Salmonellosis - Causes, Symptoms and Treatment .MF .
Salmonellosis - a group of acute infectious diseases, zooantraponoznoy nature, caused by numerous bacteria of the genus Salmonella, and is characterized by a primary lesion of the gastrointestinal tract, resulting in further dehydration, intoxication and joining polymorphic clinic in the future.
causative agent of salmonellosis
Exciter first discovered in the early 19th century in the bodies of the deceased person and the meat, which he used yesterday.In the future, all diseases with similar symptoms began to unite in the name of "salmonellosis".
causative agent of salmonellosis, pathogenic for humans, approximately 100 types, but the most common - Salmonella typhimurium, S. enteritidis, S. panama, S. infantis, S. newpart, S. agona, S.derby, S. london, S. paratyphi A / B, S. schotmuelleri.
flow and the risk of diseases caused by the following factors of pathogenicity:
1. flagella (H-antigen) are located on the periphery of the pathogen, they cause the movement
2. Capsule (K antigen) explains the protection of phagocytes
3. Inferiority phagocytosis predisposes to the developmentsepsis
4. Features invasions (introduction) make the penetration of the pathogen in virtually unchecked glublezhaschie tissue
5. Adhesion (fixation) at the expense of the fibrils, pectins, LP-saccharide complex
6. Have exotoxins (waste products emitted during the life):
-labile exotoxin = enterotoxin implementing its mechanism of action by activating a cascade of enzyme systems (adenylate cyclase), activated by cAMP - this causes the output of Na and Cl from the intestinal cells, and followed by the concentration gradient out the water into the intestinal lumen, and so is the formation of diarrhea withfurther dehydration,
- thermostable exotoxin mediates its effects through guanylate cyclase, this entails the phenomenon of rapid vascular permeability,
- cytotoxin causes damage to the epithelial cells
7. Endotoxin - biologically active substances secreted after destroying phagocytosis.In this case endotoxin is lipopolysaccharide complex and it plays a major role in the formation of poisoning:
- causes hypersensitivity of delayed and immediate type
- reduces neutrophil degranulation and the release of biologically active substances
- activates the synthesis of prostaglandin and thromboxane - it triggers platelet aggregation in small capillaries,develops inflammation, DIC (disseminated intravascular coagulation).Prostaglandins in additives like enterotoxins stimulate secretion of Na and Cl, and causes smooth muscle contraction and intestinal motility.
Salmonella are relatively resistant to the effects of various environmental factors:
• At room temperature on household items is stored up to 3 months;
• In dry feces of animals up to 4 years;
• In water up to 5 months in meat and dairy products up to 6 months on eggshells to 24 days;
• High temperatures hardly disastrous, because salmonella are killed almost instantaneously only at 100 ° C at 70 ° C for 30 minutes.Resistance to high temperatures increases when the pathogen is in meat products (meat 400g with a thickness of 19cm should be boiled for 2.5 hours, only after that the meat can be regarded as safe).Salting and smoking virtually no effect on Salmonella.
• Resistance exciter notes and to low temperatures down to -80 ° C;
• Resistance to UV radiation;
• When handling disinfectants are killed within 20 minutes.
Susceptibility pervasive, without gender, age and territorial restrictions.But the greatest risk of morbidity among children within a year from the moment of birth, due to imperfect immunity.Salmonellosis occurs throughout the year, but sporadic outbreaks ascertained more frequently in the summer months.
Causes salmonellosis infection
Source - pets and livestock (cattle, pigs), poultry (chickens, geese, ducks), cats, birds, fish, sick people and bacillicarriers.Ways of transmission - nutritional (in eggs, dairy and meat products) and the contact and contact-household.Very often, when using eggs for food, do not pay attention to the modification of the protein and the yolk (it can be either bleeding or clouding or musty smell) - is often salmonellёznye infected eggs, which occurs in the use of the inevitable contamination.Therefore, as soon as you notice this while cooking, immediately dispose of the contaminated product and all that contacted with him, and the dishes in which you discovered this, pour bleach, hand and treat it with a solution (simple soap is not enough!).
Currently, of all salmonella parasites are most common for several reasons: because of the centralized food supply;the development of antibiotic resistance to the formation of hospital strains, which are characterized by outbreaks of winter, high mortality and contact-household transmission mechanism as a major.
Symptoms of salmonellosis
incubation period believe since the introduction of the pathogen in the macro-organism before the first clinical symptoms, the duration of this period shirokovariabelna and can last from 6 hours - up to 8 days, but in most cases observed after 12-24 hours from the time ofconsumption of contaminated product.
Proceeding in the gastro-intestinal tract, Salmonella reach small intestine, mucosal attached via adhesion factors (№5 with transfer factors of pathogenicity are shown above).
period clinical manifestations indicates the beginning of the action exotoxin, which is released during tissue penetration in glublezhaschie, and there begins the action of phagocytosis (ie, there is devouring pathogen immune system cells) and endotoxins released during the destruction of Salmonella, these biologically active substances causespecific symptoms.
But part of the originator, because of resistance to phagocytosis, is spread by lymphatic and hematogenous (in lymph and blood), causing all sorts of symptoms, not only on the part of the stomach and intestines.Depending, on what the body most compromised, then there is one or another clinical form (gastrointestinal, typhoid, septic, meningeal, erased, subclinical, carriage) - in various forms, dominates its symptoms.
So, when gastrointestinal form the main fulcrum for endo- and exotoxin is the cyclase and guanylate cyclase system, so come to the fore violation of water-salt metabolism due to diarrhea occurring in which watery diarrhea, frothy, foul-smelling,with carnations as "pond scum", with a frequency of 7-10 times a day, for 10 days.For the disease is characterized by acute onset and, against diarrheal syndrome, note the weakness, lethargy, mild abdominal pain (especially in the epigastric and umbilicus).It is also noted pain on palpation of the abdomen, his rumbling and bloating.Depending on the following symptoms may join the severity of dehydration:
• the part of the cardiovascular system (tachycardia, snzhenie blood pressure, muffled heart sounds);
• (convulsive readiness may occur headache and dizziness, and in young children) the central nervous system.
Feature of salmonellosis (not only of this particular form) is that the younger the age, the more severe the disease.
When typhoid form , instead of 7-10 days of recovery emerge features characteristic of typhoid:
- undulating fever,
- hepatosplenomegaly (enlargement of the liver and spleen, which is determined by palpation),
- small rozeolёznaya appears on the bodyrash on day 7 (similarly as in typhoid fever).
Clinical manifestations are held for a long time (3-4 weeks) and are characterized by a gradual fading of the symptoms.
Septic form occurs when the CID (immunodeficiency) and / or the newborn.It is characterized by the spread of the pathogen through lymphatic and hematogenous in various organs and tissues, with the formation of purulent foci in them in the form of osteomyelitis, arthritis, cholecystitis, etc.Starting this form as well, ie with symptoms of gastroenteritis (diarrhea, abdominal pain - all that was at GI-form), but subsequently joins the rash in the form of petechiae (spots), but in severe cases, in the form of large hemorrhages andpyoderma.
From the first day there is a defeat of the central nervous system and cardiovascular system.This form on for longer with frequent deaths.
When salmonellosis meningeal form flows like a septic form, but, in contrast to it, the only septic focus is the central nervous system.Most often it is observed in children of different age groups due to the high permeability of the BBB (blood brain barrier), in this case, to gastrointestinal symptoms joins cerebral symptoms:
- frequent seizures because of increased seizure activity;
- vomiting not bringing relief;
- babies, before closing the large fontanelle (up to 2 years), it can be seen bulging and pulsing;
- occur meningeal signs (neck stiffness, and Keringa Brudzinskogo symptom).
erased form of salmonellosis slight diarrhea syndrome is characterized by 1-2 times a day for 2 days.
subclinical and carrier can only be detected by laboratory methods.
The course of the first year of life: a very heavy form with prevalence of gastrointestinal symptoms in the form of enterocolitis heavy diarogennogo syndrome.In 90% of cases of septic shape is formed and flows into a mixed infection.Features of nosocomial salmonellosis: these strains (types) of antibiotic resistance, a severe course and fatal outcome.
after undergoing post-infectious diseases of the immune system is formed, but it is type-specific and lasts less than a year.
1. Epidemiological criteria aimed at establishing the source of infection and to identify contact persons.
2. Clinical characteristics aimed at the detection and differentiation of the leading symptoms (intoxication, diarrhea, gepatosplenomegoliya, the presence or absence of generalized forms)
3. Laboratory findings:
- OAK: povysheny A ^, ↑ Hf with a shift to the left, ↑ SOE
- Bacteriological method is aimed at the detection of the causative agent of biological fluids (feces, blood, urine, the affected organs) and suspicious products.The final results come to the 5 day.
Salmonella under the microscope
- Serological: ELISA (enzyme-linked immunosorbent assay), RGA and Phragmites (reaction of indirect hemagglutination) - these methods are directed to the detection of antibody titer.Results ready by about the 7th day.
final diagnosis is competent only if the pathogen is detected.
Treatment of salmonellosis
conjunction with treatment drugs requires bed rest.Below will be given treatment in accordance with the national standard, but this is only a schematic representation, in the life of an individual approach is carried out taking into account the age of indicators / degree exsicosis / toxicity and the degree of dehydration.
1. Etotropnaya therapy aimed at the destruction of the pathogen and the drugs of choice are: enteriks, hlorhinoldol, ciprofloxacin, salmonelny bacteriophage sangviritin.
2. Pathogenetic therapy:
- rehydration therapy aims to restore the water-salt metabolism, using rehydron and Trisong.
- Detoxification therapy is aimed at the elimination of dehydration and the amount of fluid injected depends directly on the degree of dehydration.This applies glucose and reopoligljukin.
- eubiotics and biologics: baktisuptil, Linex, Atsipol, bifidum-laktobakterin.
- sorbents: Smecta (for removal of waste products of Salmonella).
- fermentoterapii: mezim forte, Oraz.
- antidiarrheal drugs: calcium gluconate, indomethacin.
- antispasmodics (painkillers): Nospanum or its analogs.
Dieting and table №4;Excluded from the diet foods that irritate the stomach and intestines, and dairy products are high-melting fats.You can not assign starvation diets, fraught with aggravation of immunodeficiency, as well as prevents the slowdown reporativnyh processes in the digestive tract.From food exclude products that increase the motility, fermentation processes, containing a large number of crude fiber: black bread and crackers out of it, whole milk, yogurt, fermented baked milk, cream, porridge on whole milk, beans, beets, cucumbers, sauerkraut, radish, radish, citrus, pears, plums, grapes, meat and fish broth, fatty meats / fish / poultry, as well as all acute and alcohol.
Rehabilitation and Prevention
The following methods can be attributed to non-specific prevention: duration of hospital stay in the localized form - 14 days, in generalized - up to 30 days.After the treatment is carried out bacterial study after 2 days, and twice, with negative results, allow patients to work.Food processing is subjected to clinical examination for up to 3 months with a monthly single dose study of stool - if results are positive, the work does not permit within 15 days and arrange for another job and parallel wires 5-fold examination of feces and once bile if bacterial isolation continues for more than 3months - transferred to another job for 1 year with a parallel examination of stool 1 time in half a year, and after this year produce a five-fold examination of feces and bile single study with an interval of 1-2 days, when again a positive result - excluded from the work, andif negative - is removed from the account and return the workplace.
Along with these measures strengthen the veterinary and sanitary inspection of livestock in the areas of content, process technology / storage / preparation of carcasses.As well as watching the San surveillance on food enterprises for the control of equipment and cooking quality.
As a preventive measure should be well boil thoroughly meat and eggs, personal hygiene.
specific prophylaxis: to be developed, because it is based on the principle of vaccination, which is created by neutralization virulent strains - in this case it is impossible, because these virulent strains, there are more than 2.5 thousand.
are numerous and varied:
- Vascular collapse with the formation of acute cardiac and renal failure;
- septic complications with the development of purulent lesions in various organs and tissues and the formation as a result of: arthritis, osteomyelitis, endocarditis, abscesses of the brain, spleen, liver and kidney failure, meningitis, peritonitis, appendicitis, pneumonia, urinary tract infections, toxic shock.
- The most dangerous complication is for others a carriage, emerging because of incomplete phagocytosis.
disease is fatal.
therapists Shabanova IE