Hepatitis C in children

Hepatitis C in children is the leading cause of acute hepatitis in hemodialysis centers, among patients in organ transplant departments, in oncology hospitals, plasmapheresis centers, etc.

Epidemiology

In Western Europe and the USA, up to 95% of all cases of post-transfusion and parenteral hepatitis are caused by HCV. The disease occurs after transfusion of virus-containing blood, plasma, fibrinogen, antihemophilic factor and other blood products. Outbreaks of hepatitis C have been noted among patients with immunodeficiencies after intravenous infusions of immunoglobulin preparations.

Hepatitis C virus (HCV) is transmitted exclusively parenterally, mainly with blood products and during various invasive interventions, including through microtraumas during household contact. The possibility of perinatal transmission of infection from mother to fetus transplacentally, as well as during labor and immediately after birth when the child is contaminated with the mother's blood through damaged skin, has been shown. Sexual transmission of HCV is quite probable.

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Causes hepatitis C

The hepatitis C virus belongs to the flavivirus family. It has a diameter of 22 to 60 nm, and is found both in blood and in liver extracts of humans or experimentally infected chimpanzees. Unlike other hepatitis viruses, it is found in the blood serum of patients in extremely low concentrations, and the immune response in the form of specific antibodies is very weak and late. The virus is sensitive to chloroform, formalin, and is inactivated within 10 hours when heated to 60 °C, and within 2 minutes when boiled. Sterilization of blood products using ultraviolet rays is effective.

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Pathogenesis

In the mechanism of liver cell damage in hepatitis C, the leading role is played by immune cytolysis, realized by T-cell cytotoxicity directed against infected hepatocytes. The possibility of direct cytopathic effect of the virus on liver cells is allowed. In the pathogenesis of the formation of chronic forms of the disease, the weakened ability of blood mononuclear cells to produce y-interferon, as well as a change in the ratio of immunoregulatory subpopulations of T-helpers and T-suppressors with a predominance of the latter and the associated insufficiently effective T-cell and humoral immune response against the pathogen and infected hepatocytes, are of decisive importance. The increased ability of the HCV antigen to disguise itself in immune complexes is also of certain importance, which brings this disease closer to immune complex diseases.

Symptoms hepatitis C

The incubation period is on average 7-8 weeks, with fluctuations from several days (in case of massive infection) to 26 weeks. The disease begins gradually with asthenovegetative and dyspeptic manifestations: lethargy, malaise, nausea, sometimes subfebrile body temperature. Abdominal pain, sometimes vomiting are possible. After a few days, dark urine and discolored feces appear. All patients have an enlarged liver, sometimes - the spleen. Jaundice appears rarely, only in 15-40% of patients. In the absence of jaundice, the leading symptoms are malaise, asthenia and enlargement of the liver. In the blood serum of all patients, ALT and AST activity is increased, in some patients the content of total bilirubin is increased due to the direct fraction, a decrease in the prothrombin index, dysproteinemia, etc. are possible. The indicators of functional liver tests fully correspond to the severity of liver damage and the stage of the pathological process.

Acute hepatitis C occurs in 10-20% of cases, in other children the disease takes a chronic course. The transition to the chronic stage is manifested by persistent hyperfermentemia with a relatively satisfactory general condition, a complete absence of complaints, a slight increase and compaction of the liver. At the stage of formed chronic hepatitis, patients may complain of increased fatigue, weakness, dyspeptic phenomena. During examination, vascular changes (telangiectasias, palmar erythema) can be detected, the liver is always enlarged, often the spleen. Despite the low severity of clinical symptoms, the pathological process in the liver morphologically in most cases corresponds to chronic active hepatitis, often with signs of developing cirrhosis.

Forms

Viral hepatitis C is classified in the same way as other viral hepatitis. Typical and atypical variants of the disease are distinguished.

According to severity, there are mild, moderate, severe and malignant forms, and according to course - acute, protracted and chronic.

The characteristics of clinical forms and the criteria for their diagnosis are the same as for other types of hepatitis.

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Diagnostics hepatitis C

The diagnosis of hepatitis C is established by detecting specific antibodies to structural and non-structural proteins of the virus in the blood serum using the ELISA method, as well as viral RNA using the PCR method.

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Treatment hepatitis C

General principles of treatment of patients with acute and chronic hepatitis C are the same as for other viral hepatitis. Bed rest, diet, and symptomatic agents are prescribed. In malignant forms, glucocorticoids are prescribed, and in patients with chronic hepatitis C, recombinant interferon preparations (Viferon, Intron A, Roferon-A, etc.) are successfully used, as well as its inducers, in particular Cycloferon and thymic immunomodulators (Tactivin).

Prevention

The principles of hepatitis C prevention are the same as those of hepatitis B. The use of disposable syringes, infusion systems, catheters, and compliance with the rules for sterilization of surgical, dental and other instruments lead to a significant reduction in the incidence of not only hepatitis B, but also hepatitis C. Testing blood products for anti-HCV and transaminase activity with subsequent exclusion of positive samples leads to a significant reduction in the incidence of hepatitis C among recipients of blood products.