Erisipeloid - Causes, symptoms and treatment. MF.

Erisipeloid( pig face, erythema breaker, rubella naturalists, murine septicemia, erizipeloid Rosenbach) is an acute zooanthroponous bacterial infection, with a contact mechanism of transmission, characterized by damage to the skin and joints.

Pathogen - Erysipelothrix rhusiopathiae - short, Gram-positive bacillus( when stained Gram stained in blue-bluish color).There is no dispute, no capsules, no flagella.

Pathogen of erysipeloid under microscope

Despite the absence of protective structures( spores and capsules), the causative agent is quite stable in the external environment:

• during cooking, it perishes within 3 hours;
• in animal corpses is kept for 4 months, in open space - there is no data;
• salting and smoking do not kill the pathogen;
• The disastrous effect of some disinfectants: 1% solution of bleach and 3% solution of lysol;
• The causative agent is sensitive to the antibiotics of the penicillin and tetracycline groups.

Susceptibility and prevalence is ubiquitous, without sexual and age restrictions, but at risk are: butchers, cooks, livestock people, fishermen, hunters, housewives, agricultural workers - a category of people who can have direct contact with raw infected meat orcare for sick animals. Summer-autumn seasonality is recorded.

Causes of infection with erysipeloid

The source and reservoir( keeper) of the infection are agricultural, domestic animals and some marine life( pigs, sheep, large and small cattle, dogs, chickens and ducks, rodents, fish and crayfish).The mechanism of transmission of infection is contact, possibly contact and everyday, that is, not only with direct contact, but also in contact with contaminated objects. Infection often occurs when contact with an infected animal or meat through damaged skin.

Symptoms of erysipeloid

The incubation period - the time from the moment of penetration of the pathogen to the first symptoms lasts 1-7 days, but on average 2-3 days. Gates of infection are microtraumas on the skin, with the passage of which the pathogen leaves an inflammatory trail, from that moment it can be considered the beginning of the next period.

The period of clinical manifestations will be characterized besides inflammatory changes on the skin, further spreading through the blood and lymphatic vessels, causing dissemination( dissemination) to other organs and tissues with the appearance of secondary foci in them. This is characterized by arthritis, carditis( endocarditis, myocarditis), central nervous system and lung damage, as well as anginal syndrome.

Depending on the prevalence of a clinical picture, the appropriate clinical forms are identified:

• Cutaneous form of erysipeloid is characterized by specific changes in the entrance gateway of the infection, namely, the first signs of the disease is the appearance of a fast-growing red-violet plaque( 2-3 cm increase in sizein diameter per day), with swelling along the periphery but with the preservation of clear boundaries, accompanied by itching / burning / throbbing pain. On the same erythematous site, several vesicles( vesicles) with transparent or hemorrhagic contents may appear. From the red-violet plaque depart painful inflamed lymphatic vessels - that is, lymphangitis, regional lymph nodes - regional lymphadenitis also increase.

• Anginosa form of erysipeloid - occurs when eating contaminated meat and manifests itself in the throat( with hyperemia of the lymph glotopharynx) and febrile-intoxication syndrome.

• The articular form is manifested by arthralgia and deforming arthritis in the following, with both polyarthritis( multiple lesions) and monoarthritis possible( only one joint is affected).The duration of this clinical period can last from 3 weeks to 12 months.

• Cardiomyopathic form of erysipeloid - manifested by damage to the valvular apparatus of the heart, followed by a disturbance of hemodynamics in a small or large circle of blood circulation. This form can lead to complete destruction of the valves. The main clinical manifestations will be determined by the topic of the lesion( ie which valve is affected) and the character( stenosis or dilation) - there will be corresponding symptoms and changes on the ECG, but valvular lesions are often combined:

- When mitral valve stenosis( clamshell to the left) arises left ventricular failure and left ventricular hypertension, which manifest inspiratory dyspnea( a complication arises during inspiration and no satiety) and bluish-pink blush on the cheeks due to hypertension in the pulmonary and hypertension violation+ hemoptysis + dry cough + frequent dizziness + pain in the likeness of angina pectoris + rolling hoarseness + possible thromboembolic complications( often with concomitant violations withortyvayuschey systems) + ECG changes( extension P wave in II standard lead and dextrogram) and echocardiography( very informative method) + palpation determining apical impulse can detect a change of its borders + auscultation flapping first tone and diastolic murmur listens on top of aposition on the left side;

- In dilatation of the mitral valve( mitral regurgitation), this is an insufficient valve closure, as a result of which a return of blood is performed during systole. This defeat is manifested by shortness of breath.occurring either during exercise or in a prone position and particularly during the night( up to the development of cardiac asthma) + noise after I tone after exertion and lying on his left side, on top in the expiratory phase( duration and sound volume is directly proportional to the severity)+ ECG and echocardiography also show changes.

- Stenosis of the aortic valve - having symptoms of angina + dyspnea similar both in mitral valve stenosis + systolic murmur after I tone is listened on the basis of the heart, also along the carotid artery and heart apex + on the ECG( dextrogram increase in QRS amplitude, reduction ST, negativeT wave in leads V5-V6) + EchoCG for determining the degree of stenosis.

- Dilatation aorta - manifest dyspnea as orthopnea( dysfunction of respiration in the supine position) + auscultation auscultated "blowing" postdiastolichesky noise due to reverse casting of blood from the aorta into the left ventricle + visible ripple carotid artery( "dance carotid") in whichthe patient's head is often reeling from side to side with a certain periodicity, negative by type head movements + or symptom Mousseau( pokachivaenie Glov back and forth) + fumble capillary pulse Quincke determined at small depressingnail bed + sign Hill( systolic blood pressure on the tibia higher than 20 mm Hg at the shoulder) + levocardiogram determined on the ECG and negative T waves and ST segment in the left chest leads.

- Tricuspid valve stenosis( tricuspid valve located in the right heart) often does not manifest clinically, but with decompensation, hepatosplenomegaly( increased spleen and liver) is possible.

- The dilatation of the tricuspid valve can also occur asymptomatically, but hepatosplenomegaly, a decrease in systolic blood pressure, and possibly a diastolic increase are possible.

• The septic form indicates the generalization of the process and, in this case, the fever-intoxication syndrome with a rise in temperature to 40 ° C, a consciousness disorder and a general malaise comes to the forefront of clinical manifestations. With this clinical form, the other symptoms listed above( skin manifestations in the form of erythema, an anginous clinic, joint manifestations, cardiomyopathies) may also join.

Diagnosis of erysipeloid

In addition to epidemiological and clinical parameters, the bacteriological method is also taken into account - by isolating the pathogen from the edematous fluid or a piece of biopsy skin. Serological diagnostic methods are not used.

Treatment of erysipeloid

Etiotropic treatment in the form of prescriptions of drugs - penicillin or erythromycin at age-related dosages for a week. In severe toxicosis - corticosteroids, with arthritis - the imposition of gypsum langa.

Complications of erysipeloid

From the heart - deformation of valves with immediate replacement by artificial ones. From the joints - deforming arthritis.

Prevention of erysipeloid

Veterinarno-specific prevention consists in vaccinating animals + identifying / isolating / treating sick animals + control in meat-packing plants. Medico-sanitary prevention consists only in the observance of measures of personal prophylaxis and disinfection;Specific prevention is not developed.

After the transferred disease, unstable immunity is formed and, therefore, repeated infection is possible. Sick people for others are not dangerous.

Therapist doctor shabanova IE