Typhus and Brill 's disease - Causes, Symptoms and Treatment .MF .
Typhus (historical, european, lousy, cosmopolitan, hungry, military, prison military fever, Brill's disease - it's all synonyms of typhus) - acute antraponoznoe disease with transmissible mechanism of transmission caused by R. prowazeki characterized by cyclical passage with a primary lesioncardiovascular and nervous systems and rozeolёznymi rashes on the skin, these symptoms occur in the background of a typical fever.
This disease has always been associated with the socio-economic decline, wars, migrations, etc.The term "fever" was introduced by Hippocrates and still means in Greek - "smoke", "mist", "dizziness" and used to refer to all states, accompanied by dizziness.
Causes of infection with typhus
Like all rickettsioses, typhus is very contagious and the patient becomes infectious with the onset of rickettsial blood (the last 2-3 days of incubation period) and keeping contagion throughout the febrile period, and after a 7-8 days from the normalization of temperature.The main carrier of Ricketts
symptoms of typhus
As with all infectious diseases, from typhus infection has periods (incubation, start, and during the height of rekonvolistsentsiya).
The incubation period - the time from the beginning of the introduction of the pathogen, until the first signs of the disease.It takes 6 to 25 days, but on average 12-14 days.During this period, Rickettsia, trapped in the body through damaged skin (scratch raschёsy, cracks, etc.), within 15 minutes are in the blood, and then penetrate the endothelial cells (vascular cell), affecting mainly small vessels (capillaries, precapillaries,artkrioly and venules), where there is intense multiplication and accumulation within these cells.This further leads to cell death as a result of swelling and desquamation.The death causes the release of rickettsiae and some of them die, and of the re-striking vascular cells (now new), and again there is a destruction of cells with subsequent release of Rickettsia even in large quantities and, as soon as their number reaches a certain concentration, manifested the initial symptoms of the disease - during the clinicalmanifestations.But
damaging effect on blood vessels has not only the pathogens, but the toxin, rendering paralytic expansion and increased permeability of the vascular wall with the development of diffuse redness.Later formed destructive-proliferative vasculitis, that is, formed of functional shifts in violation of food and gas exchange, hemodynamic disorders and water and electrolyte balance.In turn, a violation of the permeability and leads to disruption of the protein ratio in the organs and tissues - is diagnosed with a decrease of the total protein in the blood and systemic metabolic disorder that creates a vicious circle, because the disturbed metabolism directly or indirectly damages the vascular endothelium, releasing Rickettsia.
The initial period of the clinical manifestations of typhus
initial period of clinical manifestations is considered from the onset of fever, until the development of the rash, this period lasts 4-5 days.Getting sharp, with the rise in temperature in the first 2 days before their maximum numbers, joined obscheintoksikatsionnye symptoms as loss of appetite, inactivity, general malaise, anxiety, irritability, refusal to eat, and have 3-4 days of illness can detect specific manifestations.
At the forefront hemodynamic disturbances (from the cardiovascular system):
• characteristic appearance of the patient in the form of puffiness and facial flushing, as well as the conjunctiva (vascular injection sclera);
• appearance point of petechiae in the mucous membranes of the soft palate, uvula, and anterior palatine arches;
• positive symptom pinch - after a light pinch on the skin are hemorrhage;
• diastolichnskogo decrease in blood pressure due to impaired venous return, and then drop and systemic blood pressure;
• acute myocarditis with a lesion wire system, which manifests a sense of heart and disruptions in the heart, pains of different nature and intensity;
• Redness of the skin of the face, neck, upper trunk, and mucous membranes of the conjunctiva / sclera / soft and hard palate - because of paralytic toxin and vascular lesions it is the upper and middle cervical sympathetic ganglia.
• Moderate and severe tachycardia and then - this is the result of a compensatory response to blood vessels and the expansion of the deposit.
symptoms from the CNS are often recorded movement disorders, and the specifics of their independent of lesion locations:
• symptom Govorov, Godelier (difficulty with protruded tongue out of his mouth, in which the tongue protrudes jerks) and / or deviation of the tongue (deviation language in protrudedfrom the midline) - this occurs in lesions of the medulla oblongata;
• meningeal signs - because of the destructive changes occur specific disseminated purulent meningoencephalitis;
• at defeat striapolidarnoy system - mask-like face, a consequence gipomimiya or Amim;
• with encephalitis - a violation of articulation (dysarthria), swallowing (dysphagia), moderate nystagmus, sudden respiratory distress, drop in blood pressure, a fine rhythmic tremor tongue / lips / fingers.If changes in the central nervous system are recorded, from the first days of the disease - is diagnostically adversely.
From the respiratory system:
• rhinitis, nasal congestion and appears profuse discharge;• laryngitis and bronchitis - hoarseness, sore throat, dry cough.
From the urinary system: low back pain and a decrease in the number of detachable urine;Further examination - positive symptom Pasternatskogo (pain in the lumbar region at effleurage).Urination disorders of central origin, not peripheral.
the part of the digestive tract motility disturbances observed in the form of spastic or atonic constipation and flatulence.
during the height of typhus
height period lasts 4-10 days and is considered from the onset of the rash to a temperature normalization.
Features rash with typhus
first place localization - in the area of the clavicle, the lateral surfaces of the trunk, armpits rash then spreads to the abdomen, chest, hips and limbs.
Rash istinnopolimorfna, ie on the same area of the body exhibit different nature rashes - roseola petechiae and pale red color, their size from 1-10 mm, clear boundaries, but sometimes there is the jagged edges.First formed roseola (when pressed, they may temporarily disappear, and then reappear), and after 2-3 days, they turn into petechiae due to rupture of small blood vessels walls.But roseola can finish their existence is not turning into petechiae, and gradually they become pale yellow, and then completely disappear - it occurs on day 4 from the beginning of their appearance.Petechiae and disappear on day 4, becoming bluish-purple, then yellowish, leaving behind pigmentation for 5 days (sometimes more).
CNS: strong painful headache, symptoms of the initial period is growing, there are signs of damage to the peripheral nervous system: neuritis, neuralgia, polyradiculoneuritis, plexites.But the most frequent poliradikulity, which manifest themselves in the form of pain when pressed during the corresponding nerves and muscles.Also, frequent tissue trophic changes - quickly formed bedsores, trophic ulcers, catarrhal and ulcerative changes in the laryngeal mucosa, etc.Most often there are ulnar neuritis, axillary, brachial, peroneal and sciatic nerves.The defeat of the auditory nerve can cause a one-sided loss of hearing, and with the defeat of the nuclei of the auditory nerve - complete deafness.With the defeat of the vestibular apparatus observed dizziness, spontaneous nystagmus.Changes to a deformation of the part of the pupils, pupillary reflexes, lethargy, anisocoria - say about the defeat of the optic nerve.During this period, there are pathological reflexes (Gordon, Oppenheim, Marinescu-Radovici) and general tremor.
defeat of the autonomic nervous system is characterized by frequent changes completely opposite signs due to phase character response rickettsial intoxication, and is manifested it in the following: the excitement is quickly replaced retardation, facial flushing - pallor, tachycardia - bradycardia (heart rate is common, it is weak), andetc.Features of the temperature curve - rises in the early days up to 39-40 ° C and at 4-5 and 9-10 days begin to decline for a few hours, and then returns to its original position, and only on the 14th day comes to a slow but steady decline.
From the urinary system - loss of central origin manifested urinary retention or involuntary urination.
part of the digestive system - hepatosplenomegaly (enlargement of the liver and spleen), with yellowness palmar and plantar surfaces, but not because of violation of pigment metabolism, but because of the carotene, hence the skin and sclera remain unchanged, and urobilin with bile pigmentsnot determined.
rekonvalistsentsii Stage - clinical recovery of 2-3 weeks.This phase starts with a slow, but constant temperature reduction at day 14 from onset.In addition to the decline of temperature, all the symptoms come to naught.
Depending on rikketsiemii toksinemii and will depend on the severity of the disease: light, moderate, and severe form of abortive.
1.Obscheklinichesie research methods:
- changes to the UAC depends on the severity of the disease, but remain unchanged leukopenia with lymphocytosis (but at the height of the disease is possible and leukocytosis), there are huge granulocytes, Türk cell snizhetplatelet count, erythrocyte sedimentation rate is moderately increased (20-30 mm / h), the end of the febrile period - anemia with poikilocytosis.
- in the OAM is a change of color and increase in density (1030 and more), alyuuminuriya and cylindruria, and at the height of the febrile period - microhematuria
- Analysis of the cerebrospinal fluid shows only the lymphocyte cell count
- Biochemical research methods only indicate the severity of intoxication in the form of metabolic acidosisresidual nitrogen and creatinine, glucose might change in either direction (as reduction and enlargement), a decrease of the total protein, albumin and broken globulin ratio in favor of the latter.
2. Additional diagnostic methods consist in monitoring an individual organ systems: ECG study in dynamics, ultrasound, EEG, X-ray of lungs, consultation of other specialists - all this on the testimony.
3.Spetsificheskaya diagnostics - serological methods of study:
Weil-Felix reaction helps to identify antibodies to R. prowazeki, is one of the major reactions, but its main disadvantages - late diagnosis (at the end of the second week) and the cross sensitivity to other rickettsiae.
RAC (complement fixation test) - specific and highly sensitive diagnostic method also helps determine the antibody but with 5-7 days of disease (60% of patients) and 2 weeks of disease - from 100%.
Phragmites (reaction indirect gemmaglyutinatsii) - reaction, giving a qualitative and quantitative determination of antigens and antibodies.It becomes positive already with 3-4 days of disease.
ELISA (enzyme immunoassay) - to determine the specific antibody class G and M, so if determined IgM - say fresh infections if determined increase IgG - say Brill disease (which will be described later), if the IgG remained high withinat different times - it shows the postponed disease.
Treatment consists of bed rest, complete rest and gentle diet, also assigned causal, pathogenetic and symptomatic therapy.Etiotropic treatment - tetracycline drugs (tetracycline, metatsiklin, aureomycin, chlortetracycline, terramycin, oletetrin, oxytetracycline, morfotsiklin, doxycycline).But even drugs with the same group can have a different degree of efficiency, so the approach to assignment is to be differentiated.The most common drug of choice is doxycycline, because his background drop in temperature occurs at 3 hours, also reduced the severity of typhoid status.
antibiotic therapy is prescribed throughout the febrile period and 3 more days after normalization of temperature.If there is intolerance to tetracyclines can use backup products - chloramphenicol, rifampin, erythromycin.
Pathogenetic treatment is aimed at reducing toxicity and eliminating violations of the cardiovascular and nervous systems.So to prevent the reduction of pressure is applied Aarterialnogo adrenaline, caffeine, norepinephrine and epinephrine, but these drugs are only in intensive care units, so be sure to hospitalized patients, so that when a progressive pressure drop immediately apply the above-mentioned drugs.
Due to the damaging action of histamine administered antihistamines - tavegil, diazolin etc.When developing thrombophlebitis and thrombosis prescribe anticoagulants since the early days of the disease, and often the drug of choice is the heparin.
Symptomatic treatment is given depending on the prevailing symptoms.
statement made no earlier than 12 days from the normalization of temperature and positive dynamics on the part of laboratory diagnostics.
Complications associated with vascular disorders, leading to collapse, thrombosis, thrombophlebitis, thromboembolism and, as a consequence of all this - pressure ulcers, gangrene, ischemic stroke, hemiplegia and hemiparesis, intestinal bleeding.Regardless of the degree of blood supply, frequent connection of secondary infections.
This disease only occurs in people who recover from typhus, ie as a result of endogenous relapse, so the symptoms are identical to typhus, but proceed in a lighter form.Relapses are registered, even after 20-30 years.
Unlike typhus, no relation to specific cases of the disease, there is no involvement of transporters (lice), there is no seasonality is not possible to determine the duration of the incubation period, because we are talking about endogenous relapse, ie the pathogen is a long time in the patient's bodybut dormant.
The temperature curve is not "cuttings", unlike typhus temperature curve, which is characterized by sharp daily temperature gradients 2-3 times for the entire febrile period lasting an average of 14 days.Less formed granulomas in brain vessels.The duration of febrile period is reduced by 2 times and lasts 12-15 days, and 6-12
disease occurs much more easily, and diagnostic methods are the same, but the Weil-Felix reaction remains negative, so the diagnosis should always be carried out in conjunction with serological drugmireactions (PAP RAC, IHA, ELISA)
Nonspecific prevention is the patient isolation and disinsection in the foci of infection, and in contact person must daily to measure its temperature for 25 days and its increasing consult your doctor immediately.
Specific prevention is the use of chemical typhus vaccine - is a purified antigen from R. prowazeki (subcutaneously 0.5 ml dose).In outbreaks of typhus carried by emergency chemoprophylaxis vvedniya doxycycline 0.1 g 1 time per day, or rifampicin 0,3g 2 times a day, or tetracycline 0.5 g 3 times a knock - used these drugs for 10 days.
remaining rickettsioses clinical symptoms, complications and treatment of typhus are identical, but there are some features discussed in the relevant articles.
therapists Shabanova IE