Viral hepatitis D is an acute viral liver disease that occurs as a result of infection of the body with a defective RNA-containing virus from the Deltovirus family, characterized by the development of persistent inflammation in the liver, which subsequently leads to liver failure, cirrhosis or cancer.
It is possible to become infected with viral hematitis D only if the hepatitis B virus is present in the body. It is impossible for a healthy person to become infected with hepatitis D, since the virus is defective and multiplies by introducing the hepatitis B virus antigen into HBs.
According to WHO (World Health Organization) observations, about 5% of people who are ill or are carriers of the hepatitis B virus become ill with viral hepatitis D.
Hepatitis D is common throughout the world, but the incidence of the disease varies from country to country.
Countries with a high prevalence of infection:
- Colombia;
- Venezuela;
- northern part of Brazil;
- Romania;
- Moldova;
- Central African Republic;
- Tanzania.
Countries with an average prevalence of infection:
- Russia;
- Belarus;
- Ukraine;
- Kazakhstan;
- Pakistan;
- Icarus;
- Iran;
- Saudi Arabia;
- Turkey;
- Tunisia;
- Nigeria;
- Zambia;
- Botswana.
Countries with a low prevalence of infection:
- Canada;
- Argentina;
- Chile;
- Great Britain;
- Ireland;
- France;
- Portugal;
- Spain;
- Switzerland;
- Italy;
- Norway;
- Sweden;
- Finland;
- Australia and Oceania.
In the countries of the former CIS, the incidence rate of hepatitis D is steadily growing; over 10 years, the rate of infected people has increased 3 times.
Viral hepatitis D affects mainly young and middle-aged people (from 18 to 40 years), the infection occurs with the same frequency among men and women.
The prognosis of the disease is unfavorable and in 10-15 years leads to death. The cause of death is the development of hepatic coma, which leads to liver failure.
Causes
The cause of the disease is an RNA-containing virus from the Deltovirus family.
This virus is isolated only in patients with viral hepatitis B in the presence of HBs antigen in the blood serum, since this antigen is the basis for the start of reproduction of the hepatitis D virus. Getting into the blood of a healthy person or infected with hepatitis A or C, hepatitis D does not develop, because the virus can not normally exist and multiply.
The source of infection is a sick person or a virus carrier (there are no symptoms of infection, and the hepatitis D virus is detected in the blood). Infection occurs parenterally (when the blood of an infected person interacts with a healthy one).
This way of transmission of hepatitis D is realized through:
- surgical interventions with contaminated or poorly disinfected instruments;
- a blood transfusion from a donor who has hepatitis D;
- sexual intercourse not protected by a condom;
- placenta, in case of infection of the mother, to the fetus;
- reusable or non-sterile instruments used in beauty and dentistry salons.
They also distinguish a risk group for those individuals who are predisposed to infection with viral hepatitis D due to their profession or certain diseases:
- doctors;
- nurses;
- orderlies;
- patients with viral hepatitis B;
- HIV-infected;
- AIDS patients;
- patients with diabetes mellitus or hypothyroidism.
Classification
According to the type of infection with the hepatitis D virus, there are:
- coinfection - this happens when the body is simultaneously infected with viral hepatitis B and D;
- superinfection - with hepatitis B, a few years later the patient becomes infected with viral hepatitis D.
According to the duration of the disease, there are:
- protracted viral hepatitis D - up to 6 months;
- chronic hepatitis D - more than 6 months.
Symptoms of viral hepatitis D
The period of initial manifestations
- increase in body temperature;
- headache;
- noise in ears;
- dizziness;
- general weakness;
- increased fatigue;
- slight nausea;
- decreased appetite.
The period of a detailed symptomatic picture
- frequent nausea;
- vomiting of intestinal contents;
- jaundice (yellowing of the skin and mucous membranes);
- dark urine;
- discoloration of feces.
The chronic period of the disease
- pallor of the skin;
- lowering blood pressure;
- increased heart rate;
- bleeding gums;
- the appearance of hemorrhages on the skin;
- vomiting blood or "coffee grounds" - occurs when bleeding from the upper intestines, stomach or esophagus;
- "tarry" stool - occurs when bleeding from the intestines;
- dark red blood in the stool - occurs when bleeding from hemorrhoidal veins;
- an increase in the volume of the abdomen (occurs in the presence of ascites - free fluid in the abdominal cavity);
- swelling of the lower extremities.
Terminal period of the disease (initial manifestations of hepatic coma)
- hepatic encephalopathy, dementia (patients are not critical of themselves, do not orient themselves in space and time, do not recognize loved ones, “fall into childhood”);
- the appearance of arrhythmia;
- the appearance of shallow breathing;
- anasarca (swelling of the whole body);
- prolonged bleeding from the veins of the digestive system;
- frequent loss of consciousness.
Diagnostics
Laboratory research methods
The very first diagnostic tests that the doctor you contact refer to are a general blood and urine test:
- a general blood test, in which there will be an increase in leukocytes, a shift in the leukocyte formula to the left and an increase in ESR (erythrocyte sedimentation rate);
- general urinalysis, in which there will be an increase in leukocytes and squamous epithelium in the posture of vision.
Changes in these analyzes indicate an inflammatory reaction in the body, in order to clarify in which organ the pathological process occurs, additional laboratory examination methods are prescribed.
Liver tests:
|
Indicator |
Normal value |
Significance in hepatitis D |
|---|---|---|
|
total protein |
55 g/l and below |
|
|
total bilirubin |
8.6 - 20.5 µmol/l |
28.5 - 100.0 µm/l and above |
|
direct bilirubin |
8.6 µmol/l |
20.0 - 300.0 µmol/l and above |
|
ALT (alanine aminotransferase) |
5 – 30 IU/l |
30 - 180 IU/l and above |
|
AST (aspartate aminotransferase) |
7 – 40 IU/l |
40 - 140 IU/l and above |
|
Alkaline phosphatase |
50 – 120 IU/l |
120 - 160 IU / l and above |
|
LDH (lactate dehydrogenase) |
0.8 – 4.0 pyruvite/ml-h |
4.0 pyruvate/ml-h and above |
|
Albumen |
34 g/l and below |
|
|
Thymol test |
4 units and more |
Coagulogram (blood clotting):
Lipidogram (cholesterol analysis):
Serological research methods
Analyzes that can directly determine the marker of viral hepatitis D in the blood serum of a sick person and thereby make a final, accurate diagnosis. Among the methods of examination are:
- ELISA (enzymatic immunoassay).
- XRF (X-ray fluorescence analysis).
- RIA (radioimmune analysis).
- RSK (complement fixation reaction).
- PCR (polymerase chain reaction) is the most sensitive and expensive method.
Interpretation of results:
Instrumental research methods
- Ultrasound of the liver, in which it is possible to determine the consequences of viral hepatitis D or its complications (fibrosis or cirrhosis).
- Liver biopsy - taking with a needle, under the control of ultrasound of the liver tissue, followed by examination under a microscope. The method allows you to establish an accurate diagnosis and the presence of complications, but is invasive (penetrating) and therefore has not become widely used in viral hepatitis D.
Treatment of viral hepatitis D
Medical treatment
The duration of treatment, the frequency of taking drugs and the dosage is selected individually for each patient by the attending physician.
Surgery
Surgical treatment is used to alleviate the patient's condition with the development of complications from viral hepatitis D. These include:
Alternative treatment
Treatment with alternative medicine should only be carried out in combination with medications and with the permission of your doctor.
The most effective methods of alternative treatment for viral hepatitis D are:
A diet that alleviates the course of the disease
Viral hepatitis D requires a strict diet.
- Allowed the use of cereals, pasta, boiled vegetables, non-fatty meats, poultry and fish, non-fat dairy products, compotes and fruit drinks.
- It is forbidden to consume legumes, smoked, salty, fatty, spicy foods, canned food, coffee, carbonated water, juices in tetra packs, alcohol, pastry and chocolate.
Complication
- tense ascites;
- bleeding from the gastrointestinal tract;
- hepatic coma;
- hepatic encephalopathy;
- anemia (anemia).
Hepatitis D is an acute or chronic infectious lesion of the liver with a parenteral mechanism of infection caused by the hepatitis D virus (HDV).
A specific feature of the disease is its secondary nature. Infection with HDV is possible only against the background of prior infection with the hepatitis B virus (HBV). About 5% (according to other sources - up to 10%) of HBV carriers are simultaneously infected with HDV. Chronic viral hepatitis caused by exposure to HBV and HDD is currently confirmed in approximately 15–30 million people, according to information provided by the World Health Organization.
Liver damage in hepatitis D
For the first time, HDV was obtained in 1977 by a group of Italian scientists from liver cell biopsies of patients suffering from viral hepatitis B. An erroneous assumption was made that a fundamentally new HBV marker was isolated, however, further studies showed that the detected particles are independent pathogens, defective viruses ( viroids). Later, a fundamentally new type of hepatitis caused by these viruses was classified, called viral hepatitis D.
The prevalence of the disease in different regions varies significantly: from isolated cases to the defeat of 20–25% of those infected with the hepatitis B virus.
According to the spread of viral hepatitis D, all regions are conditionally divided as follows:
- highly endemic - the frequency of HDV infection exceeds 60%;
- regions of medium endemicity - the incidence rate is 30–60%;
- low-endemic - HD is fixed in 10-30% of cases;
- regions of very low endemicity - the frequency of detection of antibodies to HDV is not higher than 10%.
The Russian Federation belongs to the zones of low endemia, although some researchers attribute such positive statistics to the absence of mandatory diagnostics of anti-HDV antibodies in patients with HBV.
Synonyms: hepatitis delta, viral hepatitis D, HDV infection, HDV infection.
Causes and risk factors
Currently, 8 HDD genotypes have been identified, which have a specific distribution and differ in clinical and laboratory manifestations (for example, the 1st genotype is common in Europe, the 2nd in East Asia, the 3rd is found mainly in Africa, tropical Asia , in the Amazon basin, etc.).
The main route of infection is blood contact (transmission through the blood):
- at medical and diagnostic manipulations (including stomatologic);
- for cosmetic and aesthetic procedures (tattoo, manicure, piercing);
- with blood transfusions;
- when using injecting drugs.
Less common are the vertical route of transmission of the virus (from mother to child during pregnancy) and the sexual route. Infection within the same family is possible with close household contact (the formation of family foci of chronic hepatitis D is often observed in highly endemic regions).
Forms of the disease
In combination with viral hepatitis B, there are:
- co-infection (parallel infection);
- superinfection (attached against the background of existing chronic hepatitis B).
Depending on the severity of the process:
- acute hepatitis D;
- chronic hepatitis D.
Acute hepatitis-delta is stopped, as a rule, within 1.5–3 months, the chronicity of the disease occurs no more than in 5% of cases.
Both acute and chronic disease can occur in a manifest form with a detailed clinical and laboratory picture or in the form of latent (latent) HDD infection, when the only sign of hepatitis is a change in laboratory parameters (active symptoms are absent in this case).
In accordance with the severity, the following forms of hepatitis D are distinguished:
- light;
- moderate;
- heavy;
- fulminant (malignant, rapid).
Stages of the disease
There are following stages of hepatitis D:
- incubation (from 3 to 10 weeks);
- preicteric (on average - about 5 days);
- icteric (several weeks);
- convalescence.
Symptoms
During the incubation period, there are no symptoms of the disease; despite this, the patient is a virus shedder.
The preicteric period debuts acutely:
- intoxication symptoms - headache, fatigue, decreased tolerance to habitual physical activity, drowsiness, muscle and joint pain;
- dyspeptic phenomena - loss of appetite up to anorexia, nausea, vomiting, bitterness in the mouth, bloating, pain and a feeling of fullness in the right hypochondrium;
- an increase in body temperature up to 38 ºС and above (noted in approximately 30% of patients).
Symptoms of the icteric period:
- characteristic staining of the skin and mucous membranes, scleral icterus;
- enlargement and soreness of the liver;
- subfebrile body temperature;
- weakness, loss of appetite;
- urticarial rashes like urticaria on the skin;
- discoloration of feces, dark shade of urine.
More than half of the patients have a two-wave course: after 2–4 weeks from the onset of the icteric stage of the disease, against the background of the subsiding of the symptoms of the disease, general well-being and laboratory parameters deteriorate sharply.
Acute hepatitis-delta is stopped, as a rule, within 1.5–3 months, the chronicity of the disease occurs no more than in 5% of cases.
Acute superinfection is more severe than co-infection, it is characterized by a violation of the protein-synthetic function of the liver, the outcomes of the disease are usually unfavorable:
- death (with a fulminant form that develops in 5–25% of patients, or in a severe form with the formation of subacute liver dystrophy);
- the formation of chronic viral hepatitis B + D (approximately 80%) with a high activity of the process and rapid transformation into cirrhosis of the liver.
Diagnostics
The main laboratory diagnostic method to confirm the presence of HDV infection is testing HBsAg-positive patients (persons who have detected hepatitis B virus antigens) for the presence of anti-HDV antibodies in the blood serum.
Methods for diagnosing viral hepatitis D:
- analysis of data on previous contact with possibly infected blood, medical and other manipulations;
- characteristic clinical manifestations in the icteric form of the disease;
- determination of IgM and IgG to HD in HBsAg-positive patients;
- detection of HDV RNA (HDV-RNA) by polymerase chain reaction;
- specific changes in the biochemical blood test (increased levels of liver enzymes AST and ALT, a positive thymol test, hyperbilirubinemia, a possible decrease in sublimate test and prothrombin index).
A specific feature of the disease is its secondary nature. Infection with HDV is possible only against the background of prior infection with the hepatitis B virus (HBV).
Treatment
Joint therapy of hepatitis D + B is carried out, during which the following are prescribed:
- interferons (including PEG-interferon);
- antiviral drugs (there are no specific drugs that target the hepatitis D virus);
- immunomodulators;
- hepatoprotectors;
- detoxification therapy;
- desensitizing agents;
- vitamin therapy;
- enzyme preparations.
The duration of antiviral therapy is not defined, the question of its termination is decided depending on the patient's condition. (May take a year or more.)
For patients with fulminant hepatitis and advanced cirrhosis, liver transplantation is considered.
Possible complications and consequences
Complications of hepatitis D can be:
- cirrhosis of the liver;
- hepatocellular carcinoma;
- acute liver failure;
- hepatic encephalopathy;
- bleeding from varicose veins of the esophagus;
- hepatic coma, death.
Forecast
The prognosis for the acute course of HDV-co-infection is favorable: most patients are cured, the disease acquires a chronic form in 1–5% of cases.
Superinfection is prognostically unfavorable: chronic hepatitis is noted in 75–80% of patients, cirrhosis develops rapidly, often with subsequent malignancy.
The prevalence of the disease in different regions varies significantly: from isolated cases to the defeat of 20–25% of those infected with the hepatitis B virus.
Prevention
Basic preventive measures:
- observance of safety precautions when working with blood;
- refusal of casual unprotected sexual contacts;
- refusal to take drugs;
- receiving medical, cosmetology services in official licensed institutions;
- implementation of systematic medical examinations in case of professional contact with blood.
Video from YouTube on the topic of the article:
Hepatitis D is a non-independent form of liver pathology. Delta virus (HDV) is able to multiply only in the presence of a “stimulant”, which is the virus. Because of this, the severity of this dual disease is greatly increased. The only thing that calms a little is the rarity of this form of hepatitis in our country.
Due to the specifics of the transmission of the disease from person to person (through blood and sexual contact), the risk group is mainly the younger generation.
The important thing is that the acute form can be cured within a few months. However, if you miss the initial stage of the disease, the process goes into a latent chronic form. In the chronic form, the virus is destructive to the liver, gradually destroying it.
Viral hepatitis D belongs to the group of VH (viral hepatitis), characterized by contact transmission of an infectious agent. At the same time, the reproduction of viral particles in the liver tissues is possible only if the patient has the hepatitis B virus.
For reference. In patients without concomitant hepatitis B, hepatitis D (delta hepatitis) is not registered, due to the defectiveness of the pathogen itself.
The course of viral hepatitis D is always severe, and the prognosis for recovery is often unfavorable (the disease is often complicated by hepatic coma). The most unfavorable prognosis for hepatitis D is in patients with concomitant HIV infection.
Important. The combination of HIV and hepatitis D is often accompanied by a fulminant course of infection with the development of cirrhotic degeneration of the liver tissues and hepatic coma.
Viral hepatitis D code according to the ICD10 classification:
- B16.0 for a combination (co-infection) of hepatitis D and B if the course of the disease is complicated by hepatic coma;
- B16.1 for co-infections D and B, not accompanied by the addition of hepatic lumps;
- B17.0 for the addition of acute hepatitis D if the patient is a carrier of hepatitis B viruses.
Etiological factors of the disease
Hepatitis D viruses were discovered in 1977. Because the virus was isolated from a patient with hepatitis B, the scientists assumed it was the fourth hepatitis B genotype and named it delta (D is the fourth letter in the Greek alphabet).
Subsequently, ongoing studies have shown that the pathogen belongs to a new genus of hepadnaviruses - deltaviruses.
A specific feature of the infectious agent is the inferiority of its genome. That is, this virus alone is not capable of causing a disease, since there are no regions in its genome that can encode envelope proteins.
In this regard, hepatitis D cannot develop on its own. However, if a patient has hepatitis B, the addition of delta agents (hepatitis D virus) contributes to the development of severe lesions of the liver tissues.
For reference. The ability of the hepatitis D virus to interact with the causative agent of hepatitis B is due to the high ribonucleic activity of the pathogen (pronounced ability to bind to other ribonucleic-containing viral particles).
The hepatitis D virus has a high rate of resistance to environmental factors. The causative agent is able to calmly tolerate high temperatures, freezing, exposure to acids and ultraviolet radiation.
Virus inactivation can be carried out with disinfectants based on proteases and concentrated alkalis.
Hepatitis D - how is it transmitted
For reference. Viral hepatitis D refers to anthroponotic infectious diseases, that is, the main source of pathogens is a sick person. Most often, patients with chronic viral hepatitis B and D pose an epidemic threat.
The modes of transmission for hepatitis D are similar to those of hepatitis B.
Infection is carried out:
- parenterally (surgical operations, aseptic (criminal) abortions, drug injections, constant hemodialysis, constant need for donor blood (the patient has hemophilia), etc.);
- sexually (in patients who often change sexual partners, as well as in homosexuals, acute hepatitis D is often recorded);
- transplacental (transmission of infection is carried out from a pregnant woman to the fetus).
For reference. It should be noted that transplacental transmission of the pathogen is the least common. At the same time, the risk of infecting a child increases significantly if a woman has HIV infection.
The main risk group for hepatitis D infection are:
- injection drug addicts;
- patients with severe kidney pathologies requiring regular hemodialysis;
- persons with severe coagulopathy (patients with hemophilia) who often require a transfusion of donor blood;
- homosexuals;
- patients who frequently change sexual partners.
Attention! Also, the disease can be transmitted in tattoo and piercing parlors, nail salons, when using other people's razors in everyday life, etc. accessories.
Hepatitis D is less common in children than in adults.
D is considered a defective microorganism, as it lacks its own coat and the enzymes necessary for reproduction. The main condition for its development in the human body is the presence of the hepatitis B virus, which facilitates the penetration of the delta virus into cells after infection.
The delta virus is a single strand of ribonucleic acid (RNA) with a protein coat on top. Penetrating into hepatocyte cells, the virus loses its capsule and begins to multiply, creating new microorganisms. The vital activity of the virus disrupts the functioning of liver cells and leads to the deposition of fat droplets in them, which ends with necrosis and death of hepatocytes. Having coped with one cell, delta viruses move on to others.
The pathogenesis of hepatitis D is not only in cell death, but also in the response of the immune system. Viral infection and disruption of the body leads to the activation of the immune system, it begins to produce antibodies. The antibodies produced by the body mainly fight the pathogens of type B hepatitis, but if it is completely destroyed, then the conditions conducive to the reproduction and development of the delta virus also disappear.
The causative agent of the hepatitis D virus is significantly different from the more commonly known microorganisms that cause hepatitis. Delta virus is considered the most contagious of them and has several genotypes that are divided along racial lines.
- The genotype of the first type is mostly detected in Europeans.
- The genotype of the second type was found in residents of Taiwan and Japan. In Russia, this genotype affects the population of Yakutia.
- The genotype of the third type is inherent in the inhabitants of Africa and Asia.
People infected with hepatitis B are considered the main group in which hepatitis D can also be detected. You can become infected with the delta virus through blood and unprotected sexual contact.
Causes and methods of infection
Hepatitis D is transmitted from a sick person to a healthy person. The source of infection is patients with acute and chronic forms of infection, as well as carriers, that is, those people who have no signs of the disease, but the delta virus itself is present in the body. If the delta virus enters the body of a person who does not have viral hepatitis D, then the microorganism will not multiply, that is, the disease is excluded. The etiology, that is, the causes of infection, is associated with infection with the blood and body fluids of a sick person, this can happen in several ways:
In rare cases, infection is detected when using some hygiene items by family members. It can be scissors, toothbrushes, razors. The risk of infection in healthcare workers is increased, since blood from a sick person on healthy skin leads to infection.
Delta virus is not transmitted through sneezing, kissing, dishes or water. Therefore, a person with the D virus does not pose any danger to others during normal communication.
Symptoms
Diet
With viral hepatitis, patients are prescribed diet No. 5. The main purpose of its use is to improve the functioning of the digestive tract and reduce the secretion of digestive juices. The following principles must be followed:
- Meals should be minimum portions of at least 4 times a day.
- Dishes should be warm, cold and hot are excluded.
- You can not eat foods containing a large amount of spices and essential oils.
All fatty fish and meat, smoked meats, chocolate, fresh pastries, pickled preparations, too salty and spicy dishes are excluded from the diet. The emphasis should be on plant and dairy foods, cereals. A sufficient amount of liquid in the form of compotes, rosehip decoctions will help free the body from toxins.
Consequences and prevention
The complications of viral hepatitis D include the development of cirrhosis, liver failure, and malignant neoplasms. With early detection of the disease, complete recovery of the liver is possible, but it may take several months.
There are two main methods for the prevention of hepatitis D. The specific method is to administer a vaccine against hepatitis B. Since in this case a person becomes protected from the B virus, the possibility of the delta virus multiplying in the body is excluded.
Non-specific methods of prevention include the use of only disposable instruments during medical and other manipulations, condom-protected sexual intercourse, and abstinence from drugs.
Viral hepatitis D(delta hepatitis) is an infectious lesion of the liver, co-infection or superinfection of viral hepatitis B, which significantly worsens its course and prognosis. Viral hepatitis D belongs to the group of transfusion hepatitis, a prerequisite for infection with hepatitis D is the presence of an active form of hepatitis B. The detection of hepatitis D virus is carried out by PCR. A study of the liver is mandatory: biochemical tests, ultrasound, MRI, rheohepatography. The treatment of viral hepatitis D is similar to the treatment of hepatitis B, but requires larger doses of drugs and a longer duration of treatment. In most cases, chronic disease is observed with subsequent outcome in cirrhosis of the liver.
General information
Viral hepatitis D(delta hepatitis) is an infectious lesion of the liver, co-infection or superinfection of viral hepatitis B, which significantly worsens its course and prognosis. Viral hepatitis D belongs to the group of transfusion hepatitis.
Exciter characteristic
Hepatitis D is caused by an RNA-containing virus, which is the only currently known representative of the “wandering” genus Deltavirus, which is distinguished by its inability to independently form a protein for replication and uses a protein produced by the hepatitis B virus for this. Thus, the causative agent of hepatitis D is a satellite virus and occurs only in combination with the hepatitis B virus.
The hepatitis D virus is extremely stable in the external environment. Heating, freezing and thawing, exposure to acids, nucleases and glycosidases do not significantly affect its activity. The reservoir and source of infection are patients with a combined form of hepatitis B and D. Contagiousness is especially pronounced in the acute phase of the disease, but patients pose an epidemic danger throughout the entire period of the circulation of the virus in the blood.
The mechanism of transmission of viral hepatitis D is parenteral, a prerequisite for the transmission of the virus is the presence of an active hepatitis B virus. The hepatitis D virus integrates into its genome and enhances the ability to replicate. The disease can be a co-infection, when the hepatitis D virus is transmitted simultaneously with B, or a superinfection, when the pathogen enters the body already infected with the hepatitis B virus. The most significant risk of infection during blood transfusion from infected donors, surgical interventions, traumatic medical manipulation (for example, in dentistry).
The hepatitis D virus is able to overcome the placental barrier, can be sexually transmitted (the spread of this infection among persons prone to promiscuity, homosexuals is high), which in some cases has a familial spread of the virus suggests the possibility of its transmission through household contact. Patients with viral hepatitis B, as well as carriers of the virus, are susceptible to viral hepatitis D. In particular, the susceptibility of persons who are chronic carriers of HBsAg is high.
Symptoms of viral hepatitis D
Viral hepatitis D complements and aggravates the course of hepatitis B. The incubation period of coinfection is significantly reduced, 4-5 days. Superinfection incubation lasts 3-7 weeks. The preicteric period of hepatitis B proceeds similarly to that of hepatitis B, but has a shorter duration and a more rapid course. Superinfection may be characterized by the early development of edematous-ascitic syndrome. The icteric period proceeds in the same way as in hepatitis B, but bilirubinemia is more pronounced, signs of hemorrhage often appear. Intoxication in the icteric period of hepatitis D is significant, prone to progression.
Co-infection proceeds in two phases, the interval between the peaks of clinical symptoms of which is 15-32 days. Superinfection is often difficult to differential diagnosis, since its course is similar to that of hepatitis B. A characteristic difference is the rate of development of the clinical picture, the rapid chronization of the process, hepatosplenomegaly, a disorder of protein synthesis in the liver. Recovery takes much longer than in the case of hepatitis B, residual asthenia may persist for several months.
Diagnosis of viral hepatitis D
In the acute phase of the disease, specific IgM antibodies are noted in the blood, over the next few months only IgG are detected. In wide practice, diagnosis is carried out using the PCR method, which makes it possible to isolate and identify the RNA virus.
To study the state of the liver in viral hepatitis D, ultrasound of the liver, rheohepatography, MRI of the liver and biliary tract are performed. In some cases, to clarify the diagnosis, a puncture biopsy of the liver can be performed. Nonspecific diagnostic measures are similar to those for hepatitis of a different etiology and are aimed at dynamic control of the functional state of the liver.
Treatment of viral hepatitis D
Treatment of hepatitis D is carried out by a gastroenterologist according to the same principles as the treatment of viral hepatitis B. Since the hepatitis D virus is more resistant to interferon, the basic antiviral therapy is adjusted towards increasing dosages, and the duration of the course is 3 months. If there is no effect, the dosages are doubled, the course is extended to 12 months. Since the hepatitis D virus has a direct cytopathic effect, drugs of the corticosteroid hormone group are contraindicated in this infection.
Forecast and prevention of viral hepatitis D
The prognosis in the case of mild to moderate co-infection is more favorable, since a complete cure is observed much more often than with superinfection. However, co-infection with hepatitis B and D viruses often proceeds in a severe form with the development of life-threatening complications. Chronic coinfection develops in 1-3% of cases, while superinfection develops into a chronic form in 70-80% of patients. Chronic viral hepatitis D leads to the development of cirrhosis. Recovery from superinfection is extremely rare.
Prevention of viral hepatitis D is similar to that of viral hepatitis B. Preventive measures are of particular importance for people with hepatitis B who are positive for the presence of the HBsAg antigen. Specific vaccination against viral hepatitis B effectively protects against delta hepatitis.
