Pappatacha fever (flebotomny, mosquito fever) — the acute arbovirusny illness which is characterized by the short-term fever expressed by a headache and muscle pain, a characteristic injection of vessels of scleras, the long period of reconvalescence.
Etiology. The virus, the causative agent of fever of a pappatacha, includes 12 serological types, 5 of which pathogens for the person. Monkeys, mice, rats, dogs at whom the infection proceeds latentno are sensitive to a virus. The virus termolabilen, is sensitive to usual disinfectants, in blood serum at — 70 °C in the dried-up look remain till several years.
Epidemiology. An infection source — the sick person. A carrier and the reservoir of an infection are mosquitoes which transmit a virus transovarialno. Mosquitoes become infectious in 7 — 8 days. The possibility of parenteral infection is allowed. Fever of a pappatacha is widespread in tropics and subtropics. Meets in the countries of Central Asia and Transcaucasia.
Pathogeny. The virus gets into a human body at a sting the infected mosquito, breeds in cells of reticulohistocytosis system during an incubation interval. The virusemia proceeds to 2 — the 3rd day of an illness. The main changes come in small vessels, muscles, a nervous system. Immunity is short, 3 — 6 months.
Clinic. The incubation interval lasts 3 — 9 days. The illness begins sharply with a fever and rise in temperature to 39 — 41 °C. Since 1 days a severe headache and muscle pain, morbidity at the movement of eyes. Are pathognomonic the Peak symptom — a limited injection of vessels of scleras at outside corners of eyes in the form of the triangle turned by top to a cornea, and a symptom of Taussiga — the expressed pain in attempt to lift fingers upper eyelids. The sharp dermahemia of the person, neck, breast is noted. The hyperemia and puffiness of a mucous membrane of a pharynx (handles and a uvula) with dot hemorrhages are observed. Sometimes on 2 — the 3rd day of an illness appears the korepodobny or melkopapulezny rash which is quickly passing usually with normalization of temperature. The tachycardia noted in the 1st day is replaced by bradycardia. Some patients have meningeal symptoms, an abdominal pain, diarrhea. In blood a leukopenia. To 3 — to the 5th day of an illness temperature falls critically that is followed by sharp weakness, pouring then. The short-term feverish period is replaced long (2 — 4 weeks) by the reconvalescence period. The expressed astenisation, decrease in working capacity, a mental depression, a headache, sleeplessness are observed.
Differential diagnosis. The diagnosis of fever of a pappatacha is established on the basis of epidemiological data (the endemic area, seasonality) and a characteristic clinical picture — the acute beginning, short-term high fever, severe pain in muscles, pathognomonic symptoms (Taussiga and Peak), bradycardia, a leukopenia.
The beginning of a disease of flucan remind fever of a pappatacha which differs from flu in an incidence maximum in June-July (a mass departure of mosquitoes). At flu pain is localized generally in the field of superciliary arches and temples, gastrocnemius muscle pain is not characteristic of it. Besides, pappatach differs from flu in lack of the catarral phenomena (cold, cough), existence of symptoms of Taussiga and Peak.
From a pappatacha has similarity fever of the dengueon initial symptoms of an illness, seasonality, places of distribution. However the polyadenitis, plentiful pruritic rash with the subsequent peeling are not characteristic of a pappatacha observed at the dengue the second feverish wave, changes of joints and gait. At the dengue symptoms of Taussiga and Peak are not observed.
In the first days of an illness of a pappatacha it is necessary to differentiate with malaria. Both diseases begin with a fever, fast temperature increase, a headache, a mialgiya. Malaria differs in early increase in the sizes of a liver and spleen, frequency (3-and 4-day) the characteristic feverish attacks observed by the bigger duration of an illness, absence at pappatach of bradycardia, symptoms of Taussiga and Peak. The diagnosis of malaria is confirmed by detection in a thick drop (smears) a plasmodium.
The anicteric form of a hay feverdiffers from pappatacha fever in the illness duration, existence of a hepatolienal syndrome, symptoms of damage of kidneys, a leukocytosis in blood. Symptoms of Taussiga and Peak at a hay fever are absent. At microscopy of blood and urine leptospira are found.
From enteroviral diseaseswith fever of a pappatacha has similarity "a small illness" (summer flu, enteroviral fever). Differentiation happens extremely difficult, and sometimes only symptoms of Taussiga and Peak, characteristic of a pappatacha, allow to make the correct diagnosis. At pappatach muscle and joints pain is more expressed. It is necessary to consider also the long period of reconvalescence at this disease. At "a small illness" symptoms of other enteroviral infections, in particular vesicular rash in a pharynx can be observed. Statement of the diagnosis is helped by virologic and serological researches.
The tick-borne typhinia reminding initial symptoms of a pappatacha is characterized by an intermittent current with alternation of the periods of fever and an apireksiya, early increase in a spleen, easy yellowness of scleras, tachycardia, a leukocytosis. The diagnosis is confirmed by detection of spirochetes in blood (a thick drop).
The diagnosis of fever of a pappatacha is confirmed by allocation of a virus, intratserebralny infection of newborn mice, and also increase of an antiserum capacity in pair serums in RTGA, RSK and a neutralization test.
Prevention — protection against attack of mosquitoes.