Brucellosis Symptoms

Brucellosis is an infectious disease that occurs with the defeat of many organs and systems. Especially the musculoskeletal system suffers. The disease can be caused by one of three kinds of bacteria belonging to the genus Brucella. The first of these( Br. Melitensis) causes diseases in goats and sheep;transmitted to a person, the infection is most severe. The causative agent of brucellosis in cattle is Br.abortis bovis, brucellosis of pigs causes Br.abortis suis. Only cases were observed;caused by brucella of the first two types, affecting large and small cattle.

Epidemiology. Distribution of brucellosis among people depends on the extent of the disease affected by farm animals. Symptoms of brucellosis in farm animals may be absent or the disease manifests itself as fever, mastitis( especially in goats), arthritis, spontaneous miscarriages.

A person is infected from patients with brucellosis of cows and goats with raw milk and dairy products, from sheep - with the use of low-brynna cheese. In addition, you can get infected and eat little-cooked or roasted meat of sick brucellosis animals, while caring for them( cowgirls, milkmaids), assisting the aborted animal( occupational diseases of veterinary workers).

Pathogenesis. Penetrating into the body through the digestive tract, damaged skin or mucous membranes, the pathogen spreads through the lymph and blood vessels throughout the body. The reticuloendothelial system responds to brucellosis infection by enlarging the liver and spleen, a number of lymph nodes. Brucellosis can affect any organs and tissues of the body, but the musculoskeletal system suffers, the synovial joints of the joints, tendons, ligaments, articular bags( with the development of bursitis), and fascia are affected.

Manifestations of the disease are very diverse. The incubation period lasts 1-6 weeks. Then the body temperature rises sharply to high figures, 39-40 °.Fever flows in waves( the temperature then decreases, then rises), accompanied by chills and heavy pouring sweat. Enlarged lymph nodes, liver and spleen. There are pains in the muscles, joints and bones. The sleep is broken, the appetite disappears. Infections of the genitals( in women ovaries, in men testicles).

The incubation period averages 12-14 days. In some patients, a prodromal period occurs within 3-4 days, manifested as general malaise, loss of appetite, sleep disturbance, irritability.

Then the patient's body temperature rises to 38.5-39.5 ° C for 3-7 days. Approximately in 20% of patients brucellosis begins more sharply. In the further course of brucellosis, the temperature curve can develop according to one of the following types: 1) undulating( "undulating"), characteristic mainly of sheep-goat type brucellosis;2) remittent, 3) intermittent, 4) constant( at which fluctuations between morning and evening temperatures are less than 1 °), occurring less frequently than others.

During the first 7-10 days from the onset of the disease, there is a discrepancy between the high temperature response and the rather satisfactory state of health of patients who are still able to work during this period. Complaints of patients during the first 10 days of illness consist in a feeling of general weakness, pain in the lumbar region, lumbosacral articulation, neck muscles, a significant sweating, which is easy to identify and with an objective examination of the patient. The moisture of the skin, especially the palms, is also noted when the patient's body temperature drops to normal.

Approximately 15-16 days after the onset of the disease, the clinical symptoms of brucellosis become quite pronounced. It is accepted to distinguish acute brucellosis, lasting up to 3 months, subacute( prolonged), lasting from 3 to 6 months, and chronic brucellosis( including with recurrent course and generalization of infection, bacteremia), which lasts up to 2 years( and occasionally up to 3-4 years).

At the height of clinical symptoms of acute brucellosis, patients become irritable, make many complaints about health, sweating, pain not only in the areas described above, but also in various, mostly large, joints. In 75% of patients, peripheral lymph nodes increase in size, which become slightly painful on palpation, but do not weld together and with subcutaneous tissue.

Joint damage extends predominantly( or exclusively) to large joints;most often affected knee, then - ankle, hip, shoulder, and less often - elbow joints;In some patients, brucellosis affects the sacroiliac joint. In the affected joint, there are long-lasting pains, which can be aggravated by movement. The configuration of the affected joint changes, its outlines are smoothed out due to edema and inflammation of the soft tissues in its circumference( periarthritis);the skin above the affected joint is hotter than in other areas, slightly glossy, can acquire a pink tinge. Simultaneously, only 1-2 joints are affected, then other large joints are affected. Often bursitis, cellulitis, tendovaginitis are noted. Possible lesions of large bones, including - vertebrae( osteoperiostitis).With prolonged, persistent, joint damage, contractures and ankylosis develop.

When palpation is defined small, dense nodules( clusters of cells, fibrosites) located in the area of ​​the sacrum, wrists, along the ribs. Peripheral blood is characterized by leukopenia, aneosinophilia, neutropenia, increased ESR.In vaccinated against brucellosis disease proceeds more easily.

If the patient receives an effective treatment at an early date, the disease may end at the stage of acute brucellosis. In the absence of such treatment, the disease after the acute stage enters the stage of subchronic, subacute brucellosis. In this stage of the disease, in addition to the symptoms noted by the musculoskeletal system, the pathological symptoms from the nervous system increase;patients become irritable, capricious, even whiny;possible lesions of the genitals( in men - orchitis and epididymitis, in women - metrorrhagia, salpingo-oophoritis), in pregnant women - spontaneous abortions.

Chronic brucellosis can occur either with recurrent generalization, or with the development of persistent disorders in the locomotor apparatus. At this stage of the disease, various types of lesions of the central and especially the peripheral nervous system can be observed;During periods of generalization of infection, the patient's body temperature is raised and all symptoms become aggravated.

Diagnosis of the disease is based on bacteriological and serological studies.

Recognition is based on a carefully collected history( to clarify the possible circumstances of infection, taking into account the epizootic situation), clinical symptoms in their development, the results of diagnostic laboratory studies( the picture of peripheral blood), the results of serological and allergic reactions( samples).After the 10th day from the onset of the disease, it is possible to put a skin allergic test by Byrne, for which strictly 0.1 ml of brucellin is injected strictly on the forearm onto the forearm;the results are evaluated after 24 and 36 hours. With a positive sample at the injection site, a red spot( a zone of hyperemia with a diameter of at least 3-6 cm) is formed in the skin of brucellin.

Antibodies to brucella circulating in the blood of patients can be detected by Wright agglutination reaction, indirect hemagglutination reaction, RSK, and also in a technically simplified Haddleson reaction. For the minimal diagnostic titer of Wright's reaction, her positive results( + or + +) are taken when the blood serum of a patient is diluted with isotonic sodium chloride solution in a ratio of 1: 200. Wright's reaction and Byrene's test can be positive for a long period after recovery, as well as in individuals, grafted against brucellosis.

Differential diagnosis in the first 8-10 days of the disease is carried out with typhoid fever, sepsis, infectious mononucleosis, and in areas where malaria is found in the population - also with this disease. After the 10-15th day of the disease, a differential diagnosis is made with rheumatic and rheumatoid polyarthritis.

Non-steroidal anti-inflammatory drugs and physiotherapeutic treatment( UHF, diathermy, paraffin application) are effective in treatment.

For the treatment of patients with acute and subacute brucellosis, tetracycline antibiotics are most effective, which are prescribed 0.3-0.4 g 4 times a day for 7-10 days. We recommend repeated courses( 2-3) at intervals of 10 days. Indication for the appointment of repeated courses - the absence of a persistent drop in body temperature. With prolonged flow( after a drop in temperature), vaccination is recommended to prevent relapses. Along with antibiotics prescribe desensitizing drugs( dimedrol, suprastin, diprazine), anti-inflammatory drugs( rheopyrin, analgin, brufen), with pronounced allergic manifestations showing corticosteroids.

For treatment of subacute, as well as chronic brucellosis in the stage of recurrent generalization, vaccine therapy combined with treatment with antibiotics and other drugs mentioned above is used. The most effective intravenous method of vaccine therapy. The first time in / in is injected with 250 000 microbial bodies of the vaccine and observe the patient for 6 hours, given his reactions. With a moderate reaction, which has a curative value, they begin the course of vaccine therapy. If there is a shock reaction, then this therapy should be abandoned. The first treatment dose of the vaccine should be 500,000, then 1 000 000, 3 000 000, 5 000 000, 10 000 000, 25 000 000, 50 000 000 and end with a dose of 75 000 000 microbial bodies per injection;only 8 intravenous infusions of a medical vaccine are made.

Following the abatement of the acute inflammatory changes in the joints, the patient is prescribed therapeutic exercise, applying the appliqués to the paraffin joints in a warm form, as well as dry heat. With the onset of remission with persistent normal body temperature and a decrease in ESR to 15-16 mm / h, recovering from brucellosis can be directed to spa treatment( Sergievskie mineral waters, Pyatigorsk, Kumagorsk, Talgi, Uchum, Shira, Belokurikha - taking into account contraindications).

What folk remedies to use with this disease look here.

Prevention is primarily to eliminate infection among farm animals and disinfect the environment. In a locality where brucellosis is found among farm animals, disinfection of animal products and raw materials is of great importance. Milk of cows and goats can be consumed only after boiling or pasteurization. All dairy products( curdled milk, curd, kefir, cream, butter) should be prepared from pasteurized milk. A significant role in combating the spread of brucellosis among animals is played by preventive vaccinations with special vaccines. Vaccination and revaccination of people at risk of infection is also necessary.

Prognosis with adequate treatment is normal.

Prevention of the disease is aimed at reducing the incidence of animals.