INFECTIOUS DISEASES : JAUNDICE INFECTIOUS. EPIDEMIC HEPATITIS. BOTKIN'S DISEASE (HEPATITIS EPIDEMICA. MORBUS BOTKINI) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. S. P. Botkin, contrary to the doctrine Virchow of a purely mechanical nature jaundice, first expressed strong confidence in her infectious etiology. Currently, proven etiologic role filterable virus.
Epidemiology. Epidemic outbreaks in peacetime occur mainly in children's institutions. During the wars of the epidemic jaundice noted in the warring armies in different geographic and climatic zones. They wore vyrazhenny and endemic. Season epidemic is predominantly spring months. Sources of infection are not installed. Judging by the epidemics associated with vaccines, in which people were introduced human serum, the virus remains in the blood of healthy people. Virusencyclo in animals has not been proven, although there are indications of the existence of viral jaundice mice. Recently put forward the position that the main source of infection are people suffering from blurred forms. Experimental studies have demonstrated that patients secrete the virus in the faeces, but infects human dose seems to be very high. In natural conditions for mass infection required a significant concentration of the virus. It can be formed in reservoirs subjected to the systematic fecal contamination, for example, during the spring snowmelt, heavily contaminated by fecal masses. There are indications on the role of rats infecting food. Nominated in foreign countries claim drip path transmission instill reasonable doubt.
The pathogenesis. The basis of disease is a common infection with a pronounced structural and functional damage to the liver. In rare cases, even mild forms of jaundice can periodici in acute yellow liver dystrophy.
Symptoms. The beginning of acute, moderate reaction temperature and dyspeptic phenomena (loss of appetite, nausea, rarely vomiting and diarrhea). The appearance of jaundice in 3 - 5th day of the disease with relatively good health. Enlargement of the liver and less of the spleen. Leukopenia with lymph and monocytosis. With the sporadic form of the disease is gradual, jaundice is more intense, increasing and seal liver and spleen more pronounced leukopenia is not so natural.
For. Incubation is 30 to 45 days (epidemic) and 2 - 3 months (after vaccination). The beginning of the disease gives a few characteristic features. During prodrome: mild fever, General malaise, weakness, lack of appetite. When some evidenceand outbreaks during the period of prodrome dyspeptic disorders expressed more sharply, naturally there are intermittent diarrhea. Jaundice appears on 3 - 4 - 5-day, casu in good health condition of the patient. The duration of jaundice and its intensity is different. The liver increases progressively sensitive to palpation. Urine becomes yellowish color; discoloration of stool incomplete and inconsistent. The temperature decreases rapidly, less remains to subfebrile figures. Patients feel more satisfactory; the appetite is gradually recovering. Leukopenia with limfotsitoz kept throughout the disease; monocytosis is gradually increasing. When the sugar load is prolonged hyperglycemia. Persistent increase in blood bilirubin and urobilin. The duration of the disorder of liver function greatly exceeds the subjective feeling of sickness and even in milder forms it takes about 30 days; characterized by weakness.
Complications are rare; there is acute yellow liver dystrophy.
Recognition during prodrome possible in the presence of the epidemic. With the appearance of jaundice should differentsirovat from leptospirosis. When the last acute onset with high fever, severe muscle pain (calf), aversion to foods abrupt soreness of the liver, very often, herpes, skin hemorrhages, hematuria; constantly albuminuria, skin itching; leukocytosis with neutrophilia and left shift, increasing anemicare, acceleration ROHE; undulipodia for fever.
The reaction agglomeration when leptospirosis positive, epidemic jaundice - negative.
Conclusion people from endemic focus plucks disease. Each hearth needs to find out the path of propagation (the contamination of food, water). Protection products from rodents. Deratization. Use boiled or chlorinated water. Active case detection in organized groups; the isolation of patients.
Bed rest even in milder forms, Frequent fractional meals, limiting protein to physiological norms (about 100 g per day), limiting fat (50 g), a sufficient amount of carbohydrates and vitamins C and B1. The exception extractive, spicy and savoury. Valid animal proteins and good emulsifying fats (butter, diluted milk); carbohydrates in the form of soups, mashed vegetables and fruits, cereals. When a protracted period shown contrasting days: protein days (up to 200 - 300 grams of meat within 2 days) with subsequent discharge (sugar, fruit day). In cases of medium and high severity used insulin (10 units for half an hour before lunch) and glucose (20 - 40 ml of 40% solution into a vein) or sugar per os (100 g). A nice effect is the use of hologon (debolina) 5 times a day to 0.2 or intravenously 20 ml of 5 - 20% solution for 8 to 10 days. Blood bilirubin gradually decreases, icteric staining becomes paler, toxic symptoms quickly disappear. Good effect and application of Jalona at 1.0 intramuscularly for 10 days. Zaharin recommended calomel 0.06 1 hour 1 powder before easing (green chair), but not more than 10 powders. In the absence of the chair after the last of the powder give 30,0 01. Ricini. In the morning on an empty stomach systematically 1 teaspoon of magnesium sulfate in hot water or mineral water (Slavyanovskaya, Smirnovskaya, Essentuki № 17, № 4 warmed on an empty stomach in the morning and at night). The good effect gives duodenal drainage: enter the duodenum through a tube 40 ml of 25% solution of sulphate of magnesia, and an hour later an additional 200 ml of 5% solution of sulphate of magnesia. All these activities have a choleretic effect and help to remove toxins from the intestines. Symptomatically with pain - atropine, belladonna; for insomnia, irritation - a warm bath, wiping a 0.25% solution of carbolic acid, free vinegar.