Listeriosis belongs to zoonozny infectious diseases, has the polymorphic clinical current with prevalence of defeat of mononuklear and nervous cages or flowing in an anginozno-septic form. Listeriosis has generally fecal and oral way of distribution, also listeriya can get into an organism in the aerosol and transplacentary way. On primary clinical symptoms listeriosis is divided into the anginozno-septic, septiko-granulematozny, glazo-ferruterous and mixed forms. Definition of a monotsitoz in AS WELL AS allocation of the activator is the cornerstone of diagnosis of listeriosis during the bacteriological research.
Listeriosis belongs to zoonozny infectious diseases, has the polymorphic clinical current with prevalence of defeat of mononuklear and nervous cages or flowing in an anginozno-septic form. Listeriosis is classified depending on a clinical picture, being subdivided on anginozno-septic, glazo-ferruterous, septiko-granulematozny (develops mainly at a fruit or the newborn child) and mixed forms.
Characteristic of the activator
Listeriosis is caused by Listeria monocytogenes bacterium representing a mobile, facultative and anaerobic, grampolozhitelny, short stick. Listeriya do not form a dispute, can take root into cages and form the capsule, promoting the latent course of an infection. In the external environment are steady, easily transfer freezing, will breed in the soil and water, on plants and in corpses of animals at a temperature from 4-6 °C. The inactivation at impact of a sunlight occurs 2-15 days later, in formalin solution – in 20 minutes. In the salted products can keep viability at concentration of salt of 6-20% rather long time. 5-10 minutes later perish at a temperature of 100 °C. The majority of strains, with rare exception, is sensitive to antibiotics of a broad spectrum of activity.
The tank and source of listeriosis are animals and objects of the environment (water, the soil, etc.). Many pets and birds get sick with listeriosis, infection cases at wild mammals (rodents, foxes, minks, raccoons, hoofed) and birds are noted (pigeons). Sowing by bacteria of fishes and seafood is possible. Allocation of the activator happens to excrements, saliva, milk, sperm. The person can become an infection source at realization of a vertical way of infection (from mother to the child perinatalno and at a lactation). Women in childbirth and newborns allocate the activator of 10-12 days after a rodorazresheniye.
Listeriosis is transmitted through various mechanisms (fealno-oral, transplacentary, aerosol) mainly alimentary way. Animals catch at consumption obsemenenny bacteria of water and food. Epidemiological value in maintenance of an ochagovost of an infection is played by the blood-sicking insects (in particular pincers) receiving the activator from rodents and other animals and extending it among healthy individuals.
The person usually catches at consumption of the infected animal products, or at the use of the infected water, fresh vegetables. Transmission of infection at working off of animal raw materials is possible (wool, down, skins, etc.), at the same time the contact way of transfer through damages of integuments is implemented. Infection sexually from the person to the person, and also vertical transfer from mother to the child is in rare instances noted. People possess quite low natural susceptibility to listeriosis. The disease develops mainly at persons with the weakened immunity, advanced or early children's age.
Pathogenesis of listeriosis
Bacteria get into an organism through mucous membranes of a digestive tract, sometimes through damages of integuments. At distribution of the activator with blood and a lymph feverish reaction is shown. Listeriya settle in lymph nodes and almonds, other bodies. There is a reproduction of bacteria (at the same time there is a corresponding local inflammatory reaction). At active progressing in lymph nodes and tissues of internals (and at pregnant women – in a placenta) listerioma (necrotic small knots) are formed. The heavy course of listeriosis can lead to development of sepsis.
The incubatory period of listeriosis can make from several days to one and a half months. The course of listeriosis happens sharp, subsharp, abortive, and also chronic – recidivous. Cases of a long bakterionositelstvo without the expressed clinical picture are recorded. Most often listeriosis proceeds in an anginozno-septic form. At the same time the main manifestations are symptoms of quinsy, usually catarrhal or follicular, having current, similar to streptococcal quinsy. Such form of listeriosis has the favorable forecast, recovers in 5-7 days.
At development of the ulcer and film quinsy which is followed by fever, the disease at a favorable current lasts 12-14 days, cough and cold can be noted, almonds are increased, sharply hyperemic and covered with films. Quinsy usually is followed by regionarny lymphadenitis. In certain cases listeriozny quinsy (both ulcer and filmy, and follicular) can progress in sepsis (most often at adults). At the same time the expressed remitiruyushchy fever, intoxication, increase in a liver and spleen is noted. On skin various rashes, on almonds – a white raid can be noted.
The nervous form of listeriosis proceeds in the form of meningitis, an encephalomeningitis or abscess of a brain. The clinical current of these states at defeat by listeriya does not differ from that in case of nonspecific bacterial damage of the central nervous system (meningealny symptomatology – a rigidnost of occipital muscles: Brudzinsky's symptoms and Kerniga, symptoms of encephalitis, frustration of a peripheral innervation – paresis and paralyzes, poliradikulonevrita etc.).
Quite seldom found glazo-ferruterous form of listeriosis usually develops in case of contact with a sick animal. It is shown in the form of conjunctivitis against the background of the general symptomatology (fever and intoxication) and increases in lymph nodes (mainly cervical and parotid). At survey of patients the century is noted puffiness, the eye crack is narrowed, complaints to deterioration in sight take place. Lymph nodes are increased, moderately painful at a palpation. Listeriosis in such form usually to last of a month, to three.
At newborns (and fruits at antenatalny infection) listeriosis proceeds in a septiko-granulematozny form. Listeriosis at the pregnant woman can proceed asymptomatically or in the erased form, remaining not distinguished. Pre-natal infection of a fruit results. On early terms it, as a rule, leads to termination of pregnancy or rough anomalies of development. Listeriosis at newborns proceeds extremely hard, the fever reaching critical figures, the expressed intoxication, vomiting, diarrhea is noted. Tsianotichna integuments, are noted rozeolezno-papular rashes. Heavy violations from breath take place, a warm rhythm. Distribution of purulent process on a brain cover usually comes to an end with death.
Listeriosis at chest age originally proceeds as a SARS, with a hyperthermia and catarrhal symptomatology, further developing in bronchial pneumonia or pleurisy. In 15-20% of cases after recovery at children disorders of functioning of TsNS and a peripheral innervation remain. In certain cases there is a synchronization of an infection. The current at a chronic form is characterized by insignificant expressiveness of symptomatology, patients can note short-term temperature increase of a body, catarrhal signs, dyspepsia. In certain cases symptoms of chronic pyelonephritis come to light.
Diagnosis of listeriosis
Listeriosis quite often (in particular in case of an anginozno-septic form) is followed expressed monotsitozy. The quantity of monocytes can reach 60-70% of all cells of white blood. Specific diagnostics consists in carrying out a bacteriological research. The activator is allocated from blood, a likvor, slime from a nasopharynx, dab from a conjunctiva. If necessary for the analysis take a biopsy of lymph nodes, amniotic waters (amniocentesis) or placentae (a biopsy of a horion).
Crops is made in the first 7-10 days of a disease. Serological diagnostics is made by means of RA, and also RNGA, RSK in pair serums. Serological researches can yield false positive results, in view of close anti-gene structure from a stafilokokkama. In diagnostics of a nervous form of listeriosis consultation of the neurologist, carrying out EEG of a brain and a rheoencephalography, a lyumbalny puncture can be required, at suspicion on development of abscess - brain MPT or KT.
Treatment of listeriosis
The choice of tactics of treatment is carried out according to clinical norm of a disease. As etiotropny means doxycycline, erythromycin have good effect . The nervous form of listeriosis usually is the indication to purpose of intravenous administration of benzylpenicillin of sodium salt. Treat medicines of a reserve and ciprofloxacin. Glazo-zhelezistaya a form usually to be treated with application of local means: a drop with sulfatsetamidy and a gidrokortizonovy emulsion. If necessary appoint dezintoksikatsionny therapy, febrifugal and antihistamines. At complex therapy there are vitamins and adaptogens.
Forecast and prevention of listeriosis
In most cases forecast favorable. Deterioration in the forecast is noted at development of a nervous form (there can be consequences in the form of disorder of the TsNS function and a peripheral innervation, threat of a lethal outcome), pregnancy (probability of termination of pregnancy and congenital listeriosis of a fruit). The adverse forecast has a disease at children of the first year of life, persons of senile age and patients with an immunodeficiency.
The general prevention of listeriosis includes measures of sanitary and hygienic and veterinary control over livestock farms, the enterprises of the food industry and public catering, water sources. As a preventive measure of spread of an infection rodents make deratization. For the purpose of individual prevention it is recommended to pregnant women to refuse the animal products which did not undergo due culinary processing (long preparation at high temperature conditions), or not having the hygienic certificate.