Personal site of Ph.D Roman G. Myazin

Acute Viral Hepatitis C

Patient Z-o A.B., 24, appealed for medical aid to the Department of Propedeutics of Internal Diseases of Volgograd State Medical University on February, 21, 2006 with complaints of aching pains in the right hypochondrium, the deterioration of appetite and sleep, flaccidity, undue fatigability, the decrease of efficiency.

From anamnesis: two moths ago the patient had the abrupt temperature rise  up to 38,5o C, sclera and dermal integuments turned yellow, the patient suffered from slight biliary pruritus. The patient was hospitalized to the infectious diseases hospital №9, where a high level of ALT (1,5 mkkat/l) was detected, AST was Norma (0,28 mkmol/l), total bilirubin level was eleveted (38,0 mkmol/l) owing to indirect fraction (32 mkmol/l). The investigation results of HBV-infection markers were negative. The invenstigation of HCV-infection markers detected HCV RNA. The diagnosis was formed: «Acute viral hepatitis C, syndromes of cytolysis and cholestasis». The patient underwent the course of treatment with solution of glucose in combination with hepatoprotectors (essenciale). Acute manifestations (the icteritiousness of dermal integuments and sclera, skin itch) decreased. The patient didn't have any special antiviral treatment. 1 month later the patient was discharged from the hospital to be observed by the infectiologist at the place of residence.

Objectively: dermal integuments and sclera are of usual staining, the lower edge of the right lobe of liver is along the right costal margin edge, it is soft, the palpation is painless. The spleen isn’t palpable.

According to results of the abdominal cavity ultrasound investigation: the liver tissue is of usual echogenicity, has a small-grained structure, homogeneous. The anteroposterior size of the right lobe of liver is 11,0 cm, of the left lobe of liver – 6,2 cm, of the caudate lobe of liver – 3,4 cm.

Common blood analysis: Er – 5,2x10x12, Hb - 120 g/l, colour index – 0,9, Tr - 290x10x9, Le - 4,8x10x9, b -1, e - 0, band neutrophils - 3, s – 48, l – 30, m - 7. ESR – 10 mm/h. Blood clotting time – 4 min 10 sec. Blood glucose – 4,0 mmol/l. Whole protein – 88 g/l, albumins – 49 %, a1-globulins – 3 %, a2 – globulins – 11 %, b-globulins – 18 %, g-globulins – 19 %, A/G coefficient -0,97.

Coagulogramma: plasma recalcification time – 183 sec., trombotest rate – IV, prothrombin index – 88 %, plasma fibrinogen – 3 g/l, fibrinogen B – low-positive.

Clinical urine analysis: light-yellow, transparent, reaction – acid, relative density – 1014, glucose – not detected, protein –not detected, Le – 2-3 within eyesight, Er – not detected, plano epithelium cells – a small number, cylinders –not detected.

Biochemical tests: MDA – 12,4 mkmol/l, DC – 1,3 u., Cat – 13,6 mkmol/ml/min, SOD – 1,4 conv.u/ml, GP – 3,02 mkmol/ml/min, SU – 0,3 u., SG -0 u., CPl – 34,0 mg%, NAG – 12,76 nmol/ml/min, total bilirubin – 20,4 mkmol/l, thymol test - 4,5 u., ALT – 1,3 mkkat/l, AST – 0,26 mkkat/l.

To make the diagnosis of liver disease and its activity more exact, the complex investigation of the presence of hepatitis C virus in the blood serum of the patient by the methods of Immune-Enzyme Analysis (IEA) and Polimerase Chain Reaction (PCR) were made.

Virologic tests: anti-HCV spectrum was detected; anti-HCV-cor Ag detected with the coefficient of positivity 3,8; anti-HCV NS3 Ag detected with the coefficient of positivity 4,2; anti-HCV NS4 Ag detected with the coefficient of positivity 1,4; anti-HCV NS5 Ag was not detected; anti-HCV Ig M detected. HCV RNA was detected by the method of PCR (HCV RNA « positive + »).

For the purpose of detoxicant and antiviral treatment the patient underwent according to the scheme the monotherapy course of 10 intravenous drip infusions of Natrii Hypochloriti into the cubital vein with the speed of 20 - 30 drips per minute in the dynamically increasing concentration (from 300 to 600 mg/l) of the fresh-made solution as 200 ml injections in a day. The patient underwent the procedures successfully.

1 month after the finishing of the course of treatment all above-named investigations were made once again.  It was detected the full normalization of LPO indices, liver-specific enzymes and standard liver tests. It was observed a significant increase of AOP enzymes: MDA – 7,69 mkmol/l, DC – 0,9 u., Cat – 26,1 mkmol/ml/min, SOD -2,9 conv. u./ml, GP – 4,2 mkmol/ml/min, SU - 0 u., SG – 0 u., CPl – 34,2 mg%, NAG – 11 nmol/ml/min, total bilirubin – 16 mkmol/l, thymol test -3,0 u., ALT – 0,38 mkkat/l, AST – 0,18 mkkat/l.

At the end of the course of treatment the patient didn’t have any aching pains in the right hypochondrium, the appetite and sleep improved, the efficiency of the patient increased.

The recurring virologic testing after the course of Natrii Hypochloriti treatment showed: anti-HCV spectrum detected, anti-HCV-cor Ag detected with the minimum coefficient of positivity 0,09; anti-HCV NS3 Ag was not detected; anti-HCV NS4 Ag was not detected; anti-HCV NS5 Ag was not detected; anti-HCV Ig M detected. HCV RNA was not detected by the method of PCR (HCV RNA « negative – »).

The recurring virologic investigations made 6 and 12 months after the finishing of Natrii Hypochloriti treatmant showed the positive dynamics of all laboratory data. HCV RNA again was not detected 6 and 12 months later (HCV RNA « negative – »). Anti-HCV Ig M stopped being detected. Such positive laboratory and virologic dynamics is being kept up to nowadays, for more than 4 years.

Since then the patient hasn’t undergone any recurring supporting courses with Natrii Hypochloriti or any other antiviral medicamentations which can influence hepatitis C virus. Subjectively the patient feels perfectly well and doesn’t have any complaints.

     

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