Brucellosis - Causes, symptoms and treatment. MF.
Brucellosis( Maltese fever, Cyprus fever, Gibraltar fever, undulating fever, Bruce's disease, Bang's disease) is a disease that is a zoonotic bacterial infection with a high chronicle potential, characterized by a variety of symptoms, but the most common defeat is the musculoskeletal system and peripheralnervous system, and proceeding against the background of a general intolerance and febrile state.
Initially, one of the scientists( Martson in 1856) observed an unknown fever with accompanying symptoms on the island of Malta, and therefore gave it the name "Maltese fever", the same scientist established that the main source of the disease are sheep and goats, and infection occurs whenconsumption of raw milk. Later there were those who discovered the same fever later, and called this fever their own name - either out of a thirst for vanity, or because of ignorance( scientist Bruce 1887 and others).But there were also scientists who supplemented the Maltese fever data:
• Wright and Semple found that serum from patients with brucellosis gives an agglutination reaction, since then this observation is used for diagnostic purposes as a serological reaction.
• Other scientists registered infectious abortions due to this disease.
Brucellosis causative agent
Pathogens are several microorganisms of the genus Brucella( Brucella melintensi, abortus, suis, canis and others).The causative agents are intracellular parasites, gram-negative( that is, they give a pink color in coloring, which is of diagnostic importance for bacterioscopy).Dispute and capsules do not form, but despite the absence of these structures, this does not beg for their stability and virulence( the degree of disease).
The causative agent of brucellosis
Pathogens are strict aerobes( ie oxygen is required for their reproduction) and do not grow in a non-corrosive environment, and for a good growth when growing on nutrient media, an increased concentration of CO необходима is needed, in diagnostics, namely bacteriological sowing, Optimum( in addition to the gas composition, the temperature is selected), and even after this it takes a long time to wait for the beginning of growth of 2-4 weeks. Because brucellas are dangerous pathogens, laboratory diagnostics are also carried out in specialized well-equipped laboratories that meet the requirements of prevention.
Structural features characterize specific virulence and include:
• Ability to inhibit phagocytosis( the true cause of this factor is not well understood), but this allows brucellae to be inaccessible to antibodies and antibacterial drugs.
• Ability to transfer to L-forms( partial or complete deprivation of the cell wall with preservation of pathogenicity, ie, malignant capacity, which is activated when favorable conditions are created, with this form the bacterium is as if in its vital state).This transformation occurs as a result of incomplete phagocytosis and the inability of antibacterial drugs to completely destroy the pathogen.
• High capacity for invasion( intubation) and intracellular parasitization, especially in lymphocytes and CMF hornets( mononuclear phagocyte system) due to good protection against phagocytosis and, as a result, the immune system fails and allergic alteration, this in turnleads to the formation of secondary foci of infection in internal organs with further morphofunctional( disruption of structure and function) changes and chronic infection, due to the possibility of prolonged stay of the pathogen instate of preservation.
• The presence of endotoxin, which is released only with a dominant phagocytic activity( ie, when phagocytosis takes precedence) and causes general toxicity symptoms.
• High enzymatic ability: release of H₂S( hydrogen sulphide gas, which in various concentrations can have both anti-inflammatory and cytotoxic effects).It is able to form phosphatase( involved in the process of calcification, which is possible and explains the proliferation of bone tissue in the joints and the occurrence of arthrosis).Forms urease( enzyme catalyzing the decomposition of urea on NH₃ and CO₂, which plays a role in the formation of intoxication syndrome).Forms catalase( an enzyme that cleaves H₂O₂ on H₂O and O₂ - it probably prevents an oxidative explosion).
• Weak hyaluronidase activity causes the dissociation between connective tissue cells in organs and tissues, this leads to the destruction of their tissues and subsequent disruption of function.
Stability:
• Under normal conditions, the environment and foodstuffs persist for a long time:
- in water and brynza for more than 2 months
- kefir - up to 11 days
- milk - 40 days
- in solid grades of cheese - 1 year
- raw milk - 3 months
- salted meat - 1 month
- wool - 4 months
- oil - 5 months
• At low temperatures - up to several years
• At high temperatures: 60 ° C -30 minutes, 100 °C( boiling) - death is instantaneous.
• UVI and disinfectant solutions also act instantly fatal.
Brecellosis is common in many countries and around the world, about 500,000 diseases are recorded per year. But there are territorially dangerous zones, ie with a potentially dangerous risk, to them include: the Republic of Dagestan, the Krasnodar and Stavropol Territories, the Southern Urals, the Altai and the Republic of Tyva are areas with cattle-breeding orientation of agriculture.
Susceptibility is high and ubiquitous, without age and sex restrictions, and the infectious dose is small and amounts to 10-100 microbial bodies.
Causes of infection with brucellosis
Source - farm animals( sheep, goats, cows, pigs, dogs).Ways of infection - contact, alimentary, aerogenic. The contact path is of a professional nature, because infection occurs when amniotic fluid enters open parts of the body( for calving, care of newborn calves, lambing) - mainly veterinarians, calves and shepherds become infected. Also, the contact transfer pathway can also be active when working with raw meat of infected animals. Alimentary infection occurs with the use of unpasteurized milk or the preparation of food products. The aerogenic pathway is active when air enters the respiratory tract with dust containing brucella( grazing and sheepfold), as well as in laboratories with disturbed safety regimes.
Symptoms of brucellosis
The incubation period is the interval from the moment of introduction of the pathogen to the first clinical manifestations, lasting on average from 7 days to several months. Getting into the body through microtraumas of the skin, through the mucous membranes of the digestive and / or respiratory tract, the pathogen is captured by tissue macrophages and passes through the propagation stage:
• first enters the lymphogenous structures, spreading in macrophages is the lymphoid stage;
• through the lymphoid system enters the bloodstream - this is the hematogenous stage;
• the causative agent enters the internal organs by hematogenous and lymphogenous pathways and this indicates the stage of polychamp infestations( poly = many) with various metamorphoses( change at the structural and functional level) - the degree of seeding will depend on the severity of allergic reconstitution.
The incubation period ends when phagocytosis( the cells devouring the immune system of foreign structures) begins to dominate the spread of the pathogen and thus stimulates the release of endotoxin( it is released only after the death of the pathogen) and the period of clinical manifestations begins.
The period of clinical manifestations can occur at any stage of the pathogen distribution, therefore the above-described incubation period is so variable and can last up to several months. Symptoms are very diverse and complex in diagnosis, because many organs are affected. A number of authors, based on this, decided to simplify the variety of symptoms and focused on the reactivity of the immune system response, highlighting the compensation stages, which are characterized by their symptoms:
1. Compensated stage - the formation of the primary latent infection of
2. Decompensated - the formation of an acute-osseptic form
3. Subcompensation refers to the gradual restoration of the reserve capabilities of the immune system - the formation of a chronic metastatic phase( i.e., the formation of polychagenstions, mentioned above).
4. The compensatory stage indicates recovery, but postinfection phenomena often remain( but possibly their absence).
• The compensated stage is characterized by a condition of imaginary well-being, when symptoms are practically absent, or subclinical( manifestations are minimal).But even in this case, specific laboratory data are positive.
• The decompensated stage is characterized by a high fever( 39-40 ° C) with a large daily amplitude( eg in the morning of 37, and in the evening of 40 and, the higher the daily difference, the heavier the condition), the increase in lymph nodes, hepatosplenomegaly( enlargement of the liver andspleen).At this stage, foci of seeding are still absent.
• Subcompensation is characterized by a general toxication symptom against a background of a number of organic lesions, generalized lymphadenopathy( lymph nodes are enlarged in different areas - axillary, inguinal, occipital, etc, their colibrations are different, the consistency is also different), hepatosplenomegaly and polyorganism lesionslower, in frequency in descending order):
- From the musculoskeletal system: pain in the large joints( ulnar, knee, etc.) due to overgrowth of bone tissue, with timem is bound by the movement and swelling, but there is no hyperemia or skin changes over the joint( this is important for differential diagnosis).One of the manifestations of the defeat of the musculoskeletal system is sacroiliitis( defeat of the sacroiliac joint).To determine the defeat of this localization, a number of diagnostic techniques are needed( the symptom of Eriksen, Nahläss, Larrei, Janat-Ber), but the most striking and simple example is pain in the iliac articulation, lying on the stomach, trying to bend the leg in the knee joint.
- Myositis is manifested by blunt and prolonged pain in the muscles, often in the place of weather. In the thickness of the muscles, palpation( palpation) is determined by painful seals - infiltrates.
- Fibrositis( inflammation of the perivascular soft tissues) is often localized in the subcutaneous fatty tissue of the abdomen, forearm, back and waist. They are probed in the form of various dense and painful formations of various sizes( from 5mm to 4cm).In the future, they can either be sclerized( because of the deposition of calcinates), or dissipated without a trace.
- Defeats the nervous system: the peripheral nervous system is more often affected, with the development of neuritis, polyneuritis, sclerositis;when the CNS is affected, there are symptoms that are characteristic of myelitis, meningitis, encephalitis and meningoencephalitis.
- Urogenital system: in men this condition is harakterzuetsya orchitis, epididymis and a decrease in sexual function;in women - salpingitis, metritis, endometritis, amenorrhea, infertility, infectious abortions, but if the child survives - observe congenital brucellosis.
- Visual system: lesions occur at any level( from iritis and to damage to the optic nerve) is characterized by visual impairment.
- Cardiovascular system: myocarditis, endocarditis, endo / peri / panvasculitis, impaired vascular permeability.
• Compensatory stage( residual): characterized by post-infection consequences and, from the side of any of the above systems, residual changes can be observed, remaining for 2-3 weeks.
Diagnosis of brucellosis
1. Epidemic prerequisites( place of work, eating poor-quality meat or dairy products, etc.).
2. Clinical data due to its variability and varying degrees of maloinformativny, therefore, resort to laboratory diagnostic methods.
3. Laboratory confirmations are performed according to the "Federal standard medical care in the diagnosis of brucella":
- OAK( ↓ Lc and E, ↑ Lf and M, thrombocytopathies)
- OAM( check 2 times in dynamics)
- feceson the eggs worm
- biochemical study to determine compensation from the liver( bilirubin, ALT, AST, APF)
- blood for bacteriological research, ie for the presence of brucellas
- blood test for the Wright-Semple reaction( this is the most informative method)
- Coombs reaction( 2 rfor the dynamics)
- Allergic Burne sample( by intradermal brutsillina), the result measured at the largest swelling: 1cm to -somnitelnaya reaction -slabopolozhitelnaya 1-3 cm, a positive 3-6sm more 6cm - strongly positive.
- ECG
- ultrasound of internal organs
- X-ray of the spine and joints
- ELISA( to determine the intensity of immunity look at IgG and M, in the presence of M- it speaks of acute process, G - chronic or sluggish)
- Consultation of narrow specialists on indications
Serological( Wright's reaction) and allergic reactions can be false-positive in vaccinated people. But here the negative result of the reaction to Byrne clearly indicates the absence of the disease( not counting HIV-infected).
Brucellosis microscopy
Treatment of brucellosis
Treatment is also performed in accordance with standards:
1. Antibiotic therapy is performed for 1.5 months using one of the following regimens:
• doxycycline + streptomycin or rifampicin;
• co-trimoxosol + rifampicin;
• doxycycline + gentamicin;
• rifampicin + ofloxacin.
2. The therapeutic dose of a brucellosis vaccine( suspension of inactivated or killed vaccines) with subcutaneous injection at the stage of decompensation, and with intradermal administration during the initial stages of the disease. Individual selection of doses is carried out, but this type of therapy is very rarely used, because antibiotic therapy quite justifies expectations.
3. Desensibilizing therapy consists in prescribing antihistamines( eg prometazine).
4. NSAIDs( non-steroidal anti-inflammatory) drugs are used in the defeat of the musculoskeletal system. Use deklofenak, ibuprofen, etc.
5. SCS( glucocorticosteroids) are used in combination with NSAIDs when they are ineffective.
6. Immunomodulators are used when the immune status changes. Polyoxidonium is often used.
7. Physiotherapy is applicable for lesions of the musculoskeletal system and peripheral nervous system
8. Sanitary treatment.
Complications of brucellosis
• Complications include residual changes in organs and systems in the compensatory stage( described above).
• Secondary bacterial complications of
• Incompatible complications from CNS and musculoskeletal system.
Prevention of brucellosis
1. Veterinary:
- preventive agent introduction to favorable farms by systematic examination and culling of sick animals
- vaccination of animals
- hygienic maintenance and disinfection of premises in livestock farms
2. Health care:
- special clothing of livestock workers and systematicexamination for brucellosis,
- sanepidrem in the food industry, namely the control of potentially dangerous products;Pasteurization of milk, keeping the cheese for 2 months, and for hard cheese - 3 months.
- livestock workers and the population of disadvantaged epidemic areas are injected with a brucellosis live dry vaccine( CVW), but now they use the chemical brucellosis vaccine( XBV)
. They also put emphasis on medical examination for those who have recovered - they are put under the supervision of a doctor for 2 years, with quarterly clinical andserological examinations, and if the titer of serological reactions increases, the patient is repeatedly examined at least once every 2 months, if necessary, the treatment is prescribed. And in 1 year of clinical examination, a prophylactic, antiretroviral course is performed at each examination. They are taken into account when specific laboratory diagnostics give negative results.
Brucellosis physician consultation:
Question: Is immunity formed after a previous illness?
Answer: Yes, but it is relaxed and its duration can vary from several months to 6 years. Possible repeated infection with the penetration of high doses of the pathogen. The formed immunity is cross, ie against the main types of brucella. The formed immunity speaks about the formed completed phagocytosis, ie about good compensation from the immune system.
But the opinion of scientists diverge on this issue even to this day - regarding the intensity, duration and specificity of the formed immunity, so do not be surprised if you meet in the literature absolutely opposite beliefs. Probably, such errors are connected with incorrectness in diagnostics.
Question: Is the sick person contagious?
Answer: no
Question: What are the advantages of vaccination?
Answer: In vaccinated patients, the disease is easier and less prolonged, while the temperature is low, the symptoms are minimal. But even among vaccinated people, the defeat of the locomotor system is manifested to the fore and manifests itself in the form of arthralgia. Also, the vaccine can be used in the treatment of chronic brucellosis, because it stimulates the formation of post-infection immunity. For vaccination, they stopped using a live dry vaccine, because she is happy with allergy, in return she received a chemococcus brucellosis vaccine( in no way inferior to the previous one).
Doctor therapist Shabanova IE