What is Hepatitis C in Children?
Hepatitis C is a liver disease caused by a hepatitis C virus in a child or adult.
Epidemiology
95 out of 100 cases of post-transfusion and parenteral hepatitis in the USA and Western Europe are caused by HCV (hepatitis C virus). The disease often occurs after a blood transfusion containing the virus, plasma, antihemophilic factor, fibrinogen and other blood products. Also, the disease can be caused by intravenous infusions of immunoglobulin preparations in sick children with immunodeficiencies. Among acute hepatitis, hepatitis C is the leading among patients in departments of organ transplantation, in hemodialysis centers, in plasmapheresis centers, oncology hospitals, etc.
Hepatitis C is transmitted exclusively through blood, along with blood. Therefore, there is a great risk of contracting blood transfusion or its preparations if the blood has not been adequately checked. The risk of infection is present with any injection or surgery using non-sterile instruments. Hepatitis C is transmitted through household contact with microtrauma. There is a chance of infection of the fetus from a sick mother through the placenta. An infant can catch hepatitis C during or after birth, if there is even slight damage to the skin. They suggest the likelihood of sexual transmission of HCV.
Causes of Hepatitis C in Children
Hepatitis C virus belongs to the family of flaviviruses, its diameter is 22-60 nm. HCV can be detected in the blood, in human liver extracts, or in chimpanzees that have been infected during the experiments.
HCV differs from other types of hepatitis in that it is found in small amounts in the blood serum of a sick child. Specific antibodies give a weak immune response at the wrong time.
Hepatitis C virus can be killed with chloroform and formalin. Also, with an increase in ambient temperature to 60 ° C, the HCV dies in 10 hours. Boiling allows you to destroy the HCV in 2 minutes. Blood products to destroy the virus are sterilized with ultraviolet rays.
Pathogenesis during Hepatitis C in Children
In the mechanism of hepatic cell damage in hepatitis C, the leading role is played by immune cytolysis, realized by T-cell cytotoxicity directed against infected hepatocytes. Researchers admit the possibility of direct cytopathic effects of HCV on liver cells.
Chronic forms of hepatitis C can occur due to the weakened ability of blood mononuclear cells to produce γ-interferon, 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 to the pathogen and infected hepatocytes. An increased role in the formation of chronic forms of hepatitis C is also played by the increased ability of the HCV antigen to mask in immune complexes, which brings this disease closer to immunocomplex ones. Immunocomplex diseases mean a group of diseases that arise as a result of deposition of immune complexes in various organs and tissues of a person, including the walls of blood vessels and glomeruli of the kidneys.
Pathomorphology
There are no strictly specific changes in the liver with hepatitis C. In acute hepatitis C, portal inflammation is less pronounced. This is an inflammation of the liver cells surrounding the portal area. The portal area is the area where the artery, vein, and bile duct enter the liver tissue. Focal necrosis is less common, steatosis is more pronounced (if you compare hepatitis C with other forms). Liver steatosis is also known as fatty liver. It is expressed in the accumulation of fat in the tissues of the liver.
In chronic hepatitis C, the portal and periportal inflammatory response with the accumulation of mononuclear elements intensifies. Mild fibrosis can also be detected with a tendency to septal proliferation (proliferation of body tissue by cell division).
In hepatocytes, diffuse dystrophic changes from mild to severe, including balloon dystrophy and necrosis, are observed.
The chronic process in the liver can manifest itself in a morphological picture similar to that of persistent hepatitis. But most often it is active hepatitis with relatively rare bridge-like necrosis and moderate lymphoid infiltration.
Symptoms of Hepatitis C in Children
Clinical manifestations
The incubation period for hepatitis C lasts from 7 to 8 weeks. If the infection is massive, the period is reduced to several days. If a small amount of the virus enters the body, the incubation period will be 26 weeks. The disease has a smooth, not acute onset. Feeling of malaise, lethargy, nausea, and body temperature may rise slightly. In some cases, sick children complain of abdominal pain, and vomiting is also possible. The urine darkens and the feces become discolored after a few days. All sick children have an enlarged liver, and in some cases, an enlarged spleen. In 15-40% of sick children, jaundice is noted, this is a relatively low percentage.
If there is no jaundice, in such cases, symptoms such as asthenization, malaise, and enlarged liver are most pronounced. The activity of AlAT and AsAT in blood serum was increased (in 100% of cases), in some cases, the content of total bilirubin was increased due to the direct fraction. Rarely, there is a decrease in prothrombin, the phenomenon of dysproteinemia, etc. The performance of liver function tests depends on the severity of liver damage.
Hepatitis C is classified according to the same parameters as other hepatitis. The disease can be typical and atypical. According to the severity parameter, hepatitis C is classified into mild, moderate and severe, as well as malignant. With the passage of hepatitis C is divided into acute, protracted and chronic forms.
Flow
Only in 10-20 cases out of 100 there is an acute course of hepatitis C in children, in other cases the disease proceeds in a chronic form. Upon transition to the chronic stage, hyperfermentemia and a relatively normal general condition of the child are noted. No complaints. But the liver can be slightly enlarged and compacted. When chronic hepatitis has formed, patients develop fatigue, weakness in the body, and dyspeptic symptoms (digestive tract disorders). Inspection allows you to record changes in the vessels, for example, telangiectasia, palmar erythema. In all cases, the liver is enlarged, an enlarged spleen is often observed. 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 emerging cirrhosis.
Diagnosis of Hepatitis C in Children
A blood test helps to diagnose HCV, in which ELISA methods in the blood serum find specific antibodies to structural and non-structural proteins of the virus. Also, the PCR method allows you to detect the RNA of the virus, which makes it possible to make an accurate diagnosis – hepatitis C in children.
Hepatitis C Treatment in Children
They treat hepatitis C in children according to general principles, like other types of hepatitis of a viral nature. A sick child is shown bed rest, a special diet, and remedies for relieving symptoms. With malignant forms of the disease, doctors prescribe corticosteroid hormones. Patients with chronic forms of hepatitis use recombinant interferon preparations, for example, intron A, viferon, roferon A and others, as prescribed by the attending physician, for treatment.
To remove the toxic load on the liver, enterosorption therapy is performed using drugs such as enterodesis or enterosgel. For long-term enterosorption, selective enterosorbent is used, which has pronounced hydrophobic properties.
Children with chronic viral liver damage (HBV and HCV) are prescribed combination therapy using drugs with antiviral activity with a different mechanism of action. If the child has a more chronic form of hepatitis B, lamivudine and cycloferon or viferon and picloferon are recommended.
Patients need pathogenetic therapy – aimed at the mechanisms of the development of the disease. In chronic hepatitis C, ursosan – ureodeoxycholic acid is used. It has a corrective effect on the main links of pathogenesis, which determine the chronic course of infection. Ursosan gives immunomodulatory, anticholestatic, antioxidant, antifibrotic effects. The drug is used in a dose of 10 to 15 mg per kg of the body of a sick child per day while taking interferons. Or conducting monotherapy with ursosan (only 1 drug is used for treatment). The course can last from 3-6 months to 1 year.
Prevention of Hepatitis C in Children
The basic principles of prevention coincide with those for hepatitis B. It is necessary to use only disposable syringes to avoid the ingress of infected blood into the body of a healthy child. When carrying out any procedures involving injections, parents should strictly monitor the instruments (including syringes) used by the staff of the medical institution. Disposable systems should be infusion, catheters.
You should adhere to the rules for sterilization of medical equipment – surgical, dental, etc. This will help reduce the incidence of both hepatitis C and hepatitis B.
To reduce the incidence rate among Croca recipients, it is necessary to test blood products for anti-HCV and transaminase activity. Positive samples are excluded.