To Sodok – the disease of group of spirokhetoz developing at a sting of mouse-like rodents, proceeding with recurrent fever and skin manifestations. Symptoms to a sodok include primary affect (infiltrate with expression in the place of a sting, limfangit), and also the repeating fever attacks, polymorphic rash, regionarny lymphadenitis. As methods of specific diagnostics to a sodok serve the microscopy of a thick drop of blood and dab from primary affect, bacteriological crops, serological reactions, biological test. The activator to a sodok is sensitive to purpose of penicillin, tetratsiklin, tsefalosporin, macroleads.
To Sodok (disease of a rat sting) – bacterial , proceeding with feverish attacks, local inflammatory changes, lymphadenitis and polymorphic skin rashes. The name of a disease comes from the Japanese words "so" - a rat and "doku" - poison. For the first time the disease to a sodok was registered in the Asian region (Japan, China, India), however now cases are known worldwide. Today in medical literature over 500 episodes to a sodok, from them 55 in the territory of the former USSR are described. The close to a sodok disease in the kliniko-epidemiological plan – heyverkhillsky (gaverkhillsky) fever or is widespread in North America.
Reasons for a sodok
The disease to a sodok is caused small spirilly of family spirokht (Spirillum minus Carter, Xing. - Spirochaeta morsus muris, Spirochaeta Sodoku, Treponema japonicum). Spirilla represents a short, thin, helicoid gramnegativny bacterium with 2-3 shtoporoobrazny curls. Length from 3-5 microns (sometimes to 15 microns), width – 0,2 microns. Thanks to terminal zhgutika, the spirilla is mobile and moves by rotation round its pivot-center. The activator to a sodok is sensitive to factors of the external environment; quickly perishes under the influence of high temperatures and disinfectants.
The tank and source of the activator, mainly, rats whose contamination of Carter's spirillama can reach 10-25% are a sodok. At rats the disease proceeds in the form of conjunctivitis and keratit. More rare as carriers of an infection other small rodents (mice, polecats), cats, dogs act. In an organism of animals of a spirilla are found in saliva, blood, fabrics and bodies. As a factor of transmission of infection serves saliva of the infected animals, and the person catches to a sodok as a result of stings of animals, generally rats. Cases of infection of staff of laboratories, and also infection at hit of allocations of animals on the injured skin or mucous membranes, the use of kontaminirovanny food, milk are known.
According to literary data, about a quarter of the diseased a sodoka are made by children aged from 1 up to 14 years, mainly boys. The wide geography to a sodok is connected with universal distribution of rodents. The disease is registered in the countries with the low level of sanitary culture of the population and places with a big congestion of rodents more often.
In the field of entrance gate (a wound of skin) of a spirilla cause mestnovospalitelny reaction – primary affect which is characterized by hyperaemia, cellular infiltration, fibrin loss. Further distribution of the activator happens in the limfogenny way that is followed by a giperplaziya of the lymphatic device. After this there comes the phase of a hematogenic dissemination leading to distribution spirokht on all organism with blood current. Thus spirilla get into bodies (a liver, a spleen, kidneys) where are fixed, causing repeated generalization of an infection from time to time – recidivous rises in temperature and skin manifestations.
Symptoms to a sodok
From the infection moment before development of a clinical stage of an infection on average there pass 10-14 days (sometimes up to 4 weeks). By this time the wound formed on the place of a sting of the infected rodent, as a rule, already cicatrizes, however in connection with a disease demonstration on the place of entrance gate painful infiltrate, hyperaemia and hypostasis of soft fabrics appears again. Further there is a necrotic ulceration of infiltrate, there is regionarny lymphadenitis and limfangit. In total all these manifestations also make primary affect at a sodoka.
Generalized manifestations to a sodok develop sharply: suddenly there is a fever to 39-40 °C accompanied with a fever, weakness, mialgiya, headaches, artralgiya. High temperature keeps 4-6 days, then critically decreases with plentiful sweating. The repeated attack arises in 4-9 days and 3-4 days proceed. The fever recurrence alternating with the afebrilny periods can repeat from 4-5 to 20 times. Gradually fever weakens, and apireksichesky intervals are extended, however the disease to a sodok can drag on for several months.
For 2-3 day of a debut of a feverish attack on skin there is urtikarny, makulo-papular or makulo-eritematozny rash which from the place of primary affect extends to all body and extremities. The subsequent recurrence of fever is followed by a new wave of polymorphic rashes. At height of rise in temperature rash becomes brighter and more plentiful, at decrease - turns pale or disappears absolutely. The phenomenon of "a theatrical make-up" - limited hyperaemia on a pale face is characteristic a century. Synchronously with attacks of fever increase in a liver and spleen is noted.
At patients to a sodok polyarthritises, miozita, conjunctivitis can develop. Anemia, bronchial pneumonia become more rare complications to a sodok, glomerulonefrit, myocarditis, an endocarditis, decrease in sight, relative deafness, mental disorders, paralyzes. At children's age, depending on prevalence of these or those symptoms to a sodok, the following clinical forms of an infection distinguish:
- typical (primary affect, intermittiruyushchy fever, skin rash)
- meningoentsefalitichesky (squint, spasms, fontanel tension)
- rheumatoid (artralgiya, swelling of joints)
- gastrointestinal (nausea, vomiting, anorexia, belly-aches, a liquid chair with slime, dystrophy).
Diagnostics and treatment to a sodok
The basis of kliniko-epidemiological diagnostics a sodoka is made by anamnestichesky and clinical data: the contact with rodents preceding a disease or a rat sting, recurrent fever, synchronism of a sharpening of primary affect and rash with feverish attacks, etc. The preliminary diagnosis to a sodok is confirmed laboratory by means of detection in a thick drop of blood and dab from primary affect. Also bacteriological crops of blood and pus on nutrient mediums are used. For identification of specific antibodies from the 8-10th day of a disease serological researches are conducted: agglutination reaction (AR), immunofluorescence (REEF), reaction of binding of a complement (RBC).
Quite often at a sodoka positive reaction of Wasserman drops out (false positive test on syphilis). Biological test consists in vnutribryushinny infection of guinea pigs; in several days of a spirilla are found in exudate of an abdominal cavity, and at animals pakhovy lymphadenitis develops and orkhit. In order to avoid diagnostic mistakes it is necessary to exclude malaria, rheumatoid arthritis, returnable typhus, leptospirosis, a tulyaremiya, a brucellosis, a disease of cat's scratches, a rickettsial disease, a meningococcal infection.
The place of a sting is subject to primary surgical processing. As etiotropny medicines at a sodoka penicillinic antibiotics are applied by a course of 7-10 days. At resistance of the activator to penicillin antibiotics of a tetracycline row, streptomycin, tsefalosporina, macroleads, intravenous administration of a novarsenol are used. Patients are subject to hospitalization to an absolute recovery.
Without treatment the disease to a sodok proceeds is long, up to 4-6 months, leading to exhaustion of patients and a lethal outcome approximately in 10% of cases. For prevention holding deratization actions (extermination of rats), a protection of people from contact with rodents, preventive reception of a tetratsiklin is necessary at a sting of rats. Immunoprevention methods to a sodok are not developed.