What is Hepatitis D in Children?
Hepatitis D (delta) is a disease caused by a parasite virus that requires the presence of HBV (hepatitis B virus) for its reproduction. Hepatitis delta is of the following types:
- acute delta (super) infection of the hepatitis B virus carrier;
- acute hepatitis B with delta agents (co-infection) without hepatic coma
- acute hepatitis B with delta agents (co-infection) and hepatic coma.
The carriers and sources of infection are sick people with acute or chronic form, carriers of IOP virus without clinical manifestations (healthy) and carriers of antibodies to hepatitis delta virus.
The only route of IOP transmission is parenteral. You can get infected by transfusion of blood or its elements, with repeated use of catheters, needles and other medical equipment that came into contact with infected blood.
Rice of infection is especially high in those who are constantly undergoing transfusion of blood or its preparations, as well as in the attendants of hemodialysis centers, surgeons and drug users.
Infection occurs through HBsAg-positive blood or its preparations, which contain antibodies to IOP. Donors of such blood are usually patients with chronic hepatitis, in all cells of the liver in all cases it is possible to find antigen-delta.
IOP can be transmitted to the fetus through the placenta from a sick mother. But the more frequent way of infecting infants is during childbirth or immediately after them. Damaged skin and mucous membranes of the child serve as the entry gate for infection.
Persons who did not have this disease are susceptible to IOP, as are carriers of HBV. The highest probability of infection in young children and people with chronic hepatitis B.
Causes of Hepatitis D in Children
Hepatitis D virus (IOP) is a spherical particle whose diameter is from 35 to 37 nm. Its outer shell is the surface HBV antigen (HBsAg). In the center of the particle is a specific antigen (AgD) containing small RNA (genome).
Antigen-delta is located mainly in the hepatocyte nuclei in the form of aggregates of individual particles with a size of 20-30 nm. It is resistant to high temperatures and acids. It can be inactivated with proteases and alkalis.
Pathogenesis during Hepatitis D in Children
When infected with hepatitis D virus, co-infection and superinfection can develop. Co-infection develops in people who have not had HBV and do not have immunity to it. Superinfection prone to patients with chronic hepatitis B or carriers of HBV. Co-infection is the process of attaching another virus to a cell that is infected with some other virus. Thus, the cell is already infected with two viruses. With superinfection, their number is more than two. With co-infection, hepatitis B and hepatitis delta develop.
It is not possible to identify any specific morphological features inherent only to hepatitis delta. Signs of a severe inflammatory process prevail.
Symptoms of Hepatitis D in Children
4 forms of the disease are distinguished depending on the development mechanism:
- chronic hepatitis delta on the background of HBV carriage
- IOP delta superinfection
- chronic co-occurring hepatitis B and hepatitis delta
- mixed acute HBV and IOP infection (co-infection).
With co-infection from 8 to 10 weeks, the incubation period lasts. Then symptoms similar to those in acute hepatitis B appear. The onset of the disease is marked by fever, muscle weakness, unwillingness to eat, vomiting and nausea, abdominal pain, enlarged liver and spleen. A blood test reveals an increased content of total bilirubin due to a direct fraction in the blood serum, high activity of hepatocellular enzymes, dysproteinemia.
A disease with a favorable course lasts from 1.5 to 3 months. In some sick children, protracted forms with pronounced symptoms are likely. The manifest clinical forms usually do not end with the formation of chronic hepatitis. Children under 5-6 months often fall ill with a malignant form of hepatitis, which leads to death. Acute manifest forms of coinfection without chronicity can nevertheless lead to primary chronic hepatitis B and hepatitis delta, which have a latent (latent) course, without the manifestation of an acute phase.
Superinfection of IOP. When an IOP infection is layered on chronic hepatitis B, the incubation period is from 3 to 4 weeks. In such cases, the symptoms are similar to acute hepatitis. There is an increase in temperature to the level of 38-39 ° C, there is a general malaise and weakness in the body, there may be nausea and vomiting, abdominal pain. After 2-3 days, the urine darkens, and the feces become discolored. Sclera becomes icteric – the same thing happens with the skin of a child. The liver and spleen are enlarged.
A blood test shows an increase of 3-5 times the total bilirubin in the blood serum, the activity of the liver-cell enzymes increases by 4-10 times, the thymol test increases, etc.
Often the disease is severe, even malignant forms can occur, leading to death in some cases. In other situations, the formation of chronic hepatitis Delta with a high activity of the process.
Chronic active hepatitis B and hepatitis D are mixed chronic infections. In these cases, symptoms of intoxication are clearly manifested. The child’s fatigue increases, emotional instability manifests itself in the form of a change in mood and behavioral oddities. The appetite of a sick child decreases, the processes in the gastrointestinal tract are also disrupted, which is manifested in nausea, severity in the epigastric region, flatulence. In some cases, mild ictericity of the skin is observed. In all cases, the liver and spleen are enlarged. You can constantly observe multiple small bruises on the hands and novae. Sometimes nosebleeds occur. Often found telangiectasias, palmar erythema and other extrahepatic signs.
In all patients, a decrease in prothrombin, high activity of liver cell enzymes, HBsAg, HBeAg and markers of current hepatitis D (IOP RNA and anti-HDV IgM and dysproteinemia phenomena. The disease may have a severe course, with the manifestation of short remissions (alleviation of symptoms) ), while exacerbations last longer. After 5-6 years, the disease is designated as chronic active hepatitis delta with the formation of cirrhosis of the liver. In such cases, hemorrhagic manifestations, a sharp compaction of the liver, hepatic signs, high activity of liver-cell enzymes, low prothrombin index, sublimate test, and progressive dysproteinemia.
Diagnosis of Hepatitis D in Children
Hepatitis D is diagnosed by the presence of IOP RNA, HBV DNA, antibodies of the IgM and IgG class and ELISA for IOP and HBV in the blood (using the PCR method). The disease is also diagnosed by analyzing the symptoms. If in a child with chronic hepatitis B or in a healthy carrier of HBsAg, exacerbations are observed with symptoms of intoxication, a sharp increase in the liver, manifested by jaundice, an increase in the activity of liver cell enzymes, all this indicates hepatitis D.
Hepatitis D Treatment in Children
Treatment for hepatitis D is the same as for hepatitis B. Doctors, when constructing a treatment regimen, take into account the severity of symptoms that appear, the severity of the disease as a whole. The course of IOP is unpredictable, because patients are required to be hospitalized in an infectious diseases hospital. Most often prescribed interferon, adefovir, enceavir, lamivudine, galstena, livolin forte, liv 52, silymar. The complex of treatment includes adherence to a sparing diet.
Prevention of Hepatitis D in Children
Hepatitis B prevention measures play an important role in order to avoid superinfection in patients with chronic hepatitis B and HBV carriers.
Superinfection can develop close household contact (in the presence of microtrauma of the skin and mucous membranes of the child), as well as with parenteral manipulations and the transfusion of infected blood products.