Campilobacteriosis

Description:

Campilobacteriosis - group of infectious diseases of the animals and the person who are characterized by varying severity and polymorphism of manifestations.

Short historical data.
For the first time activators in patients with diarrheas were found by T. Esherikh (1884). The possibility of their circulation in blood of the patient is proved by J. G. Vincent (1947). Noted the etiological importance of microorganisms in development of enterit in people E. King.
Since the beginning of the 80th years of the 20th century domestic and foreign researchers paid attention to rather high level of the diarrheal diseases of the population caused by kampilobakter (more than 8%).

Campilobacteriosis symptoms:

Gastrointestinal form.  The incubation interval proceeds on average 2-5 days. Approximately a half of patients in the first 2-3 days of a disease has nonspecific grippopodobny symptoms: fervescence to 38 °C and more, oznoba, a headache, muscle and joints pains. Soon in a clinical picture of a disease there are lines giving it the nature of gastritis, a gastroenteritis, gastroenterocolitis, coloenteritis or colitis.

According to current option the clinical picture of a disease can be very similar to gastritichesky or gastroenteritichesky options of food toxicoinfection or acute dysentery. In such cases the final diagnosis is made only after its confirmation by a bacteriological research.

Development of a coloenteritis and colitis is especially characteristic of patients in Europe and, in particular, in Ukraine. Against the background of all-toxic signs or a little later there are abdominal pains localized mainly in the left ileal area or having diffuse kolikoobrazny character. Intensity is various; sometimes pains are so expressed that simulate a picture of an acute abdomen. Nausea and vomiting are possible. The chair is plentiful, liquid, fecal, fetid, green color. Frequency of defecations varies from several times to 10 times a day and more. However at development of kolitichesky option of a disease of an excrement quickly become scanty, in them there are a slime and streaks of blood, and approximately at a half of patients of an excrement take a form of "a rectal spittle". The phenomena of a hemocolitis are more characteristic of the campilobacteriosis caused by S. jejuni. Tenesmus and false desires appear infrequently.
In rare instances the terminal ileitis and a mesadenitis develop. In 1-3 weeks after the beginning of diarrhea there can be phenomena of reactive arthritis or develop a spotty, spotty and papular or urtikarny dieback. Duration of a disease varies of several days to 2 weeks and more, a recurrence is possible.

Generalized form. The main activator - S. fetus subspecies fetus. It is most often shown by bacteremia, long fever, but without multiorgan dissimination of activators and development in bodies of microabscesses. Pregnant women and children of younger age are most susceptible to this option of an infection.
The clinical picture of a septicopyemia develops against the background of the previous diseases more often - cirrhosis, a diabetes mellitus, tuberculosis, malignancies, a leukosis, etc., and also at immunosuppressive states. The secondary septic centers can form in lungs, a liver, a brain, kidneys, a myocardium, a peritoneum, creating against the background of the expressed intoxication of manifestation of the corresponding clinical options - meningitis and meningoentsefalit, myocardites and endocarditises, hepatitises, nephrites at the general serious condition of patients. In these cases the disease can complicate development of infectious and toxic shock.

Chronic form. On a developmental character reminds хрониосепсис; it is shown by a sluggish current, subfebrile condition, progressive weight loss. From time to time patients have abdominal pains, nausea, vomiting and a liquid chair. Arthritises, a keratitis, conjunctivitis, vaginita and a vulvovaginitis can accompany the course of a disease.

Subclinical form (bacteriocarrier). Allocation of the activator with excrements in the absence of clinical signs of a disease, but with increase of credits of specific antibodies in blood is characteristic. Bakteriovydeleniye duration in most cases does not exceed 1 month.

Complications.
At hard proceeding generalized infection of a complication are connected with formation of abscesses in various bodies and possible development of infectious and toxic shock.

Campilobacteriosis reasons:

Activators - mikroaerofilny gram-negative mobile sporoneobrazuyushchy bacteria of the family Campylobacter of the Campylobacteriaceae family. According to the last classification, the Campylobacteriaceae family includes 2 sorts - Campylobacter and in addition to it - Arcobacter. Kampilobaktera are presented spiral (can have one and more rounds), S-shaped or curved cells. At cultivation more than 48-72 p is formed by kokkovidny forms. Bacteria are whimsical to culture conditions. Usually they are grown up on the Wednesdays with blood added with various inhibitors of growth of kontaminiruyushchy flora. An optimum рН - 6,2-8,7, temperatures - 42 °C. The atmosphere of cultivation has to contain not less than 10-17% of C02. Nine types of kampilobakter are known, however the greatest value in pathology of the person S. have jejuni, S. of coli, S. of lari and S. of fetus subspecies fetus. Less often diarrheas cause S. in the person of hyointestinalis, S. of upsaliensis, S. of sputorum subspecies sputorum. The vast majority of cases of a campilobacteriosis causes S. in children and adults of jejuni. The majority of cases of generalized and septic forms of an abenteric campilobacteriosis causes S. of fetus subspecies fetus. From four types of Arcobacter A. cryaerophilus group of 1 V and A. butzleri have clinical value.

Kampilobaktera are sensitive to drying, long impact of a direct sunlight. In fresh water at a temperature of 4 °C survive within several weeks, at 25 °C - 4 days, in the soil and a dung of birds - to 30 days. When heating to 60 °C of a bacterium perish in 1 min.; boiling and chlorination of water causes their bystry death. Kampilobaktera are sensitive to erythromycin, levomycetinum, streptomycin, Kanamycinum, are insensitive to penicillin, are steady against streptocides and Trimethoprimum.

Epidemiology
Tank and source of an infection - wild and farm animals and birds at whom in addition to a disease also the carriage is possible. The role of wildings and birds in spread of an infection is less significant, however is established that the frequency of infection of birds reaches 25-40% at pigeons, 45-83% - at rooks and 90% - at crows. Pigs, cattle, hens are natural tanks of the activator often. The greatest epidemiological danger is constituted by hens, cattle, pigs and sheep, especially asymptomatic bacillicarriers. Animals and birds - carriers allocate activators to the environment during the long period (several months and even years). The role of sick people and bacillicarriers is less significant. Duration of allocation of kampilobakter at the person makes 2-3 weeks, in rare instances can reach 3 months.

The transfer mechanism - a fecal and oral, main way of transfer - food (through meat and dairy products, vegetables, fruit) with which the majority of group diseases and large flashes is connected. The most often food way of transfer is implemented at consumption of not enough well thermally processed broilers, and also pork and products of its processing (cutlets, jellies, etc.). The role of raw milk in transfer of the activator is insignificant. The household way of transfer of the activator is possible, especially at infection newborn, pregnant and elderly. The disease can arise in direct contact with sick animals in the course of care of them during otyol and lambing. Infection occurs also at the use of insufficiently thermally processed meat infected is intravital or when cutting. The majority of flashes of a campilobacteriosis in the USA is connected with the use of pasteurized milk. Undoubted value has also the waterway of transmission of infection. Different types of bacteria quite often allocate from water of various reservoirs. The infected or sick women can give kampilobakter to a fruit transplatsentarno, at childbirth or to the post-natal period. Cases of development of a campilobacteriosis after hemotransfusion, a hemodialysis are described. Among animals the campilobacteriosis is transferred sexual, alimentary and contact in the ways.

Natural susceptibility of people high what the high level of a prevalence a campilobacteriosis of children up to 2 years testifies to. The clinical picture of a disease can vary from an asymptomatic carriage before severe defeats that in many respects defines a condition of resistance of a macroorganism and first of all the immune status. Persons with immunodeficiencies make risk group. Maternal antibodies do not suppress colonization by bacteria of intestines of newborns. Character and duration of postinfectious immunity at a campilobacteriosis are insufficiently studied. Obviously, it has type-specific character.

Main epidemiological signs. The disease is widespread everywhere. Distribution of a campilobacteriosis is caused by an intensification of livestock production, the increased international and national trade in animals, sterns, animal products. The campilobacteriosis makes from 5 to 14% of all registered cases of intestinal infections.

Incidence has sporadic character; most often the family centers of a campilobacteriosis are registered. Features of epidemic and epizootic processes at a campilobacteriosis are increase in circulation of activators among hens and the increase in the importance of agricultural birds connected with it as infection source for people. In economically developed countries infection with an infection is connected mainly with the infected chicken meat, in developing countries - with water. The disease is registered during the whole year, with rise in incidence in aestivo-autumnal months. Campylobacters quite often cause "diarrhea of travelers". The important social factors influencing prevalence of a campilobacteriosis are sanitary and hygienic living conditions, national habits and character of food of the population. People of all age are ill a campilobacteriosis, but it is the most frequent children from 1 year to 7 years. Early transition to artificial feeding increases risk of infection of babies. Nozokomialny cases of a campilobacteriosis are described among newborns.

Treatment of the Campilobacteriosis:

Treatment at development of a gastrointestinal form of a disease as a gastroenteritis or enteritis are usually limited to purpose of symptomatic means; need of causal treatment is relative as in such cases the disease is inclined to self-restriction. Etiotropic treatment is appointed at kolitichesky option of a gastrointestinal form, generalized and chronic forms of a campilobacteriosis, and also in all cases at patients with the burdened premorbidal background. Causal treatment includes purpose of erythromycin on 500 mg 4 times a day (to children - on 40 mg/kg/days). Reserve drugs - ftorkhinolona (ciprofloxacin), drugs of the second row - clindamycin, gentamycin, doxycycline, and also furasolidone (at kolitichesky option). Doses of these drugs depend on age of patients, a course of treatment not less than 7 days. In some cases repeated courses of etiotropic means or change of drugs at their small clinical performance are required that can be connected with the increasing resistance of kampilobakter to antibiotics, in particular to erythromycin.