Signs, symptoms and genotypes of hepatitis C, causes of infection
- What is Hepatitis C?
- Symptoms of hepatitis C
- Signs of hepatitis in women and men
- How is hepatitis C spread?
- Hepatitis C genotypes
- Other types of hepatitis
- Hepatitis C treatment
More than thirty years ago, infectious disease specialists used a single name for viral hepatitis in humans - Botkin's disease or jaundice. After typing the virus, human hepatitis began to be denoted by letters of the Latin alphabet from '' A '' and further in order to '' F ''
What is Hepatitis C?
New, modern, varieties of the virus are designated by the initials of the first patients GB, TTV. Scientists do not exclude further detection of forms of the virus of this group. For now, we will focus on the most common and dangerous form of hepatitis, which has the letter 'C'.
Hepatitis C is a viral human disease, the pathogen belongs to the Flaviviridae family, the Hepavirus genus, the type of HCV (hepatitis C virus) or HCV (English). First identified in 1989.
In an electron microscope, it is a small, spherical structure covered with a shell. Genetic information is contained in one gene, which carries information about six to eleven genotypes.
Features of the HCV virus:
- Human HCV infection occurs mainly parenterally (bypassing the digestive tract), when the virus enters the bloodstream, then into the liver parenchyma. The main route of infection is intravenous injection of drugs with a dirty syringe, infection is possible when the virus penetrates through the mucous membranes during unprotected sexual contact.
- Liver damage in HCV is accompanied by concomitant diseases of internal organs, various metabolic disorders, as well as the immune system.
A high variability of the immune receptors of the viral envelope is characteristic. The virus easily deceives the human immune system, it is regularly modified. As a result, scientists periodically discover new forms, types, subtypes of the virus.
- A chance of complete recovery in acute form of hepatitis is available in about 15% of patients, in the rest it turns into an asymptomatic chronic form, which ends in cirrhosis, sometimes with liver cancer.
- The development of pathogenesis as a chronic disease is one of the features of hepatitis C. Icteric staining of integuments in patients may be absent or appear for a short time.
- A small bonus. For this form of hepatitis, intrauterine infection is possible, but not typical (transmission of the virus from a pregnant woman to her fetus).
Since 2004, hepatitis C has been included in the list of socially significant infectious diseases in the Russian Federation. The disease refers to predominantly chronic infections (reduced working capacity of people of active age), difficult to control the spread, since there is no vaccine. Up to 90% of people who inject heroin-type drugs are carriers of the virus. Asymptomatic carriers of hepatitis C are the reservoir and vectors of the disease.
A distinctive feature of the chronic form of hepatitis is that the virus is in the human body in an active and inactive state. In this case, the states of activity change repeatedly.
The trick is that antibodies in the blood (traces of the virus) are detected, and the virus in the blood (pathogen) is absent, that is, it is in a non-replicative phase and therefore cannot be treated.
Confirmation of the disease and monitoring the effectiveness of treatment is carried out on the basis of a comprehensive diagnosis:
- laboratory methods, including determining the concentration of the virus (RNA), the amount of specific antibodies;
- instrumental methods of liver imaging, puncture of the organ parenchyma and further laboratory research in order to determine the nature of damage to liver cells.
How long does the hepatitis C virus live?
Virus resistance tested in laboratory conditions. It has been experimentally proven that the virulence of the hepatitis C pathogen persists on different surfaces, including the syringe needle, for more than four days at room temperature.
It is inactivated by boiling in two minutes. When heated to 60 0 C, it loses its virulence within two minutes. Direct irradiation with ultraviolet light inactivates it within about 10 minutes.
Meanwhile, the likelihood of the virus entering the bloodstream is quite high in various everyday situations or medical care errors (see below).
How long do people with hepatitis C live?
On average, after ten to thirty years, the chronic disease ends in severe, irreversible liver damage - cirrhosis. Since the main risk group is young people under 30 years old, the prospect of getting fatal consequences at 40-60 years old and even earlier is relevant. Approximately 20% of chronic patients with this form of viral hepatitis expect such an outcome.
In an infected person, the quality of life is reduced due to damage to liver function. Its important function decreases - detoxification of metabolites, especially after consuming fatty foods, alcohol. Blood stagnation is potentially dangerous due to a decrease in the filtration function of the liver.
Possible premature death of a person infected with the hepatitis C virus, caused by indirect causes. One of the probable causes of death is a decrease in the functional competence of the liver, which pulls with it a train of pathologies (disruption of the cardiovascular system, kidneys, lungs).
The end of the disease - cirrhosis of the liver is manifested by a total dysfunction of the organ, desolation of small vessels and the formation of large blood flow paths. Liver cirrhosis is an irreversible process; it is almost impossible to cure it with modern methods. As a result of compaction of the parenchyma, congestion develops in the abdominal cavity (ascites). Stagnation of blood is accompanied by the expansion of the walls of the arteries of the liver. This is a potential threat of vascular rupture and bleeding. In exceptional cases, liver cancer develops.
Symptoms of hepatitis C
The main group of patients complaining of general malaise and weakness does not associate complaints with liver damage.
One of the features of hepatitis C is the absence or short-term yellowness of the integument. Jaundice (icterus) of the sclera of the eyes, skin is a symptom of liver damage, or rather a symptom of an increase in the concentration of bile pigment in the blood. Bilirubin, as this pigment is called, can enter the bloodstream with one of the forms of pathology of the bile ducts or liver parenchyma.
Read more: The norm of bilirubin in the blood
Common clinical symptoms accompanied by hepatitis C:
- general weakness, apathy;
- decreased activity while doing work;
- disgust, often decreased appetite;
- pain, discomfort in the right hypochondrium associated with dyskinesia (stagnation of bile) or inflammation of the gallbladder, damage to the liver parenchyma is not manifested by pain;
- on palpation, the doctor feels an increase in the size of the liver and spleen, the patient feels an increase in the liver by a feeling of bursting in the right hypochondrium;
- fever of a persistent type is possible.
A feature of the pathogenesis of hepatitis C, as well as hepatitis B (similar pathogenesis), the possible presence of extrahepatic symptoms. The absence of a visible connection of symptoms with liver damage, with a deep analysis, nevertheless confirms this connection.
Major extrahepatic symptoms:
- damage to joints and heart muscle - rheumatoid inflammation;
- damage to the organs of vision of various nature;
- papular rash on the skin or mucous membranes, possibly in the form of a separate disease - lichen planus;
- damage to the excretory organs (kidneys, bladder).
Unfortunately, none of the above symptoms is pathognomonic (main, defining), but always confirms damage to the liver or other organs that have a close relationship with it.
The main symptoms confirming the connection of the disease with hepatitis C are detected by laboratory and instrumental methods.
Signs of hepatitis in women and men
Hepatitis C does not have gender differences; it manifests itself equally in men and women. Often this form of hepatitis has no signs at all, except for general and extrahepatic symptoms (see above).
The consequences of hepatitis C appear imperceptibly, long after infection. Adults should increase epidemic alertness, stop drug use, unprotected, casual sex.
It is sad if an infant is at risk of contracting hepatitis C as a result of parental carelessness.
Hepatitis C in pregnant women
Always associated with enormous stress on the body of a pregnant woman. The acute form of active hepatitis can be dangerous to the fetus. Meanwhile, modern ideas about the chronic pathogenesis of this form of the disease give reason to consider it possible to successfully carry a fetus in the absence of signs of liver degeneration.
In some cases, complications are possible. Their signs are diverse and cannot be classified within the framework of this text. Monitoring the course of pregnancy in this case is carried out in a hospital or outpatient setting.
Severe consequences associated with the degeneration of the liver in the form of cirrhosis are not compatible with pregnancy and bearing a fetus. Women with cirrhosis are advised to give up pregnancy.
Hepatitis C in infants
Here are answers to pressing questions about the possibility of intrauterine infection, as well as infection during breastfeeding.
- No more than 6% of cases of fetal infection during pregnancy and childbirth were recorded, while the transmission of the virus is possible only in the active (replicative) phase of pathogenesis.
- The breast milk of an infected mother is safe for the baby if there is no damage to the nipples of the nursing, infected woman and the mouth of the newborn.
- Antibodies to the virus penetrate the placental barrier, therefore, in an infant born by an infected mother, antibodies to virus C are found in the blood until one year of age.
- Intrauterine infection is excluded in a child born to an infected mother with a decrease in titers, the disappearance of antibodies at one year of age. For about 5% of children, this statement is not true.
- Babies born to women infected with hepatitis C are under the special supervision of infectious disease specialists.
How is hepatitis C spread?
In about 25% of adults and 46% of children, the exact cause of infection is unknown. The most significant route of transmission of the C virus is intravenous drug administration using non-sterile (virus-infected) injection needles. A possible, uncontrolled route of infection is sexual contact in the presence of damage to the mucous membranes of the external male or female genital organs.
Possible routes of parenteral accidental infection in hospitals and public service rooms:
- intravenous drug administration, transfusion of infected blood;
- dental procedures of a surgical or therapeutic nature;
- shaving with common razors;
- some procedures in beauty parlors associated with the risk of accidental bleeding;
- there is a hypothesis about the transmission of the C virus by the bite of blood-sucking synanthropic insects (bedbugs), forest bloodsuckers (mosquitoes, mosquitoes)
Can you get hepatitis C?
The oral-fecal route of infection, characteristic of the A, E forms, is not excluded during the transmission of the C virus, but with a low degree of probability. Oral (oral) infection is possible if the mucous membrane of the gastrointestinal tract is damaged.
In addition to the C form, the parenteral pathway is characteristic of viruses (B, D, F), as well as relatively new forms (GB, TTV).
Is Hepatitis C Sexually Transmitted?
Infection in this way is possible, however, due to the characteristics of the virus, genital infection is not the main one, as well as the household route of infection. The main condition for the transmission of the C virus is damage to the integument of the skin or mucous membranes of their bleeding or microbleeding.
Hepatitis C genotypes
According to modern concepts of virologists, hepatitis C has six genotypes. The term "genotype" refers to the difference in a virus at the molecular (genetic) level.
Most scientists recognize six genotypes. The presence of three more genotypes is considered as a scientific hypothesis.
Since the general reader is indifferent to the genetic differences of the virus, we will focus on the description of the six main genotypes.
Knowledge of the genotypes and their quasi-types are important for infectious disease doctors when:
- the choice of methods of therapy for the disease;
- determination of the epidemic situation of hepatitis C.
Genotypes have a specific territorial distribution. The same treatment principles apply to the same genotypes of different territories.
Genotypes are denoted by Arabic numerals (from one to six), and quasi-types or subtypes are denoted by letters of the Latin alphabet (a, b, c, d, e), and so on:
- First genotype. It is ubiquitous; three quasi-types are distinguished (1a, 1b, 1c). When confirming this genotype, one should count on long-term treatment, for one year or more.
- Second genotype. The ubiquitous genotype and four quasi-types (2 a, b, c, d) are characteristic. The duration of treatment is usually no more than six months.
- Third genotype. Distributed everywhere. It has been proven that there are six quasi-types (3 a, b, c, d, e, f). This genotype is characterized by fatty degeneration (infiltration) of the liver parenchyma - steatosis. Treatment time depends on the quality of the diagnosis. The average treatment time is limited to six months.
- Fourth genotype. Distributed in the countries of the Middle East and Central Africa. In the conditions of Russia, it is little studied. Ten quasi-types are identified (4a, b, c, d, e, f, g, h, i, j).
- Fifth genotype. First registered in South Africa. Has one quasi-type. In the conditions of our country, it remains a poorly studied pathology.
- Sixth genotype. Registered in Asian countries, has one quasi-type. In the conditions of Russia it is poorly studied
Other types of hepatitis
Various human hepatitis have ambiguous epidemic significance for the human body, differ in the methods of treatment, the possibility of specific prevention.
The name of the disease has been preserved - Botkin's disease. A widespread infection occurs in about 40% of patients with hepatitis. It is transmitted by the oral-fecal route, through the use of food contaminated with a virus, water, accidental ingestion of other objects into the digestive tract. The parenteral route of infection is very rarely possible.
- Inflammatory, necrotic changes in the liver;
- Organ enlargement;
- Yellowness (icteric staining) of the integument;
- Dark urine;
- Colorless feces (no pigment).
The stage of jaundice is characterized by the absence of contagiousness. The pathogenesis is characterized by an acute course for up to three to four weeks.
Read more: Hepatitis A - symptoms, causes of infection, prevention and treatment
Has the designation HBV or HBV in the English language literature. Parenteral infection. The pathogen is found in urine, semen, as well as in the discharge of female genital organs. Just like hepatitis C is characterized by a chronic course of the disease.
The main difference from the similar hepatitis C is the high risk of intrauterine transmission of the pathogen from mother to fetus. Clinical signs resemble hepatitis C. It is also characterized by an undulating course, a chronic form of the disease. It is accompanied by cirrhosis, possibly malignant degeneration of liver epithelial cells.
For hepatitis B, a vaccine has been developed and introduced into daily practice, which is also effective against hepatitis D. Newborns from women infected with this hepatitis must be vaccinated. The first dose in the delivery room, revaccination after a month and a year later. The decision on further vaccination is made by doctors based on the results of laboratory diagnostics.
Read more: Hepatitis B - symptoms of manifestation, causes of infection, prevention and treatment
It is a delta infection of hepatitis B. Only in the presence of the B virus is the development of the D form of the disease possible. Parenteral infection and chronic course are characteristic.
Clinical signs resemble hepatitis B. It is characterized by a severe course of the acute form of the disease. A joint course with a closely related B pathogen is often observed.
Prevention is based on the use of the hepatitis B vaccine and non-specific methods. Treatment is similar to that for acute and chronic pathogenesis of other herpes.
Read more: Hepatitis D - symptoms, causes, treatment
Characterized by infection through the digestive tract, as well as an extremely acute course of the disease. It is characterized by a severe course in pregnant women. The rest resembles the acute forms of other hepatitis C by the oral-fecal route of infection. In particular, it is similar to hepatitis A.
Read more: Hepatitis E - symptoms, causes, treatment
The independent existence of the virus is discussed, not recognized by all researchers. Sometimes called by the first letters of the sick person - GB. Often, the detection of the G virus directly correlates with the detection of hepatitis C. Parenteral infection and the chronic course of pathogenesis are characteristic. The clinical picture resembles other forms of hepatitis with parenteral infection. The picture of the disease is similar to that of hepatitis C.
Read more: Hepatitis G - symptoms, causes, treatment
Therapy of acute and chronic forms of hepatitis has a fundamental difference. Treatment of the acute form is aimed at eliminating the main symptoms, protecting the liver from further damage, and protecting the main functions of the organ.
Intravenous administration of saline solutions stimulating the elimination of toxins from the body, vitamins is prescribed, choleretic drugs are prescribed inside.
A feature of the treatment of acute hepatitis C is the mandatory appointment of immunocorrectors. This measure is associated with the peculiarity of the pathogen. For other hepatitis, correction of immunity in the acute course of the disease is not advisable.
Sometimes patients are surprised at the lack of intensive care for acute forms of hepatitis. The fact is that additional drug load, excluding symptomatic treatment, is potentially dangerous for the damaged liver.
On the subject: List of the best hepatoprotectors for liver restoration
In addition to symptomatic treatment, proper dietary nutrition is important.
In case of acute liver damage, dietary therapeutic food is prescribed, which is usually designated table number 5, which includes:
- Bakery products (slightly dried);
- Soups with vegetables, cereals, milk;
- Low-fat meat (beef, chicken, rabbit);
- Low-fat fish (cod, pike perch);
- Dairy products (fermented milk, hard cheese, egg omelet, butter);
- Drinks (tea, compote, homemade juices, still mineral water);
- Dessert (jam except strawberry varieties, honey, sweets, sugar, marshmallow, fruit candy)
- Fruit (green apples, persimmons, watermelon, bananas)
Fried, smoked, pickled, fermented, carbonated, canned foods, as well as products with salty, sour, sharp, spicy taste are prohibited.
Some popular foods are prohibited:
- fruits, vegetables and berries (kiwi, melon, rose hips, strawberries);
- products (jellied meat, mushrooms in any form, processed cheese, sour cream, cream, milk).
Read more: Diet for hepatitis C
More relevant is the treatment of the chronic form of hepatitis C. Obligatory prescription of immunomodulators of different pharmacological groups:
- interferons or interferon stimulants (RoferonA, Reaferon, Intron A, others)
- correctors of humoral or cellular immunity (cycloferon, amiksin, others);
The doctors periodically change the proofreaders. During fever, the appointment of antipyretic medications or physical methods (wiping) of regulating body temperature is indicated.
For chronic hepatitis C, which has a complex relationship with the immune system, antiviral drugs are prescribed (Remantadin, Ribavirin).
On the subject: Is it possible to completely cure hepatitis C?
The diet for the chronic course of hepatitis C is less strict. It is believed that foods prohibited in the acute phase of the disease are limited to the use of once a week.
Author of the article: Kletkin Maxim Evgenievich | Hepatologist
Education: Diploma in the specialty "General Medicine" received at the Military Medical Academy. S. M. Kirov (2007). At the Voronezh Medical Academy. NN Burdenko graduated from residency in the specialty "Hepatologist" (2012).