. Other forms of hepatitis are accompanied by a rather long icteric period.
Recovery or transition to a chronic form. The outcome of the disease depends on many data, including the characteristics of the virus that caused the disease. Botkin's disease in the overwhelming majority of cases leads to a complete recovery. It is quite difficult to achieve the absolute disappearance of hepatitis B and C viruses. This requires an intensive course of treatment, which can take several months or even years.

The preicteric period can proceed in different ways. The catarrhal form is accompanied by the appearance of all the symptoms that would also occur with any common cold. These include: a cough without phlegm, a runny nose with runny and watery discharge from the nose, an increase in body temperature to subfebrile or febrile numbers, an increase in general weakness and fatigue, as well as an incoming headache.

Quite often, in babies during this period, doctors make the wrong diagnosis, considering these clinical signs as manifestations of an acute respiratory illness or flu.

Only laboratory tests, which easily show the causative agent of the infection, help to identify the disease. However, this period remains for quite a long time without a correct diagnosis.

The gastritic or dyspeptic form is characterized by the appearance of adverse symptoms from the organs of the gastrointestinal tract. The child may experience discomfort and soreness in the epigastrium. The baby hiccups more often, complains of nausea or vomiting. As a rule, during this period, the sick child's appetite decreases. Incorrect diagnosis leads doctors to misdiagnose, implying that the baby has simple food poisoning.

The asthenovegetative variant is also not accompanied by the appearance of bright and specific symptoms. The child becomes a little lethargic, gets tired quickly even after performing his usual actions, eats without appetite, may complain of a headache. Usually, parents during this period think that the baby is not sick, but simply very tired or naughty. It is quite difficult to suspect a disease at this stage, even for an experienced doctor.

The rheumatological variant of the preicteric period is quite rare. Babies usually begin to complain of pain in the legs when walking. By visual inspection, the area of the joints may not be changed in any way. However, even the baby's gait begins to change. Usually, the baby tries not to step on the painful leg, as this noticeably increases his pain. Some autoimmune forms of the disease are accompanied by the appearance of rashes on the child's skin, which in appearance may resemble allergic ones.

The preicteric period gradually subsides, and the baby develops bright and specific signs of liver damage, which are well known to every mother. This is jaundice. It usually builds up in a couple of days. The sclera of the eyes, visible mucous membranes, and then the skin become yellow. It can range from bright lemon to olive. This is determined by the infectious characteristics of the causative agent of the disease.

The severity of this sign also depends on age. In newborns and infants, yellowing of the skin may be slightly expressed. Some forms of jaundice are accompanied by unbearable itching of the skin. When examined, such babies show numerous scratching marks on the skin.

With a severe course of the disease, a child may experience various hemorrhages.

This is due to the fact that the liver normally synthesizes substances that have a positive effect on blood vessels and capillaries. In case of violation, their ruptures occur, and the outflow of blood outward. The baby may develop nosebleeds or various bruises on the skin. During this time, as a rule, the child becomes more excitable.

By the end of the icteric period, all the main functions of the liver are gradually normalized. This leads to the fact that the negative symptoms of the disease disappear. The child begins to feel much better. On average, this period lasts only a couple of weeks.However, in more severe cases of the disease, it can be up to several months. These situations indicate the development of a protracted period of the disease.

Also in children's practice, there are alternative forms of the course of the disease:

Anicteric. With this option, the child's skin remains pale pink. Bilirubin levels may be normal or slightly elevated. The borders of the liver usually do not exceed the norm. Examination can reveal the causative agent of the disease, as well as a slightly increased level of special liver enzymes - transaminases.
Erased. Practically does not cause uncomfortable symptoms in the baby. On examination, doctors find some enlargement of the liver. Diagnosis of the disease in this form of the disease is most difficult.
Subclinical. With this variant of the disease, the baby does not have any clinical manifestations of the disease. The child is doing well. It is very difficult to identify the disease in this course. To establish a diagnosis, special laboratory tests are required to determine the pathogen in the blood, as well as the antibodies developed by the body to it.

The first signs in newborns and infants

Doctors call congenital forms of the disease fetal. In this case, infection occurs in utero: from mother to child. If a pregnant woman is infected with hepatitis viruses, as well as if she has an acute form of the disease, she can easily infect her unborn baby.

Congenital hepatitis is increasingly common in the neonatal practice of treating pediatricians and infectious disease doctors. This is largely due to the lack of all necessary vaccinations in expectant mothers. Hepatitis in newborns can also be called serum hepatitis. This means that the virus got to the baby through the liquid component of the blood - serum.

The development of the disease in newborns and infants can be quite rapid. In some cases, this leads to the development of numerous complications. Many of them are even capable of contributing to life-threatening conditions such as shock or coma. In these cases, intensive treatment in the intensive care unit is already required.

But not always in a newborn child, viral hepatitis is severe. If a child was born with a good weight, as well as without various concomitant pathologies of internal organs, then the development of the disease in him may be quite easy. Such children necessarily require increased attention from their parents and medical personnel.

Among the distinguishing features in babies of the first year with hepatitis are the following:

In some cases, the disease can proceed with erased symptoms.... This option is also called anicteric, since the baby does not develop jaundice.
A sharp increase in liver enzymes... Liver transaminases can increase several times. This indicates damage to the liver cells. With the development of the cholestatic variant of the disease, which is accompanied by a violation of the outflow of bile, an increase in the level of bilirubin is also observed.
Increased liver size... Its boundaries can significantly exceed the maximum permissible for a given age. With autoimmune variants of hepatitis, the spleen also enlarges. The doctor will be able to determine these deviations during the examination, as well as when performing an ultrasound examination.

Frequent transition of the disease to a chronic form... This is usually typical for those forms of the disease that developed with a subacute course. The prolonged and destructive effect of viruses on hepatocytes leads to their damage and disruption of the basic functions of the liver.
Mixed forms of the disease... In some weakened babies, viral hepatitis is combined with bacterial. Most often - with streptococcal. Such forms of the disease are quite difficult and require the appointment of not only antiviral agents, but also antibiotics.

Symptom-free course... Also, doctors call this form latent. It is possible to suspect its presence in a child only with careful observation of the baby. Observant parents will be able to notice dark spots on the diaper from urine, which result from increased levels of liver enzymes. Babies suffering from a latent form of the disease may regurgitate food too often, and also refuse to breastfeed.
Possible development of fulminate forms of the disease... Such hepatitis is most dangerous in babies of the first six months of life. If a newborn child at this age is found to have this disease, then usually he is hospitalized in the infectious diseases department for intensive treatment.

Violation of the course of the main periods of hepatitis, as well as changing the timing of the incubation period. In this case, the baby may not have a period without jaundice. The child's temperature rises sharply. It usually rises to febrile numbers.
Prolongation of the icteric period... It can even last up to one and a half months. The examination reveals a very high level of bilirubin in the child. In some cases, it can even exceed the norm by several times. When examining such children, doctors usually reveal large sizes of the spleen. In this case, the borders of the liver for a long time can remain within the age norm.
Frequent development of complications. The risk of possible negative consequences of the disease in newborns increases several times. The younger the child, the higher the risk of complications. Usually the most severe course of the disease is in babies during the first 3-6 months of life.

Basic diagnostics

In the vast majority of cases, the diagnosis of viral hepatitis is easy enough. In 75% of babies with jaundice, doctors find signs of this disease. The doctor can suspect a disease already during a routine examination and determination of the size of internal organs. After such a clinical examination, the doctor writes out several tests and studies that allow you to accurately establish the diagnosis.

The following tests are used to detect hepatitis in a child:

General and biochemical blood tests.
Examination of urine for the detection of bile pigments in it.
Immunoassay blood test to find the causative agent of the disease. A positive test indicates the presence of viruses in the child's body. However, the test is not highly specific. This leads to a false positive result. In such situations, re-inspection is required after several months.
A serological test to detect antibodies. It takes some time for their formation, so it is impossible to detect them at the initial stage of the disease.
PCR. A fairly accurate study that helps detect various viruses inside the body.
Ultrasound examination of the abdominal organs. It helps to establish the real size of the liver and spleen, and also provides a qualitative description of the existing abnormalities in these organs.

Is it possible to give birth to a healthy baby to a mother with hepatitis?

The risk of intrauterine infection during pregnancy is quite high. Most often this question is asked by women with hepatitis B or C. The type B virus is small and very easily crosses the placenta. Mothers with viral hepatitis B, according to statistics, have already infected babies in the vast majority of cases.

You can influence this. Planning a pregnancy is very important to reduce the risk of intrauterine infection. Before the onset of conception, the expectant mother can receive all the necessary treatment. It will help reduce the concentration of viruses in the body. Later, during pregnancy, this will help to significantly reduce the risk of possible infection of the baby.

All expectant mothers who are planning a child should be vaccinated.

The schedule of vaccinations against hepatitis B is approved in Russia by an official document. Please refer to the National Vaccination Schedule for vaccination dates. For reliable protection against hepatitis B, only three doses of the vaccine will be required. Such a simple preventive measure will protect the unborn baby from possible infection with a dangerous disease.

Hepatitis C is also a fairly common threat during pregnancy. Scientists have proven that viral pathogens of this disease can hardly cross the placenta. However, there is still a risk of infection. Most cases of infection are registered during childbirth. When passing through the birth canal, a child can become infected.

There are currently no vaccinations for hepatitis C. Therefore, every mom during pregnancy should follow the basic rules of prevention. It is necessary to limit and minimize all possible contacts that can lead to infection of her and the unborn baby. In some situations, you can even get infected with viral hepatitis C in a beauty salon while carrying out a trim manicure.

Complications

Many forms of hepatitis result in complete recovery. 90% of babies who underwent Botkin's disease in childhood never remember about it. Parenteral forms, which arise from infection through the blood, usually do not have such a good course and prognosis. Quite often, they turn from an acute course into a chronic form.

With hepatitis B, adverse complications may develop already during the preicteric period. According to statistics, they are observed in babies in 5-15% of cases. The most common complications include: hemorrhagic bleeding, skin rash, joint pain, blood in the urine.

After hepatitis C, a child may develop an autoimmune disease.

Some babies develop some rheumatologic diseases. Doctors note the appearance in such children of symptoms of tardive cutaneous porphyria, lichen planus and other pathologies. Until now, scientists have not given an answer to why these conditions develop in children with viral hepatitis C.

Lightning-fast forms of hepatitis, accompanied by mass death of liver cells, occur in 1-5% of cases. Such a rapid development of the disease is accompanied by profuse necrosis in the liver. The baby's condition deteriorates sharply. In some cases, even shock or coma may develop. Treatment requires urgent hospitalization and massive infusion therapy.

Chronization of the process occurs in about 40-50% of babies. Chronic hepatitis significantly affects the child's quality of life. The kid can suffer from increased fatigue, poor study and get tired very quickly. These children, as a rule, have decreased or impaired appetite. Some toddlers have difficulty falling asleep or often wake up in the middle of the night.

How to treat?

Each clinical form of viral hepatitis is treated differently. Botkin's disease goes away on its own in a few weeks. This form of the disease requires only the appointment of symptomatic treatment. The use of any special antiviral agents to eliminate the virus is not required. Usually, the child's body copes well with the elimination of microorganisms and the normalization of its work.

Therapy of parenteral viral hepatitis is a rather difficult task. The choice of drug treatment regimen is carried out by an infectious disease doctor. A child who has been found to have infectious pathogens in his blood is registered with a dispensary. The kid must undergo obligatory medical consultations and take all the necessary tests. During the acute period of illness, hospitalization is usually not required.

The only exceptions are cases when a child suffers hepatitis in severe and especially fulminant form. In this situation, the baby is hospitalized in the infectious diseases department of the children's hospital for all the necessary treatment.

The complex of therapy for the acute period of the disease includes:

Antiviral treatment. It is prescribed for parenteral forms of hepatitis. Various drug therapy regimens are used. Sofosbuvir therapy is used to treat hepatitis C. This tool has a fairly high efficiency and a good range of tolerance.

Elimination of intoxication. This is facilitated by plentiful drinking, as well as the use of sorbent and antipyretic agents. As sorbents, you can use: activated carbon, Smecta and other drugs.

To eliminate high fever, it is better to choose paracetamol-based drugs, since they do not have a toxic effect on the liver.

Immunomodulatory. Helps restore the normal functioning of the immune system. Immunoglobulin therapy has positive effects in the treatment of hepatitis C. Interferon drugs can also be used.

Choleretic. Are prescribed for severe cholestasis syndrome. In this case, there is stagnation of bile and a violation of its outflow through the biliary tract. As a similar treatment, suitable: Hofitol, Cholenzym and other drugs. Prescription of drugs is carried out only after an ultrasound examination of the liver and gallbladder. In the presence of stones in these organs, choleretic agents cannot be used.

Hepatoprotectors. Are prescribed to eliminate and prevent death or severe damage to liver cells. The choice of the drug depends on the age of the child, as well as taking into account the variant of the pathogen.
Health food. Babies with chronic hepatitis must follow a diet throughout their lives. Fried and fatty foods are strictly prohibited for them. Also, all fast food products and cooked with a lot of oil are excluded from the menu. Proper nutrition with a sufficient supply of lean meats and poultry, as well as cereals and dairy products is a successful guarantee of the normal functioning of the liver for many years.
Bed rest during jaundice. This simple measure helps to reduce the risk of complications in the future. To achieve a faster recovery, the baby should be given a sufficient amount of fluid. This will help to quickly cope with the negative symptoms of the disease.

Forecast

Even the transition to the chronic form of the disease does not have a significant effect on the child's life expectancy. Toddlers maintain an active lifestyle for many years. Only 2% of children can develop quite dangerous complications. They usually develop in newborns and babies. The quality of life largely depends on the form of the disease.

Viral hepatitis C usually occurs without severe symptoms for a long period of time. If untreated, they can lead to the development of long-term consequences in the child. Already in adulthood, he develops total damage and death of liver cells - cirrhosis. In this case, a person should already receive therapy for life, sometimes this is even an indication for establishing a disability group for him.

Preventing viral liver diseases is only possible through prevention. Today there are excellent and effective vaccinations against hepatitis B and A. They will help protect the child's body from dangerous parenteral infections. Vaccination against hepatitis B begins already in the hospital. The vaccination schedule is strictly regulated and included in the National Calendar.

Dr. Komarovsky will talk about viral hepatitis in the next video.