Brucellosis
Description:
Brucellosis - the zoonotic infectious and allergic disease inclined to synchronization proceeding with preferential defeat of a musculoskeletal system, cardiovascular, nervous and sexual systems.
The main source and tank of an infection - sheep, goats, cattle and pigs. Cases of infection of people with a brucellosis from rens are noted. In rare instances horses, camels, yaks and some other animals who allocate the activator with milk, urine, a stake, amniotic liquid can be a source of infection. Most often the person catches a brucellosis from the small cattle which activator (V. of melitensis) causes the majority of severe forms of a disease. Also quite often the person catches V. of abortus from cattle, however clinically expressed infection is registered in isolated cases. Disease is easy; the sick person is not dangerous to people around.
Mechanism of transfer of the activator various, most often fecal and oral; are also possible contact and household (at hit of the activator on the damaged integuments and mucous membranes) and aerogenic transfer mechanisms. Epidemic value of foodstuff and raw materials of animal origin define massiveness of planting, a type of the activator, duration of its preservation. The greatest danger is constituted by crude dairy products (milk, sheep cheese, cheese, koumiss, etc.), meat and raw materials (wool, astrakhan astrakhans and skin) from the goats and sheep sick with a brucellosis. Meat constitutes considerably smaller epidemiological danger as it is, as a rule, used after heat treatment. However in some cases at insufficient heat treatment (national peculiarities of cooking - a stroganin, a shish kebab with blood, crude forcemeat, etc.) meat and meat products can be the reason of infection with a brucellosis.
Sick animals contaminate brucellas the soil, a laying, a forage, water becoming in turn the factors causing infection of the person. Cases of infection of the person when cleaning manure are registered. The aspiration way of infection is possible at an ingalirovaniye of the air and dust mix containing the infected fragments of wool, manure, the earth. This way of infection is possible at a hairstyle, wool sorting, down comb-out (development, knitting and so forth), and also when cleaning rooms and territories where support animals or process raw materials from them. At the same time brucellas can also get through a mucous membrane of a conjunctiva of eyes. Chances of laboratory aerogenic infection during the work with cultures of bacteria. Cases of infection of people through water are known, however epidemiological value of this way of transfer is small. Pre-natal infection of a fruit and infection of children when feeding with breast milk are possible.
Natural susceptibility of people high. Postinfectious immunity lasts usually 6-9 months. Recurrent diseases observe in 2-7% of cases.
Brucellosis symptoms:
The incubation interval is equal to 1-4 weeks, but can be extended up to 2-3 months at development of latent infection. According to the modern clinical classification based on the standard classification of G. P. Rudnev distinguish acute (lasting up to 1,5 months), subacute (up to 4 months), chronic (more than 4 months) and residual (clinic of effects) forms.
Acute brucellosis. Can gradually develop (more often at elderly persons) or quickly. At the gradual beginning of a disease throughout various time (from several days to several weeks) patients complain of an indisposition, weakness, sleep disorders, decrease in working capacity, a joint pain, various groups of muscles and a waist. At inspection note subfebrile condition, sometimes - increase in peripheral lymph nodes as a micropolyadenopathy. Further gradually symptoms of intoxication accrue, body temperature becomes high, there are oznoba and pouring sweats, the liver and a spleen increase in sizes.
At bystry development the acute brucellosis is shown by rise in body temperature to high figures (39 °C and above) within 1-2 first days of a disease. Fever of remittiruyushchy, wavy or intermittent character is accompanied by the expressed fever which is coming to the end with profuse sweating. Feverish reaction usually continues several days, but can be extended to 3-4 weeks, accepting wavy character. At the same time in most cases the health of patients owing to moderate intoxication remains rather satisfactory even against the background of high temperature of a body and enough essential objective changes. This clinical feature inherent to a brucellosis, often is the reason of difficulties when carrying out differential diagnosis of a disease.
Patients complain of a headache, emotional instability, irritability, sleep disorders, muscle and joints pains. At survey at height of fever note a hyperemia of the person and neck, pallor of integuments of a trunk and extremities. Peripheral lymph nodes, especially cervical and axillary, slightly increase in sizes, can be a little painful at a palpation. The micropolyadenopathy which is considered as a precursory clinical sign of a brucellosis is met infrequently recently (no more than in 20-25% of cases). Sometimes in hypodermic cellulose, but a bowl in muscles and sinews it is possible to palpate painful dense small knots or nodes the size from a pea to small egg - fibrosites and cellulitises though their emergence in patients is more characteristic of the following, subacute form of a brucellosis. The liver and a spleen are increased, sensitive at a palpation. Organ defeats of a musculoskeletal system, the sexual sphere, a peripheral nervous system with the corresponding focal symptomatology develop in 10-15% of cases already in the acute period of a disease.
Severity of a brucellosis in many respects depends on a type of the activator (its virulence). Usually the diseases caused by V. abortus proceed easier, than the defeats caused by V. melitensis.
Subacute form. The recurrent current is characteristic. The feverish periods with temperature reaction of different degree of manifestation and duration (is more often till several days) alternate with the apireksiya periods. During rises the temperature curve gains the wrong character, the level of temperature is subject to considerable fluctuations even within a day.
Patients show numerous various complaints. Diffusion muscle, bones and joints pains, paresthesias, oppressed mood disturb. The dream and appetite worsen, muscular weakness develops, dryness in a mouth, thirst, locks appear.
At survey of patients quite often reveal fibrosites and cellulitises. From cardiovascular system note relative bradycardia at height of fever and small tachycardia during the periods of normal body temperature, a priglushyonnost of cardiac sounds. In hard cases symptoms of infectious and allergic myocarditis, endocarditis and pericardis can be found. Pathology of a respiratory organs is revealed seldom (catarral quinsies, pharyngitises, bronchitis, bronchial pneumonia). Changes of digestive organs have functional character that is reflected in complaints of patients. In hard cases development of a meningism and slow serous meningitis is possible.
Much more often than at an acute brucellosis multiorgan defeats and allergic reactions (a dieback, dermatitis, reactions develop from superficial vessels of skin, etc.). First of all observe defeats of a musculoskeletal system: arthritises and polyarthritises, synovites, bursitis, tendovaginitis, etc. Defeats of the sexual sphere are typical - men have orkhita and epididymites, women have frustration of a menstrual cycle, endometritises, misbirths. Defeats of a nervous system can be shown in the form of plexites, ishioradikulit.
Chronic brucellosis. Variability of clinical manifestations and a recurrent current are characteristic. Temperature reaction and other displays of intoxication weak or are moderately expressed. The periods of aggravations replace remissions which duration can reach 1-2 months. The aggravation of symptoms is observed at emergence of fresh focal processes.
In a clinical picture of a chronic brucellosis focal defeats from various bodies and systems prevail.
Signs of changes of a musculoskeletal system are characterized by development of recurrent, is long the proceeding arthritises with frequent involvement of circumarticular cellulose (periarthritis), a bursitis, a tendovaginitis, periostites, perichondrites. Fibrosites and cellulitises in lumbosacral area and over elbow joints are typical. Defeats of various departments of a backbone are shown by severe pains, restriction of movements, deformations, destructive changes.
Defeats of a nervous system are expressed as radiculitises, plexites, intercostal neuralgia, neuritis of acoustical and visual nerves, disorders of sensitivity. Development of an encephalomeningitis, a diencephalic syndrome is in rare instances possible. Changes from the autonomic nervous system cause a hyperhidrosis, the neurangiosis phenomena. Often neurosises and reactive states ("difficult character" of patients) form.
Urogenital pathology is shown by orkhita and epididymites at men, oophorites, salpingites, endometritises and disturbances of a menstrual cycle at women. The pregnancy nevynashivayemost, a dysmenorrhea, infertility are characteristic.
At a chronic brucellosis complex organ defeats (the mixed form) most often develop.
The chronic active brucellosis can last up to 2-3 years, and at repeated infection - and much longer. Its transition to a chronic inactive form is characterized by lack of formation of the fresh centers and intoxications, dominance of functional disturbances, long preservation of serumal antibodies and a positive skin allergy test (Byurne's test).
Brucellosis effects (residual brucellosis). Remain in the absence of the activator in a human body. The residual phenomena, generally functional character owing to immunoallergic reorganization and disorders of the autonomic nervous system are characteristic: perspiration, irritability, changes of the psychological sphere, arthralgia, sometimes subfebrile condition.
At the same time more serious consequences of a brucellosis can be connected with development of irreversible fibrous and cicatricial changes with involvement of nervous trunks, textures, roots that provokes emergence of various neurologic symptoms.
The organic changes of a musculoskeletal system sometimes developing at had a brucellosis (deformations of joints, ankiloza, contractures, an atrophy of muscles, a spondylosis), in some cases demand surgical treatment and definition of group of disability.
In conclusion it should be noted that the course of a disease at the present stage distinguishes a number of features:
* feverish reaction of the wrong type is more often limited to subfebrile condition;
* defeats of a musculoskeletal system are shown first of all by pain reactions, is more rare - focal inflammatory processes;
* the lymphadenopathy and increase in a spleen develop no more than in 25% of cases;
* focal defeats develop earlier, in 12-15% of cases already in the period of an acute brucellosis;
* organic lesions of TsNS observe seldom;
* defeats of visceral bodies at a chronic brucellosis are usually shown by disturbances from cardiovascular system;
* the residual brucellosis proceeds generally with functional, but not organic disturbances.
Brucellosis reasons:
Activators - aerobic and mikroaerofilny motionless gram-negative bacteria of the sort Brucella. On the international classification the sort Brucella consists of 6 independent types which subdivide into a number of biovar. Brucellas differ in the expressed polymorphism: in one drug observe cocci and the extended sticks. Century of melitensis are more often presented by kokkovidny forms, V. to abortus and V. suis - sticks with the rounded-off ends. Most often damages at the person are caused V. by melitensis presented 3 biovaram (the main owners - sheep and goats). Slightly more rare - V. abortus presented 9 biovaram (the main owner - cattle), and V. suis presented 4 biovaram (the main owners - pigs, hares, reindeers). In rare instances damages at the person are caused by V. canis (the main owner - dogs). Definition of types and biovar of brucellas in specific territories and in the centers of an infection has important epidemiological and epizootological value from the point of view of classification of the centers, assessment of degree of tension of epidemic and epizootological processes, establishment of the facts of migration of brucellas from one species of animals on another, identification of ways of distribution of the activator, the choice of tactics of treatment, etc. Brucellas have high invasiveness and can get through the unimpaired mucous covers; they are carried to intracellular parasites, but they can also be out of a cell. Brucellas are rather steady in external environment. In water over 2 months, in crude meat - 3 months, in salted - up to 30 days, in sheep cheese - 2 months, in wool - up to 4 months remain. Brucellas perish when heating to 60 °C in 30 min., at boiling - is instant. Are sensitive to effect of many disinfectants - 2% solution of carbolic acid, 3% solution of kreoline and lysol, 0,2-1% solution of chloric lime and chloroamine kill them within several minutes.
Treatment of the Brucellosis:
The mode out-patient in lungs and stationary in hard cases of a disease. Causal treatment is effective at an acute brucellosis; the smaller effect is observed at activation of process at patients with subacute and chronic forms. Optimum consider purpose of two antibiotics, one of which has to get through a cellular membrane. Apply one of the following combinations taking into account contraindications (children up to 15 years, pregnancy, a lactation, epilepsy).
* Rifampicin (on 600-900 mg/days) and doxycycline (on 200 mg/days) inside a continuous course, lasting not less than 6 weeks. At a recurrence the course of treatment is repeated.
* Doxycycline (on 100 mg 2 times a day) a course on 3-6 weeks and streptomycin (on 1 g intramusculary 2 times a day) during 2 weeks. This combination is more effective previous, especially at a spondylitis, but the used drugs show high toxicity.
* Oflaksatsin (on 200-300 mg 2 times a day) inside and rifampicin in the above-stated doses.
Duration of use of drugs explains expediency of control over their reception by patients.
In complex therapy of a brucellosis apply disintoxication means by the general principles of their use, ATP, methionine, soft immunostimulators (Dibazolum, pentoxyl, Thymalinum, etc.). Widely apply anti-inflammatory drugs - non-steroidal anti-inflammatory drugs (indometacin, Brufenum, etc.). At pains (neuritis, neuralgia, pains of vegetative character) carry out symptomatic therapy in the form of novocainic blockade of 1% by novocaine solution, intravenous administrations of 0,25% of solution of novocaine in the increasing doses.
Use of glucocorticoids should be carried out carefully. Their appointment by force at defeats of TsNS (meningitis, an encephalomeningitis), and also at the expressed inflammatory changes (orkhita, neuritis, etc.) and lack of effect of other anti-inflammatory drugs.
The medical (killed) brucellous vaccine to treatment of patients is applied in recent years more and more seldom because of its ability to cause immunity suppression, to increase a possibility of a recurrence, to cause autoimmune reactions and reactions to the ballast substances which are contained in it.
During permanent remission at a chronic form and a residual brucellosis appoint physiotherapy exercises, physiotherapeutic and sanatorium treatment (UVCh, quartz, paraffin applications, radonic bathtubs).
