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Diagnosis - Brucellosis

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Differential diagnosis. The assumption of a brucellosis arises in the presence at the patient of fever, a hyperhidrosis, defeats of a musculoskeletal system, a hepatolienal syndrome, a leukopenia and a lymphocytosis. Discrepancy between high temperature and satisfactory health of the patient in an initial stage of a disease is observed. A variety of clinical displays of a brucellosis, involvement in pathological process of various bodies and systems causes need of differential diagnosis with rheumatism, infectious nonspecific polyarthritis, sepsis, tuberculosis, a typhoid.

Unlike rheumatism arthritis at a brucellosis differs in a smaller volatility and more persistent current, is followed by increase in regional lymph nodes. Changes in heart at a brucellosis meet less often while at rheumatism the endomyocarditis diagnosed by means of kliniko-tool methods of research develops more often (an ECG, FKG, etc.). Multi-infection chances when in the presence of the symptoms characteristic of rheumatic damage of heart, positive serological tests are defined on a brucellosis. Carefully collected anamnesis, fixed supervision over patients and efficiency of treatment of one of diseases allow to resolve an issue correctly. It is necessary to consider that are characteristic of rheumatism increase in SOE, a moderate leukocytosis, increase in credits of antistreptolysin - Oh, the S-reactive protein, an antistreptogialuronidaza.
Serological tests (Wright, Heddlson) and allergy test of Byurne are negative.

Considerable difficulties arise if necessary to differentiate a brucellosis with infectious nonspecific polyarthritis. Its similarity in an acute phase decides on brucellous arthritis by existence of fever, a recurrent current, arthralgias, disproteinemias. Quickly enough developing atrophy of muscles in the affected joints, existence of "rhematoid" small knots in joints in combination with a hypoalbuminemia, a hypergammaglobulinemia, positive difenilaminovy test, increase in amount of fibrinogen in the presence of a neutrophylic leukocytosis and noticeable increase in SOE allow to stop on the diagnosis of infectious nonspecific polyarthritis. It is more difficult to differentiate brucellous defeats of a musculoskeletal system from subacute and chronic infectious polyarthritis. At this disease unlike a brucellosis the moderate leukocytosis, a lymphopenia, positive hemagglutination reaction of Vaaler — to Rouza and changes of roentgenograms are defined (narrowing of joint cracks, education uzur on joint surfaces of bones). Specific serological tests on a brucellosis, data of an epidanamnez in each case allow to verify the diagnosis.

In differential diagnosis of a brucellosis and sepsis the assessment of clinical symptoms of an illness in comparison to the anamnesis is of great importance. Mistakes are possible owing to the wrong interpretation of high temperature, a fever, perspiration, a hepatolienal syndrome, a dieback, arthralgias or arthritis. A disease the long time can remain not distinguished with patients with a brucellosis and to be regarded as a septic condition of the obscure etiology. At differentiation in these cases It is necessary to consider feature of a course of a brucellosis, rare involvement in process of lungs and the alimentary system, lack of the piyemichesky centers. For sepsis the neutrocytosis, and is characteristic of a brucellosis — a leukopenia, a lymphocytosis a leukocytosis. Crops of blood on sterility in combination with data of serological researches resolve diagnostic doubts.

Long subfebrile condition, the expressed astenisation, adenopathy, leukopenia and lymphocytosis in some cases demand differential diagnosis of a brucellosis with a pulmonary tuberculosis. At tuberculosis emaciation, pallor, perspiration is more expressed. Crucial importance has careful clinical, especially X-ray inspection of a thorax when accounting laboratory and special methods of inspection: reactions of the Tuberculine test and to Mant, allergy test of Byurne, research of a phlegm, serological tests of Wright, etc.

In cases of defeat of a rachis at patients with a brucellosis it is necessary to exclude a tubercular spondylitis first of all. The decision is, as a rule, unambiguous here: signs of destructive process and vertebrae on the roentgenogram indicate a tubercular etiology of an illness if processes of a reparation prevail over destruction, tuberculosis is excluded. Informative value for justification of a brucellous etiology of a spondylarthritis has a radiological symptom of the "brackets" or periosteal outgrowths going from a lateral surface of vertebrae.

The acute beginning of a brucellosis, hyperthermia, gepatoliyenaldy syndrome and in some cases encephalopathy allow to assume a typhoid. The headache, long temperature increase, increase in a liver and spleen, a leukopenia and a lymphocytosis are the general for these diseases. The accruing intoxication, apathy, the typhus status and some other the signs not inherent to a brucellosis is characteristic of a typhoid.