Sapropyra
Description:
Sapropyra (an epidemic sapropyra, the European sapropyra, sypny vshiny typhus) - an acute antroponozny rickettsiosis with intoxication and a generalized pan-thrombovasculitis, fever, the typhus status, a dieback and defeat of cardiovascular and nervous systems.
Tank and source of an infection - the sick person constituting danger during 10-21 days: in the last 2 days of an incubation, all feverish period and the first 2-3, sometimes 7-8 days of normal body temperature.
The transfer mechanism - transmissible; the activator is transmitted through louses, mainly clothes and in a smaller measure of head. The louse catches at a krovososaniye of the patient and becomes infectious for the 5-7th days. For this term there is a reproduction of rickettsiae in an intestines epithelium where they are found in a huge number. The maximum term of life of the infected louse of 40-45 days. The person catches, rubbing when combing excrements of louses to places of their stings. Infection with an air and dust way at inhalation of the dried excrements of louses is also possible and at their hit on a conjunctiva.
Natural susceptibility of people high. Postinfectious hyperimmunity, but the recurrence known as Brilla-Tsinsser's disease are possible.
Sapropyra symptoms:
Incubation interval. Varies from 6 to 25 days, about 2 weeks on average proceed. During a disease allocate the next periods.
Initial stage. About 4-5 days - proceed from the moment of fervescence before emergence of a dieback. At the same time consider that the louse catches at a krovososaniye on a body of the sick person and is capable to transmit an infection not earlier than in 5-7 days. It is desirable to establish the clinical diagnosis in these terms for timely holding disinsection actions and by that to prevent spread of a disease.
The sapropyra distinguishes the acute beginning; the prodromal phenomena in the form of feeling of weakness, deterioration in a dream and mood, weight in the head note only at certain patients. Body temperature within a day rises to high figures, its increase is accompanied by a headache, an ache in a body. In the next days body temperature remains at the level of 39-40 °C, accepts constant character. For the 4-5th days of a disease at a part of patients it quickly decreases ("rozenbergovsky cutting") without improvement of a state and health, and then again reaches high figures. The fever at a sapropyra is uncharacteristic and can be shown only in the first day of a disease. Symptoms of the expressed intoxication accrue: headache, dizziness, thirst, persistent sleeplessness, tactile, acoustical and visual hyperesthesia. In certain cases there is vomiting of the central genesis.
Sick eyforichna, are excited, sometimes observe a black-out. Integuments of the person, neck and an upper part of a trunk are hyperemic, the person одутловато, amimichno, the injection of scleras, a hyperemia of conjunctivas ("rabbit eyes") are expressed. Skin is dry, hot. From the 2-3rd day of a disease endothelial symptoms appear (bandage signs, a pinch, Konchalovsky's symptom). By 3-4th days in 5-10% of cases small hemorrhages on transitional folds of conjunctivas (Kiari-Avtsyn's symptom) develop. Owing to the increased fragility of vessels at reception of firm food there can be dot hemorrhages on a soft palate, a uvula and a mucous membrane of a back wall of a throat (Rosenberg's enantem). Pathology from a respiratory organs is uncharacteristic, excepting hurried breathing. Cardiac sounds are muffled, absolute tachycardia is expressed. Observe a clear tendency to arterial hypotension. Language dry, is laid over by a white plaque. The liver and a spleen are a little increased from the 4-5th day from the beginning of a disease, are painless at a palpation. The oliguria is possible.
Disease heat period. Its approach marks emergence of a dieback for the 5-6th day of a disease. During this period high, constant or remittiruyushchy fever remains; "rozenbergovsky cuttings" can be observed for the 10-12th days of a disease. The main complaints of patients remain and amplify, the headache becomes painful, gains the pulsing character. On skin of a trunk and extremities plentiful rozeolyozno-petekhialny rash in one step develops. It is more expressed on the side surfaces of a trunk and the internal surfaces of extremities. On a face, palms and soles rash does not arise. The subsequent podsypaniye for a sapropyra are uncharacteristic. Language dry, it is frequent with a dark brown plaque at the expense of hemorrhagic emigration through cracks on its surface. Clearly the hepatolienal syndrome is expressed, often there are a meteorism and locks. Occasionally there are moderate pains in lumbar area and a positive symptom of effleurage (Pasternatsky) due to defeat of small vessels of kidneys and a hemorrhage in the renal capsule. The oliguria with emergence in urine of protein and cylinders accrues. The atony of a bladder and suppression of a reflex on an urination owing to toxic defeat vegetative nervous ганглиев can develop; at the same time urine is emitted with drops (a paradoxical mocheiznureniye).
The bulbar neurologic symptomatology accrues. It is shown by a language tremor, its deviation, a dysarthtia, an amimia, a smoothness of nasolabial folds. It is put out tolchkoobrazno tongue, touching with a tip teeth (Govorov-Godelye's symptom). Sometimes note swallowing disturbances, a nystagmus, an anisocoria, slackness of pupillary tests. There can be signs of a meningism or serous meningitis with increase in quantity of lymphocytes in cerebrospinal fluid, and also pyramidal signs - disturbances of oral automatism, Gordon's signs and Oppengeyma.
Weight of a sapropyra can fluctuate over a wide range. At heavy disease the so-called typhus status (status typhosus) can develop in 10-15% of cases. The mental disturbances which are shown psychomotor excitement, garrulity, sometimes dysmnesias are characteristic of it. Sleeplessness progresses; the superficial dream is accompanied by dreams of frightening character because of what patients sometimes are afraid to fall asleep. Often observe a disorientation of patients, the nonsense, hallucinations, a loss of consciousness are possible.
The period of a heat comes to an end with normalization of body temperature that usually occurs by 13-14th day of a disease.
Reconvalescence period. After recession of body temperature intoxication symptoms decrease and disappear, signs of defeat of a nervous system slowly regress; by this time rash dies away, the sizes of a liver and spleen are normalized. Long, to 2-3 weeks, weakness and apathy, pallor of skin, functional lability of cardiovascular system, decrease in memory remain. Retrograde amnesia is seldom or never possible. An early recurrence at a sapropyra does not develop.
Sapropyra reasons:
The activator - a gram-negative small motionless bacterium of Rickettsia prowazeki. The dispute and capsules does not form, morphologically a polimorfn: can have an appearance of cocci, sticks; all forms keep pathogenicity. Usually they are painted by Romanovsky-Gimza's method or silvering according to Morozov. Cultivate on complex nutrient mediums, in chicken embryos, in easy white mice. Never breed only in cytoplasm and in kernels of the infected cells. Possess a somatic thermostable and type-specific heat-labile antigen, contain hemolysins and endotoxins. In excrements of the louses getting on clothes keeps viability and pathogenicity within 3 months and more. At a temperature of 56 °C perishes in 10 min., at 100 °C - for 30 pages. It is quickly inactivated under the influence of chloroamine, formalin, lysol, acids, alkalis in usual concentration. It is carried to the second group of pathogenicity.
Treatment of the Sapropyra:
In cases of a sapropyra or at suspicion on it hospitalization of the patient is necessary. The high bed rest is appointed not less than till 5th day of normal body temperature. Allow to get up the patient for the 7-8th day of an apireksiya, to go - in 2-3 days, at first under observation of medical staff because of danger of an orthostatic collapse. Patient care, a toilet of skin and oral cavity are necessary for prevention of decubituses, stomatitis, parotitis. The food allowance is usual.
For etiotropic treatment use drugs of a tetracycline row (tetracycline in a daily dose of 1,2-1,6 g, doxycycline on 100 mg 2 times a day) or levomycetinum on 2,5 g/days. The positive effect from use of tetracycline drugs is shown in 2-3 days of therapy. The course of treatment covers all feverish period and the first 2 days of normal body temperature. Active disintoxication therapy with intravenous administration of solutions and an artificial diuresis is necessary. In cases of cardiovascular insufficiency apply Sulfocamphocainum, Cordiaminum, ephedrine in average therapeutic doses. According to indications appoint analgetics, sedative and somnolent drugs. For prevention of thromboses and a thromboembolism during the early period of a disease recommend anticoagulants (heparin, Phenilinum, Pelentanum, etc.). Glucocorticoids (Prednisolonum) apply only at a heavy sapropyra with the expressed intoxication and threat of development of a collapse because of acute adrenal insufficiency. Excessive hobby for antipyretics can promote development of acute cardiovascular insufficiency.
The extract of patients is carried out not earlier than the 12th day of an apireksiya (the period of a rassasyvaniye of granulomas).
