Brucellosis - Causes, Symptoms and Treatment .MF .
Brucellosis (Malta fever, Cyprus fever Gibraltar, undulating fever, Bruce's disease, Bang's disease) - a disease that is a zoonotic bacterial infection, with high potential for chronic, characterized by a variety of symptoms, but most often there is a defeat of the musculoskeletal systemand peripheral nervous system, and runs on the background obscheintoksikatsionnogo and fever.
Initially, one of the scientists (Martson in 1856) observed an unknown fever with accompanying symptoms on the island of Malta, and therefore gave it the name "Maltese fever", the same scientist has found that the main source of the disease are sheep and goats, as well infection occurswhen using raw milk.In the future, there were those who showed the same fever later, and called his name this fever - whether from lust vanity, whether due to ignorance (scientist Bruce et al 1887).But also there were some scientists who supplemented with data on the "Maltese fever»:
• Wright and Semple found that serum from patients with brucell
• Other scientists infectious abortions were recorded due to this disease.The causative agent of brucellosis
Activators - some microorganisms of the genus Brucella (Brucella melintensi, abortus, suis, canis and others).Pathogens are intracellular parasites, gram-negative (ie, staining give a pink color that has diagnostic value in microscopy).The dispute and capsules do not form, but in spite of the absence of these structures, it is not pleading their resistance and virulence (degree of pathogenicity).
causative agent of brucellosis
Pathogens are strict aerobes (ie for their reproduction needs oxygen) and beskilorodnoy environment does not grow, and for good growth when grown on nutrient media require increased concentration of SO₂, in the diagnosis, namely bacteriological sowing, you need to create the optimum laboratory (in addition to the gas composition of the selected temperature), and even after a long wait the beginning rosta≈2-4 week.Brucella Tk belong to dangerous pathogens, and the laboratory diagnosis carried out in the well-equipped specialized laboratories, appropriate prevention requirements.
structural features characterize the virulence of specific and include:
• The ability to inhibit phagocytosis (the true cause of this factor is poorly understood), but it allows you to be available for brucella antibodies and antimicrobials.
• The ability to move in an L-shape (partial or complete deprivation of the cell wall maintaining pathogenic, ie the ability of malware, which is activated by the creation of an enabling environment; In this form of the bacterium is as though in his lifetime condition).This transformation is the result of incomplete phagocytosis and the inability of antibacterial drugs completely destroy the pathogen.
• High capacity for invasion (introduction) and intracellular parasitism, especially in the lymphocyte and oraganah CMF (the system of mononuclear phagocytes) due to well protected from phagocytosis and, as a consequence, there is a failure in the immune system and allergic alteration, which in itsturn entails the formation of secondary foci of infection in the internal organs with further morphological and functional (violation of the structure and function) changes and chronic infections due to the possibility of a longer stay in the state of conservation of the pathogen.
• The presence of endotoxin, which is only released when the dominant phagocytic activity (ie where phagocytosis takes precedence) obscheintoksikatsionnye and causes symptoms.
• High enzymatic capacity: allocation of H₂S (hydrogen sulphide gas, which in various concentrations can have both anti-inflammatory and cytotoxic effect).Capable of forming phosphatase (involved in the process of calcification, and that may explain the proliferation of bone and joint arthrosis appearance).Produces urease (an enzyme catalyzing the decomposition of urea to NH₃ and SO₂, which plays a role in the formation of intoxication syndrome).Forms catalase (an enzyme that breaks N₂O₂ to N₂O and O₂ - perhaps it prevents oxidative burst).
• Weak hyaluronidase activity causes a disconnect between the connective tissue cells in organs and tissues, it leads to the deconstruction of their tissues and subsequent dysfunction.
• Under normal conditions in the environment and food products is maintained for a long time:
- in water and more than 2 months brynze-
- yogurt - to 11 days
- milk - 40 days
- in hard cheeses -1 year
- raw milk - 3 months
- salted meat - 1 month
- wool - 4 months
- oil - 5 months
• At low temperatures - up to several years
• At high temperatures: 60 ° C to 30 minutes,100 ° C (boiling) - instantaneous death.
• UVB and disinfecting solutions also are instantly fatal.
Brёtsellёz prevalent in many countries around the world registered about 500,000 cases per year.But there are danger zones geographically, ie a potentially dangerous risk attributed to them: the Republic of Dagestan, the Krasnodar and Stavropol Territories, the Southern Urals, Altai and Tuva Republic - a territory with livestock-oriented agriculture.
high susceptibility and pervasive, no age and gender restrictions, with the infectious dose is low and amounts to 10-100 microbial bodies.
Causes of brucellosis infection
Source - livestock (sheep, goats, cows, pigs, dogs).Modes of transmission - contact, alimentary, aerogenic.Contact path is professional in nature, because the infection occurs by ingestion of amniotic fluid in the open areas of the body (when calving, caring for newborn calves, lambing) - infected mainly veterinary workers, calf, shepherds.Also, the contact transmission route can be active and when working with raw meat of infected animals.Alimentary infection occurs when consuming unpasteurized milk or preparation of products neg.The airborne route is active when inhaled dust containing Brucella (grazing and sheep pen), as well as in laboratories with security breaches.
Symptoms of brucellosis
incubation period - considered the period from the moment of introduction of the pathogen to the first clinical symptoms, lasts for an average of 7 days to several months.Once in the body through the skin microtrauma through the lining of the digestive and / or respiratory tract pathogen captured tissue macrophages and passes phasing Distribution:
• first enters the lymphatic structures extending in macrophages - a lymphoid stage;
• through the lymphoid system into the bloodstream - a hematogenous stage;
• hematogenous and lymphogenous by the pathogen enters the internal organs and it is said stage poliochagovyh contamination (poly = many) different metamorphoses (at the structural and functional changes in the level) - degree obsemenёnnosti will depend on tyazhёsti allergic restructuring.
incubation period ends when phagocytosis (immune cells devouring alien structures) begins to dominate over the spread of the pathogen and thus stimulates the release of endotoxin (it stands out only after the death of the pathogen) and begins a period of clinical manifestations.
period of clinical manifestations can occur at any stage of the spread of the pathogen, so the above incubation period of a variable and can last up to several months.The symptoms are very diverse and difficult to diagnose, because it affects multiple organs.Some authors, based on this, we decided to simplify the variety of symptoms and have focused on the reactivity of the response of the immune system, highlighting the compensation stage, which is characterized by its symptoms:
1. Compensated stage - the formation of latent primary infection
2. Decompensated - forming ostrosepticheskoyform
3. subcompensation says gradual restoration of reserve capacity of the immune system - the formation of metastatic chronic phase (ie the formation of poliochagovyh contamination, as mentioned above).
4. Compensatory stage talking about recovery, but often are post-infectious events (but perhaps lack thereof).
• Compensated stage is characterized by an imaginary state of being, when the symptoms are virtually absent, or for subclinical (minimal symptoms).But even in this case, specific laboratory findings are positive.
• Decompensated stage is characterized by high fever (39-40 ° C) with high daily amplitude (ie, for example, 37 in the morning and in the evening and 40, the higher the daily difference, the harder state), lymphadenopathy, hepatosplenomegaly (enlargement of the liverand spleen).At this stage, no more centers of contamination.
• subcompensation characterized obscheintoksikatsionnym symptoms on a number of organic lesions, generalized lymphadenopathy (enlarged lymph nodes in various fields - axillary, inguinal, occipital, etc., their calibration is different, too different konsitentsiya), also noted hepatosplenomegaly and multiple organ damage (they willare listed below by frequency in descending order):
- from the musculoskeletal system: pain in the large joints (elbow, knee, etc.) iz-za overgrowth of bone, eventually joins the restriction in movement and swelling, but congestion andchanges in the skin over the joint is not observed (this is important for the differential diagnosis).One of the manifestations of lesions of the musculoskeletal system is sacroiliitis (defeat sacroiliac joint).To determine the lesion of this localization requires a number of diagnostic techniques (symptom Eriksen, Nahlassa, Larrey's, Dzhenat-Ber), but the most striking and easy to conduct an example can be considered a pain in the sacroiliac joint, lying on his stomach, when you try to bend the leg at the knee joint.
- Myositis appear dull and prolonged pain in the muscles, often to replace the weather.The thicker muscle palpation (palpation) define seal painful - infiltrates.
- fibrosis (perivascular inflammation of the soft tissues) are often localized in the VLS (subcutaneous fat) area of the lower leg, forearm, back and waist.Palpable in a variety of dense and painful formations of various sizes (from 5mm-4cm).In the future, they can either sclerotic (due to the deposition of calcifications) or completely dissolve.
- lesions of the nervous system, most often affects the peripheral nervous system, the development of neuritis, polyneuritis, sklerozitov;with the defeat of the central nervous system, symptoms characteristic of myelitis, meningitis, encephalitis and meningoencephalitis.
- Urogenital System: in men is a condition haratkerzuetsya orchitis, epidimitom and decreased sexual function;women - salpingitis, metritis, endometritis, amenorrhea, infertility, infectious abortion, but if the child survived - watch congenital brucellosis.
- visual system: failure occurs at any level (from iritis and to the defeat of the optic nerve) characterized by impaired vision.
- Cardiovascular system: myocarditis, endocarditis, endo / peri / panvaskulity, violation of vascular permeability.
• Compensatory stage (residual) effects characterized by post-infectious and by any of the above systems, there may be residual effects that persist for 2-3 weeks.
diagnosis of brucellosis
1. Epidemic background (work place, eating substandard meat or dairy products, etc).
2. Clinical data due to its variability and varying degrees of manifestation little information, so resort to the methods of laboratory diagnostics.
3. Laboratory confirmation is carried out in accordance with in accordance with the "federal standard volumes of medical aid in the diagnosis of Brucella»:
- KLA (↓ A ^ and E, ↑ Lf and M thrombocytopathy)
- OAM (check 2 times in dynamics)
- calon ova
- biochemical study to determine the compensation of the liver (bilirubin, ALT, AST, alkaline phosphatase)
- blood for bacteriological examination, ie the presence of Brucella
- blood test for response to Wright-Semple (this is the most informative method)
- Coombs' test (two times in dynamics)
- Allergy test Burne (by intradermal brutsillina), the result is evaluated by the value of edema: up to 1cm -somnitelnaya reaction, 1-3 cm -slabopolozhitelnaya, 3-6sm a positive, more than 6cm -sharply positive.
- ultrasound of internal organs
- X-rays of the spine and joints
- ELISA (to determine the intensity of immunity watching IgGi M, if M says about ostroprotekayuschih process, G - a chronic or low intensity)
- Consultations on the testimony of specialistsSerological
(Wright reaction) and Allergic reactions can be false-positive in vaccinated people.But Burne negative reaction clearly points to the absence of disease (except HIV cases).
Treatment of brucellosis
treatment is carried out in accordance standards:
1. Antibiotic treatment is carried out within 1.5 months with one of the circuits:
• doxycycline + streptomycin or rifampicin;
• co-trimaksozol + rifampicin;
• doxycycline plus gentamicin;
• rifampicin + ofloxacin.
2. brutsellёznoy therapeutic dose of the vaccine (suspension of inactivated or killed vaccines) with subcutaneous administration at the stage of decompensation, and intradermal injection at the initial stages of the disease.Carry out individual selection of doses, but this type of therapy is used very rarely, because antibiotics quite live up to expectations.
3. Desensebiliziruyuschaya therapy is the appointment of antihistamines (promethazine n6aprimer).
4. NSAIDs (non-steroidal anti-inflammatory) drugs used in the defeat of the musculoskeletal system.Use deklofenak, ibuprofen and others.
5. corticosteroids (glucocorticoids) is used in combination with NSAIDs as they are ineffective.
6. immunomodulators used in the change in the immune status.polyoxidonium often used.
7.Fizioterapiya applicable in the defeat of the musculoskeletal system and the peripheral nervous system
8. Sanitary and spa treatment.
• Complications include residual changes in the organs and systems in the compensatory stage (described above).
• Secondary bacterial complications
• disabling complications of the central nervous system and the musculoskeletal system.
- preventing introduction of the agent into the economy by enabling a systematic inspection and culling of sick animals
- vaccination of animals
- hygienic maintenance and disinfection of premises in livestock farms
2. Health Service:
- wearing specialclothes livestock workers and systematic testing for brucellosis,
- sanepidrezhim in the food industry, namely potentsialnoopasnyh control products;Pasteurization of milk, cheese aging for 2 months, and hard cheeses - 3 months.
- livestock workers, and disadvantaged populations endemic areas are administered brutsellёznuyu live dry vaccine (FIDM), but are now using chemical brutsellёznuyu vaccine (HBV)
-Also focus on clinical examination had been ill - they are put under medical observation for 2 years, with quarterly clinical andserological surveys, and if the titer serological tests increases, the patient re-examined at least 1 time in 2 months, prescribe treatment if necessary.At 1 year of clinical examination for each examination is carried out for prophylactic anti-relapse.With Registry removed when specific laboratory diagnosis gives negative results.