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viral hepatitis[′vī·rəl ‚hep·ə′tīd·əs]
also known as epidemic hepatitis, infectious jaundice, and Botkin’s disease (after S. P. Botkin who, in 1888, was the first to advance the opinion that the disease is infectious in nature), a viral disease that primarily affects the liver. The pathogenic agent is a filterable virus (pathogenic only for man and resistant to environmental conditions) found in the stools and, for an extended period, in the blood of the patient.
Viral hepatitis is a widespread disease, occurring in every country of the world. According to the far from complete data of the World Health Organization (WHO) for 1950 to 1961, incidence of the disease varied from 40.5 to 90.4 per 100,000 population and tended to increase. Most of the cases are recorded in fall and winter. Epidemics are fostered by insufficient cleanliness, overcrowding, and violation of the rules of personal hygiene. The disease strikes people of all ages, although it is particularly common in children, among groups of whom it spreads in chainlike fashion from one child to another.
Those suffering from the disease are themselves the source of the infection. Their excretions enter the environment, where they can pollute sources of water supply, food products, everyday objects, and hands. Flies help to spread the disease. The virus may enter the body through the mouth or enter the blood directly through broken skin (parenterally), by injections made with a poorly sterilized syringe, and especially by transfusion of blood or plasma obtained from a donor who has had viral hepatitis in either manifest or latent form (serum hepatitis). The infection can also be transmitted through the air.
The incubation (latent) period is usually from three to four weeks, but often it lasts as long as 11 months. Generally the disease develops gradually. The appetite disappears and the patient experiences weakness, a sensation of heaviness in the epigastrium, occasionally abdominal pain, chills, and elevated temperatures. Elderly patients suffer pain in the joints. The skin and sclera turn yellow at the height of the disease. The liver and spleen become enlarged. Mild forms may occur without pronounced jaundice, although sometimes the disease assumes a protracted course with persistent jaundice. The liver becomes hard and its functional cells are replaced by connective tissue (cirrhosis). However, complete recovery is the rule in most cases.
The diagnosis of hepatitis is based on a thorough examination of the patient. His blood and urine are analyzed in detail in the laboratory. Punch biopsy of the liver is performed in some cases.
Treatment generally includes hospitalization (the patient remains in the hospital for one month on the average), a vitamin-rich diet with adequate amounts of carbohydrates and animal proteins, limited salt, and high-calorie food, taken in small but frequent portions. Large quantities (about 2 liters daily) of fluid are recommended, including fruit juices, glucose solution, and water with honey. Spicy foods and alcoholic beverages, cakes, and pastries in general are prohibited. If the course of the disease is severe, glucose solutions and sometimes blood and plasma are injected intravenously to neutralize the toxins and strengthen the body’s defenses. Drugs, such as hormonal preparations and lipotropic agents (those that prevent fat deposit in the liver) and oxygen therapy are prescribed on an individual basis. Antibiotics are administered only in case of inflammatory changes in the biliary tract. Hepatitis patients are discharged from the hospital no sooner than 21 days after they begin to feel well and their liver functions appear normal. Persons who have had viral hepatitis must return to the clinic for observation for an additional six months (sometimes a year). Health resort treatment is available in Essentuki, Truskavets, Druskininkai, and Karlovy Vary.
The prevention of hepatitis requires early detection (especially in children’s groups) and mandatory hospitalization of those found to have the disease, imposition of quarantine (in children’s groups for 50 days), medical observation of all those who have had contact with a patient during the previous 1-1½ months, disinfection of the residence, and boiling of dishes and laundry. Instruments and syringes must undergo prolonged sterilization. Children and pregnant women who have had contact with the patient should receive gamma globulin. Persons who have had viral hepatitis may never serve as blood donors.
REFERENCESMiasnikov, A. L. Boleznipecheni i zhelchnykh putei. Moscow, 1956. (Manual of internal diseases.)
Rudnev, G. P. “Bolezn’ Botkina.” In Rukovodstvo po infektsionnym bolezniam. Moscow, 1962.
Tareev, E. M., E. L. Nazaretian, and M. E. Semendiaeva. “Ostryi epidemicheskii gepatit (Bolezn’ Botkina).” In Rukovodstvo po vnutrennim bolezniam, vol. 5. Moscow, 1965.
Ugriumov, B. L. Infektsionnyi gepatit (bolezn’ Botkina). Moscow, 1966.
B. L. UGRIUMOV