Bartonelleza – group of the diseases caused by bacteria from the sort Bartonella, proceeding with primary defeat of endotelialny cages and erythrocytes. Clinical manifestations can be various: from easy and local (rash, a limfadenopatiya, conjunctivitis) before widespread system violations (fever, anemia, septic bacteremia, an endocarditis, meningitis, miyelit). Diagnostics of a bartonellez is based on detection of the activator, and also its anti-genes and antibodies in the patient's blood. Therapy is carried out by antibacterial medicines (tetratsiklina, macroleads, ftorkhinolona), according to indications is supplemented with symptomatic treatment (febrifuges, dezintoksikatsionny therapy).
The group of bartonellez includes , trench fever, Karrion's disease, bacillar , a bartonellezny syndrome with bacteremia and an endocarditis, peliozny hepatitis / , a chronic limfadenopatiya. Chronologically the first among all variety of clinical options of an infection studied Karrion's disease therefore it is usually identified with it. Endemic areas for a disease are the North-West Territories of South America. It is connected with an area of dwelling of a carrier of a bacterium – mosquitoes of flebotomus. The peak of incidence bartonellezy falls on a rainy season when mosquitoes are especially active. Other forms of an infection have no accurate geographical location that is explained by universal prevalence the planet.
Bartonella are gramotritsatelny aerobic sticks. Are capable to cause bacteremia, in an organism of the owner persistirut in erythrocytes. Quickly perish under the influence of usual disinfectants. Karrion infecting agent – B. bacilliformis. Besides, pathogenic for the person are B. henselae (causes , bacillar ), B. quitana (causes development of trench fever, a bacillar angiomatoz, bacteremia and endocarditis), B. vinsonii and B. elizabethae (are the reason of bacteremia, endocarditis), B.grahamii (causes neyroretinit), B. washoesis (promotes development of myocarditis).
Get into a human body of a bacterium through stings of mosquitoes, pincers, louses or microinjury of skin. The tank of an infection is the person sick with sharp forms, or the asymptomatic bacillicarrier. Frequency of asymptomatic bacteremia at carriers of an infection reaches 50%. A susceptibility to a bartonellez at residents of endemic areas high. Insanitary conditions, density of people promote increase in frequency of infection.
In the place of penetration of the activator primary affect – a papule, a vesicle or a pustula is formed. Further with lymph current the activator gets into lymph nodes – the limfadenopatiya develops. When overcoming a lymphatic barrier the pathogen comes to blood – there comes bacteremia. Erythrocytes and endotelialny cages of vessels, marrow, heart valves are the most sensitive to bartonella. Active reproduction of the activator in erythrocytes and their destruction causes development of hemolytic anemia.
At sharp processes in cages an endoteliya necrotic changes prevail, the wall of vessels infiltrirutsya by leukocytes and macrophages with formation of granulomas, the phenomena of proliferation are expressed slightly. In mucous membranes, skin small hemorrhages develop. Formation of new small vessels with formation angioendoteliy is characteristic of a chronic current of a bartonellez. At a solvency of system of immunity antibodies with the subsequent elimination of the activator are formed. In case of immunodeficiency there is a synchronization of process to a long persistention in blood. Lack of treatment in such situation can lead to a lethal outcome. At the recovered patients resistant immunity is formed.
Bartonellez represents group of versatile diseases. There is no uniform classification of nozologiya as bartonella remain not up to the end studied bacteria, new data on the damages caused by them appear; besides, one forms can flow in others. Today the following diseases caused by bartonella are known:
- Karrion's disease. The Antroponozny infectious disease with the inoculable mechanism of transfer proceeding as a sharp or chronic form. Temperature increase of a body, a limfadenopatiya, headaches, mialgiya, artralgiya, petekhialny rash on an integument and mucous membranes is characteristic.
- Disease of cat's scratches (, good-quality , Mollare's granuloma, limforetikulit Tsezari). The typical clinical picture represents existence of primary affect, fever, the increased regionarny lymph nodes. Also perhaps atypical current: Parino's syndrome (fever, limfadenopatiya, follicular conjunctivitis), defeat of TsNS (meningitis, encephalitis, polyneuritis) and various bodies (pneumonia, myocarditis, spleen abscesses).
- Bacillar (epitelioidny) . Defeat of an integument and internals is characteristic. At the same time on skin, angioma which are easily injured are hypodermically formed and bleed. In case of involvement of internals temperature increases, there is vomiting, perspiration, weight reduction, pneumonia, abscesses of a spleen, damage of marrow develop.
- Trench fever (tibialny or five-day fever). Patients complain of severe headaches, back, neck, bones pains, especially tibial (tibialny fever). Some patients have a rozeolezny rash. Rises in temperature each five days (five-day fever) are characteristic. The forecast is favorable, at synchronization development of an endocarditis is possible.
- Hepatic and splenic purple (bacillar purple hepatitis, peliozny hepatitis). Represents a form of a bacillar angiomatoz with primary involvement of a liver or spleen. Education in bodies of the multiple cavities filled with blood is characteristic. Clinically fever, nausea, vomiting, developments of stagnation in a liver at the expense of a sdavleniye is defined by neogenic cavities of vessels.
- Bacteremia, endocarditis. Typical symptoms characteristic of a bartonellez, no. It is clinically shown by the expressed intoxication, defeat of various bodies and fabrics (a spleen, a liver, TsNS), development of the DVS-syndrome. At an endocarditis there are noise of various character, the decompensation of cardiovascular system develops.
Karrion's disease is phasic process. Can proceed in the form of sharp (fever of Oroya) or a chronic phase (the Peruvian wart). Perhaps simultaneous development of clinic of both stages. In classical option the chronic stage replaces sharp in 1-2 months.
Incubatory period of a bartonellez from 10 to 120 days (on average about 2 months). At expansion of a clinical picture there is fever of the wrong type, rise in temperature to 39–40 °C is followed by a fever, and decrease – perspiration, reminding malaria. Patients complain of headaches, an indisposition, belly-ache, joints, muscles. The expressed pallor at the expense of anemia is characteristic. There can be various symptoms of violation of the neurologic status up to development of a coma. On skin, mucous membranes there are small hemorrhages. The liver, a spleen, lymph nodes increases. At a favorable outcome of a disease of people recovers, however without treatment the lethality makes from 40 to 90%.
At preservation of the activator in an organism passes into a latent stage with the subsequent reactivation and development of a chronic phase ‒ the Peruvian wart. Again temperature increases. On a body there is papular rash which is transformed to small knots from 3 mm to several centimeters in the diameter over time. Most often rashes are localized on a face, a neck, extremities. Damage of mucous membranes of a mouth, vagina, digestive tract, etc. is observed. Knots can bleed and with accession of a secondary infection. At a favorable current in 1-2 months there occurs recovery, knots are resolved without hem.
The most widespread complication is accession of a secondary salmonellezny infection. In case of development of a septic form of a disease the lethality sharply increases. Besides, infection of ulcerations of rashes at the Peruvian wart is possible, in that case wounds heal with a hem. At defeat of mucous there are bleedings. Bacteremia and polyorgan defeats promote development of sepsis which usually is followed by the DVS-syndrome. Regurgitation of high degree on heart valves leads to insolvency of compensatory opportunities of heart that demands surgical replacement of the valve. Defeats of TsNS result in neurologic deficiency, bacillar promotes oppression of functions of a liver.
At suspicion on consultation of the therapist, infectiologist, dermatologist, in case of defeat of nervous system – the neurologist, development of purulent complications – the surgeon is necessary. During fizikalny inspection pallor, on skin – primary affect with a regionarny limfadenopatiya is noted, at a palpation – the increased liver, a spleen. In diagnostics the following laboratory and tool methods are used:
- Blood tests. Generally and biochemical blood tests it is observed hemolytic makrotsitarny normo-or gipokhromny anemia, inflammation markers (SRB, a pro-calcitonin, increase in level of globulins), acceleration of SOE. Leykotsitoza can not be, at thrombosis decrease in indicators of fibrinogen, increase in the D-dimerov level is noted.
- Direct detection of the activator. At microscopy of dabs of blood painted according to Romanovsky-Gimz, pathogenic microorganisms come to light outside of and in blood cells. Also as medicine biopsiyny material from lymph nodes or elements of rash can be used. On blood crops previously it is possible to judge existence and degree of bacteremia in 3 days, it is final – in 7-10 days. DNA of the activator identify by PTsR method.
- Serological methods of diagnostics. Carry out definition of antibodies (IgM and IgG) in serum of blood of the patient by method of reaction of hemagglutination, binding of a compliment, an indirect immunofluorescence, the immunofermental analysis. For detection of anti-genes carry out an immunoblotting, a western-blotting.
- Ultrasonography of abdominal organs. Ultrasonography of OBP is not a specific method of identification of a bartonellez. During the procedure increase in a liver, spleen, intra belly lymph nodes is defined. Identification in parenchymatous bodies of the cavities filled with liquid, the proliferation centers is possible. The similar picture can remind a set of other diseases.
Differential diagnostics of a bartonellez is carried out with a skin form of tuberculosis, angiosarkomy, a skin tumor, in particular a myeloma. More widespread nosology – – should be differentiated with an atypical mikobakterioz, syphilis, a tulyaremiya, a lymphoma. Difdiagnostik of a bacillar angiomatoz needs to see off with Kaposha's sarcoma, angiomy, planocellular and bazalnokletochny cancer. The endocarditis and bacteremia need to be distinguished with the similar diseases caused by other pathogens.
Treatment of a bartonellez
Treatment is performed in an infectious hospital. Observance of a bed rest is necessary. Etiotropny therapy is carried out by antibacterial medicines. As the subsequent secondary accession of salmonellosis is possible, it is rational to use ciprofloxacin or in combination with a β-laktamny antibiotic. Medicines of a reserve are macroleads, tetratsiklina, rifampicin. If necessary symptomatic treatment (dezintoksikatsionny therapy, febrifugal medicines, gepatoprotektor, transfusion of eritrotsitarny weight) is appointed. After washing by antiseptics apply bandages with antibacterial ointments the infected skin elements.
Forecast and prevention
In a sharp phase in the absence of the accompanying pathology and in due time begun treatment the forecast favorable. However at immunosupression with massive bacteremia development of a bacillar angiomatoz, defeats of nervous system, a decompensation of warm activity due to defeat of valves is possible. In a stage of the Peruvian wart lethal cases are almost not described, mortality is connected with accession of an infection. Specific prevention of a bartonellez is not developed. Individual measures of protection provide application of repellents, anti-mosquito grids.