Atypical mikobakterialny infections
- Symptoms of Atypical mikobakterialny infections
- Reasons of Atypical mikobakterialny infections
- Treatment of Atypical mikobakterialny infections
Atypical mikobakterialny infection - a complex of the granulematozny damages caused by the mycobacteria different from classical pathogens - causative agents of tuberculosis and leprosy.
Symptoms of Atypical mikobakterialny infections:
Tuberkulyozopodobny defeats. Lungs, kidneys, integuments and bone and joint system are involved in pathological process. Often complicate the course of emphysematous processes. At 40-50% of patients with immunodeficiency cause generalized damages.
Lymphadenites. Are clinically more often shown by damages of cervical lymph nodes (a so-called skrofula); the last are painless, can ulcerate or be drained outside; system manifestations weak or more often are absent.
Skin defeats. Typical consider infection of wounds of the extremities received at blow about a wall of the pool or any object at a bottom and coast of a reservoir. Observe formation of the ulcerating granuloma which is spontaneously limited within several weeks in more exceptional cases more often persistent infection forms.
Observe the chronic pulmonary defeats at middle-aged persons registered so far it is universal less often. A bursitis of an elbow joint at repeated injuries is possible and skin defeats, cervical lymphadenites and a syndrome of a carpal tunnel at persons with immunodeficiencies (most often after therapy by hormonal drugs).
Methods of the research Allocation and identification of the activator on the growth rate, formation of pigments (on light or in the dark) and pathogenicity for laboratory animal AT to Mycobacterium kansasii cross react with Ag of Mycobacterium tuberculosis and at the infected persons note a positive Mantoux test. Differential diagnosis Leprosy Tuberculosis Borreliosis Plague.
Reasons of Atypical mikobakterialny infections:
Activators - Mycobacterium ulcerans, Mycobacterium marinum (Mycobacterium balnei), Mycobacterium kansasii, Mycobacterium avium-intracellulare, Mycobacterium xenopi, Mycobacterium szulgai, Mycobacterium scrofulaceum, Mycobacterium fortuitum, Mycobacterium malmoense.
Epidemiology. The majority of activators is eurysynusic in the environment; some live in water and a coastal zone, causing diseases in fishes, others (for example, Mycobacterium avium-intracellulare) - in birds. Most often infection occurs at inhalation of mycobacteria, the use of the infected products and penetration of the activator through microtraumas of skin and mucous membranes. Pathogeny. Got mycobacteria are englobed by macrophages and are transported in regional lymph nodes; phagocytal reactions incomplete, and the activator persistirut in cytoplasm of macrophages. Inflammatory reaction insignificant, but in the place of penetration develops primary affect. In dynamics on the course of regional lymphatic ways and nodes primary complex which is characterized by development of granulomas forms. The microscopy of bioptat reveals in the last the centers of not caseous necrosis containing acid resisting bacteria.
Treatment of Atypical mikobakterialny infections:
At pulmonary defeats. The combination of an isoniazid of 600 mg, rifampicin of 300 mg, streptomycin of 1 g and Ethambutolum of 15-25 mg/kg 1 р / is recommended to days.
At M.'s defeat marinum - minocycline on 100 mg each 12 h during 6-8 weeks.
At M.'s defeat kansasii and M. xenopi is effective standard antitubercular therapy with obligatory purpose of rifampicin.
Surgical intervention is recommended at the localized defeats at patients of young age without pathology of other bodies and systems.
At lymphadenitis - at children from 1 to 5 years surgical treatment is shown.
At the skin damages caused by M. marinum - tetracycline (1-2 r/days) and a combination of rifampicin and Ethambutolum within 3-6 months.
At the infections caused by wounds or foreign bodys.
Surgical treatment of a wound and removal of a foreign body. Medicinal therapy: сульфатримоксазол (50 mg/kg of days), doxycycline (200-400 mg/days), цефокситин (200 mg/kg/days), amikacin (10-15 mg/days) within 3-6 months.
At the disseminated defeats - the combination of antituberculous remedies (as at pulmonary defeats) only reduces bacteremia and temporarily weakens symptoms.
Current and forecast. A current - progressing. More than at 20% of patients celebrate a disease recurrence within 5 years.