Brutsellezny uveit – the bacterial inflammation of a vascular cover of an eye caused by microorganisms of a genus of brucellas. The main symptoms of a disease are conjunctiva hyperaemia, a photophobia, decrease in visual acuity, emergence of "floating pomutneniye" and "front sights" before eyes. The biomicroscopy, an oftalmoskopiya, a contactless tonometriya, a vizometriya, ultrasonography and laboratory tests is applied to diagnosis (RIF, PTsR, Byurne's test). Etiotropny treatment comes down to purpose of local and system antibiotic treatment. Hypotensive medicines, NPVS and glucocorticosteroids are symptomatic used.
Brutsellezny uveit - it is the inflammatory process developing directly in a uvealny cover. In 1886 the English scientist David Bruce found the unknown group of bacteria earlier – brucellas, and also described symptoms of infection of the main bodies and systems with them. Damage of eyes at a brucellosis is observed at 26% of patients. Pathology is widespread everywhere, however the incidence is highest in agricultural regions. About 74% of patients indicate contact with animals, 70% – consumption of fresh milk, cheese or a liver. In 38% of cases the positive family anamnesis of a brucellosis is noted.
Reasons of a brutsellezny uveit
The etiology of a disease is connected with direct infection of a vascular cover of eyes with bacteria of a genus of brucellas. Representatives of microorganisms of this class are small gramotritsatelny aerobic kokkobakteriya. Thanks to ability to intracellular reproduction pathological agents remain in an organism a long time. Optimum temperature of activity of microbes – 37 °C. Bacteria are very exacting to conditions of nutrient medium. As causative agents of a disease are considered brucellas, pathogenic for the person of a look, three the main: Maltese (Brucella melitensis), bull (Brucella abortus), pork (Brucella suis).
High penetration is characteristic of brucellas. They pass through a conjunctiva and cause damage to covers of a forward segment of an eye with direct transition to a horioretinalny zone. Also bacteria get through sites of a mikrotravmatization of skin and even the uninjured mucous membranes of bodies of respiratory and digestive systems. Further with lymph current they extend on an organism and settle in lymph nodes. The subsequent hematogenic dissemination of microorganisms becomes the reason of infection of a vascular cover without primary inflammation of a conjunctiva.
Brucellas can be in phagocytes and inhibit merge fagosy with lysosomes. Bacteria form L-forms, persistirut long time in an organism that leads to formation of granulomas. Upon the return transition to an initial form there is a recurrence of a brutsellezny uveit. The expressed hypersensitivity of the slowed-down type is characteristic of a disease. At a brucellosis all structures of an eyeball can be involved in pathological process, the greatest danger is constituted by development of a panuveit. A morphological substratum of a disease – a granulematozny inflammation with tendency to formation of multiple exudates of a horioidea.
Symptoms of a brutsellezny uveit
The clinical picture of a disease in many respects depends on a type of the activator. At infection with the Maltese brucella the heavy long current with high probability of synchronization is characteristic of pathology. Other species of microorganisms cause easier forms of an inflammation of a vascular cover of an eyeball. At isolated brutsellezny twine pathological changes come to light on the one hand. After a certain period similar defeat is found in the second eye. If the disease develops against the background of a generalized brucellosis, the symptomatology is always symmetric.
At forward twine patients show complaints to discomfort and morbidity in periorbitalny area, reddening of eyes, the expressed photophobia and dacryagogue. In case of intermediarny localization of process the main symptoms of a disease are sight "zatumanivaniye", emergence of "front sights" and "floating pomutneniye" before eyes. Progressing of a disease leads to decrease in visual acuity. At the complicated current of a brutsellezny uveit there are unnatural dark stains under review. Because of severe pain patients close eyelids and close eyes hands. Bright light exponentiates strengthening of clinical symptomatology.
At a forward form of a uveit tape-like dystrophy of an iris and a keratopatiya is often noted, back sinekhiya are formed. Increase in the intraocular pressure (VGD) becomes the oftalmogipertenziya reason. At violation of intraocular hydrodynamics the risk of development of secondary glaucoma significantly increases. At the accompanying defeat of a crystalline lens the zadnekapsulyarny cataract progresses. The most terrible complication of a brutsellezny uveit – an ekssudativny otsloyka of a retina. At some patients brutsellezny uveit is combined with the expressed jet inflammation of a vitreous body and hypostasis of a makulyarny zone of a retina. Distribution of pathological process on all structures of a uvealny path leads to a panuveit (iridotsiklokhorioidit).
Diagnosis is carried out by the infectiologist and the ophthalmologist, is based on anamnestichesky data, data of fizikalny inspection, results of tool and laboratory diagnostics. The palpation of lymph nodes, ultrasonography of abdominal organs and a X-ray analysis of a thorax for an exception of a generalized form of a brucellosis is in addition carried out. The following methods of a research are appointed:
- Immunofluorescence reaction (REEF). Pathological material is processed by means of special marked fluorokhromy antibodies. In the presence in dab of anti-genes of brucellas they contact antibodies. By consideration of dab through a luminescent microscope the characteristic luminescence comes to light.
- Cultural research. Crops of blood on nutrient mediums are carried out. Growth of colonies of brucellas demonstrates existence of these bacteria in an organism. It is possible to confirm the diagnosis with a cultural method only 50-70% of cases.
- Skin and allergic test of Byurne. At an organism sensitization intracutaneous allergic test with brutselliny positive. On the place of introduction of allergen there is a red painful papule of an oval form towering over skin level.
- Polymerase Chain Reaction (PCR). It is the serological method of diagnostics allowing to reveal DNA of brucellas in biological material by means of amplification of nucleinic acids. Reliability of result reaches 98-100%.
Visually hyperaemia and puffiness of forward department of eyes, maceration of skin in okologlaznichny area is defined. At unilateral process the anizokoriya due to narrowing of diameter of a pupillary opening on the struck party is observed. For confirmation of specific changes at brutsellezny twine the following methods of tool diagnostics are applied:
- Oftalmoskopiya. At survey of an eye bottom symptoms of hypostasis of a disk of an optic nerve and an internal cover are visible. In peripheral departments the horioretinalny centers of an inflammation with accurately outlined borders are found. At the expressed ekssudation the otsloyka of a retina is noted.
- Eye biomicroscopy. At survey of a forward segment the perikornealny injection, the granulematozny centers of an iris and back sinekhiya is visualized. Cellular reaction of a vitreous body is defined. At a chronic current local thickenings of an iris are looked through.
- Viziometriya. At an easy course of disease visual acuity corresponds to reference values. The expressed visual dysfunction is characteristic of severe forms of a brutsellezny uveit, the type of a clinical refraction corresponds to a miopiya of high degree.
- Contactless tonometriya of an eye. Distinguish uveita with hypo - or hypertensia. Value of intraocular pressure directly depends on passability of trabekulyarny network. At violation of circulation of the VGD watery moisture significantly raises.
- Ultrasonography of an eye. Ultrasonography is applied at turbidity of optical environments of an eyeball and impossibility of performance of an oftalmoskopiya. In the mode of AV-scanning hypostasis of structures of a uvealny path, cellular suspensions in a cavity of a vitreous body comes to light.
- Gonioskopiya. Inspection of the forward camera is performed at increase in VGD. Visually forward sinekhiya, signs of a neovaskulyarization of an iris and a corner of the forward camera are defined. At a long current the centers of the organized exudate are visible.
Treatment of a brutsellezny uveit
Therapeutic tactics depends on features of a course of a disease. Etiotropny therapy is based on prescription of antibiotics from group of tetratsiklin and aminoglycosides. Besides the specified medicines apply the medicines capable to get in cages – sulfanylamides () to achievement of necessary effect. The most effective scheme of treatment it is considered to be a combination of doxycycline and a netilmitsin. Duration of a course makes 21 days. Further for 1 week reception only of an antibiotic of a tetracycline row is shown.
In the absence of effect of the appointed therapy introduction of medicines from group of a reserve is recommended. The following representatives of a class of ftorkhinolon treat them: ciprofloxacin hydrochloride, , . These medicines are used independently or in combination with doxycycline. In addition include local nonsteroid resolvents in a complex of treatment. At a heavy current instillations of glucocorticosteroids are shown. System introduction of hormonal medicines is justified only at the expressed allergic reaction (a small tortoiseshell, Quincke swelled). At development of symptoms of an oftalmogipertenziya add instillation of hypotensive drops to the program of treatment.
Forecast and prevention
The forecast at brutsellezny twine doubtful. Synchronization of process is followed by formation of dense soyedinitelnotkanny granulomas on the structures of a uvealny path becoming the reason of permanent decrease in visual acuity. After treatment unstable immunity is formed, 3-5 years later the reinfektion is possible. For the purpose of specific prevention of the population from risk group the special vaccine is developed, however it is effective only for 10-12 months therefore repeated carrying out an inoculation is shown every year. Nonspecific preventive measures come down to washing of hands with soap or processing by antiseptics before touches to okologlaznichny area. It is recommended to drink the pasteurized or boiled milk, to consume thermally processed meat.