CLINICAL AND LABORATORY FEATURES OF THE COURSE VIRAL HEPATITIS A IN PATIENTS OVER 50

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Relevance. HAV is an acute, cyclic, benign disease that is common among children. According to WHO experts, up to 1.4 million people are infected with HAV annually in the world [1]. The Russian Federation belongs to the countries with medium HAV endemicity. The maintenance of the epidemiological process is carried out through the implementation of the contact-household route of transmission of the pathogen, in case of non-compliance with the rules of personal hygiene [2, 3, 6]. According to the official data of Rospotrebnadzor in the Voronezh region, over the past 10 years, there has been a decrease in the incidence of HAV from 6.20 to 3.37 per 100,000 population. There is also a tendency to reduce the number of sick children from 0 to 17 years old from 22.9% to 11.4% [3, 7]. A decrease in HAV circulation among children leads to an increase in the cohort of adults who do not have immunity to the virus and, as a result, the number of clinically pronounced forms [4, 5].
Objective. To study the clinical and laboratory course of HAV in patients older than 50 years at the present stage.
Materials and methods. Under observation were 31 patients (20 men and 11 women) with a diagnosis of CAA, icteric form, aged 50-66 years, who were treated at the Voronezh VOKIB in 2018-2021. The diagnosis was established on the basis of clinical and laboratory studies in accordance with the International Classification of Diseases of the tenth revision. The diagnosis was confirmed by enzyme immunoassay by detecting antibodies to the HA virus aHAV IgM in the blood.
The results obtained were subjected to statistical processing using non-parametric tests Mann - Whitney, Kruskal - Wallis using the computer program SPSS Statistics 19.0.
Results. Patients were sent for hospitalization on the 8.3±3.5 day from the onset of the disease.
The duration of the preicteric period was 5.2±2.9 days. In the preicteric period, 90.3% of patients had asthenovegetative symptoms, dyspeptic disorders in 93.5%, fever in 93.5%, catarrhal symptoms in 12.9% of patients. Improvement in well-being with the appearance of jaundice was noted by 35.5% of patients.
The diagnosis with which patients were admitted to the hospital was different: 54.8% of patients had hepatitis unspecified, 6.4% had a respiratory infection, and 3.2% had chronic hepatitis C. Only 9.7% of patients, in who had a history of established contact with a patient with CAV, the diagnosis of the referring institution was CAV. 70.9% of patients were residents of Voronezh, 29.1% of patients lived in the Voronezh region (Kantemirovsky, Petropavlovsky, Ostrogozhsky, Semiluksky districts).
All patients had comorbid somatic diseases. Thus, 77.4% of patients had chronic diseases of the gastrointestinal tract, 22.6% of patients had damage to the cardiovascular system, 9.7% had liver cysts, and 3.2% had liver cirrhosis.
On examination, icterus of the sclera and yellowness of the skin were detected in 97.6% of patients, hepatomegaly was observed in 93.5% of patients, and splenomegaly in 16.1%. 16.1% of patients complained of pruritus.
In the general blood test, lymphocytosis was detected in 38.7% of patients, leukocytosis in 9.7%, and normocytosis in the rest of the patients. In the biochemical analysis of blood, there was an increase in total bilirubin to 115±69.2 µmol/l, direct bilirubin 74.1±48.2 µmol/l, ALT 632.4±434.7 IU/l, thymol test - 22.1 ±9.2 units, alkaline phosphatase 579.9±263.7 IU/l, gamma-glutamate transpeptidase - 360.2±153.2 units/l.
The average duration of hospitalization was 16.3±6.4 days. Patients were prescribed basic pathogenetic, symptomatic treatment, including a sparing motor regimen and diet, plenty of fluids, and vitamin therapy.
Discussion. According to the results of the study of the characteristics of the course of HAV in patients older than 50 years, the course was observed predominantly according to the asthenovegetative and dyspeptic variant. Every third patient experienced an improvement in well-being with the appearance of jaundice. All patients had concomitant pathologies, among which diseases of the gastrointestinal tract prevailed. Laboratory diagnostics showed an increase in the following biochemical parameters: total bilirubin, direct bilirubin, ALT, thymol test, alkaline phosphatase, gamma-glutamate transpeptidase.
Conclusion.
1. Over the past 10 years in Voronezh and the Voronezh region there has been a marked decrease in the incidence of HAV.
2. Improving the sanitary and hygienic living conditions of the population has led to a decrease in the circulation of the HA virus among children and, as a result, an increase in the number of non-immune adults.
3. Due to the relative well-being in the region for this disease, clinicians are less alert to HAV. Faced with patients in the prodromal period, with a polymorphism of clinical manifestations, primary care physicians have difficulties in the diagnostic search, leading to late diagnosis, as a result of this untimely hospitalization.

About the authors

Anastasia Naidenko

Voronezh State Medical University

Author for correspondence.
Email: ledianastasianaidenko@yandex.ru
ORCID iD: 0000-0001-6818-6532
SPIN-code: 7762-6670

Student

Russian Federation, Russia, Voronezh, Studencheskaya street, 10

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