Anthrax - Causes, Symptoms and Treatment .MF .
Anthrax (malignant carbuncle; Anrhrax; disease rag-pickers, sorters wool disease) - osoboopasnaya acute saprozoonoznaya, a bacterial infection of a contact mechanism of transmission and characterized by serous-hemorrhagic inflammation of the skin and other organs against the backdrop of intoxication.
disease known since ancient times as "sacred fire", "Persian Fire", and others. In pre-revolutionary Russia, in view of the predominant distribution in Siberia, it became known as anthrax.Significant role in this played the title Russian scientist S.St. Andrew, autoinfection proved the identity of the anthrax humans and animals, as well as pointed out the possibility of its transmission from animals to humans.Do not worry, Andrew's recovered.
The pathogen - Bacillus antracis, is a gram-positive (blue staining in smears) fixed wand.To the culture medium is not demanding and they form colonies in the form of the waste yarn from the center, as a result of this growth is often compared
• When ingested, the capsule form - it protects the pathogen from phagocytosis (destruction of cells of the immune system);
• Outside of the body, under the influence of environmental factors, pathogen produces spores, which makes it extremely stable.
• The presence of somatic and capsular antigen that has diagnostic value in setting Ascoli reaction;
• The presence of a complex toxin, which consists of a 3-yoh components: PF - factor swelling, the effect of which is based on the accumulation in the cells cAMP - activation of this cascade reaction explains output Na and Cl from the cell, and after them, and the water in the intercellular space,edema occur.PA-protective antigen, popadenii which causes the formation of immunity, LF-lethal factor causing death, having a cytotoxic effect and summarizing edematous factor, by the formation of pulmonary edema.
vegetative anthrax have the same degree of stability, as well as other bacteria bessporovye - at temperatures above 75 ° C are killed in 5-10 minutes, the corpses of animals under the influence of metabolic products of putrefactive bacteria and enzymatic factors - death occurs within 7 days.Also pathogen dies rapidly under the action of boiling and disinfecting solution for several minutes.
Another is the case with the spore-forming shape that manages to be formed from the part of the agents, who have come under the conditions of unfavorable factors: soil stored for decades (60 years) after the master of death and, if re-enters in a different body, begin to germinate into vegetativeform and become active again.Resistant to boiling - dying for 30-60 minutes.Autoclaving (steam action 100 ° C) - 40 minutes.Dry heat at a temperature 140 ° C mold spore kill within 3 hours.Direct UVB destroy over 20 days or more.Disinfecting solution (chloramine, a hot formaldehyde, hydrogen peroxide) kill spores within 2 hours.
universal susceptibility to infection and associated pathways, infective dose and quantity of host resistance factors.Geographical distribution is not limited, but the most frequently recorded episodic outbreaks in temperate countries, and mainly in the livestock areas in the spring and autumn period.By repeating biological cycles (burial of infected animals from entering the pathogen → soil → → sporulation other animals eating contaminated grass → infection), the causative agent of anthrax contributes to the creation of long-term soil active foci, ie potentially dangerous areas - "accursed field".As such, there is no geographical foci, there is a conventional division of foci: vocational agricultural, professional and industrial and consumer.
source of infection - the soil (a natural reservoir, so the disease is called saprozoonozom), large and small cattle, horses, camels, wild animals - the animals secrete pathogen with their body fluids.Ways of transmission - contact (through infected household items products of animal waste or soil), alimentary (through an infected food), airborne dust (through the air), transmissive (through ectoparasites).
Symptoms of anthrax
The incubation period - the time from the introduction of the pathogen into the microorganism and before the first clinical symptoms, can last when anthrax from a few hours up to 8 days, but usually 2-3 days.The duration of this period will depend on the pathways and the infective dose of the pathogen.For example, if the contact mechanism of transmission occurs cutaneous, and the incubation period of 2-14 days, and there is a generalized form in aerogenic or alimentary infection, in which the incubation period lasts only a few hours, and death occurs in 2-3 days.But the way the contact does not rule generalization, simply reduces the chances of such a fulminant course of the disease, both in the generalization.
in place of the introduction of the pathogen is an action of the toxin, and it indicates the beginning of the next period, because in this place there is a modification of the tissues.The period is characterized by the clinical manifestations of acute onset, and depending on the entrance gate there is a cutaneous or generalized form.But in any case, where it had not penetrated the pathogen, everywhere is the same mechanism - under the influence of exotoxin is damage to the vascular endothelium, resulting in impaired permeability, there is serous-hemorrhagic edema, inflammation, hemorrhagic infiltration and loss of sensitivity to infection gates:
• When the skin form - in the place of introduction develops a reddish or bluish spot, similar to an insect bite → after a few hours there is degeneration of the spot in a pimple (bespolostnoy bubble - papule) copper-red → then this pimple turns into a vial with serous-hemorrhagic contentand next - child small bubbles.While all this is accompanied by the formation of skin burning and itching, while combing the vials are opened with the formation of ulcers, covered with a dark brown crust (resembles a crayon, from here and the name of the disease antrax- coal) - This indicates the formation of carbuncle (inflammation of the skin andsubcutaneous fat around a group of hair follicles).Around this education - flushing (redness), swelling, and loss of pain sensitivity.Near the carbuncle register regional lymphadenitis (increase in the most closely situated lymph nodes - they are compact, mobile, little susceptible) and lymphangitis (enlarged lymph vessels located near the carbuncle).Availability lymphadenitis - a sign of skidding of the pathogen by macrophages in the lymph nodes.Skin changes are in the background obscheintoksikatsionnogo condition and fever (38-40 ° C), in the form of fever, weakness, headache and decreased blood pressure.At 8-10 days of illness with proper and timely treatment processes occur scarring and epithelialization of the ulcer, with a sharp drop in temperature and the improvement of the general background state.After another 10-30 days, the scab is torn away, and the ulcer heals.
Cutaneous anthrax in the localization of the face - neck
eschar with anthrax
It looks like an ulcer by about day 10 of illness
• Generalized form can be a primary,ie during infection by the alimentary or the airborne and secondary as a result of septicemia due to the spread of the pathogen through lymphatic and hematogenous.This form is characterized by rapid onset, shaking chills, rezkovyrazhennymi symptoms of intoxication, headache, vomiting, tachycardia, hypotension progressing (system pressure drop), voiceless heart tones.
While infecting the airborne path arises pulmonary form generalizvannogo flow and everything else, which is characteristic of generalized joining the following symptoms: dyspnea, pain in the chest when breathing, shortness of breath, cough with bloody sputum, which almost immediately becomes jelly-like consistency, respiratory weakening and shorteningpercussion sound indicates razvivshemsya pleurisy (inflammation of the pleural / lung sheets), in the distance are heard mixed wet rales.In this form of death occurs in 90% of cases within 2-3 days, even with treatment.When
alimentary infection by developing intestinal form of generalized flow, for which besides obscheharakternyh symptoms characterized as follows: the first day of illness - cutting pain in the lower abdomen, bloody vomiting and loose stools mixed with blood, rapidly developing peritonitis and intestinal paresis.
Diagnosis of anthrax
1. According to the data of epidemic - study job (for livestock care, cutting of carcasses, work with skins and hides), conditions and place of residence (rural areas), eating contaminated food (eating meat is not past veterenarno-sanitary control, the forced culling of sick animals) and so
2. According to clinical data - the presence of a black eschar with whisk hyperemia ( "black crayon on a red background").This skin formation cut away a needle and, if the sensitivity is reduced or absent, it gives the chance to confirm the preliminary diagnosis.
3. Laboratory findings:
- bacteriological research by smear microscopy of biological material of the patient: blood, urine, vomit, feces, sputum
- genetic method (determination of pathogen DNA by PCR method, ie, polymerase chain reaction)
- serological method: IFA (immunofluorescence reaction) and Phragmites (reaction of indirect hemagglutination) - these two eksperss method, aimed at determining the antigen.ELISA (enzyme-linked immunosorbent assay) - determines the intensity of the immune system.
- immunohistochemical method
- skin-allergic test with antraksinom
4. Additional methods of investigation for suspected generalized form: ultrasound, lumbar puncture, the KLA, OAM - they only apply to determine the level of compensation on the part of the studied organ and system solutions forfurther preparation of the treatment plan.
treatment of anthrax
comprehensive treatment consisting of a causal, pathogenetic and symptomatic therapies.It is also necessary to observe bed rest for the period of the disease and compliance with therapeutic feeding - table №13, and move on enteral-parenteral nutrition in severe cases (ie partially normal feeding, and partly - intravenous-drip).
1. Causal treatment is aimed at destruction of the pathogen, with the use of such drugs as ampicillin, doxycycline, rifampin, pefloxacin, ciprofloxacin, gentamicin, amikacin - combine them with each other and are used in the respective age doses for 7 days, and when heavy currents- over 14 days.
2. Pathogenetic therapy is administered protivosibireyazvennogo immunoglobulin.
3. Topical treatment is only in the treatment of the affected areas of skin antiseptic solutions.Dressings are not applied, surgery is not used, because it can provoke generalization of infection.
4. With the development of complications zhizniugrozhayuschih (ITSH - infektsionnotoksichesky shock) used prednisone (strongest GCS), is carried out detoxication therapy aimed at combating hemodynamic disturbances - used polyionic solutions with the addition of polyglucin, reopoliglyukina or gemodeza.
Extract convalescent patients with cutaneous form is carried out after the rejection of a scab and scar formation.In generalized forms prescribed after a full clinical recovery and double negative result of bacteriological studies with 5 day intervals.Management of such patients at home is unacceptable hospital.
ITSH, sepsis, meningitis, ARF (acute respiratory failure)
prevention of anthrax
Veterinary: detection and timely diagnosis followed by treatment or slaughter of sick animals, epizootic outbreak survey, disinfection of corpses, the destruction of the meat /hides / wool of dead animals, the current and final disinfection in the outbreak, making healthy cattle cemetery / pasture / unfavorable for pathogen areas, as well as routine immunization of live anthrax vaccine farm animals in disadvantaged areas.Medikosanitarnye event:
• monitoring compliance with the general sanitary rules in the procurement, storage, transportation and processing of raw materials of animal origin;
• vaccinal live spore dry beskapsulnoy vaccine - twice Planning (potentially dangerous areas) or unplanned (on epidemic indications, followed by a booster every year);
• timely diagnosis, hospitalization and treatment of patients;
• epidemic outbreak survey, followed by the current and final disinfection;
• a ban on dissection patients because of the high risk of infection with spores;
• people in contact with sick people or animals are introduced and etiotropic protivosibireyazvenny immunoglobulin preparations for 5 days, and contact was observed within 14 days.
Consultation of anthrax:
Question: Does a sick person dangerous?
answer: sick people do not represent a danger to others, but in contact with them in order to prevent all the same conduct passive immunization.
Question: Does immunity is formed after suffering the disease?
answer is formed, but not long-lasting and stable, there are cases of repeated illnesses.
Question: What does the vaccine prophylaxis?
A: the vaccine is considered to be highly efficient and dramatically reduces the risk of disease.
therapists Shabanova I.E