Allergic subsepsis is the simptomokompleks of infectious and allergic genesis with not clear etiology which is generally striking children and similar according to the characteristics with autoimmune collagenases. Symptoms are suddenly developing severe fever lasting from 2-3 days up to several months, rashes on skin of eritematozny or koreoidny character, pain and swelling of joints (polyarthritis). Diagnostics is made on the basis of a clinical picture of a disease and results of laboratory analyses (OAK, biochemical blood test). Treatment is complex, includes application of antibacterial means, nonsteroid anti-inflammatory medicines, in difficult cases glucocorticoids and cytostatics can be used.
Allergic subsepsis, or Visslera-Fankoni's disease, was allocated in separate nosological unit in the forties of the 20th century (in 1943 by G. Vissler and, irrespective of it, in 1946 to G. Fankoni). The etiology and many stages of pathogenesis of a syndrome are studied insufficiently for today. Usually the disease affects children at the age of 3-8 years, however cases of development of pathology in babies in the first weeks of life are described. There are no exact data on prevalence of subsepsis, generally – because of complexity of its differential diagnostics with some forms of jet arthritis, Steel's syndrome and true sepsis. Some authors consider that Visslera-Fankoni's syndrome is one of stages of development of the present a collagenase.
The disease etiology at the moment is definitely not established, experts in the field of clinical allergology, immunology, an infektologiya and some other the medical directions are engaged in its studying. Despite a clinical picture, characteristic of sepsis, crops of blood of patients practically always are sterile, it demonstrates that the infection is only a starting factor for immunological reaction. A number of patients with allergic subsepsis in the anamnesis has frequent episodes of intolerance of flower pollen, household dust, some foodstuff and medicines. It is unknown whether allergic reaction is a link of pathogenesis of a disease or just points out the changed reactivity of an organism of the patient and the broken condition of its immune system.
In blood of some persons anti-nuclear antibodies and other indicators of autoimmune pathological processes decide on Visslera-Fankoni's disease. It unites a disease with a number of autoimmune pathologies, such as Steel's syndrome, rheumatism, jet polyarthritis. The fact that subsepsis is inclined to spontaneous disappearance with recovery of the patient contradicts his consideration as initial stage of kollagenoz. There is a hypothesis that several diseases of various genesis can be shown by this simptomokompleks. The ambiguity in questions of development of pathology complicates development of effective etiotropny therapy therefore treatment is carried out symptomatic, by means of complex use of medicines from different groups.
Because of weak study of an etiology of allergic subsepsis there are many gaps in understanding of processes of pathogenesis of this state. According to the most widespread theory of development of a syndrome of Visslera-Fankoni, under the influence of the center of a bacterial infection of sharp or chronic character there is a system perverted immunological reaction. Assume that development of reaction is provoked by a septitsemiya at which activator anti-genes in large quantities get to a blood-groove. Because of features of reactivity it is activated system of a complement (mainly in tissues of skin and articulate covers). It conducts to emergence of characteristic rash and an artralgiya. In cells of epidermis find the increased quantity of components of a complement.
The pathogenesis of fever and hyperthermia at subsepsis presumably is explained by activation of macrophages and allocation of a set of pyrogenes by them. Not clear are aspects of emergence of anti-nuclear antibodies, a neytrofiliya and sharply expressed leykotsitoz characteristic of true sepsis. It is considered that emergence of antibodies to a cellular kernel indicates transformation of allergic subsepsis in true collagenases that it worsens the forecast of a disease. The pathogenesis of development of damages of heart (myocardites and perikardit) at this state is unknown. They are noted at small percent of patients, extremely seldom lead to complications, are inclined to spontaneous treatment.
Symptoms of allergic subsepsis
In most cases the disease begins sharply, against the background of full health, without any prerequisites or the prodromalny phenomena. In rare instances allergic subsepsis arises soon after the postponed quinsy or a respiratory disease. High temperature (to 38-39 °C) becomes the first display of pathology, fever has continuous or intermettiruyushchy character with periodic sharp rises and temperature drop with frequency in 2-3 days. Decrease in temperature after peak continues 10-18 hours and is followed by plentiful sweating. The general duration of the period of a hyperthermia can make up to several weeks or months.
During the first hours after temperature increase on skin there are rashes of eritematozny or urtikarny character. Frequent localization of rash – integuments of legs and hands, less often they are registered on skin of a breast, the person, a stomach. Skin elements can become less expressed and appear again, frequency of rashes often coincides with the periods of increase and decrease in temperature and feverish manifestations. Patients complain of a moderate skin itch in the field of rashes. Hypodermic consolidations in the form of small knots, similar to similar manifestations are found in a part of patients at rheumatism. At height of an attack increase in various groups of lymph nodes – mainly, inguinal, axillary, cervical is noted.
Articulate manifestations, various on expressiveness, – from not intensive pains to considerable hypostasis and reddening are characteristic of allergic subsepsis. More often joints of hands are surprised (interphalanx, luchezapyastny, elbow), in some cases joints of a backbone and the lower extremities can inflame. Localization of articulate defeats can change at each attack of pathology. Against the background of high temperature sometimes arise belly-ache, muscles, at development of myocarditis pain in heart appears. At fever frustration from the central nervous system are possible: sleep disorders, uneasiness, confusion of consciousness.
Complications of allergic subsepsis are registered rather seldom. The most serious consequence of a disease is development true a collagenase – juvenile rheumatoid arthritis or rheumatism. Among other complications heart failure because of development of myocarditis or a perikardit, damage of a liver extremely seldom is registered. Fever can provoke an exacerbation of the chronic diseases of various bodies which are available for the patient. At patients of younger age (3-4 years) the risk of development of repeated episodes after the remission period is high. High temperature sometimes becomes the cause of febrilny spasms.
At diagnosis of allergic subsepsis the immunologist or the pediatrician pays attention to a clinical picture of pathology, results of laboratory blood test. As additional researches appoint a X-ray analysis and an electrocardiography. It is important to exclude as soon as possible true sepsis which demands urgent antibiotic treatment and other emergency measures. Also within diagnosis of a disease of Visslera-Fankoni use the methods designed to differentiate this state with typical collagenases – for example, juvenile rheumatoid arthritis. Hold the following diagnostic events:
- Survey and collecting anamnesis. The hyperthermia, rash on hands and legs of various character is found, identification of consolidations in skin, similar to rheumatic small knots is possible. The palpation of lymph nodes defines their increase and morbidity, some joints are painful when pressing, skin in their projection is hyperemic. The anamnesis often indicates existence of allergic diseases.
- Laboratory blood test. In the general blood test comes to light sharp , the small neytrofiliya with weak neytrofilny shift to the left and increase in quantity of eosinophils is possible. At fever height SOE significantly raises. The biochemistry of blood confirms a giperglobulinemiya (due to increase in concentration of IgG and IgM), decrease in level of albumine and components of a complement, sometimes are registered anti-nuclear antibodies.
- Tool researches. At accession of pathology of heart on the ECG symptoms of myocarditis – an irregular rhythm, changes of a segment of ST, various types of blockade of conduction system are registered. When carrying out a X-ray analysis of a thorax strengthening of the pulmonary drawing, imposing on a pleura and symptoms of pleurisy is defined. Ultrasonography of an abdominal cavity demonstrates increase in the sizes of a liver (at the height of fever) and, more rare, spleens.
Differential diagnosis of allergic subsepsis is performed with true sepsis, juvenile rheumatoid arthritis and other types a collagenase – for this purpose sick appoint a number of additional researches. Crops of blood on nutrient mediums show its sterility that excludes bacteremia and system infectious defeat. Make a biopsy of a sinovialny cover of the affected joints with a further histochemical research for an exception of rheumatoid arthritis.
Treatment of allergic subsepsis
The uniform standard scheme of treatment of pathology does not exist because of insufficiently studied etiology and pathogenesis. Usually apply the complex therapy directed to fight against an infectious factor, decrease of the activity of inflammatory processes. In hard cases appoint medicines for reduction of activity of immunity. Traditional febrifuges (paracetamol, acetilsalicylic acid) poorly help with elimination of fever at allergic subsepsis, however as a part of complex treatment can render salutary effect. The main components of therapy are:
- Antibacterial therapy. Use medicines of a broad spectrum of activity, mainly – a penicillinic row. Efficiency and validity of application of antibiotics at this allergic pathology is challenged by some experts, however the best results of treatment with their appointment, than without that are statistically proved.
- Anti-inflammatory therapy. Apply various medicines from group of nonsteroid resolvents – acetilsalicylic acid, sodium diclofenac, indometacin, an ibuprofen. In difficult hard cases and at the expressed hyperthermia glucocorticoids can be appointed – only they are capable of short term to reduce body temperature at allergic subsepsis.
- Immunosupressivny therapy. In especially hard cases perhaps short-term use of tsitostatik for reduction of expressiveness of immune reactions. Especially often they are applied at damages of heart and the expressed inflammation of joints.
Some doctors consider purpose of salycylates at this pathology ineffective and give preference to a combination of antibiotics to glucocorticoids. Separate cases of effective use of antihistamines are noted. The bed rest, during the periods of fall of temperature of a body – walk in the fresh air is shown to patients. Careful control of laboratory indicators of blood is necessary for early identification of symptoms of rheumatoid arthritis and other kollagenoz. Auxiliary treatment is directed to reduction of side effects from long reception of antibiotics and NPVS (protection mucous a stomach, intestinal microflora restoration), restoration of the water-salt exchange broken as a result of the increased sweating.
Forecast and prevention
The forecast of allergic subsepsis usually favorable, however is required careful control of a condition of patients in order to avoid development of complications. Defeat and an inflammation of joints in the absence of rheumatoid arthritis does not lead to restriction of their mobility after knocking over of an attack. Myocarditis and inflammations of serous covers, as a rule, also recover without consequences. Attacks of fever can last up to 2-4 months then are capable to disappear spontaneously. In the subsequent emergence of new episodes of subsepsis is possible, however in process of growth of the child they become all bystrotechny and proceed easier. In the absence of consequence complications at adults are absent. Because of the poorly studied reasons and pathogenesis of a disease preventive actions are not developed.