Tularemia
Description:
Tularemia - an acute infectious natural focal disease with damage of lymph nodes, integuments, sometimes an eye, a pharynx and lungs and followed by the expressed intoxication.
In 1910 near the lake Tulyare in California of D. the IAC-which found the disease reminding bubonic plague on a clinical picture in gophers. Soon it and Ch. Chapin allocated the activator which was called Bacterium tularense (1912) from sick animals. It was found out later that people, and according to the offer E also are susceptible to this infection. Francis (1921) it was called a tularemia. Later the activator was called in honor of Francis, is detailed it studied.
Tank and source of an infection - numerous species of wild rodents, zaytsevidny, birds, dogs, etc. Bacteria are allocated from 82 types wild, and also from domestic animals (a sheep, a dog, artiodactyl). The main role in maintenance of an infection in the nature belongs to rodents (a water rat, an ordinary vole, a muskrat, etc.). The sick person is not dangerous to people around.
The transfer mechanism - multiple, most often transmissible. The activator remains in the nature in the cycle "tick-a animal", is transferred to farm animals and birds by mites and blood-sicking insects. Specific carriers of a tularemia are ixodic mites. The person catches a tularemia as a result of direct contact with animals (removal of skins, gathering of the fallen rodents, etc.), and also an alimentary way through the foodstuff infected with rodents and water. Often infection occurs through blood-sicking carriers (mites, mosquitoes, fleas, gadflies and other arthropods). Infection and (is possible a respiratory way at inhalation of the infected dust from grain, straw, vegetables). Cases of diseases of people on the productions connected with processing of natural raw materials (the sugar, krakhmalo-patochny, spirit, hempen plants, elevators, etc.) on meat-processing plants are registered, at a face of sheep and cattle on which there were infected ticks, on suburbs of the cities located near the natural centers. Cases of delivery of an infection when transporting products and raw materials from areas, unsuccessful on a tularemia, are known.
Natural susceptibility of people high (nearly 100%).
Tularemia symptoms:
According to clinical classification, allocate the following forms of a tularemia:
* on localization of local process: bubonic, ulcer and bubonic, glazo-bubonic, anginous and bubonic, pulmonary, abdominal, generalized;
* on current duration: acute, long, recurrent;
* on severity: easy, medium-weight, heavy.
Incubation interval. Lasts from 1 to 30 days, most often it is equal to 3-7 days.
Symptoms of a disease, the general for all clinical forms, are expressed in fervescence to 38-40 °C with development of other symptoms intoxicationsof - fever, a headache, muscular pains, the general weakness, anorexia. Fever can be remittiruyushchy (most often), constant, intermittent, wavy (in the form of two-three waves). Duration of fever is various, of 1 week up to 2-3 months, most often it proceeds 2-3 weeks. At survey of patients note a hyperemia and pastosity of the person, and also mucous membrane of a mouth and nasopharynx, an injection of scleras, a conjunctiva hyperemia. In some cases there is a dieback of various character: erythematic, makulo-papular, rozeolyozny, vesicular or petekhialny. Pulse урежен (relative bradycardia), arterial pressure is reduced. In several days from the beginning of a disease the hepatolienal syndrome develops.
Development of various clinical forms of a disease is connected with the mechanism of infection and entrance infection atriums defining localization of local process. After penetration of the activator through skin the bubonic form in the form of lymphadenitis (bubo), regional in relation to infection atriums, develops. Perhaps isolated or combined defeat of various groups of lymph nodes - axillary, inguinal, femoral. Besides, at hematogenous dissimination of activators secondary buboes can form. There are a morbidity, and then a hyperadenosis to the sizes of hazelnut or small egg. At the same time pain reactions gradually decrease and disappear. Contours of a bubo remain clear, the phenomena of a periadenitis are insignificant. In dynamics of a disease buboes slowly (sometimes within several months) resolve, suppurate with burrowing and release of slivkoobrazny pus or are sclerosed.
Ulcer and bubonic form. Develops at transmissible infection more often. On site implementations of a microorganism within several days are consistently replaced each other by a spot, a papule, a vesicle, a pustule, and then a superficial ulcer with raised edges. The bottom of an ulcer becomes covered by a dark crust in the form of "cockarde". At the same time regional lymphadenitis (bubo) develops. In the subsequent scarring of an ulcer happens slowly.
In cases of penetration of the activator through a conjunctiva there is a glazo-bubonic form of a tularemia. At the same time there is a damage of mucous membranes of eyes in the form of conjunctivitis, papular, and then erosive and ulcer educations to department of yellowish pus. Defeats of a cornea observe seldom. These clinical manifestations accompany expressed the century and regional lymphadenitis swelled. Course of a disease usually rather heavy and long.
Anginous and bubonic form. Develops after penetration of the activator with the infected food or water. Patients complain of moderate pharyngalgias, the complicated swallowing. At survey of an almond are hyperemic, increased and edematous, soldered to surrounding cellulose. On their surface, a thicket on the one hand, the grayish-white necrotic plaques removed hardly are formed. It is expressed swelled palatal handles and a uvula. Further there is an almond fabric destruction to formation of the deep, slowly healing ulcers with the subsequent formation of a hem. Tulyaremiyny buboes arise in submaxillary, cervical and parotid areas, a thicket on the party of the struck almond.
Abdominal form. Develops owing to damage of mezenterialny lymph nodes. It is clinically shown by severe pains in a stomach, nausea, occasionally vomiting, anorexia. Sometimes diarrhea develops. At a palpation note morbidity about a navel, positive symptoms of irritation of a peritoneum are possible. As a rule, the hepatolienal syndrome forms. It is possible to palpate mesenteric lymph nodes seldom, their increase is established by means of ultrasonography.
Pulmonary form. Proceeds in the form of bronkhitichesky or pneumonic option.
* The Bronkhitichesky option is caused by damage of bronchial, mediastinal, paratracheal lymph nodes. Against the background of moderate intoxication there are dry cough, pains behind a breast, in lungs listen to dry rattles. Usually this option proceeds easily and comes to an end with recovery in 10-12 days.
* The pneumonic option is characterized by the acute beginning, the sluggish, exhausting current with high long fever. Pathology in lungs is clinically shown by focal pneumonia. Pneumonia is distinguished by quite heavy and acyclic current, tendency to development of complications (the segmented, lobulyarny or disseminated pneumonia which is followed by increase in above-mentioned groups of lymph nodes, bronchiectasias, abscesses, pleurisy, cavities, gangrene of lungs).
Generalized form. Clinically reminds tifo-paratyphoid infections or heavy sepsis. High fever becomes incorrectly remittiruyushchy, remains long. Intoxication symptoms are expressed: headache, oznoba, mialgiya, weakness. Confusion of consciousness, nonsense, hallucinations are possible. Pulse лабилен, cardiac sounds deaf, arterial pressure low. In most cases from the first days of a disease the hepatolienal syndrome develops. Further emergence of a resistant dieback of rozeolyozny and petekhialny character with localization of elements of rash on symmetric body parts - forearms and hands, shins and feet, on a neck and a face is possible. At this form development of the secondary buboes caused by a hematogenous disseminirovaniye of activators and metastatic specific pneumonia is possible.
Tularemia reasons:
The activator - the motionless gram-negative aerobic encapsulated bacteria of F. tularensis of the family Francisella of the Brucellaceae family. Show the expressed polymorphism; most often have the form small коккобацилл.
At bacteria allocate three subspecies:
1.nearktichesky (African);
2.sredneaziatsky;
3.golarktichesky (European-Asian).
The last includes three biological options: the Japanese biopitch, erythromycin - sensitive and erythromycin - steady. Intraspecific differentiation of the activator of a tularemia is based on distinctions of subspecies and biovar on a number of phenotypical signs: to biochemical activity, composition of higher fatty acids, pathogenicity degree for the person and animals, sensitivity to certain antibiotics, and also features of ecology and an area of the activator. Are found in bacteria About - and Vi-antigens. Bacteria grow on vitelline or agar mediums with addition of rabbit blood or other nutrients. From laboratory animals white mice and Guinea pigs are sensitive to infection. Out of the owner's organism the activator remains long. So, in water at 4 °C it keeps viability of 1 month, on straw and grain at a temperature is lower About °C - up to 6 months, at 20-30 °C - up to 20 days, in skins of the animals who fell from a tularemia at 8-12 "With - more than 1 month. Bacteria are unstable to high temperature and disinfectants. 5% phenol solution, corrosive sublimate 1:1000 solution (kills bacteria within 2-5 min.), 1-2% formalin solution (destroys bacteria for 2 h), 70 ° alcohol, etc. apply to disinfection. For full disinfecting of corpses of the infected animals them it is necessary to keep not less than 1 days in disinfecting solution then to subject to autoclaving and burning.
Treatment of the Tularemia:
Causal treatment provides the combined use of streptomycin on 1 g/days and gentamycin on 80 mg 3 times a day intramusculary. It is possible to appoint doxycycline on 0,2 g/days inside, Kanamycinum on 0,5 g 4 times a day and sisomicin on 0,1 g 3 times a day intramusculary. The course of treatment by antibiotics is continued till 5-7th day of normal body temperature. The second row of antibiotics includes generation cephalosporins III, rifampicin and levomycetinum.
Carry out disintoxication therapy, antihistaminic and antiinflammatory drugs (salicylates), vitamins, cardiovascular means are shown. Apply salve dressings, compresses, laser radiation, a diathermy to topical treatment of buboes and skin ulcers. At suppuration of a bubo carry out its opening and drainage.
Patients are written out from a hospital after clinical recovery. It is long not resolving and sclerosed buboes are not a contraindication for an extract.
