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High-quality lymphoreticulosis

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High-quality lymphoreticulosis
Diagnosis

The high-quality lymphoreticulosis (illness of cat's scratch) — the acute infectious disease developing after scratch or a sting of a cat is shown by temperature reaction and an inflammation of regional lymph nodes.

Etiology. The activator belongs to chlamydias. Infectious particles have them rounded shape, 250 in size — 300 nanometers, are found in macrophages and cells of a reticuloendothelium, have a similar development cycle, group antigen and identical chemical composition with the activator of an ornithosis and other representatives of Chlomydozoaceae group.

Epidemiology. An infection source — cats in whom infection does not cause symptoms of a disease. There is an assumption that an infection source for cats are birds and mouse-like rodents. The activator is found in cats in saliva and urine, on paws it gets more often with saliva. The main way of infection of the person — direct contact with cats (scratch, a sting). However the possibility of pollution of water, foodstuff, the pricking objects is not excluded and separate cases of infection of people owing to contact with the infected objects of external environment are described. Sporadic cases are registered in many countries of the world. More often children are ill. Diseases are observed generally during the autumn and winter period. The transmission of infection from the patient is not established to people around.

The pathogeny is studied insufficiently. The activator from the place of penetration into an organism on lymphatic ways reaches regional lymph nodes. There it, breeding, causes nonspecific inflammatory process. It leads to increase and their morbidity. Histologically in the struck lymph nodes inflammation sites with the necrosis centers are found. Tissue of a lymph node is full-blooded, an infiltrirovana mononuclear cells, lymphocytes, proliferation of a reticuloendothelium is noted. Necrotic sites are surrounded with polymorphonuclear leukocytes, in the subsequent are replaced with connecting fabric. Breaking a barrier of a regional lymph node, the activator gets to blood. There comes the phase of generalization of an infection with its clinical manifestation, dissimination, and also fixing of the activator in other bodies, and development of secondary lymphadenites. The importance is attached to toksiko-allergic impact of the activator on an organism.

Clinic. The incubation interval makes from 1 to 3 weeks. The disease usually begins sharply with a fever, temperature increase. Patients complain of the general weakness, a headache, and also muscle and joints pains. In cases of a heavy current there is nausea, vomiting. In the period of clinical manifestation of an infection or a little earlier on site scratch dense, quite often pruritic papule, with a purulent small knot in the center, sometimes — with a necrosis site appears. It is necessary to notice that primary affect is found not always. Objectively the easy hyperemia of the person is defined, on skin sometimes there is rash of various character. Tachycardia according to temperature reaction is more often observed, but there is also relative bradycardia.

The most important sign in the diagnostic relation is regional lymphadenitis, generally unilateral. As the most frequent localization of scratches are brushes and forearms, lymphadenitis of elbow and axillary lymph nodes respectively comes to light. Lymphadenites are much less often observed cervical, pakhovy and other localization.

The inflamed lymph nodes are increased in sizes, are slow-moving, slightly painful. Changes come not only in the next, but also more remote lymph nodes. The increased lymph nodes dense to the touch, slightly painful, sometimes fluctuate in the center. The part of patients has a periadenitis. In such cases morbidity in the field of the struck node is more expressed, the limited hyperemia, puffiness of the fabrics surrounding a lymph node, local temperature reaction is noted. The inflamed lymph nodes quite often abscess and are spontaneously opened, sometimes they should be opened. At part of patients of purulent fusion of lymph nodes does not occur, and there comes quite fast sklerozirovaniye with the subsequent Cicatricial changes. Other available palpations lymph nodes are not changed or their insignificant increase is noted.

Depending on a way of infection and the place of penetration of the activator into an organism development of various clinical forms of an illness is possible: eye — with increase in parotid and perednesheyny lymph nodes, anginous — with submaxillary regional lymphadenitis, abdominal — with damage of mezenterialny lymph nodes, pulmonary — with reaction of peribronchial and mediastinal lymph nodes. There are messages on development at a high-quality lymphoreticulosis of changes in bone system and defeats of the central and peripheral nervous system in the form of meningitis, meningoentsefalit, meningoentsefalomiyelit, neuritis, radiculitises. Also the combined forms of an illness meet. The clinical current can be various — from asymptomatic easy forms to heavy with a failure, especially at defeat of the central nervous system. Usually the disease lasts several weeks and comes to an end with recovery, at development of recurrence accepts a long current (till 2 — 3 months and more) with reaction revival on site of the former scratch.



 
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