REACTIVE (TOXIC) HEPATITIS AS COMPLICATION OF THE MEASLES IN MILITARY SERVICEMEN

Abstract

The aim of the work – to study the incidence of hepatitis, its clinical and laboratory manifestations in measles in military personnel during the last measles epidemic in Ukraine in order to improve the effects of treatment.

Materials and methods. In order to study the frequency of development of hepatitis, clinical and laboratory manifestations of measles in military personnel during the last epidemic in Ukraine, 235 medical records of inpatients with measles, who were hospitalized at the Hospital of Infectious Diseases of the National Military Medical Clinical Center «The Main Military Clinical Hospital», were analyzed for the period from 01.01.2018 till 12.31.2018.

Research results. Complications in the form of reactive (toxic) hepatitis were detected in 29 % of measles patients. The highest percentage of patients with a complication of hepatitis by months was in May – 40 % of patients, in June – 46.6 %, in November – 83.3 %, in December – 28.1 %. Mainly hepatitis was registered in conscripts (49 % of patients) and officers – in 22 % of patients. Reactive (toxic) hepatitis was more often diagnosed on Me=7 days from the moment of illness (Q₂₅=6, Q₇₅=8), and from the day of hospitalization on Me=2 days, (Q₂₅=2, Q₇₅=4).

In 72.5 % of patients, hepatitis was diagnosed on the background of high body temperature, in 27.5% – on the background of normal body temperature. In patients with hepatitis, the maximum body temperature was predominantly febrile (47.8 %) and pyrethic in 39.1 %. Complaints and symptoms of gastrointestinal lesions showed 30.4 % of patients (nausea – 14.5 %, feeling of discomfort in the abdomen – 11.6 %, loose stool – 10.1 %, vomiting – 8.7 %. The number of leukocytes in 68 % was within the normal range, the leukopenia – in 23 %, the leukocytosis – in 9 %. In patients with measles, complicated by reactive hepatitis, at admission to treatment was leukopenia, in the future the level of leukocytes increased and reached the maximum values for 13-15 days from the disease, but the level of norm did not exceed. Preferably, the granulocyte indices were within the normal range. The maximum mean AlAT and AsAT levels were 4–6 days of disease Me=(115.8±85.1), min=17.7, max=391 and Me=(87.3±85.1), min=64.9, max=119.9, and from 10–12 days began to return to normal. With complications for hepatitis + pancreatitis, the mean AlAT values throughout the disease period were above normal, and the maximum values reached 10–12 days of the disease. Palpator size of the liver and spleen did not increase.

Conclusions. In young people, measles can be complicated by reactive (toxic) hepatitis. In the vast majority of patients, complications were diagnosed only after biochemical blood tests, due to the low incidence of complaints (nausea in 14.5 %, discomfort in the hypochondrium – in 11.6 %, vomiting – in 8.7 %, decreased appetite – 2.9 %), so the real incidence of hepatitis is much higher than detected (29 %).

More often reactive (toxic) hepatitis was diagnosed on Me=7 days from the moment of the disease (Q₂₅=6, Q₇₅=8) both on the background of the raised and normal body temperature, both on the background of other complications and without them.

Taking into account either insignificant or completely absent symptoms in the liver, pancreas against the background of the cortex of the mild and moderate course, in order to eliminate complications of these organs in the cortex, it is necessary to carry out mandatory examinations for AlАT, AsAT, blood amylase, diastasis period from 3 to 9 days from the beginning of the disease, even when patients have no complaints.