Infectious diseases. Tularemia. Etiology. Epidemiology. Pathomorphology and pathogenesis (most important)

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Infectious diseases. Tularemia. Etiology. Epidemiology. Pathomorphology and pathogenesis (most important)

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34. Tularemia. Etiology. Epidemiology. Pathomorphology and pathogenesis

Tularemia - a typical zoonosis, is a natural focal infectious disease that occurs with symptoms of general intoxication, fever and the development of specific lymphadenitis, less often without pronounced disorders. The causative agent is Francisella tularensis (Pasteurella tularensis).

Etiology. The causative agent of tularemia is a short Gram-negative immobile bacterium that does not have a capsule and does not form spores. When grown on nutrient media, the bacteria show pronounced signs of polymorphism. Working with cultures of the pathogen requires special care due to the risk of infection.

Epidemiology. The causative agent of tularemia has been isolated from one hundred different species of mammals and arthropods. Type A bacteria are commonly found in white-tailed rabbits and ticks. Type B is more characteristic of rats, mice, squirrels, beavers, nutmeg rats, moles, birds and ticks that parasitize them. Carriers of tularemia are fleas, lice, mosquitoes and horseflies.

The disease can occur in children who consume contaminated food (rabbit meat or proteins) or water. Often the disease occurs after being bitten by infected ticks, mosquitoes, or other carriers of the disease.

Pathomorphology and pathogenesis. A person becomes infected with tularemia when the pathogen penetrates through the affected or healthy skin, mucous membranes, with an insect bite, through the lungs or the gastrointestinal tract. After 48-72 hours, an erythematous, maculopapular formation appears on the skin at the site of bacteria penetration, rapidly ulcerating, and local lymphadenopathy. The causative agent multiplies in the lymph nodes and causes the formation of granulomas in them. Subsequently, bacteremia can develop, leading to the defeat of a variety of organs. Nevertheless, the most pronounced changes occur in the reticuloendothelial system.

With the inhalation route of infection, bronchopneumonia develops, less often lobar pneumonia. Inflammatory changes are localized in the places where bacteria settle, accompanied by necrosis of the walls of the alveoli. In some cases, bronchitis rather than pneumonia may occur after inhalation exposure.

The causative agent of tularemia, which has entered the lungs, is phagocytosed by alveolar macrophages and enters with them into the lymph nodes of the root of the lungs, and from there into the general circulation. Typhoid forms of tularemia are caused by aspiration of chewed contaminated food.

The factors that determine the virulence of the causative agent of tularemia have not yet been studied. F. tularensis does not produce exotoxin, and no relationship between virulence and antiphagocytic activity of individual strains of these bacteria was noted.

The causative agent of tularemia is an intracellular parasite that can persist for a long time in monocytes and other cells of the macroorganism, which creates the risk of a chronic course and subsequent exacerbations of the infection.

Author: Pavlova N.V.

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