Brucellosis - a disease harakterizuescheesya defeat of the musculoskeletal system, the nervous, reproductive and other systems.
Brucella are resistant in the external environment. In water they are stored over 2 months, milk - 40 days, BRYNZA - 2 months, in raw meat - 3 months, a saline - up to 30 days, wool - to 4 months. Brucella are killed when heated and exposed to many disinfectants.
From a sick person healthy Brucella is not transmitted. Reservoir and source of infection are domestic animals (sheep, goats, cows, pigs, dogs rarely).
Infection from sick animals brucellosis contact occurs, food and air ways. Contamination by contact most often occurs at the skin contact amniotic fluid (assistance in hotels, lambing, when caring for a newborn calves, lambs). Often infected with veterinarians, calf, shepherds and others. Infection may occur and in contact with the meat of infected animals with manure.
Brucella penetrate the slightest damage to the skin. Food contamination often occurs through raw milk as well as in the use of dairy products (cheese, cheese, butter). Infection by air may occur if inhaled dust path comprising Brucella (in grazing areas and paddock for keeping sheep), as well as laboratories in violation of technology security. This route of infection is relatively rare. Often ill persons of working age (18 ~ 50 years). In most cases, it is the professional disease.
symptoms of brucellosis
Brucellosis occurs by ingestion of 10 microbes. Gated infections are microtraumas skin, mucous membranes of the digestive and respiratory tracts. At the site of the gate any changes do not develop infection. According lymphatic Brucella reach lymph nodes. Multiplication and accumulation of microbes when brucellosis occurs mainly in lymph nodes, from which Brucella periodically enter the bloodstream.
For brucellosis is characterized by severe allergic alteration of an organism. Brucellosis is characterized by a tendency to chronic course, which is associated with prolonged stay in the brucella organism.
After suffering brucellosis formed immunity, but it is not very long, and after 3-5 years may re-infestation. Not every infection leads to the development of the disease. The response depends, probably, on the state of the immune system. In some individuals, the infection occurs without any manifestations, in other booming infectious process or from the outset occurs as chronic. Streets with very weak immune systems even live brucellosis vaccine can cause a reaction that resembles the disease.
Manifestations of acute brucellosis
The incubation period for acute onset brucellosis may last about 3 weeks, but the incubation may last for several months.
Ostrosepticheskaya form is characterized by high fever (39-40 ° C and above). Despite the high and very high body temperature of patient's condition is good (at a temperature of 39 ° C and above the patient can read a book, play chess, watching television, and so on. D.). This form of brucellosis does not threaten the patient's life, even without treatment, it ends in recovery.
Manifestations of chronic brucellosis
Syndrome characterized by chronic forms of intoxication (weakness, headache). Common attributes include a long low temperature, weakness, increased irritability, bad dream, Violation of appetite, decreased performance. Almost all patients have enlarged lymph nodes. Often revealed an enlarged liver and spleen. Against this background, it marked the defeat of the joints, nervous and reproductive systems. If brucellosis may be other lesions (pneumonia, myocarditis, Eye damage, etc..), But they are less frequent.
The defeat of the musculoskeletal system is the most common manifestation of chronic brucellosis. Patients complain of pain in muscles and joints, especially in the major. Most affected knee, elbow, shoulder, hip joints, rarely - small joints of the hands and feet. Swollen joints, mobility in them is limited, the skin over them, as a rule, normal color. Violation of mobility and deformity of the joints caused by the growth of bone tissue. It involves the spine, usually in the lumbar spine.
The defeat of the nervous system is most often seen in chronic brucellosis
- neuritis,
- polyneuritis,
- radiculitis.
Central nervous system (myelitis, meningitis, encephalitis, Meningoencephalitis) are rare, but occur quite long and hard.
Changes in the reproductive system in men occur in
- orchitis,
- epididymitis,
- decreased sexual function.
The women are observed
- salpingitis,
- endometritis,
- there amenorrhea,
- may develop infertility.
Pregnant women often occur miscarriage, stillbirth, miscarriage, Congenital brucellosis in children.
Sometimes there are changes in the eye (iritis, chorioretinitis, uveitis, keratitis, Optic atrophy and others.). When aerogenic infection often develop pneumonia sluggish current brucellosis, which unsuccessfully treated with antibiotics. May be myocarditis, endocarditis, Aortitis and other disorders of the cardiovascular system.
Treatment
Principles and methods of treatment depend on the form of brucellosis. Antibiotic treatment can give effect only when ostrosepticheskoy (acute) form of brucellosis, when chronic forms of appointment plays a secondary role of antibiotics, has major importance vaccine therapy.
Treatment of the acute form of brucellosis
In this form it is necessary to prescribe antibiotics in relatively high doses. Insufficient dosage premature cancellation and cause the development of drugs to further forms of chronic brucellosis. Antibiotics should be given continuously.
Tetracycline - 0.5 g every 6 hours for 3-6 weeks, for the first 2 weeks, in addition, used streptomycin (intramuscularly) at a dose of 1 g after 12 hours. Tetracycline is contraindicated in pregnant women and children up to 8 years.
If it is impossible to use the above scheme can assign Biseptolum (co-trimoxazole) for 6 tablets a day for 4 weeks. Combination Biseptol rifampicin (900 mg daily) gives the best results. When a full course of relapses are rare. Assign vitamins.
chronic forms of treatment
Antibiotics for chronic forms of brucellosis have been ineffective. The main role in these forms plays assignment drugs with nonspecific and specific desensitizing action. In chronic forms of vaccine therapy is most effective, which is not only a desensitizing activity, but also stimulates the immune system.
Patients administered vitamin complex, non-specific stimulators of hematopoiesis (pentoxyl, nukleinovokisly sodium metatsil). In the winter, it is imperative to carry out a general ultraviolet irradiation. Applied antihistamines (Pipolphenum, Suprastinum et al.). When expressed inflammatory changes (orchitis, neuritis et al.) Assigned corticosteroids (40-50 mg of prednisone for 2-3 weeks, or comparable dosages of other corticosteroids).
For specific desensitization and enhance immunity apply vaccinotherapy. With acute allergic rearrangement brucellin use, but often special (killed) therapeutic vaccine. Live vaccine is prescribed only for prophylactic purposes. Proposed different methods of vaccine administration: intravenous, intramuscular, subcutaneous and intradermal. It must be remembered that inaccurate vaccine dosage may exacerbate disease (overdose) or to the absence of pronounced effect (in low doses). In this regard, the choice of method of administration, and the calculation of an individual dose plays a big role.
The most widely in the treatment of chronic brucellosis received subcutaneous and intradermal administration of the vaccine. Subcutaneously administered vaccine at current brucellosis deterioration and severity of the process. An important principle of vaccine therapy is the selection of individual doses. In some measure of reaction severity is judged by Burne sample intensity. Subcutaneous administration often begin with 10-50 million microbial cells. If local and general reactions are absent, the vaccine is administered in an increased dose on the next day. For treatment of such a dose is selected, which causes a moderate reaction. Following injection of the vaccine made only after disappears reaction to previous administration of the vaccine. Once the dose administered at the end of the course was adjusted to 1-5 billion microbial cells.
Intradermal vaccine therapy is more gentle. This method is used in the compensation stage, but also at the transition brucellosis in latent form. By severity of skin reactions selected operating vaccine dilution (it should cause local reactions in the form of reddening of the skin with a diameter of 5 to 10 mm). The vaccine was injected intradermally in the palmar surface of the forearm on the first day of 0.1 ml of 3 places then added every day 1 injection and adjusted on day 8 to 10 injections. If the vaccine reaction is reduced, then take a more concentrated dilution.
Keep in mind that even with the complete disappearance of all clinical manifestations, from 20-30% in the future may come a worsening of the disease.
Forecast for life under favorable brucellosis.
Prevention of brucellosis
Prevention of the disease is based on the fight against brucellosis farm animals.
Compliance with preventive measures in the care of the animals.
Vaccination and revaccination live vaccine antibrucellar persons at risk of brucellosis.
