|
Arabic
Bengali
Chinese
English
French
German
Hebrew
Hindi
Italian
Japanese
Korean
Malay
Polish
Portuguese
Spanish
Turkish
Ukrainian
Vietnamese|
Lecture notes, cheat sheets
Infectious diseases. Bacterial zoonoses: brucellosis, anthrax, tularemia, plague, psittacosis, yersiniosis. Etiology, epidemiology, pathogenesis, clinical picture, diagnosis, treatment (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 20. Bacterial zoonoses: brucellosis, anthrax, tularemia, plague, ornithosis, yersiniosis. Etiology, epidemiology, pathogenesis, clinic, diagnostics, treatment 1. Brucellosis Zoonotic infectious-allergic disease, with the manifestation of general intoxication, damage to the musculoskeletal system, nervous and reproductive systems. Etiology. Currently, six species of Brucella are known. The main carriers are goats, sheep, cattle, pigs. Brucella are microorganisms that have a spherical shape, their size is 0,3-0,6 nm. Gram-negative and grow on normal nutrient media. Under the influence of antibiotics, they are able to transform into L-forms. Brucella are characterized by a high capacity for invasion and intracellular parasitism. As they break down, endotoxin is released. The resistance of the pathogen in the external environment, as well as in food products (milk, cheese) is characteristic. High temperatures lead to death when boiled. Low temperatures contribute to the preservation of a long time. They die quickly when exposed to direct sunlight and common disinfectants. Epidemiology. The focus of infection is large and small cattle. For infection, the alimentary or contact route is characteristic. Immunity is not strained and short-lived, on average lasts 6-9 months, is not strictly specific. Pathogenesis. For infection, the alimentary route or microdamages of the skin are characteristic (during assistance with calving, lambing, etc.). The spread of the pathogen occurs throughout the body by the hematogenous route, which is the cause of allergopathy and the formation of foci in various organs and systems. Clinic. The duration of the incubation period ranges from 6 to 30 days. Brucellosis is characterized by polymorphism of clinical manifestations. In some infected people, a primary latent form occurs without clinical symptoms, the manifestation of which is characterized by immunological reactions. For others, the course of the disease occurs in acute (acuteseptic) or chronic (primary chronic metastatic and secondary chronic metastatic) forms. From the moment the clinical symptoms disappear (while Brucella remains in the body), the disease transitions into a secondary latent form, which can again lead to an exacerbation and again turn into one of the chronic forms when the body weakens. The acute form of brucellosis is characterized by high fever (up to 40 °C), during which patients feel well (sometimes they even remain able to work). There is a moderate headache, repeated chills, increased sweating, and fatigue. All groups of peripheral lymph nodes (micropolyadenitis), liver, and spleen are moderately enlarged. At the end of the prodromal period, the symptoms of intoxication increase, and at the height of the disease there is a temperature of remitting type with a rise in the afternoon or in the evening hours. As the toxic-septic process develops, changes in the respiratory system such as catarrhal inflammation of the upper respiratory tract, bronchitis, bronchopneumonia, and bronchoadenitis are revealed. When the nervous system is damaged in the midst of an acute form of the disease, headaches, irritability, emotional instability, and sleep disturbances are present. In severe cases, mental disorders, the phenomena of meningism and meningitis are observed. The course of meningitis is sluggish, without pronounced cerebral and meningeal symptoms. In the case of chronic forms, against the background of subfebrile (less often febrile) temperature and reticuloendotheliosis (micropolyadenitis, enlarged liver and spleen), various organ changes appear. Large joints (periarthritis, arthritis), muscles (myositis), peripheral nervous system (mono- and polyneuritis, radiculitis, plexitis), and reproductive system (orchitis, oophoritis, endometritis, spontaneous abortion) often occur. The course of chronic forms of brucellosis is long, exacerbations are replaced by remissions. In some patients, even after sanitization of the body from Brucella, there may be persistent residual effects (residual brucellosis). Diagnosis is based on epidemiological data and characteristic clinical manifestations. Differential diagnosis should be made with sepsis, malaria, tuberculosis, rheumatoid arthritis. Specific reactions that are used include the Wright, Huddleson, intradermal allergy test with brucellin (Burnet test). Treatment. In the acute form, the main is etiotropic therapy, the duration of which is up to 3-4 weeks. Antibiotics of the tetracycline group, streptomycin, levomycetin, rifampicin are prescribed. In chronic forms, a complex of restorative therapeutic measures is carried out simultaneously with vaccine therapy. For the purpose of immunocorrection, various immunomodulators are prescribed. Sanatorium treatment can be carried out no earlier than 6 months after the disappearance of the clinical symptoms of brucellosis. The prognosis for life is favorable, but often the disease is the cause of partial disability. Prevention. Control of brucellosis in farm animals. Specific prevention is achieved by using a live anti-brucellosis vaccine, which provides immunity for 1-2 years. Vaccination is carried out in areas where there is an incidence of brucellosis among animals. Persons at risk (caring for farm animals and workers in enterprises processing livestock products) are subject to immunoprophylaxis. 2. Anthrax An acute infectious disease from the group of zoonoses, characterized by intoxication, the development of serous-hemorrhagic inflammation of the skin, lymph nodes and internal organs and occurring in the form of a cutaneous (or septic) form. In humans it occurs in the form of skin, pulmonary, intestinal and septic forms. Etiology. The causative agent is a relatively large anthrax gram-positive bacillus that forms spores and a capsule. The death of the vegetative form of the pathogen occurs without air access, during heating, exposure to disinfectants. In the external environment, the spores of the pathogen are very stable. Epidemiology. The focus of infection are cattle. It is most often transmitted by contact, less often by alimentary, airborne dust. Pathogenesis. The entry point for the anthrax pathogen is usually damaged skin. At the site of penetration of the pathogen into the skin, an anthrax carbuncle appears in the form of a focus of serous-hemorrhagic inflammation with necrosis, edema of adjacent tissues, and regional lymphadenitis. The local pathological process is caused by the action of anthrax exotoxin, individual components of which cause severe microcirculation disorders, tissue edema and coagulative necrosis. Further generalization of anthrax pathogens with their breakthrough into the blood and the development of a septic form rarely occurs in the cutaneous form. Clinic. The duration of the incubation period ranges from several hours to 14 days (usually 2-3 days). The most common form of anthrax in humans occurs in the form of a cutaneous form (95-99% of cases) and only in 1-5% of patients in the form of pulmonary and intestinal. The characteristic manifestations of cutaneous anthrax occur at the site of infection. Initially, a red itchy spot appears, quickly turning into a papule, and the latter into a vesicle with transparent or hemorrhagic contents. Continued itching leads to the patient's rupture of the vesicle, in its place an ulcer with a dark bottom and copious serous discharge is formed. Along the periphery of the ulcer, an inflammatory ridge develops, in the area of which daughter vesicles form. At the moment, swelling (can be quite extensive) and regional lymphadenitis develop around the ulcer. There is no sensitivity in the area of the bottom of the ulcer; in addition, there is no pain in the area of enlarged lymph nodes. By the time the ulcer forms, a fever appears, the duration of which is 5-7 days, general weakness, headaches, fatigue, and adynamia are observed. Local changes in the affected area increase over approximately the same period as fever, and then a reverse development occurs: first, a decrease in body temperature is observed, the removal of serous fluid from the necrosis zone ceases, a decrease (until complete disappearance) of edema begins, and gradually at the site of necrosis a scab forms. On the 10-14th day, the scab is rejected, leading to the formation of an ulcer with a granulating bottom and moderate purulent discharge, followed by scarring. The pulmonary form of anthrax is characterized by an acute onset and severe course. Manifested by chest pain, shortness of breath, tachycardia (up to 120-140 beats per minute), cyanosis, cough with foamy bloody sputum. Body temperature quickly reaches febrile levels (1 °C and above), blood pressure decreases. The intestinal form of anthrax is characterized by the manifestation of general intoxication (fever, pain in the epigastric region, diarrhea and vomiting). Abdominal bloating, severe pain on palpation are also characteristic, and there are often signs of peritoneal irritation. An admixture of blood appears in the vomit and intestinal discharge. Any of the described forms of anthrax can lead to the development of sepsis with bacteremia and secondary foci (damage to the liver, spleen, kidneys, meninges). Diagnosis is based on epidemiological data (the patient's profession, contact with sick animals or contaminated raw materials of animal origin) and characteristic clinical skin lesions. Laboratory proof of the diagnosis is the isolation of the causative agent of anthrax. An allergic test with anthraxin has an auxiliary effect. Differential diagnosis is carried out with glanders, boils, plague, tularemia, erysipelas. Treatment. In mild forms of the disease, penicillin is prescribed at a dose of 200-000 IU 300-000 times a day for 6-8 days. An increase in a single dose of penicillin is carried out in extremely severe forms with a septic component up to 5-7 IU 1-500 times a day. The most effective is the treatment with antibiotics in combination with a specific antiulcer immunoglobulin at a dose of 000-2 ml / m. Cancellation of antibiotics occurs after a significant decrease in edema, cessation of the increase in the size of skin necrosis and separation of fluid from the affected area. The removal of the patient from infectious-toxic shock in severe forms of anthrax is facilitated by intensive pathogenetic therapy. The prognosis for the skin form and with timely treatment is favorable. With intestinal and pulmonary forms, the prognosis is questionable even in the case of early and intensive treatment. Prevention. A patient with anthrax is hospitalized in a separate ward with the issuance of individual care items, linen, dishes. Allocations of patients (feces, urine, sputum), as well as dressings, are disinfected. The patient can be discharged after complete clinical recovery with epithelialization of ulcers. When recovering from the transfer of intestinal pulmonary forms, the patient is discharged after a double negative bacteriological examination of feces, urine and sputum for the presence of anthrax. 3. Tularemia An acute infectious disease, the signs of which are an increase in body temperature, symptoms of general intoxication, damage to the lymphatic system, skin, mucous membranes, and in case of aerogenic infection - lung tissue. Tularemia refers to zoonoses with natural foci. The prevalence is observed in many regions of Russia, many types of rodents serve as a source of infection. Etiology. The causative agents are small cocci-like rods with a thin capsule, gram-negative, not forming spores. Contain two antigenic complexes: shell and somatic. Resistant in the external environment, slightly resistant to drying, ultraviolet rays, disinfectants. Epidemiology. Tularemia has multiple portals of infection. The pathogen is transmitted to humans through transmissible, contact, and aspiration routes. The following routes of infection are distinguished: through the skin (contact with infected rodents), the transmission mechanism is through ticks, mainly ixodid, in addition, there is a route of transmission through the mucous membranes of the digestive tract when consuming contaminated water and food and the respiratory tract (inhalation of infected dust). The clinical forms of the disease are closely related to the portal of infection. With the contact and transmissible mechanism of infection, bubonic and cutaneous-bubonic forms of the disease appear, with aspiration - pneumonic, with alimentary - intestinal and anginal-bubonic forms of this infection. When infected through the conjunctiva, the oculobubonic form develops. After surviving the disease, immunity is formed. Pathogenesis. The causative agent of tularemia enters the human body through damaged skin, mucous membranes of the eyes, respiratory tract, gastrointestinal tract, and its lymphogenous spread occurs. The entry of bacteria into regional lymph nodes and their proliferation cause a picture of inflammatory changes. When bacteria die, endotoxin is released, which enhances the local pathological process, and when it enters the bloodstream, it causes symptoms of intoxication. Specific tularemia granulomas are formed in the lymph nodes of the affected internal organs. Under microscopy, areas of necrosis are visible in the center, surrounded by epithelioid cells and a shaft of lymphoid elements with a small number of leukocytes. When the buboes suppurate and open, a long-term non-healing ulcer appears on the skin. Clinic. The incubation period lasts from several hours to 14 days (usually 3-7 days). The disease has an acute onset and is manifested by chills, a rapid increase in body temperature to febrile levels. Patients complain of severe headache, weakness, muscle pain, insomnia, and possibly vomiting. The skin of the face and neck is hyperemic, the vessels of the sclera are injected. In some patients, from the 3rd day of illness a rash appears, often of an erythematous nature. In bubonic forms, regional lymph nodes, especially cervical and axillary ones, are significantly enlarged. In abdominal forms, symptoms of acute mesadenitis may occur. With tularemic buboes, there is no periadenitis; the buboes fester rarely and at a later stage (at the end of the 3rd week of the disease). The duration of fever ranges from 5 to 30 days (usually 2-3 weeks). During the period of convalescence, prolonged low-grade fever may persist. The oculobubonic form, in addition to the typical damage to the lymph node, is characterized by pronounced conjunctivitis with swelling of the eyelids and ulcers on the conjunctiva. Usually one eye is affected. The process lasts up to several months, vision is completely restored. In the anginal-bubonic form, in addition to the presence of typical buboes, specific tonsillitis is observed in the form of pain when swallowing with necrotic changes on the tonsils, palatine arches, and the appearance of fibrinous plaque on the affected areas, reminiscent of diphtheria. Ulcers heal very slowly. The abdominal form is characterized by abdominal pain, flatulence, constipation, and tenderness in the area of the mesenteric lymph nodes upon palpation. The pulmonary form of tularemia is characterized by prolonged fever of the wrong type with repeated chills and profuse sweating. Patients experience pain in the chest area, complain of a cough, initially dry, then with the presence of mucopurulent and sometimes bloody sputum. X-ray is determined by focal or lobar infiltration of the lung tissue. Pneumonia has a sluggish, protracted course (up to 2 months or more) and a tendency to recur. Diagnosis of tularemia at the onset of the disease before the appearance of buboes is quite difficult. When buboes appear, diagnosis becomes easier. To confirm the diagnosis, serological methods are used - agglutination reaction, RNHA and specific skin tests with tularin. The differential diagnosis is carried out with the bubonic form of the plague, with the disease of cat scratches and purulent lymphadenitis. Treatment. Antibiotics are prescribed: streptomycin IM 0,5 g 2 times a day, tetracycline 0,4 g every 6 hours or chloramphenicol 0,5 g every 6 hours. Antibiotic therapy is carried out until the 5-7th day of normal temperature. In case of a prolonged course of the disease, killed tularemia vaccine is used (in a dose of 1 to 15 million microbial bodies at intervals of 3-5 days, a total of 6-10 sessions). If a symptom of fluctuation appears during palpation of the buboes, their opening and cleansing of pus is indicated. The prognosis is favorable. Prevention. Rodent control, protection of food and water from them. According to epidemiological indications, specific prophylaxis is carried out in some cases. 4. Plague An acute infectious disease caused by the plague bacillus - Yersinia pestis. A natural focal disease, it is a particularly dangerous infection. There are several natural foci on earth where plague is constantly observed in a small number of rodents living there. Epidemics of plague among people were often caused by the migration of rats infected in natural foci. The transmission of microbes from rodents to humans is carried out by fleas, which, in the event of mass death of animals, look for a new host. In addition, one of the methods of infection is infection when people process the skins of infected animals. The method of transmission of infection from person to person, carried out by airborne droplets, is fundamentally different. Etiology. The causative agent of plague is a small, immobile rod. It is a facultative anaerobe, does not form spores, is gram-negative, is highly resistant in the external environment, can persist in soil for up to 7 months, on clothing for 5-6 months, in milk for 3 months, and is stable at low temperatures and freezing. It is destroyed immediately when boiled, and at 55 ° C - in 10-15 minutes. It is quickly destroyed by disinfectants and is sensitive to antibiotics of the streptomycin and tetracycline series. Contains about 30 antigens, including heat-stable somatic and heat-labile capsular. Epidemiology. The hosts of the plague are rodents (marmots, ground squirrels). Plague refers to diseases with pronounced natural foci. A person, getting into a natural focus, can be exposed to the disease through the bites of blood-sucking arthropods. In rodents that hibernate during the cold season, plague occurs in a chronic form. A person becomes infected with the plague microbe in several ways: through the bites of infected fleas, by contact (when removing the skins of infected commercial rodents), by the alimentary route (by eating foods contaminated with bacteria), by aerogenic route (from patients with pneumonic plague). Pathogenesis. The pathogen enters the body through damage to the skin with a flea bite, mucous membranes of the respiratory tract, digestive system, conjunctiva. When a person is bitten by an infected insect, a papule or pustule is formed at the site of the bite, filled with hemorrhagic contents (in the case of a cutaneous form). Further, the infection spreads through the lymphatic vessels without the manifestation of lymphangitis. Bacteria proliferate in the macrophages of the lymph nodes, leading to the massive enlargement, fusion, and agglomeration that is characteristic of the bubonic form. Further generalization of the infection, which does not always develop, can lead to the development of a septic form, which is characterized by damage to almost all internal organs. From the point of view of epidemiology, screening of the pathogen into the lung tissue plays an important role, which leads to the pulmonary form of the disease. The development of this pneumonia leads to the fact that a sick person becomes a source of infection, but at the same time transmits the pulmonary form of the disease to other people. It is extremely dangerous, characterized by a lightning-fast course. Clinic. With the bubonic form of plague, sharply painful conglomerates appear, most often in the inguinal lymph nodes on one side. The incubation period ranges from 2 to 6 days (less often 1-12 days). The disease begins acutely, with an increase in body temperature to 39 °C, chills, a feeling of heat, myalgia, headache, and dizziness. The appearance of the patient is also characteristic: the face and conjunctiva are hyperemic, the lips are dry, the tongue is swollen, dry, trembling, covered with a dry, thick white coating. The patient's speech is unintelligible, blurred, the patient is inhibited or excited, delusions and hallucinations appear, coordination of movements is impaired, and a feeling of fear arises. Over the course of a few days, the conglomerate increases in size, and the skin over it often becomes hyperemic. At the same time, other lymph nodes—secondary buboes—enlarge. The lymph nodes in the primary focus soften, when they are punctured, purulent or hemorrhagic contents are obtained, which, upon microscopy, reveals a large number of gram-negative rods with bipolar staining. If antibacterial therapy is not used, the festering lymph nodes are opened and the fistulas gradually heal. The condition of patients gradually worsens by the 4-5th day, the temperature may rise, sometimes to febrile levels, but nevertheless, at first, patients may feel satisfactory. But at any moment the bubonic form can become a generalized process and turn into a secondary septic (or secondary pulmonary form). In these cases, the condition of the patients very quickly becomes extremely serious. Symptoms of intoxication increase very quickly. The temperature is accompanied by severe chills and rises to febrile levels. All signs of sepsis are observed: muscle pain, severe weakness, dizziness, congestion of consciousness, up to its loss, headaches, often agitation and sleep disturbance. With the addition of pneumonia, cyanosis and shortness of breath increase, and a cough occurs with the release of foamy, bloody sputum containing a large number of plague bacilli. It is this discharge that becomes the source of infection from person to person with the development of the primary pulmonary form. Septic and pneumonic forms of plague have all the signs of sepsis and occur with symptoms of disseminated intravascular coagulation syndrome: minor hemorrhages on the skin, gastrointestinal bleeding (vomiting of bloody masses, melena), severe tachycardia, and a rapid drop in blood pressure are possible. Auscultation shows all the signs of bilateral focal pneumonia. Diagnosis. The most important role in the diagnosis of plague in modern conditions is played by epidemiological anamnesis. Arrival from zones endemic for this disease (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpak ASSR, etc.), or from anti-plague stations of a patient with the signs of the bubonic form described above or with signs of the most severe (with hemorrhages and bloody sputum) pneumonia with severe lymphadenopathy is a serious enough argument for the doctor of the first contact to take all measures to localize the alleged plague and accurately diagnose it. It is important that under the conditions of modern medical prophylaxis, the probability of illness of medical personnel in contact with a coughing plague patient is very small. Currently, there are no cases of primary pneumonic plague among medical personnel. Diagnosis is based on bacteriological studies. Materials for bacteriological examination are punctate from a festering lymph node, sputum, blood, discharge from fistulas and ulcers. Laboratory diagnostics is carried out using fluorescence microscopy methods. In this case, a fluorescent specific antiserum is used, which stains the taken material. Treatment. If plague is suspected, the patient is immediately hospitalized in the isolation ward of the infectious diseases hospital. However, in certain cases, it is more advisable to carry out hospitalization (before establishing an accurate diagnosis) in the institution where the patient is at the time of making the preliminary diagnosis. Therapeutic measures and prevention of infection of personnel must be combined. Personnel should immediately put on anti-plague suits or three-layer gauze masks, shoe covers, scarves made of two layers of gauze that completely cover the hair, and protective glasses to prevent splashes of sputum on the mucous membrane of the eyes. All personnel who had contact with the patient continue to provide assistance. A special medical post isolates the compartment in which the patient and the personnel treating him are located from contact with other patients and personnel. The compartment should have a toilet and a treatment room. All personnel urgently undergo prophylaxis with antibiotics throughout all days of their stay in the isolation ward. In the bubonic form of plague, the patient is prescribed intramuscular streptomycin 3-4 times a day. (daily dose 3 g), tetracycline antibiotics IV 6 g/day. In case of severe intoxication, saline solutions and hemodez are administered intravenously. When blood pressure decreases, which is regarded as a sign of sepsis in this form of the disease, resuscitation measures are carried out (administration of dopamine, installation of a permanent catheter). In pneumonic and septic forms of plague, the dose of streptomycin is increased to 4-5 g/day, and tetracycline - up to 6 g. In forms resistant to streptomycin, it is replaced with chloramphenicol succinate up to 6-8 g/day. i.v. If the dynamics are positive, the dose of antibiotics is reduced: streptomycin - to 2 g/day. until the temperature normalizes, but for at least 3 days, tetracyclines - up to 2 g/day. daily orally, chloramphenicol - up to 3 g/day, in the amount of 20-25 g. Biseptol is also used with great success in the treatment of plague. In case of pulmonary, septic forms of development of hemorrhage, they immediately begin to relieve disseminated intravascular coagulation syndrome: plasmapheresis is performed (intermittent plasmapheresis in plastic bags can be carried out in any centrifuge with special or air cooling with a container capacity of 0,5 l or more) in the volume of removed plasma 1-1,5 liters when replaced with the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, daily infusions of fresh frozen plasma are necessary. Plasmapheresis is performed daily until the acute signs of sepsis disappear. Relief of hemorrhagic syndrome and stabilization of blood pressure in sepsis are indications for stopping plasmapheresis sessions. The effect of plasmapheresis in the acute period of the disease is observed almost immediately, the symptoms of intoxication decrease, the dose of dopamine decreases, muscle pain becomes less intense, and shortness of breath decreases. The medical team must include an intensive care specialist. Forecast. In modern conditions of therapy and diagnosis, mortality in the bubonic form does not exceed 5-10%, but in other forms the recovery rate is high if treatment is started in a timely manner. If plague is suspected, the sanitary and epidemiological station of the area is urgently notified. The notification is filled out by the doctor who suspects the presence of the disease, and its forwarding is ensured by the chief physician of the institution where the patient was found. 5. Ornithosis An acute infectious disease caused by chlamydia. It manifests itself in the form of fever with general intoxication, damage to the pulmonary system, central nervous system, hepato- and splenomegaly. Refers to zoonotic infections. The reservoir of infection and the source of infection are domestic and wild birds. The disease is most often recorded in the cold season. It was revealed that 10-20% of all acute pneumonias have ornithosis etiology. Etiology. The causative agent - chlamydia - is an obligate intracellular parasite, has a coccal shape and shell and is sensitive to some antibiotics (tetracycline, chloramphenicol). Chlamydia develop intracellularly, forming cytoplasmic inclusions. In the external environment, they remain up to 2-3 weeks. They die when heated and exposed to ultraviolet rays. Epidemiology. Birds are the reservoir and source. The transmission mechanism is aerogenic, the main ways of infection are airborne, airborne. Human infection occurs through contact with sick birds. The transferred disease leaves unstable immunity. Pathogenesis. The site of infection is predominantly the mucous membrane of the respiratory tract: infection occurs through airborne dust. Often the pathogen invades the small bronchi and bronchioles, causing peribronchial inflammation. The pathogen penetrates into the blood at high speed, causing symptoms of general intoxication and damage to various organs - the liver, spleen, nervous system, adrenal glands. Less commonly, the mucous membrane of the digestive tract serves as the gateway to infection. In these cases, chlamydia also penetrates into the blood, causing severe intoxication, hepato- and splenomegaly, but secondary hematogenous pneumonia does not develop. As a result, the disease proceeds atypically, without affecting the lungs. In some cases, chlamydia penetrates the central nervous system, causing a picture of serous meningitis. Clinic. The incubation period lasts from 6 to 17 days (usually 8-12 days). Pneumonic forms of psittacosis have an acute onset with fever and symptoms of general intoxication, which at a later stage are joined by signs of damage to the respiratory system. In most patients, the temperature reaches febrile levels, accompanied by chills, severe headache, pain in the muscles of the back and limbs, weakness, vomiting and nosebleeds are possible. On the 2-4th day of illness, signs of lung damage become noticeable: a dry cough appears, sometimes stabbing pain in the chest. After 1-3 days, the release of scanty mucous or mucopurulent sputum begins, sometimes mixed with blood. On examination, pallor of the skin, absence of pronounced symptoms of damage to the upper respiratory tract, decreased blood pressure, bradycardia, and muffled heart sounds are noted. In most patients, the lower parts of the lungs are affected, most often on the right. A shortening of the percussion sound over the affected area is determined, dry and fine moist rales are heard, and in some patients there is a pleural friction noise. Radiographs reveal peribronchial and parenchymal changes characteristic of focal and segmental pneumonia. At the end of the first week, hepato- and splenomegaly are detected in half of the patients. The duration and severity of individual symptoms are determined by the severity of the disease. In mild forms, intoxication is moderate, and the fever lasts 2-5 days; in severe forms, it can reach a month. The fever is of the wrong type with large daily fluctuations, repeated chills and profuse sweat, sometimes wavy. During the period of convalescence, asthenic syndrome with impaired ability to work persists for a long time (in severe forms up to 2-3 months). During the period of early convalescence, relapses and complications (myocarditis, thrombophlebitis) may occur. In some patients, the disease becomes chronic. The atypical course of acute ornithosis is manifested by meningeal syndrome, which can occur against the background of ornithosis pneumonia (meningopneumonia), or serous meningitis with a long course (with fever for up to a month, sanitation of the cerebrospinal fluid after 2 months). Sometimes ornithosis occurs in the form of an acute febrile illness with severe intoxication, hepato- and splenomegaly, but without signs of damage to the respiratory system. differential diagnosis. When diagnosing, it is necessary to differentiate with pulmonary tuberculosis and pneumonia of another etiology: meningeal forms are differentiated from tuberculous and viral meningitis. Confirmation of the diagnosis is the presence of specific antibodies (titer 1:16 - 1:32 and above) in paired sera. Treatment. Assign tetracyclines 0,3-0,5 g 4 times a day until the 4th-7th day of normal temperature. If suspected and there are signs of an incomplete pathological process, tetracycline continues to be taken until the 9-10th day of normal temperature. You can prescribe chloramphenicol, erythromycin with intolerance to the tetracycline group, but they are less effective. Penicillin, streptomycin and sulfanilamide preparations do not have a therapeutic effect in ornithosis. Pathogenetic therapy is used: bronchodilators, oxygen therapy. Complications: myocarditis. The prognosis is favorable. Prevention. Fighting disease in birds, regulating the number of pigeons, limiting their contact with people, observing the rules for processing poultry meat. The patient is not contagious to others. 6. Yersiniosis Acute infectious disease related to zoonoses. The main route of human infection is alimentary. A sick person does not pose a danger to others. Etiology. The pathogen (Yersinia) is similar in its properties to the pathogens of plague and pseudotuberculosis. Yersinia is divided into five biotypes, ten phagotypes, and according to the 0-antigen - more than thirty serotypes. Biotypes 2, 4, serotypes 3, 5, 8, 9 are of greatest importance in the structure of human morbidity. The microorganism is characterized by polymorphism, bipolar coloring, gram-negative, does not form capsules or spores. Can exist at a temperature of +5 °C. Highly sensitive to antibacterial drugs (chloramphenicol, tetracyclines, aminoglycosides). Pathogenesis. The pathogen enters the body in the lower parts of the small intestine, where terminal ileitis begins to develop, there may be ulceration. In the lymphogenous way, the pathogen reaches the mesenteric lymph nodes, where lymphadenitis is formed with a tendency to abscess formation. Clinic. The incubation period is from 15 hours to 4 days (usually 1-2 days). The main clinical forms are: 1) gastroenterocolitic; 2) appendicular; 3) septic; 4) subclinical. The disease begins acutely, with an increase in body temperature to 38-40 °C. Fever lasts up to 5 days, with septic forms longer. There are symptoms of general intoxication (chills, headache, muscle and joint pain). In the gastroenterocolitic form, against this background, pain appears in the abdomen of a cramping nature, mainly in the lower parts on the right or in the navel area. Nausea and vomiting may be present, loose stools with an unpleasant odor, up to 10 times a day, may contain pathological impurities in the form of mucus (usually there is no blood). Unlike dysentery, there is no tenesmus, the sigmoid colon is not spasmodic and painless. In the appendicular form, symptoms of appendicitis (sometimes purulent) occur. The septic form can develop in weakened patients, occur with attacks of fever of the wrong type, with repeated chills, profuse sweating, hepato- and splenomegaly, increasing signs of anemia, jaundice of the skin. This form is fatal. Diagnostics. In the blood test - leukocytosis, ESR increased. Laboratory confirmation of the diagnosis is the isolation of the pathogen from various environments of the body: from feces, blood, pus, removed appendix, and also RNGA. Yersiniosis must be distinguished from gastroenterocolitis of various etiologies (dysentery, escherichiosis, salmonellosis), appendicitis, pseudo-tuberculosis. Treatment. Antibacterial drugs are used: levomycetin (0,5 g 3-4 times a day), tetracyclines (0,3-0,4 g 4 times a day) for 5-7 days. Prevention. See Salmonella. Author: Gavrilova N.V. << Back: Protozoal infections: malaria, toxoplasmosis. Etiology, epidemiology, clinic, treatment (Malaria. Toxoplasmosis) >> Forward: Hemorrhagic fever. Etiology, epidemiology, pathogenesis, clinic, diagnostics, treatment
▪ Metrology, standardization and certification. Lecture notes ▪ Intellectual property right. Crib ▪ Obstetrics and gynecology. Crib
The existence of an entropy rule for quantum entanglement has been proven
09.05.2024 Mini air conditioner Sony Reon Pocket 5
09.05.2024 Energy from space for Starship
08.05.2024
▪ Jaybird Run Sports Wireless Headphones ▪ Butter is recognized as a harmful product ▪ Transparent and stretchable lithium-ion battery
▪ site section Frequency synthesizers. Selection of articles ▪ article Free labor of freely assembled people. Popular expression ▪ article Which world famous cosmetologist opened his first store in Ryazan? Detailed answer ▪ article Bandages on upper and lower limbs. Health care ▪ The handkerchief is tied up again. Focus Secret
Home page | Library | Articles | Website map | Site Reviews
www.diagram.com.ua |
We recommend interesting articles Section 
See other articles Section 
Latest news of science and technology, new electronics:
All languages of this page