Brucellosis - the zoonozny infection which is characterized by polyorgan pathologies and tendency to synchronization. A significant pathogenetic component of a brucellosis is allergic reactivity. Transfer of brucellas happens generally food and the waterway, is the most frequent through milk and meat of the infected animals. At cattle-farmers the air and contact way of transfer of a brucellosis can be implemented. The diagnosis is established at identification of the activator in blood, a punktata of a lymph node or tserebrospinalny liquid. Serological diagnostics can be considered reliable at positive result of several various ways at once: IFA, RLA, RNGA, REEF, RSK, etc.
Brucellosis - the zoonozny infection which is characterized by polyorgan pathologies and tendency to synchronization. A significant pathogenetic component of a brucellosis is allergic reactivity. The brucellosis is classified by character of a current, distinguishing sharp (duration up to one and a half months), subsharp (no more than four months), chronic (more than four months) and residual (the remote consequences) forms.
Characteristic of the activator
The brucellosis is caused by motionless polymorphic grampolozhitelny microorganisms of the sort Brucella. The species of the brucellas causing an infection exerts impact on weight of a current, the brucellosis caused by Brucella melitensis infection most hard proceeds. Brucellas of a vysokoinvazivna, breed in cages of an organism of the owner, but are capable to keep activity and out of a cage. In the environment are steady, more than two months, three months – in crude meat (30 days - in salted), about two months - in sheep cheese and to four – in hair of animals remain in water. Perniciously for brucellas boiling, heating to 60 °C kills them in 30 minutes.
The tank of a brucellosis are animals, an infection source for the person mainly are goats, sheep, cows and pigs. Transfer from horses, camels, some other animals is in certain cases possible. Allocation of the activator sick animals happens to excrements (kcal, urine), milk, amniotic liquid. Transmission of infection is carried out by mainly fecal and oral mechanism, most often food and the waterway, realization contact and household (is in certain cases possible at introduction of the activator through microinjuries of skin and mucous membranes) and aerogenic (at inhalation of the infected dust) ways.
Considerable epidemiological danger represent the milk received from sick animals and dairy products (sheep cheese, koumiss, cheeses), meat, products from animal raw materials (wool, skin). Animals pollute excrements the soil, water, a forage that can also promote infection of the person with a nonfood way. Contact and household and air and dust ways are implemented at care of animals and processing of animal raw materials.
At a brucellosis pregnant women have a probability of pre-natal transmission of infection, besides, post-natal transfer at a lactation is possible. People possess a high susceptibility to a brucellosis, after transferring of an infection within 6-9 months immunity remains. Repeated infection with brucellas is noted in 2-7% of cases.
Clinical picture of a brucellosis
The incubatory period of a brucellosis averages 1-4 weeks, but when forming a latent carriage is extended up to 2-3 months. The sharp brucellosis usually develops quickly, elderly persons can have a gradual beginning (in this case patients note the prodromalny phenomena in the form of a general malaise, sleeplessness, weakness, artralgiya and mialgiya with gradual increase of intoxication for several days). Body temperature sharply rises to high figures, the tremendous fever alternates with pouring then, intoxication, most often moderate, despite the expressed temperature reaction develops.
The feverish period most often makes several days, sometimes dragging on up to 3 weeks or month. Patients note frustration of a dream, appetite, headaches, emotional lability. At peak of a temperature curve hyperaemia and puffiness of the person and neck against the background of the general pobledneniye is noted. The moderate polilimfoadenopatiya – lymph nodes, mainly cervical and axillary comes to light, are a little increased in sizes and moderately painful to the touch. At a sharp form more characteristic of the subsharp course of a brucellosis of a fibrozita also cellulitises – dense painful educations on the course of sinews and muscles of the size of a pea can be also noted (sometimes reach the sizes of small egg).
Alternation of a recurrence of fever with the periods of normal temperature is characteristic of a subsharp form of a brucellosis. The feverish periods I can be various duration, temperature increase to fluctuate ranging from a subfebrilitet to extremely high values (including within a day). Fever has the directed character. Temperature increase is followed by intoksikatsionny signs: muscle and joints pain, paresteziya (feelings of a pricking, "goosebumps" in various parts of a body) the general weakness, a loss of appetite and violation of a warm rhythm (at height of fever relative bradycardia – discrepancy of frequency of a rhythm to body temperature takes place). At a normal temperature increase of pulse can be noted. Warm tones are muffled. Patients thirst, complain of dryness in a mouth, locks are frequent.
This form of a disease often is followed by fibroses and cellulitises. At a heavy current development of infectious and toxic shock is possible, (perikardit) complications in the form of an inflammation of covers of heart. The subsharp form of a brucellosis is followed by displays of an allergy – rashes, dermatitis, vascular reactions, etc.). First of all articulate the device usually suffers: jet polyarthritises, bursita and tendovaginita develop. Defeat of testicles and their appendages is characteristic of men, at women violations of periods, endometritises are possible. The brucellosis at pregnancy can promote its premature interruption.
The chronic brucellosis proceeds wavy, with manifestation of symptomatology of polyorgan defeats. At the same time an obshcheintoksikatsionny syndrome (fever and intoxication) are usually expressed it is moderated, temperature seldom exceeds subfebrilny values. Intervals between exacerbations of a disease can proceed 1-2 months. In case of formation of the new infectious center in an organism there is a deterioration in the general state. The symptomatology of a chronic brucellosis depends on primary defeat of this or that functional system the activator and expressivenesses of an allergic component.
Often inflammations of joints (arthritises) and surrounding fabrics, soyedinitelnotkanny pathologies (fibroses, cellulitis) in a waist and a sacrum, elbow joints develop. Sometimes develops spondilit, considerably worsening a condition of patients in view of intensive pains and restriction in the movement. Joints often are exposed to destruction and deformation.
Neuritis (including inflammations of an optic and acoustical nerve) and radiculitises, inflammations of nervous textures, paresteziya is frequent at patients with a brucellosis. The long course of a disease promotes development of jet neurosis. At a chronic brucellosis allergic inflammations of gonads and disorder of fertility are also characteristic (infertility at women, impotence at men). Duration of a disease can make 2-3 years and increase at repeated infection.
The residual brucellosis – the delayed infection consequences – is connected with formation of pathological reactivity. In view of reorganization of immunological structure of an organism specific reactions of an organism – the subfebrilny body temperature, psychological deviations, pathologies of joints, soyedinitelnotkanny educations are possible.
Besides, the brucellosis can leave behind serious degenerate changes of fibrous fabric, in particular significant in the field of nervous trunks and textures – the probability of development of contractures, emergence of neurologic symptomatology is high (paresis, neuropathy). The long course of a disease promotes formation of permanent functional violations from musculoskeletal structures in view of irreversible destruction of articulate fabrics and the copular device (an anchylosis and , contractures, muscular atrophies). Quite often such consequences of a brucellosis are the indication to surgical correction.
Diagnosis of a brucellosis
Bacteriological diagnostics is made in the conditions of the specialized laboratories equipped for work with causative agents of especially dangerous infections. Brucellas allocate from blood, a likvor, punktat of lymph nodes, making biological material on nutrient mediums. In view of considerable labor costs allocation of the activator is seldom made in the diagnostic purposes, definition of anti-genes to brucellas in blood of the patient and serological tests is sufficient for confirmation of the diagnosis.
Anti-genes come to light by means of IFA, RKA, RLA and RAGA. Blood serum is exposed to a research usually, but detection of anti-genes and in cerebrospinal fluid is possible. Definition of antibodies is carried out by means of RA, RNGA, RSK, RIF, and also Wright's reaction and the test for interaction of brucellas with the patient's serum. The positive result not less than in 3-4 various serological tests is considered sufficient for diagnosing. Since 20-25 in the afternoon diseases and during the long period (several years) after recovery positive reaction to skin test of Byurne (hypodermic introduction of a brutsellin) is noted.
Treatment of a brucellosis
Out-patient treatment is shown at the easy course of an infection. In case of a heavy current and threat of complications make hospitalization. For fever the bed rest is shown to patients. Etiotropny therapy means prescription of antibiotics of various groups, one of medicines surely has to have ability of penetration through a cellular wall. Application of the following antibiotikovy couples is effective: rifampicin with doxycycline or ofloksatsiny, doxycycline with streptomycin. In case of development of a recurrence appoint a repeated course of antibiotic treatment.
In addition to basic therapy appoint pathogenetic and symptomatic means: dezintoksikatsionny therapy (depending on weight of intoxication), immunoexcitants (extract of a timus of cattle, pentoksit), novokainovy blockade at a spondilita and intensive radiculitis, resolvents (nonsteroid medicines and corticosteroids depending on a current and articulate manifestations).
Earlier in complex therapy of a brucellosis applied a medical vaccine, but now refuse this practice in view of the expressed suppression of immunity and ability of a vaccine to provoke autoimmune processes. During remissions by the patient sanatorium treatment, physiotherapeutic influence (UVCh, quartz, radonic bathtubs, etc.) and physiotherapy exercises is recommended.
Forecast and prevention of a brucellosis
Usually the brucellosis does not become a cause of death of patients, the forecast is, as a rule, favorable. In cases of a long current and development of resistant destructive defects of the articulate device working capacity restriction is possible.
The complex of the preventive measures directed to decrease in incidence of a brucellosis of people joins veterinary control of the state of health of farm animals, and also sanitary and hygienic rationing of conditions of production, storage and transportations of foodstuff, annual preventive inspections of workers of agriculture.
The agricultural cattle is subject to planned vaccination, Also specific prevention by means of inoculations is shown by a live brutsellezny vaccine to the persons which are directly working with animals. Overalls for work with animal raw materials, strict following to rules of personal hygiene also belong to means of individual prevention.