Melioidosis
Description:
Melioidosis (disease synonyms: imaginary сап, Fletcher-Stanton's disease, a disease Whitmore, the septicaemia of morphine addicts, a meliodosis, psevdoyenterit) - the acute infectious disease from group of bacterial zoonoz, is attracted with a stick to a psevdosap, characterized by preferential contact mechanism of infection, a current as a septicopyemia, formation of granulomas and abscesses in bodies and fabrics, a diarrhea, dehydration, observed in an acute and chronic form.
Melioidosis reasons:
The melioidosis activator - Pseudomonas pseudomallei - belongs to the sort Pseudomonas, Pseudomonadaceae families. It is a gram-negative stick, mobile thanks to existence of flagellums, the bipolarity is well painted by aniline dyes with accurate. And the dispute does not form capsules, facultative aerobe, grows on usual mediums. In the soil and excrements remains within a month, in urine - up to 15 days, in water - up to 18 months. It is sensitive to effect of disinfecting substances (lysol, chloric lime, etc.).
Source of an infection are various animals - rats, mice, pigs, horses, cattle, sheep, cats, dogs, a kangaroo and others from which the activator with excrement, purulent discharges gets to the soil, water.
The main mechanism of transfer of a melioidosis contact, less often infection of the person occurs alimentary and even more rare in the aspiration or transmissible way. Infection from the person is not described, however cases of a melioidosis of lungs at health workers of hospitals where such patients were treated are known. The susceptibility to a disease is low. Immunity is studied insufficiently, but repeated cases of a disease is not described. A melioidosis local for the countries of Southeast Asia, the region of the Caribbean Sea, Australia.
Pathogeny:
The activator of a melioidosis gets into a human body preferential through the injured skin or, more rare, through mucous the digestive channel. From entrance gate the infection extends in the lymphogenous way, gets into regional lymph nodes which often suppurate. Getting into blood, bacteria are brought in internals and fabrics, cause formation of the specific granulomas which are exposed caseous and purulent disintegration with formation of small and large abscesses.
Melioidosis symptoms:
The incubation interval at a melioidosis lasts from 2 to 24 days, sometimes drags on up to several months and years (latent infection).
Allocate the following clinical forms of a melioidosis:
1) acute,
2) subacute,
3) chronic,
4) pulmonary;
5) abortal.
Acute form. The disease begins suddenly, with a fever, fervescence to 39-40 °C. It is shown by a joint pain and muscles, a stomach, a severe headache, vomiting, a diarrhea with dehydration, pleural pain. Often there is cough with bloody and mucous, and later purulent a phlegm of greenish color. At increase of intoxication of the patient faints, there are meningeal symptoms. On skin formation of an erythema, pustules, hemorrhagic bubbles is possible. From bodies of blood circulation tachycardia, arrhythmia, a lowering of arterial pressure is noted. Radiological in lungs come to light big pneumonic the center. The gepatosplenomegaliya is observed, peripheral lymph nodes increase. At a blood analysis the neutrophylic leukocytosis, increase in SOE is found considerable. The patient perishes from infectious and toxic shock which can develop in the first days of a disease. In other cases the clinical picture of a disease is supplemented with developing of abscesses in various bodies and fabrics.
The subacute form of a melioidosis proceeds as a septicopyemia with moderate intoxication. Body temperature within 37,5-38,5 °C, a moderate headache, vomiting does not happen. The liver and a spleen are increased, bystry weight loss. Formation of multiple abscesses in internals, muscles, hypodermic cellulose is characteristic that gives the main clinical displays of a disease. Abscesses in lungs are more often formed. Develop purulent inflammatory carry by in various bodies and fabrics in the form of an empyema, peritonitis, arthritis, pyelonephritis, cystitis, osteomyelitis, an encephalomeningitis. Without etiotropic treatment the lethality reaches 90-95% and above.
Patients with a chronic melioidosis against the background of normal or subfebrile body temperature have abscesses in internals, there are fistulas and ulcers which long do not heal. Process can last months and even years, with aggravations and remissions. In not recognizable and not treated cases the lethality makes 100%.
Pulmonary the melioidosis is characterized by subacute, more rare the acute beginning, high temperature of a body, cough with blood impurity in a phlegm, thorax pain. The clinic of heavy pneumonia with abscesses, purulent pleurisy develops. The X-ray pattern reminds tuberculosis or mycosis of lungs. If only lungs are surprised, disease depends on timeliness and adequacy of treatment.
The melioidosis can proceed in an abortal form, the having short feverish period, any specific symptomatology is not observed, however after the postponed disease in blood antibodies against a melioidosis are found. The latent form of a disease is diagnosed at inspection of patients in areas, endemic on a melioidosis, or during an exacerbation of a disease when the symptoms characteristic of a melioidosis appear.
Treatment of a melioidosis:
Use intramusculary of succinate levomycetinum on 1 g 4 times a day during ZO of days and longer is effective. More effective is the combination of antibiotics - levomycetinum with tetracycline, doxycycline or appointments them in a combination with sulfanamide drugs. Antibacterial therapy is carried out before fading of clinical displays of a disease then it is continued within a month. The pathogenetic and symptomatic treatment is applied. If infectious and toxic shock develops, use glycocorticosteroids. According to indications apply surgical methods of treatment.
Prevention is carried out as well as at a sapa. Patients are subject to obligatory hospitalization. In the center do disinfection, disinsection and deratization. Systematic observation of the endemic centers, protection of food stuffs, water sources against rodents are necessary. Specific prevention is not developed.
