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Brucellosis

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Brucellosis
Diagnosis

Brucellosis — the infectious and allergic disease which is followed by fever, defeat reticuloendothelial, musculoskeletal, vascular, nervous and other systems.

Etiology. The activator — Brucella melitensts, abortus, suis, ovis, canis, etc. A lot of the activator, the reservoir — various animals is reckoned.

Epidemiology. The brucellosis belongs to zoonotic diseases, the main source of an infection for the person — small and cattle. Infection occurs in the alimentary way (dairy products) and through the injured skin, at contact with newborn eanlings, calfs, and also at care of animals, manual department of an afterbirth, processing of hulks, etc., generally in regions of intensive animal husbandry.

Pathogeny. Causative agents of a brucellosis, having got into an organism, are brought by a lymph in regional lymph nodes. In the next 2 — 3 weeks (incubation interval) or in more remote terms of a brucella get into blood, then into marrow, a spleen, a liver, forming the metastatic centers there. From them repeated generalization is possible that it causes aggravations or recurrence and defines in such cases disease as a hroniosepsis.
The clinic of a brucellosis for the last decades lost some pathognomonic symptoms. Acute and severe forms meet seldom now. Sharply the frequency of visceral forms decreased, but the specific weight of a chronic brucellosis considerably increased. Being an infectious and allergic disease of toksiko-bacteriemic character, the brucellosis often proceeds as hroniosepsis with numerous recurrence and aggravations.

The symptomatology of a brucellosis is very various. In one cases the disease is characterized by acute process with defeat of many systems and bodies, in others it proceeds is hidden and is atypical. The illness can sharply begin with the accruing toxicosis, a hyperemia, a fever or gradually when patients note easy chilling, small weakness, unstable subfebrile condition. In the subsequent the illness is shown by new signs among which various local symptoms depending on degree of virulence of brucellas and a condition of reactivity of an organism have special value. Sometimes identify initially latent form at which there are no fever and disturbances of activity of internals with a long incubation interval. Such persons remain almost healthy and come to light only at laboratory inspections (in the local centers).

Distinguish an acute brucellosis — with prescription of clinical manifestations to 3 months, subacute — from 3 to 6 months and chronic. The chronic brucellosis is subdivided into visceral, bone and joint, urogenital, nervous forms. Various combinations of the called forms are observed. Fever belonged to the most frequent symptom of this disease in former years, recently at 1/3 patients the brucellosis proceeded at a normal temperature. Now long subfebrile temperature is characteristic of a brucellosis. Less often wavy, remittiruyushchy and intermittent types meet. One of constant symptoms — increase in regional lymph nodes, and also existence of fibrosites and cellulitises. Quite often meet arthritis, periparaartrit, is more rare — a bursitis, a tendovaginitis, a miositis. Usually several large joints are surprised, less often small also are involved in process. As typical sign of chronic forms of a brucellosis it is necessary to consider sindromokompleks of a sacroileitis and spondylosis. The hepatolienal syndrome is important for diagnosis.

At a number of patients defeats of a peripheral nervous system in the form of radiculitis, a polyneuritis, a plexitis prevail. Frustration of a vegetative nervous system are characteristic (hyperhidrosis), severe defeats of the central nervous system are possible: meningitis, arachnoiditis, hypothalamic disturbances.

The Ostroseptichesky form develops gradually, the general state a long time is not broken, patients keep working capacity, complaints to fatigue, irritability, a headache, a short-term joint pain and muscles appear. Fever can have gektichesky, incorrectly remittiruyushchy, wavy and seldom constant character. The repeated oznoba which are replaced plentiful sweating are observed. Skin is wet, usually without rash, a micropolyadenitis. In a hypodermic basis dense painful educations (fibrosites, cellulitises) can be defined. The liver and a spleen are increased.

Chronic brucellosis divide on initially and for the second time chronic. Perhaps recurrent disease. Duration of a course of initially chronic brucellosis — till 10 flyings, sometimes is more. The condition of a decompensation at this form of an illness happens at 21,3% of patients, more often process has the subcompensated character (71%). The clinical symptomatology of initially chronic brucellosis has no essential differences from clinical manifestations for the second time of chronic.

Recognition of a brucellosis is based first of all on kliniko-epidemiological data and is confirmed by laboratory tests. The brucellosis is followed by the leukopenia, a lymphocytosis which is moderately raised by SOE; degree of a leukopenia and a lymphocytosis depends on activity of process. Specific tests — Wright's reaction, Heddlsona — Kaytmazova, Byurne's test. Wright's reaction and Byurne's test can yield positive takes after recovery for a long time, quite often become positive after vaccination against a brucellosis. Heddlson's reaction often is not specific and unlike Wright's reaction has no diagnostic value, is intended for mass inspection and selection of persons for an additional examination.



 
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