Alimentary and toxic aleykiya
Alimentary and toxic aleykiya – the heavy food intoxication caused by mycotoxins of mushrooms of the sort Fusarium. Specific effect of toxin is defeat of lymphoid fabric and marrow. As the main displays of a disease serve necrotic quinsy and a hemorrhagic syndrome. Diagnostics consists in detection of the activator at bacteriological blood test and the patient's tissues, not the smaller part is assigned to careful collecting the anamnesis, existence of characteristic changes of almonds and a leykopeniya in all-clinical blood test. Treatment consists of dezintoksikatsionny, system and local antibacterial therapy, can include transfusion of components of blood.
Alimentary and toxic aleykiya
The alimentary and toxic aleykiya known also as septic, alimentary and hemorrhagic quinsy and sharp alimentary , represents the serious poisoning caused by toxin of fungi . The way of infection – food, is most often connected with consumption of products from the wintered grain containing fungus disputes. For the first time pathology was described in 1932 during epidemic in Kazakhstan; meets on all globe. It is established that residents of agricultural areas are most subject to infection, usually growth of number of the diseased is observed during the period from April to June. The sick person is not infectious for people around.
Reasons of an alimentary and toxic aleykiya
Causative agents of a disease – the sort Fusarium fungi producing toxin which causes local manifestations in the form of a necrosis and possesses a tropnost to the haematogenic and lymphoid fabrics. A source of an infection are the grain crops serving as nutrient medium for reproduction and accumulation of a poin at a wintering. Millet, a buckwheat, wheat, rye, oats and barley belong to such agricultural plants. Favorable conditions for growth of a fungus are high humidity, availability of oxygen and warmly. In cold season fungi turn into disputes and worry winter, and after approach of spring begin to produce again.
The warm winter and early spring, and also high humidity and other violations of the rules of storage of cereals are considered as risk factors of emergence of outbreak of a disease. Toxin does not collapse at heat treatment, fermentation, is capable to keep the properties up to five years, especially at storage temperature range from ‒1 °C to +5 °C. Patients reckon with immunosupression (HIV infection, long therapy by corticosteroids, immunodepressants), persons after a splenektomiya, children, agricultural toilers, employees of the food industry, the sphere of public catering as risk groups on incidence.
After hit of a poin on mucous membranes there is a local reaction connected with necrotic changes of fabrics owing to an extensive inflammation. Through a wound surface toxin is intensively soaked up in blood, carried on all organism, showing a tropnost to myeloid (a red inert brain) and later – to lymphoid fabric. Under the influence of a poin there are a blood formation oppression, inflammatory changes in a timus, a spleen, lymph nodes, peyerovy plaques and an appendix. Gradually there is a decrease in number of erythrocytes, monocytes, granulocytes, platelets, predecessors of T-lymphocytes, V-lymphocytes and NK cages, and also macrophages, dendritny cages. There are hemorrhagic changes in parenchymatous bodies, skin, the septic state develops. Immunity after the postponed disease resistant, but its duration is not studied.
The clinic of an alimentary mikotoksikoz distinguishes two options of a current which are in direct dependence on quantity of the eaten grain product, a toksigennost of a strain, concentration of toxin in foodstuff and immune competence of an organism of the diseased:
- Lightning. Bystry increase of clinical manifestations and a lethal outcome within the first days of a disease owing to the developed DVS-syndrome or sepsis is characteristic.
- Typical. About 3-4 weeks proceed, it is characterized by gradual increase of weight of a state and the expressed staging. Includes toxic, leykopenichesky and anginozno-hemorrhagic stages.
Symptoms of an alimentary and toxic aleykiya
Incubatory the period makes from 2 to 6 weeks, at the use of a large number of products from the infected grain (more than 500 g) symptoms appear in several days. Nausea, vomiting, a liquid watery chair, weakness, decrease in working capacity and fatigue are the first signs of poisoning. The described manifestations continue about 3 days, being replaced by the leykopeniya period. Clinically this state finds itself increase of weakness, an indisposition, drowsiness (this stage usually lasts 2-3, 6-8 weeks are more rare).
Further with aggravation of toxic influence there comes the anginozno-hemorrhagic stage. Patients show complaints to high rises in body temperature (more than 39 °C) shaking oznoba, note emergence of dot hemorrhages (petekhiya) on a body, is more rare – ekhimoz; desnevy and nasal bleedings. At the same time there are severe pains when swallowing, an unpleasant putrefactive smell from a mouth, dirty-gray raids on almonds, in a mouth, a throat and a throat. When progressing a disease phlegmons and abscesses of skin, cellulose and internals are formed.
Complications usually demonstrate at a lightning current of a food mikotoksikoz or in the anginozno-hemorrhagic period of typical option of a disease. The most widespread of them are pneumonia, bronchitis, abscesses of a lung, phlegmon of soft fabrics and osteomyelitis. In the conditions of the accruing immunosuppression data a state can lead to sepsis. Emergence of necrotic changes of disteel departments of extremities is in certain cases observed. Deficiency of the curtailing system of blood, defeat of parenchymatous bodies (kidneys, a liver, a spleen) lead to expansion of the DVS-syndrome with characteristic clinic of the massive not stopped bleedings.
At suspicion on an aleykiya of alimentary and toxic genesis consultation of the infectiologist, otorhinolaryngologist, pulmonologist is obligatory; after emergence of abscesses of skin and internals – the surgeon. For the purpose of identification of the activator, assessment of character and expressiveness of changes laboratory and tool inspections are carried out:
- Kliniko-biokhimichesky blood tests. In the general blood test it is observed the expressed leykopeniye, thrombocytopenia, anemia, acceleration of SOE. Biochemical indicators reflect increase in activity of nuclear heating plant, ALT, creatinine, urea.
- Identification of infectious agents. To allocate a fungus from fabrics and blood of the person - labor-intensive and expensive process. Bakanaliz is made by crops of material on nutrient mediums. Detection of toxin in grain is carried out by means of biological test (feeding of laboratory pigeons by suspicious grain, skin test on rabbits), a chromatography of grains.
- Endoscopy of ENT organs. At survey of a throat ‒ faringoskopiya ‒ are found symptoms of catarrhal, necrotic or gangrenous quinsy. The raids of dirty-gray or brown color passing from almonds on mucous throats, drinks, a mouth are typical; bleeding mucous nose and throat, formation of necroses.
At emergence of symptoms of pneumonia the thorax X-ray analysis is carried out; for the purpose of the differential diagnosis ultrasonography of abdominal organs, a small pelvis, zabryushinny space, lymph nodes is used. Differential diagnostics is carried out with diphtheria, sepsis, system mycoses, agranulotsitozy, quinsy of Simanovskogo-Plauta-Vensana, poisonings with heavy metals, radioactive materials.
Treatment of an alimentary and toxic aleykiya
Therapeutic actions begin with withdrawal from food of the poisoned products, washing of a stomach and a siphon enema (or laxative reception). It is recommended to exclude from a diet alcohol, seasonings, fat, fried, cereal products, to adhere to frequent fractional food, to serve food of room temperature (in order to avoid an additional travmatization of mucous membranes). It is necessary to watch the drinking mode, at the same time it is more preferable to use water or not sour juice. After each reception of food rinsing of an oral cavity is recommended by antiseptic solutions (, Furacilin, a calendula, a sage, a camomile).
Treatment of an alimentary and toxic aleykiya usually stationary, includes dezintoksikatsionny therapy (glyukozo-salt solutions) and reception of antibiotics of a broad spectrum of activity (penicillin, tsefalosporina). At the long course of pathology there can be a need of replacement of losses of components of blood: transfusion of eritrotsitarny, trombotsitarny weight, a leykotsitny concentrate is carried out. There are data on positive influence of a koloniyestimuliruyushchy factor on a current, weight and an outcome of a disease. For the period of treatment it is recommended to reduce doses of immunosupressivny medicines or to cancel them in the presence of such opportunity. At emergence of the localized or poured purulent processes opening and drainage, application of local antibacterial means is carried out them (ointments, suspensions).
Forecast and prevention
At an uncomplicated current the disease lasts about 3-4 weeks. At the timely request for medical care, withdrawal from the use of the infected products of manifestation of a mikotoksikoz are inclined to independent disappearance. At emergence of a hemorrhagic syndrome and necrotic changes of almonds the share of lethal outcomes makes 50-80%. However emergence of life-endangering states requires about two-three months of constant consumption of the infected cereal product, even against the background of an obvious indisposition. Timely hospitalization and careful epidemiological investigation reduces risk of death and complications.
Specific prevention (vaccine) at this stage of development of medicine it is not developed. For prevention of infection with bodies of sanitary inspection periodic inspections of grain, explanatory work with the population are carried out. Sale and purchase of the wintered grain for food needs of people and animals is forbidden (delivery on distilleries is allowed). In the territory where sporadic cases of a toxic aleykiya were recorded, grain products, raw materials from them are subject to utilization; the population has to be examined regarding a leykopeniya.