Hepatitis C in children

Hepatitis C in children is the leading among acute hepatitis in the centers of hemodialysis, among patients of organs of organ transplantation, in oncological hospitals, centers of plasmapheresis, etc.

ICD-10 code

• 817.1 Acute hepatitis C.
• 818.1 Chronic viral hepatitis C.

Epidemiology

Epidemiology

In Western Europe and the United States, up to 95% of all cases of posttransfusion and parenteral hepatitis cause HCV. The disease occurs after a transfusion of virus-containing blood, plasma, fibrinogen, anti-hemophilic factor and other blood products. Outbreaks of hepatitis C among patients with immunodeficiencies after intravenous infusions of immunoglobulin preparations were noted. 

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

[1], [2], [3], [4], [5], [6], [7], [8],

Causes of the hepatitis C

Causes of hepatitis C in children

Hepatitis C virus belongs to the family of flaviviruses. Has a diameter of 22 to 60 nm, is found both in the blood, and in extracts of human liver or experimentally infected chimpanzees. Unlike other viruses, hepatitis is found in the 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, when heated to 60 ° C it is inactivated for 10 hours, and at boiling - for 2 minutes. Effective sterilization of blood products with the help of ultraviolet rays.

[9], [10], [11], [12], [13], [14],

The pathogenesis of hepatitis C

In the mechanism of lesion of hepatic cells in hepatitis C, the leading role is played by immune cytolysis, which is realized by T-cell cytotoxicity directed against infected hepatocytes. The possibility of a 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 γ-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 inadequate T cell and humoral immune response against the pathogen and infected hepatocytes. The increased ability of the HCV antigen to mask into immune complexes also has a certain significance, which brings this disease closer to immunocomplex.

Symptoms of the hepatitis C

Symptoms of hepatitis C in children

The incubation period averages 7-8 weeks, with fluctuations from several days (with massive infection) to 26 weeks. The disease begins gradually with asthenovegetative and dyspeptic manifestations: lethargy, malaise, nausea, sometimes subfebrile body temperature. Possible pain in the abdomen, sometimes vomiting. A few days later, dark urine and discolored feces appear. In all patients, the liver is enlarged, and sometimes - the spleen. Jaundice appears rarely, only 15-40% of patients. In the absence of jaundice, the leading symptoms are malaise, asthenia, and enlargement of the liver. In the blood serum, ALT and ACT activity was increased in all patients, the content of total bilirubin was increased by a direct fraction, a decrease in the prothrombin index, the phenomenon of dysproteinemia, etc. Were possible in all patients. The parameters of functional liver samples fully correspond to the severity of liver damage and the stage of the pathological process.

Acute course of hepatitis C occurs in 10-20% of cases, in other children the disease takes on a chronic course. Transition to the chronic stage manifests by persistent hyperfermentemia with a relatively satisfactory general condition, complete absence of complaints, insignificant increase and compaction of the liver. In the stage of the formed chronic hepatitis, patients can complain of increased fatigue, weakness, dyspepsia. On examination, it is possible to detect vascular changes (telangiectasia, palmar erythema), the liver is always enlarged, often - the spleen. Despite the low severity of clinical symptoms, the pathological process in the liver morphologically corresponds in most cases to chronic active hepatitis, often with signs of developing cirrhosis.

Forms

Classification

Classify viral hepatitis C in the same way. As well as other viral hepatitis. Distinguish typical and atypical variants of the disease.

The severity of light, mild, moderate, severe and malignant, and adrift - acute, protracted and chronic forms.

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

[15], [16], [17], [18], [19], [20], [21],

Diagnostics of the hepatitis C

Diagnosis of hepatitis C in children

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

[22], [23]

Treatment of the hepatitis C

Treatment of hepatitis C in children

The general principles of treatment for patients with acute and chronic hepatitis C are the same as for other viral hepatitis. Assign bed rest, diet, symptomatic. 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

Prevention of hepatitis C in children

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 sterilization regulations for surgical, dental and other instruments lead to a significant reduction in the incidence of not only hepatitis B, but also hepatitis C. Testing of drugs blood on anti-HCV and the activity of transaminases with the subsequent exclusion of positive samples leads to a significant reduction in the incidence of hepatitis C among the recipients of blood products.