Ornithosis – the chlamydial infection proceeding with primary defeat of respiratory system. Clinical displays of ornithosis include feverish a syndrome, pneumonia, conjunctivitis, a gepatoliyenalny syndrome, symptoms of neurotoxicosis and a meningizm. The diagnosis of ornithosis is confirmed by data of serological researches (RSK, RTGA, RIF, IFA), microscopy of a phlegm, a X-ray analysis of lungs. Etiotropny therapy of ornithosis is carried out by antibacterial medicines from group of macroleads, ftorkhinolon and tetratsiklin; bronchial spasmolytics, protivokashlevy medicines, vitamins are in addition used.
Ornithosis (respiratory clamidiosis, ornithosis, disease of parrots) – a zoonozny infection as which specific causative agents hlamidiya act, and a source – birds. Ornithosis is everywhere a widespread disease that is caused by migration of birds. In structure of the acute pneumonias registered in various regions of the world, 10-20% of cases have an ornitozny etiology. This fact demands increase in level of epidemic vigilance concerning ornithosis from experts in the field of pulmonology. In most cases sporadic cases of ornithosis are registered; more rare – family, group and production flashes. Among the patients with ornithosis patients of middle and advanced age prevail; at children the infection develops rather infrequently.
The disease is caused by an obligate intracellular parasite of Chlamydophila psittaci. Features of activity of hlamidiya cause specifics of a course of ornithosis. To such special characteristics treat ability of the activator to reproduction in cages, to formation of a L-form and preservation of virulence in various conditions, to allocation ekzo-and endotoxin, tropism cages of a respiratory path and system of mononuclear phagocytes etc. The causative agent of ornithosis shows relative stability in the external environment, well transfers low temperatures. At the same time, the bystry inactivation of hlamidiya comes during the heating, influence of chlorine-containing disinfectants, ultraviolet, anti-septic tanks.
Wild and domestic, including decorative birds who are bacillicarriers act as a natural source and the tank of an ornitozny infection or carry a disease in the form of rhinitis or sharp intestinal infection. Over 150 bird species can be Chlamydophila psittaci carriers, is more often - parrots, canaries, ducks, hens, turkeys, crows, pigeons (in the cities contamination of pigeons ornithosis reaches 50-80%). Birds can transfer the activator to posterity throughout the 2nd and more generations. The causative agent of ornithosis gets to the environment together with a nasal secret and excrements of birds. Infection of the person can occur in various ways: aerogenic (at inhalation of the activator with dust), contact and household (through the feathers polluted by the activator, eggs, use objects) and fecal and oral (at the use of the infected food or entering of the activator in a mouth from dirty hands). Workers of poultry farms, and poultry farms, pet-shops, breeders of pigeons and decorative birds, and also the villagers supporting poultry on the farmstead enter into group of the increased risk on incidence of ornithosis.
As the main target of the causative agent of ornithosis in a human body serve cages of a cylindrical epithelium of airways, lymphoid and retikulogistiotsitarny cages in which there is a reproduction and accumulation of hlamidiya. In 2-3 days the struck cages collapse, and hlamidiya, their toxins and waste products get to blood, causing symptoms of an allergization and intoxication. Hematogenic distribution of activators on an organism leads to damage of lungs, a myocardium, brain, liver. Patomorfologichesky changes in internals at ornithosis include focal and drain bronchial pneumonia, increase in peribronkhialny and bifurcation lymph nodes, gepato-and a splenomegaliya, dystrophic changes in parenchymatous bodies. As hlamidiya are inclined to a long intracellular persistention, ornithosis quite often accepts a long recidivous current with formation of atelektaz of lungs and development of focal fibrosis or a diffusion pneumosclerosis.
The clinical course of ornithosis passes the incubatory period (1-3 weeks), the prodromalny period, the period of clinical manifestations and the period of recovery. The disease can proceed in a respiratory, grippopodobny, tifopodobny, meningealny and generalized form, and also in sharp or chronic option.
Before a demonstration of specific symptoms of sharp ornithosis within 3-5 days the prodromalny phenomena which are characterized by an indisposition, the general weakness, nausea, appetite loss, subfebrilitety are noted. After this fever with a temperature up to 39-40 °C which in several days decreases lytically develops. During the feverish period thirst, dryness in a mouth, a mialgiya and an artralgiya are expressed. Poorly expressed catarrhal phenomena are noted: irritation and sore throat, cold, hyperaemia of a mucous throat, laryngitis. Owing to a tropnost of the causative agent of ornithosis to an endoteliya of vessels there is conjunctivitis, an injection of vessels a skler, nasal bleedings, skin rash of spotty and papular or rozeolezny character.
For 3-5 days signs of damage of lungs join all-infectious symptoms: thorax pains, dry, and then productive cough with a mucopurulent phlegm. Radiological signs interstitsialny, small - or krupnoochagovy, share ornitozny pneumonia are defined. By the end of the first week of a disease the liver increases. Defeat of nervous system with symptoms of neurotoxicosis is characteristic of ornithosis: a headache, an adinamiya, sleeplessness, a depression, at a heavy current – hallucinations, nonsense, euphoria. Development of serous meningitis with a good-quality current is possible.
The Grippopodobny form of ornithosis is characterized, mainly, by symptoms of the general intoxication. The Tifopodobny option of an infection proceeds with fever of remitiruyushchy type, a gepatosplenomegaliya and neurotoxic manifestations. At a meningealny form of ornithosis to the forefront there are meningizm symptoms. At any of clinical forms of ornithosis the convalescence lasts for 2-3 months; during this period astenisation, bystry fatigue, decrease in working capacity, arterial hypotonia, symptoms of vegeto-vascular dystonia remains (, palmar , a tremor, a chill of extremities). At 10-12% of patients ornithosis accepts a chronic current, is more often in the form of chronic bronchitis or pneumonia with a long subfebrilitet, increase in a liver and spleen, an astenovegetativny syndrome.
Diagnostics and treatment of ornithosis
The basis for statement of the clinical diagnosis is represented by data of an epidanamnez (close engagement with birds, group incidence) and characteristic symptomatology (fever, pneumonia, a gepatoliyenalny syndrome, etc.). For laboratory confirmation of ornithosis the microscopic research of a phlegm, serological diagnostics (RIF, RSK, RTGA, IFA), a research of bioptat of the bronchial tubes received during a bronkhoskopiya, a biological test on chicken embryos is conducted.
Ornitozny pneumonia is diagnosed by means of fizikalny inspection and a X-ray analysis of lungs. At meningealny symptoms the spinal puncture with a research of tserebrospinalny liquid is carried out. Carrying out and the analysis of intracutaneous allergic test with the inactivated culture of the causative agent of ornithosis is possible. Differential diagnostics is directed to an exception of a SARS, flu, atypical pneumonia, an infectious mononukleoz, a brucellosis, Ku's fever, tuberculosis, legionellosis, deep mycoses (aspergillomycosis, histoplasmosis, a nokardioz, a koktsidioidoz).
Complex treatment of ornithosis consists of etiotropny, pathogenetic and symptomatic therapy. As basic medicines for specific therapy of ornithosis serve the antibiotics of a tetracycline row, macroleads, ftorkhinolona having anti-chlamydial activity. At a sharp form of ornithosis duration of an antibacterial course makes 10-14 days; at a chronic current 2-3 courses of antibiotic treatment with an interval of 7-10 days and change of medicine are conducted. Pathogenetic therapy of ornithosis includes purpose of immunomodulators, immunostimulators, polyvitamins, holding dezintoksikatsionny actions. The symptomatic orientation is carried by reception of febrifugal, protivokashlevy means, mucolytics.
Forecast and prevention of ornithosis
Ornithosis outcome, as a rule, favorable. However approximately at a quarter of patients in early (2-4 weeks) or late terms (4-6 months) develop a disease recurrence. At timely treatment of a complication of ornithosis arise seldom. The acute heart failure, TELA belong to number of the most dangerous of them interfaced to risk of a lethal outcome. Immunity after the postponed ornithosis unstable, repeated cases of infection are possible.
Nonspecific preventive actions provide restriction of contact with birds, strengthening of veterinary control of keeping of birds on poultry farms and in zoos, destruction of the infected livestock. In the centers of ornithosis disinfection is carried out; the persons which underwent contact with sick birds are subject to medical observation within 30 days with performing chemoprophylaxis of an infection.