Ornithosis ( Psittacosis ) - Causes, Symptoms and Treatment .MF .
zooantraponoznaya Acute bacterial infection attributable to a group of chlamydial infections with airborne transmission mechanism (possible contact-household and fecal-oral), characterized by lesions of the lung and nervous system, which runs on the background hepatolienal, feverish and obscheintoksikatsionnogo syndromes.
the first time the disease has been reported from the parrots - hence the name of its original "psittacosis» (psittakos - parrot), but once saw an infectious bond and other birds, psittacosis appeared the second name - psittacosis (ornithos - bird).
Pathogen ornithosis under a microscope
Pathogen - Chlamydophila psittaci is an obligate intracellular parasite, and has some features in the structure, which cause the disease:
• multiplies inside the affected cells;
• ability to form L-shaped - pathogen devoid of partially or completely the cell wall, allowing it to perish, and to maintain its virulence for a long time, even when exposed to damaging factors
• The pathogen can be in two forms - elementary and reticular cells, it is important in the appointment of treatment: elementary bodies are sporopodobnoy form due to the presence of a solid shell that makes the causative agent is not sensitive to the antibiotic, and the life cycle of the pathogen is outside the cell,and under adverse conditions suspended division with decreased synthesis main membrane protein and increasing the synthesis of heat shock protein (for a given pathogen, the protein is an exotoxin) - it induces the synthesis of antiinflammatory cytokines, which in turn plays a role in formation of chronic infection and long-term persistence (stay)the causative agent with the formation of infertility in women.Reticular cells - is the intracellular form of breeding, sensitive to antibiotics.That is when the reticular form is the division of the pathogen in infected cells, resulting in formation of intracellular inclusions - microcolonies chlamydia.
• Have exotoxin (heat shock protein) and endotoxin (lipopolysaccharide membrane).
• Tropism (selective destruction) to the cells of the columnar epithelium of the respiratory and urogenital tracts (mainly) alveolocytes, vascular endothelium, endocardium, CMF (the system of mononuclear phagocytes - physiologically protective cell system, which include: histiocytes of the connective tissue, Kupffer cells of the liver (stellateretikuloendoteliotsity), pulmonary alveolar macrophages, the macrophages of the lymph nodes, spleen, bone marrow, pleural and peritoneal macrophages, osteoclasts in bone tissue, neural tissue microglia, synoviocytes synovium, skin cells Langergaisa, amelanotic granular dendrocytes).With the defeat of the system (MPS), formed by the CID (immunodeficiency).
Pathogen relatively stable in the environment:
• as at room temperature, the causative agent is stored in an average of 2 days, the shell - 3 days in the feces of birds - up to 4 months.
• tolerate freezing temperatures: the «-20 ° C" is kept for half a year, when «-75 ° C" - for a year or more;
• Lower temperatures are disastrous: at 60 ° C pathogen die within 10 minutes, at a lower temperature chlamydia death occurs almost instantaneously.
• inactivates the action of disinfectants have both physical and chemical: UVI, ether, formaldehyde, 0.5% phenol, 2% Lysol, potassium yodit 0.1%, 0.5% potassium permanganate, 6% solution of peroxide - destroying the pathogen2 days;Within 10 minutes, the pathogen dies under the influence of a 0.5% solution of chlorine bleach and 2% solution of chlorine bleach kills the pathogen within minutes.
susceptibility is high, no age and gender restrictions, but most of the trend of the disease in middle and older age groups, but children at the same time is no exception.Is widespread, the incidence is registered in the form of sporadic cases and clusters, work and family outbreaks.
reasons psittacosis infection
source and reservoir (guardian) infection - different kinds of wild, synanthropic ornamental and pet birds who have psittacosis occurs as a carrier or an acute intestinal infection.Also are registered cases of infection of health care workers in the care of sick people, people sledvatelno also possible it is the source.Ways of transmission - contact-household (ie when infected subjects-related body fluids of animals), aerogenic (airborne) and fecal-oral (when infected food).
contracting psittacosis Source
symptoms of psittacosis
Before we talk about the symptoms, you should be able to recognize infected birds in order to avoid or minimize the level of contact with them.need to know in this case:
1) - epidopasnost are of the parrot family and Golubeva, and crows.
2) - psittacosis in birds either does not manifest itself and is reduced only to the carriage or manifested as rhinitis / diarrhea / adynamia (minimization of physical activity) / refusal to eat / sticking feathers.
3) - Infected birds shed the pathogen in the faeces and nasal secretions.
4) - pathogen transmission among birds is possible for two or more generations.
symptoms of psittacosis
As with any infectious disease, psittacosis starts with the incubation period - the time from the beginning of the introduction of the pathogen until the first clinical manifestations.It lasts from 7 to 25 days, but more often - 2 weeks.This period coincides with the phase of implementation and propagation of the pathogen at the site of the entrance gate (in the epithelium of the conjunctiva, the mucous membranes of the respiratory and urogenital tracts).As the propagation of the pathogen, there is a destruction of infected cells with the release of a new dose of the pathogen and its toxins, followed by the formation of bacteremia and toksinemii - but it's already talking about the beginning of the period of clinical manifestations.
period of clinical manifestations can begin as with specific symptoms (to be described later), and with prodromal symptoms lasting 3-5 days of malaise + general weakness and weakness + loss of appetite and nausea + arthralgia.During this period, there is an infection of cells Organs (especially CMF), formed immunodeficiency, is the formation of autoimmune reactions, the body rehabilitation violation of the pathogen, and as a consequence - long persistence (staying) pathogen in different cell stages (in the form of reticular / intermediate bodiesin macrophages, in the form of elementary cells in the intercellular spaces and in L-shapes in infected cells);activation of conditionally pathogenic microflora (mycoplasma, herpes, candida) and / or the formation of secondary bacterial infections.Unnecessarily to CMF are an impressive number of bodies, and failure symptoms can be very diverse - with the defeat of the joints, lymph nodes, liver, spleen, capillary endothelium, endocarditis, CNS etc.In those affected organs are activated free-radical oxidation of tissue damage to aggressive forms of O₂ and release by macrophages of proinflammatory cytokines (IL-1 and TNF), formed serous inflammation, but because of the migration of macrophages and lymphocytes - are formed multiple granulomas, which are then subjected tofibro-sclerotic transformation in the affected organs.
Tk mainly affects the cells of the respiratory tract, formed by specific symptoms:
• acute onset of rise in temperature to 39-40 ° C and obscheintoksikatsionnymi symptoms;
• chest pain;
• myalgia (muscle pain), and arthralgia (joint pain);
• nausea and vomiting;
• sore throat;
• injection of vascular sclera and conjunctiva, hyperemia of the appearance of mottled-papular rash or rozeolёznoy, nosebleeds - explains the tropism of the pathogen to the endothelium of blood vessels;
• catarrhal symptoms (runny nose, nasal congestion, sore throat, redness of the mucous oropharynx) - are mild;
• symptoms of light appear on the 3-5 day of illness, a dry cough and chest pain, 2-3 cough becomes productive with expectoration muco-purulent sputum and blood veins - this is evidence of possible developing ornitoznoy pneumonia;
• By the end of the first week of the disease, in the majority of patients with increased liver;
• Signs of neurotoxicity: headache, insomnia, lethargy, weakness, depression and euphoria often follow each other, there may be signs of meningism (false positive symptoms of meningitis);
Psittacosis can occur not only in the form of pneumonia, but also in influenza-like form, typhoid and meningeal.obscheintokskikatsionnye When symptoms are influenza-like form of the dominant;with typhoid - hepatosplenomegaly and neurotoxicosis taking place against the background of fever remitting type;with meningeal form - fairly well expressed meningeal signs (neck stiffness, symptoms and Brudzinskogo Keringa).Regardless of the form, even in the recovery period (which lasts about 3 months) and long-term remains asthenia with a sharp reduction in disability, there is fatigue, hypotension, vegetative-vascular changes (akrotsianoz, coldness of extremities, hyperhidrosis of the palms, a tremor of eyelids and fingers).
Diagnosis is based on clinical and epidemiological data: pneumonia, there is an acute inflammatory reaction in the blood, contact with poultry, can group the incidence.The diagnosis is confirmed by means of the following tests:
• sputum smear stained with Romanovsky-Giemsa;
• Serological methods: carrying RIF (immunofluorescence) for determining Chlamydia antigen;RAC (complement fixation test) is aimed at the detection of antibodies antigenneytralizuyuschih, namely looking at an increase in antibody titer in paired serum samples, the positive reaction is considered to increase the titer of 1:16, 1:32 and above;Serological methods aimed at detection of IgM (immunoglobulins indicate this class of acute period) - appear after 5 days from initial infection and reaches a maximum at 1-2 weeks and disappear after 2-3 months, but they are not formed in the reinfection and reactivation;Of IgA - secreting immunoglobulins that are beginning to be synthesized in 2 weeks, falling to 2-4 months, are also formed during reinfection and inadequate treatment, if effective therapy - their number is reduced;IgG - appear after 15-20 days and may persist for several years.
• If you suspect a ornitoznoy pneumonia using Physical methods (auscultation, percussion) with which you can discover the shortening of percussion sounds, weakened or rigid breathing scant crepitus or finely wheezing in the lower parts of the lungs, and by the end of the first week often auscultated pleural rub;And for a more complete picture of pneumonia using X-ray diagnostics, which shows unilateral lobar pneumonia, which can be interstitial, small focal, or lobar macrofocal;And note the expansion in the radiograph the roots of the lungs, increased pulmonary pattern and expanding bifurcation lymph nodes.
• From the CCC mark - a tendency to bradycardia, hypotension, lability of heart may mute heart sounds, systolic murmur and ECG signs of diffuse lesions of the heart.
• When meningeal symptoms appoint spinal tap, which shows: moderate lymphocyte cell count (300-500 cells in 1 mm), a moderate increase in protein.
• The KLA - lekopeniya and lymphocytosis, increased ESR up to 40-60 mm / h;Leukocytosis possible when layering a secondary bacterial infection.
Treatment of psittacosis
treatment systems, and presented etiotropic, pathogenetic and symptomatic methods with obligatory supervision of clinical and laboratory data.
Etitropnaya therapy - prescriptions aimed at the destruction of the pathogen and effective in this respect are the antibiotics from the macrolides, fluoroquinolones and tetracyclines (for children more likely to use macrolides, fluoroquinolones are used unnecessarily to 12 years, and tetracyclines - 8).There are different schemes of antibiotics, but in recent years following the effectiveness of an assignment scheme has been proven - azithromycin 10 mg / kg / day in 1 reception inside the 1, 7 and 14 days of treatment.Azithromycin is the drug of choice, but other antibiotics of the macrolide group also have excellent activity antichlamydial - clarithromycin, spiramycin, roxithromycin, josamycin, medikamitsin and erythromycin (antibiotics are listed in descending order of efficiency).In the acute form - antibiotics prescribed in age dosage for 10-14 days.In chronic course - used pulse therapy, which consists in appointing 2-3 antibiotic therapy courses for 7-10 days with an interval of a week, as well as antibiotics change.To help to etitropnoy therapy prescribed immunomodulators and immunostimulants - interferon viferon, tsikloferon, anaferon, timolin, timogen, polyoxidonium, likopid.But these drugs are administered only under the supervision immunogram.
Pathogenic therapy reduces the appointment:
- cytokine drugs (leykinoferon, roncoleukin)
- probiotics and prebiotics (bifiform, Linex, etc.) For the prevention of dysbiosis
- multivitamins, vitamin-mineral complexes, antioxidants, herbal adaptogens, metabolites, antihistamines, protease inhibitors, vasoactive drugs - all of this is used for readings with the appropriate clinic
Symptomatic treatment :
- when dry paroxysmal cough - sinekod, stoptussin, tussupreks, pakseladin, libeksin.But the appointment of these drugs should consult with a doctor or know history, because some of these drugs of the central action and can inhibit the action of not only cough, and respiratory centers.
- when wet cough - mucolytics (bromhexine, ambroxol, ACC, mukaltin, nursing fees)
- the appointment of antipyretics and cardiac glycosides - indicated.
Postinfectious immunity unstable and possible re-infection.
During rekrnvolistsentsii required inspection infectious disease and pediatrics (GP) at 1, 3 6 9 12 and 24 months after recovery, using additional methods - ELISA, PCR, and chest x-ray after 6, 12, 18, 24 months.Consultation of other specialists - according to indications.Dates disability - 7-10 days with influenza-like shape, 20-40 days - in case of pneumonia, the Commission established in a protracted and chronic disability within the terms.
meningitis, thrombophlebitis, hepatitis, myocarditis, thyroiditis, pancreatitis.But the main cause of complications - the formation of fibrosis, sclerosing changes in the affected organs.
aerosol vaccination is still in the development stage at the moment is available only to non-specific prevention - limit contact with birds, veterinary supervision, isolation of patients with psittacosis, disinfection of sputum from patients.
therapists Shabanova IE