Infectious diseases. Tularemia. Clinic. Diagnostics. Treatment (most important)

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Infectious diseases. Tularemia. Clinic. Diagnostics. Treatment (most important)

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35. Tularemia. Clinic. Diagnostics. Treatment

Clinical manifestations. The incubation period for tularemia varies from a few hours to 1 week. The disease begins acutely with an increase in body temperature up to 40-41 ° C, chills, pain in the muscles and joints, nausea, vomiting and sweating. Headaches are often very severe, but in young children they are usually absent. Sometimes there is photophobia, a maculopapular rash appears. Mild anemia may develop. The number of leukocytes in the peripheral blood may be within the normal range, increased or decreased, ESR may not change. There is transient proteinuria.

Primary changes on the skin with ulcerative-glandular form of tularemia during the first 3 days are maculopapular in nature. By the 4-5th day of illness, they ulcerate and become painful. Healing occurs within 4 weeks. Lymphangitis around the ulcers is usually absent. Enlarged regional lymph nodes are dense, sensitive, in 25% of cases, if left untreated, they melt.

The oropharyngeal form of tularemia is characterized by the development of purulent tonsillitis and pharyngitis, and sometimes ulcerative stomatitis. The general manifestations of the disease are the same as in the ulcerative glandular form.

The glandular form of tularemia does not differ from the ulcerative glandular, a characteristic feature is the absence of changes in the skin and mucous membranes. The oculoglandular form of tularemia is similar to the cutaneous glandular one, but the primary lesion in it is represented by severe conjunctivitis and an increase in regional lymph nodes.

The typhoid form of tularemia resembles typhus. The febrile state is kept for a long time, changes on the skin and mucous membranes may be absent. There are dry cough, severe chest pain, hemoptysis. The clinical picture of bronchitis, pneumonitis or pleurisy is observed in 20% of patients. In most patients in these cases, X-ray examination reveals the involvement of lung tissue and pleura in the process, an increase in the lymph nodes of the lung root. Often noted splenomegaly, sometimes an increase in the liver.

Diagnosis. For the diagnosis of tularemia are of great importance:

1) allergic (intradermal, dermal) test with tularin, which is put according to the type of Pirquet and Mantoux reactions. The reaction is recorded after 1-2 days and is considered positive in the presence of infiltrate and hyperemia of at least 0,5 cm;

2) serological RA with high specificity, but the late appearance of agglutinins in the blood reduces their value as an early diagnostic method; as well as RPHA and ROP - strictly specific and reliable for the diagnosis of tularemia and the retrospective diagnosis of this infection;

3) bacteriological diagnostic methods. Treatment. Positive results are obtained with treatment with streptomycin, as well as tetracycline and chloramphenicol, however, when treating the latter, relapses often occur, requiring repeated courses of treatment with tetracycline.

Author: Pavlova N.V.

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