Hepatitis D: causes, symptoms and treatment

Hepatitis D is a viral liver disease caused by the delta virus (HDV). A feature of the disease is that it occurs only in the presence of hepatitis B. That is, it is possible to become infected with form D only in the presence of virus B or after it. Without a satellite, hepatitis D viruses cannot multiply. This is a favorable feature of microorganisms, which allows somewhat restrain the number of patients.

Hepatitis D is not common in Russia. This virus is most damaging and causes cirrhosis. Pathology is transmitted through blood or through sexual intercourse. Today in the world there are about 15 million people with this diagnosis. Most patients are young people.

Distribution paths

Viral hepatitis D does not exist separately from hepatitis B. It is simply impossible for them to become infected, therefore usually viruses are infected in turn, and form B must be primary. You can also become infected simultaneously with two forms of hepatitis.

Sources of the disease are people who have a pathology in acute or chronic form. Microorganisms do not indulge in airborne droplets. Only their direct entry into the internal environment of the body can cause this disease.

Routes of transmission of hepatitis D are as follows:

• Blood transfusion. A person until a certain period may not be aware of his infection and at the same time be a blood donor. Errors and negligence when taking tests from a donor or during subsequent processing of the collected material sometimes occur, therefore, healthy people can become infected during transfusion. Most likely to get hepatitis D are patients who undergo such a procedure repeatedly.
• Use syringes by multiple individuals. The remains of infected blood are always on the tip of the needle, using one and the same tool increases the risk of infection. Most often, drug-dependent people become infected in this way.
• Any manipulations that violate the integrity of the skin - tattoos, cropped manicures, piercings, acupuncture, treatment by a dentist or cosmetologist. With insufficient disinfection of instrumentation, the remains of the virus can enter the blood of a healthy person.
• Sharing of hygiene products, hygiene items. Eyebrow tweezers , razors, toothbrushes, manicure tweezers and scissors are carriers of infection from a healthy patient.
• Sexual contact without the use of protective equipment (condom) is one of the main ways of defeating viral hepatitis D.
• Childbirth and feeding. The child becomes infected with the virus from the mother, passing through the birth canal, as well as through cracks in the nipples that may appear when breastfeeding.
• The ingress of blood from an infected patient to the site of damage to the skin of a healthy person. The situation can occur due to an incredible combination of circumstances or as a result of professional activity. Doctors are most at risk of becoming infected, because they have to work with blood, with sick patients, etc.

Hepatitis D virus is not transmitted through kisses, touching, coughing, sneezing.

Symptoms

From the moment the virus enters the body, its incubation period begins. The average period from infection to the first manifestations is one and a half months, and the maximum is six months. There are cases of superinfection when the symptoms become apparent after 20 days. Strong immunity significantly pushes the first symptoms of hepatitis, inhibiting its development and stretching the incubation period of the virus.

Once in the bloodstream, viral hepatitis D is carried by the stream into the liver and begins to multiply there, as a result of which the liver cells and the immune system that produces antibodies suffer. The immunity attack is aimed at the destruction of the virus B. When it is defeated, the virus D also can not multiply. At the same time, liver cells (hepatocytes) are already damaged by the attack of antibodies to the infection that they contained.

Symptoms of hepatitis D:

• Color change (yellowing) of the proteins of the eyes, skin, mucous membranes.
• Urine acquires a dark shade, feces gradually turn white.
• The patient experiences pain in the muscles and joints.
• Body temperature rises.
• In the area of ​​the right hypochondrium, severe pain is felt.
• The skin is periodically covered with small pink blisters. The rash quickly appears and quickly disappears without the slightest trace.
• On palpation of the abdomen, the doctor discovers an increase in the size of the liver and spleen.
• The patient constantly experiences fatigue, performance decreases, and severe itching of the skin appears.
• Without any prerequisites, bruises appear on different parts of the body, a bitter aftertaste arises in the mouth, appetite disappears, heartburn and belching torment.

The same symptoms occur with hepatitis B. A blood test for antibodies and other studies can identify which infection caused a deterioration in well-being and formidable signs.

Classification

Hepatitis D has two main forms of pathology:

• Acute - observed with simultaneous infection with two hepatitis viruses HBV and HDV. This form of the disease is successfully treated, despite its severe course. The spread of infection is easily stopped, the body develops a stable immunity to both types of virus.
• Chronic hepatitis D is formed when the patient was already a carrier of the HBV virus and later infected with the delta virus. The disease will have bursts and fades. Exacerbations can occur against the background of the use of unhealthy foods, alcohol, a decrease in the protective functions of the body, in the absence of conservative therapy.

When the severe phase of the pathology occurs, the patient is followed by severe headaches, dizziness, insomnia, sudden loss of consciousness, disorientation in time. Symptoms of skin pathology are also observed. Among them are spider veins, the appearance of bruises and bruises, frequent and heavy nosebleeds.

Diagnostics

For treatment and diagnosis, they turn to an infectious disease specialist. Hepatitis A, B, C, D and other forms of pathology leave individual markers of their presence in the body. They help determine the degree of development of the disease, the stability of immunity, make a forecast of further progress of the disease.

Types of analyzes:

• Venous blood for the detection of 5 types of antibodies.
• Biochemical blood tests.
• Ultrasound to study the condition of internal organs, primarily the liver and spleen.
• Puncture biopsy. The method examines the liver cells and allows you to most likely confirm or refute the diagnosis. Material is taken by inserting a needle into the liver, the procedure is performed under local anesthesia.

Blood for analysis for hepatitis D is taken from a vein. A prerequisite is the need to take it on an empty stomach, preferably in the morning. Antibodies produced by the immune system, antigens and RNA of the virus are detected in the blood.

What the study will tell

A disease such as hepatitis D has been studied quite well. How it is transmitted from person to person is also known reliably. But medical science cannot predict how each individual patient will respond to therapy, whether his body will be able to completely overcome the disease, how long the patient will live with strict adherence to all recommendations of conservative treatment.

Carrying out the study, the specialist draws attention to antibodies that determine at what stage the disease is:

• Immunoglobulins M anti-HDV. Their presence in the blood means that the disease is in the acute phase. They are produced by the body’s immune system to neutralize the action of the virus and signal mobilization to other participants in the internal defense. The result of activity should be the dissolution of the virus by enzymes and its absorption by macrophages.
• Immunoglobulins G anti-HDV is a practical victory over the virus. If they are found in a blood test, it means that the body successfully coped with hepatitis and even developed a stable immunity to the disease.

The absence of antibodies of group M in the blood indicates that the disease has passed into the chronic stage. Hepatitis D will require a long and painstaking treatment from the patient and the doctor. Treatment aims to mobilize the immune system and create conditions for activating the internal reserves of the body so that it can overcome the disease. How much time is required for this, the specialist cannot predict.

Treatment

How to treat hepatitis D, the doctor will tell. After diagnosing the disease, the patient begins a long process of therapy, part of which is implemented in the infectious diseases inpatient department of the hospital. Treatment is carried out in three main directions:

• Antiviral therapy. Drug treatment consists in the use of the drug "Interferon alfa." Until recently, other drugs were also used (Lamivudin, Famciclovir, etc.), but they did not show significant results. "Interferon alpha" strengthens the immunity of healthy liver cells, increasing their resistance to virus penetration. The drug also supports macrophages (immune cells) to fight the virus, has a negative effect on the ability of the virus to reproduce. Interferon alfa is administered in the form of rectal suppositories. The duration of admission in some cases is 48 weeks.
• Support for liver function is carried out by taking hepatoprotectors. Such drugs include Essentiale, Essentiale-Forte, Phosphogliv, etc. The drugs include substances that serve as the building blocks of the liver. Hepatoprotectors take a long period, at least 3 months at a dosage of 1 capsule 3 or 4 times a day.
• Normalization of the liver is also necessary for the life of the body, therefore, a specialist prescribes medications to regulate bile secretion and protect liver cells from toxins (“Hepabene”, “Tykveol”, etc.). To normalize metabolic processes, drugs based on amino acids are prescribed (Heptral, Hepa-Merz, etc.).
• The removal of toxins that violate the protective functions of the liver is carried out by the use of adsorbents (Enterosgel, Polysorb). Along with toxins, they collect and remove the breakdown products in the intestines, improving the general condition of the patient. The drugs are taken in courses lasting 14 days with a break of 2-3 weeks. Admission of adsorbents is indicated throughout the duration of treatment.

Diet

Viral hepatitis D is accompanied by impaired liver function, so it is important for the patient to follow a diet and strictly adhere to the recommended diet. The basis of nutrition is taken treatment table No. 5 (according to Pevzner). Fried foods are completely excluded from the diet. Attention is paid to the amount of liquid drunk per day (at least 2 liters).

Products are boiled or steamed, stewed. Also, you can not eat fatty meats, fish, rich broths, pickled and smoked products, confectionery, sour berries and fruits, muffins, chocolate, eggs.

The daily table should contain a large amount of fiber (cereals, vegetables), dairy products, dietary meat and fish. The size of the portions is small, the reception is carried out fractionally (5-6 times a day) with equal intervals. The duration of the diet is determined by a specialist. The transition to diet No. 4 is carried out when signs of recovery appear.

Traditional medicine recipes

Any medicines of folk healers are aimed only at strengthening the immune system and supporting liver functions. They cannot cure the disease, but they will provide significant relief and accelerate the healing process with the progress that has been made.

Herbal Medicine Recipes:

• Elecampane root. Powdered dry root of the plant is taken with a small pinch (on the tip of a knife) 2 times during the day half an hour before a meal.
• Tincture of horseradish root to restore the antitoxic functions of the liver: grind horseradish root 250 g in a blender or grate and pour warm boiled water (0.5 l). Insist for a day, strain, Tincture drink 1 dessert spoon 3 times a day (20 minutes before meals). The course is up to 3 months.
• Reception of beekeeping products (bee bread or pollen) of 30 g daily in the morning. The duration of therapy is unlimited.
• Herbal tea - sage leaves, wormwood, juniper berries, mix in equal amounts and take 0.5 cups of dry composition. Pour herbs with boiling water (3 cups), insist and strain. Drink all brewed tea during the day.

Vaccination

Hepatitis B vaccine is the best prevention of hepatitis D. Vaccination reduces the risk of infection by 90%, it creates a stable immunity for decades. This step will not help patients with a chronic form of the course of hepatitis B.

For stable immunity, vaccination is carried out three times. After the introduction of the first dose, the next patient receives a month later, and the last 4 or 6 months after the first stage of vaccination. In Russia, all newborns are vaccinated against hepatitis D. There are certain population groups that are at risk. Regardless of previous vaccinations, they should be vaccinated additionally.

Who needs preventive vaccination:

• The family of a person diagnosed with hepatitis B.
• Patients requiring a continuous blood transfusion.
• People who frequently change sexual partners.
• Injection addicts.
• Patients with HIV, AIDS, chronic liver pathologies, STDs.

Knowing all the ways of spreading hepatitis D, it is not difficult to guess what rules can protect against infection:

• Use only personal hygiene products (tweezers, tweezers, scissors, razors, toothbrushes, etc.).
• Safe sex.
• Refusal of bad habits (alcohol, drug addiction).
• Clinic staff requirements for the thorough processing of tools.

For patients diagnosed with hepatitis D, as shown by medical practice, moderate physical activity is very useful. Under loads, metabolism is normalized, restoration processes are started, oxygen supply to tissues is improved, and immunity is strengthened. At the first sign of remission, you must start sports. Cardio, cycling, walking, etc. are preferred.

Forecast

The acute form of hepatitis D responds well to treatment. The disease diagnosed in the early stages, with adequate treatment, recedes, the patient recovers in 95% of cases. In this case, the functions and cells of the liver are fully restored, and the body produces a stable form of immunity.

The chronic form of hepatitis is almost incurable, only 15% of patients recover fully. The success of therapy and the achievement of complete remission depends on the timeliness of diagnosis, compliance with all treatment conditions, the mood of the patient. How long treatment can last, no one can predict.