The concept of natural focal infections. Prevention of natural focal infections (GLPS, leptospirosis, lesteriosis, pseudotuberculosis, tularemia)

25.03.2020

Components of natural focus are: 1) pathogen; 2) animals susceptible to the causative agent - reservoirs: 3) a corresponding complex of natural-climatic conditions, in which there exists this biogeocenosis. Special group natural focal diseases make up transmissive diseases Such as leishmaniasis, tripanosomosis, tick-borne encephalitis, etc. Therefore, the obligatory component of the natural focus of the transmissive disease is also carrier. The structure of such a hearth is shown in Fig. 18.8.

1 - causative agent - Leinsmania, 2 - Natural tank - Mongolian gerbils, 3 - pathogen carrier - Mosquito, 4 - Rodent holes in the semi-derangements of Central Asia, 5 - The causative agent of the disease is a wide tape 6 - Natural reservoir - fishing mammals, 7 - Intermediate hosts - cyclops and fish, 8 - large freshwater reservoirs of Northern Eurasia

The category of diseases with natural foci was allocated Acad. E.N. Pavlovsky in 1939 on the basis of expeditionary, laboratory and experimental work. Currently, natural focal diseases are actively learning in most countries of the world. The development of new, unnecessary or low-noise territories leads to the discovery and new, unknown previously natural focal diseases.

Fig . 18.9. Mite Amblyomma Sp.

Some natural focal diseases are characterized. endemism, those. Massage on strictly limited territories. This is due to the fact that the pathogens of the respective diseases, their intermediate hosts, animal tanks or carriers are found only in certain biogeocenosis. So, only four types of pulmonary salts from p were resets in separate areas of Japan. Paragonimus. (See Section 20.1.1.3). Their resettlement prevents the narrow specificity for intermediate hosts, which live only in some reservoirs of Japan, and the natural tank are such endemic species of animals as a Japanese meadow mouse or a Japanese cunnic.

Viruses of some shapes hemorrhagic fever It is found only in certain zones of East Africa, because there is an area of \u200b\u200btheir specific carryers - ticks from p. Atyouotta. (Fig. 18.9).

A small amount of natural focal diseases occurs almost everywhere. These are such diseases whose pathogens are usually not related to the cycle of their development with an external environment and amaze a wide variety of owners. Diseases of this kind include, for example, toxoplasmosis and trichinosis. These natural focal diseases may become infected in any natural climatic zone in any environmental system.

The absolute majority of natural focal diseases affects a person only in case of hitting it to the appropriate focus (on hunting, fishing, in tourist campaigns, in geological parties, etc.) under the conditions of its susceptibility to them. So, taiga Encephalitis man infects with a bite infected tick, and opistorhoz - Singing insufficiently thermally treated fish with feline sticks.

Prevention of natural focal diseases Represents special difficulties. Due to the fact that a large number of hosts are included in the circulation of the causative agent, and often carriers, the destruction of whole biogenotic complexes arising from the evolutionary process, are environmentally unreasonable, harmful and even technically impossible. Only in those cases, if the foci are small and well-studied, it is possible to complex transformation of such biogeocenoses in the direction that excludes the circulation of the pathogen. Thus, the recultivation of deserted landscapes with the creation of irrigated horticultural farms in their place, carried out on the background of combating deserted rodents and mosquitoes, can sharply reduce the incidence of leishmaniosa. In most cases of natural focal diseases, their prevention should be aimed primarily on individual protection (preventing bite with blood-sized arthropods, thermal processing of food products, etc.) in accordance with the circulation paths in the nature of specific pathogens.

Natural focal infections are diseases common to humans and animals whose pathogens can be transmitted from animals to a person are characterized by the ability of pathogens. for a long time It is maintained in an external environment in individual territories - natural foci, in animal organisms, including rodents, birds, bloodsowing arthropods, which are sources and carriers of these infections.

The most common in the territory of the Republic of Belarus such natural focal infections as tularemia, hemorrhagic fever with renal syndrome, leptospirosis, yersiniosis, pseudotuberculosis, lemaryiosis.

Of particular importance, these infections are acquired in the active spring-autumn period and especially for citizens, traveling to the natural environment, in the country areas, as well as for children of summer country recreational institutions.

Infection of natural focal infections occurs in different ways:

Production infections are associated with work in the forest or near it (construction, forest harvesting, etc.). People infection are also possible at industrial enterprises, to the territory or in the workshop of which penetrate forest rodents. Agricultural infections occur mainly in autumn and in winter during the transportation of hay and straw, folded into stacks and omeets in the forest or near him. With the onset of cold weather in a lot of quantities, field and forest rodents are aligned. In the autumn period, people occupied on the cleaning and processing of flax are possible. The disease can be registered among shepherds, beekeepers, workers of livestock farms, warehouses and granaries, as well as in persons engaged in disassembling potato and beetrootes. Possible infection of workers and employees traveling to the collective cleaning of vegetables.

Infection when working in gardens, at the gardens and dachas. Favorite places of rodent dislocation in dacha arrays are country houses, sheds, garbage piles, dumps of conceded trees and shrubs. In the spring, in the country houses and in the adjacent territory, there are traces of rodents (litter and dry allocations of rodents), which can inhalation in the subsequent cause diseases with natural focal infections.

Infection at the place of residence (domestic) occur mainly from October to February in homes located near the forest. They are due to the fact that forest rodents populate the cellar, sheds, hayrs, heaps of twigs and woodwoods, located on the territory of the estates, and sometimes penetrate the living quarters.

Infection with short-term stay on vacation in the forest (walks, tourist hiking, fishing, hunting, etc.) occur mainly in the summer and early autumn. Possible infection during overnight stays in tents, forest shops, temporary houses, etc., available for rodents, as well as with an unsanitary state of health facilities. These infesses are most characteristic of the urban population.

Infection can also occur in the bite of bloodsowing insects: ticks, fleas, blind, etc. (most often happens in natural foci of Tularemia). A person can get infected through water of water bodies (swamps, ponds, shallow rivers, canals) when bathing, fishing, various economic activities.

Hemorrhagic fever with renal syndrome (GLPS)

Hemorrhagic fever with renal syndrome (GLPS) - acute viral natural-focal infectious disease characterized by defeat vascular system and the development of acute renal failurewhich can lead to a fatal outcome.

The GLPS virus penetrates the human body through the respiratory tract, the gastrointestinal tract and damaged skin.

The source of the virus is miserable rodents that distinguish the virus with urine and feces that can infect environmental objects, food and household items.

Transmission paths: Aerogenic (air-dust) when inhaling dust, infected with rodents and alimentary (infected food).

Leptospirosis

Leptospirosis is an acute infectious bacterial disease, the main clinical manifestations of which are symptoms of damage to the vascular system, liver and kidney, with the development of acute hepatic or renal failure.

Pathways: bacteria of various species that are inherent in certain types of animals - pigs, dogs, rats, etc. Leptospira penetrate the human body through damaged skin, intact mucous membranes and gastrointestinal tract.

Sources of infection: in natural conditions - many types of rodents, as well as pets (pigs, cattle, dogs, etc.). The animals of patients and carriers are isolated to the external leptospira with urine and infect reservoirs, food and home item (rodents).

Transfer paths - contact when communicating with patients with animals and infected objects of the external environment, water, food.

Liseriosis

Liseriosis is an acute infectious natural-focal bacterial disease, which is characterized by various clinical manifestations: angina, conjunctivitis, lymphadenitis, meningoencephalitis, gastroenteritis, septic state.

The causative agent is a bacterium of lisureness, intracellular microorganism. It has the ability to preserve and multiply in soil, water, food products (meat, milk, vegetables) even in the conditions of cold.

Sources of infection: Animals (agricultural, homemade, wild), as well as birds (decorative and home).

Path transmission infection:

food, with the use of infected products;

aerogenic, with inhalation of dust infected with rodents;

contact, when communicating with patients with animals and infected objects of the external environment;

transplascent, from the Mother of Fruit or Newborn (the development of septic conditions, the death of fruits and children in the first days of life). Special danger for pregnant women is the use of raw meat, removal of samples from raw minced meat.

Tularemia

Tulyarania is a sharp infectious disease that is transmitted to man from rodents (water rat, ondatra, hare, horselock, grounding, rat, mouse).

The causative agent of Tularerey is a bacterium with considerable resistance in the external environment.

The source of infection under Tularemia for humans are sick rodents, as well as the objects of the external environment infected with the discharges of sick animals.

A distinctive feature of Tularemia is the set of ways to transfer:

a person's infection can occur when contact with mile-like rodents;

infection can be easily applied by "dirty" hands on the mucous membrane of the eye, mouth, on food products;

you can also get infected when inhalation of dust, which is formed during the operation of the threshing, carrying hay, etc.;

during the catch of water rat, the removal of the skins, the processing of the furs (the presence of skin damage: abrasions, scratches of cuts - increases the risk of infection);

when eating contaminated with excrement or corpses of the fallen rodents of food and water;

with the bite of bloodsowing insects: ticks, fleas, blind, etc. (most often occurs in the natural foci of Tularemia).

The clinical picture is characterized by the occurrence of unilateral lymphadenitis (an increase in lymph nodes), conjunctivitis, angin. The form of the disease depends on the place of penetration of the pathogen of Tularemia into the human body.

Iraciniosal infection

There are intestinal rationsiniosis and pseudotuberculosis.

Iraciniosis is an acute human and animal infectious disease. The pathogens of the yersiniosis infection are widespread in nature, multiply in the soil, on vegetables, fruits, berries, meat, dairy and other products.

Pseudotuberculosis - acute infectious bacterial disease with polymorphic clinical picture From the scarlatin-like fever, lesions of the joints to food toxicoinfection and septic conditions.

Sources of infection during yersiniosis and pseudo-tuberculosis are various types of rodents.

The pathogen: bacteria that are kept continuing and multiply in an external environment and food products (vegetables, fruits, milk, etc.), even in cold conditions.

Transfer paths - food (through infected products) and contact.

The most significant transmission factors of infection are food products used without heat treatment, which often leads to outbreaks in organized children's teams, in violation of the storage rules of vegetables, preparation and storage of raw vegetables dishes.

A more detailed description of the synanthropic types of rodents, such as a house mouse, a black and gray rat. These disease carriers are dangerous because they live in close proximity to man, this in turn increases the likelihood of infection. The human activity is for mathithic rodents source of housing, shelter and feed base.

House mouse. The bulk of animals constantly lives in the buildings of man, which is especially characteristic of urban populations .. In nature, it is mostly in the twilight clock, in the construction of the time of daily activity in the opposite dependence on human activity. With favorable temperature and feed conditions, it is breed all year round, although some winter depression is observed. The average bulge from 5 to 7 cubs. Almost omnivorous appearance, the seeds of cereals, legumes and comprehensive seeds eat, the remains of insects, green and juicy feed are constantly found in their feed. Brings tremendous harm in settlements as an omnivorous pest of food reserves.

Rat gray. Rat is common throughout Belarus. In the summer, some individuals move into natural biotopes and returns to human housing for the winter. However, there is an opinion on the existence of two populations: synanthropic and "wild." In the presence of food can permanently reside even in industrial refrigerators. In natural conditions, Roet holes. Most of the year multiplies. Up to three litters per year on average 7 cubs. Young individuals aged 3 - 4 months can multiply. Omnivorous. In settlements, feeds mainly by garbage. Rat black. Completed throughout the territory of the republic. Being a warm-consuming than gray rat, inhabit natural biotopes only in areas with a softer climate. The rest of the range is associated with the housing of a person. In places of living with a gray rat, adheres to the upper floors, up to attic rooms. Gnobs builds on Earth under floor flooring or in the inter-storey structures of buildings. Per year brings 2 - 3 litters for 6 cubs in each. The food includes all permissible vegetable and animal feed.

To avoid infection with natural focal infections, it is necessary to observe simple rules:

it is regularly cleaning the territory of the area from the garbage, prevent the formation of garbage coup, trees, dry and other waste, which are places of mass accumulation and reproduction of rodents. Trash to export on the TWW polygons, prevent the formation of landfills in the forests;

ensure the rodent resistance of residential premises, to regularly destroy rodents of poisoners. Poisonman can be purchased at the territorial center of hygiene and epidemiology;

in no case can not catch and take rodents in the hands. If in the house or on the plot, in the environment you found the corpses of rodents or other animals, do not touch them with your hands and in no case allow it to make it children;

cleaning the house, basements after the winter, where there are traces of rodent vital activity, carry out only a wet method, without preliminary sweeping of garbage and mouse, using the means of personal protection of the respiratory organs, hands. Use for cleaning chlorine-containing drug. Solutions for cleaning prepare according to the attached instructions for the drug. The dishes are desirable to quiet with boiling water, or to process any disinfectant, according to the instructions for use;

bedding (mattresses, pillows, etc.) dry in the sun for several hours, periodically turning over. Bed linen and other accessories before use must be washed;

food products should be stored in an inaccessible place for rodents and other animals, in hermetic container. If nevertheless, you found traces of rodents about either on food products - then such products are better not to eat in food, comply with the technology of preparation and timing of the sale of salads from raw vegetables;

during work or rest in nature, you should not wash your hands before using food in the reservoir, and in no case drink water from the reservoir. To wash your hands, it is better to take water with you, or to gain in the nearest settlement in the well, column, water supply. For thickening, thirst is recommended to take with me bottled water;

in order to avoid infection during agricultural development, during hay and harvest (grilling dry hay, straw, loading, transportation, discharging, etc.) it is necessary to use a four-layer marlay bandage and mittens;

when choosing a place for overnight stays or day leisure, stamped areas of the forest with thick shrubs and grass, old stumps, dressed trees, should be avoided. It is better to choose the edge of the forest or the melan. It is necessary to lay a light blanket for Earth, a raincoat, so as not to have direct contact with the soil infected with rodents, grass;

under the night in the tent, it is necessary to cover all the slots through which rodents can penetrate. You can not sleep in the haystacks, straw, located in the forest, as they are often infected with the discharge of rodents, do not use the old straw, hay and leaves as a litter;

going into the forest in the spring - in the fall, it is necessary to use repellents - means of scaring insects; Choose clothes that prevented insect penetration to the body;

be sure to wear a headdress (especially for women and children), to conduct an inspection itself or a mutual inspection for improving ticks;

it should also be paid to the storage of food products, especially in the cellar, basements, garages. Fruits and greens should be stored in boxes. It is necessary to periodically remove fallen vegetables, and also to remove the garbage, not to eat vegetables and fruits, with traces of damage from rodents.

Department of particularly dangerous infections.

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Introduction

Natural focal zoonotic infections are diseases common to humans and animals whose pathogens can be transmitted from animals to person.

Zoonogenic infections are widespread among wild, agricultural, pets, including wild rodents (field, forest, steppe) and synanthropic (house rows, mice), as a result of which the incidence of natural focal infections is almost impossible to eliminate the incidence.

Natural focal zoonogenic infections are characterized by the ability of pathogens for a long time to persist in the external environment in individual territories - natural foci, in animal organisms, including rodents, birds, bloodsowing arthropods, which are sources and carriers of these infections.

Epidemic importance These infections are purchased into the active spring-autumn period and especially for Muscovites who leave for rest in the natural environment, and summer country recreation facilities for children.

Infection of people occurs: in contact with patients with animals (corpses), objects of the external environment, product item, products infected with rodents, as well as in the bite of animal and blood-suicing insects.

For pseudo-tuberculosis and lesteriosis, one of the main ways to transmit infection is also food, through products (milk, meat, vegetables, etc.) infected with rodents. The pathogens of these infections have the ability to maintain and multiply in food products for a long time, even in refrigerator conditions.

Diseases with natural focal infections flow in medium and severe forms, up to death (deadly) outcomes.

Liseriosis

Liseriosis (Synonym: Lièrelllez) - acute infectious disease of the zoonotic nature caused by a letterier and characterized by a plurality of ways of infection, a variety of clinical picture with a lesion of occipital and other lymph nodes, a white blood monunuclear reaction, often with septicemia and a central lesion nervous system.

Etiology and epidemiology

The beginning of the study of letteriosis refers to 1911, when a new type of microorganism was described, subsequently called Listeria. In Russia, lickeriosis was first described in 1936 by weakness (1936) in pigs. Sakharov and Gudkov described this disease in people with wound meningoencephalitis. Bilibin in 1949 presented the overall symptoms of letteriosis and the clinic of some forms of this disease.

The causative agent of the disease - Listeria - is a short (0.5-0.6 μm) sticks or kokkobacillus, gram-positive, aerobes that can cause hemolysis. Good develop on ordinary, nutrient media. Sustainable in the external environment. In soil, water, straw, grains at low temperatures of listeria can be maintained for several years. In milk, meat at 4-6 ° C is not only not dying, but also intensively breed. They are detrimental to conventional disinfectants in working concentrations. Listeria is sensitive to penicillin, tetracycles, erythromycin, leftomycetin.

Lishery spores do not form, but they can have a capsule, have 1-4 polar arranged flagellas providing mobility. Listerias have antigenic relationship with staphylococci, enterococci, hay stick and especially with the causative agent of pork faces (eryzipeloid), which makes it difficult for the serological diagnosis of the disease. Listerias form phages for which 9 phagelovaries are distinguished. L-forms of licenses are installed, which are 4-5 times less vigilant and have less enzymatic activity. Zoonogenic infection pseudotuberculosis Listeriosis

Liseriosis is a typical infection transmitted from animals. The carrier of the pathogen in nature is many types of rodents (mice, rats, gerbils, tushkars, hares, etc.). Listeria is highlighted from fox, raccoon, wild boar, muffuhar, partridges. Most wild animals, letteriosis proceeds benign. Infected animals are examined by the pathogen by the external environment.

From domestic animals is marked with goats, sheep, pigs, cattle, horses, dogs, cats, chickens, geese, ducks. A person infection most often comes from infected pets when eating insufficiently thermally treated meat and dairy products.

3Aburizing people occurs year-round. Most often arise single cases of the disease. All groups of the population are susceptible to infection, but most often the workers of animal husbandry, fields, veterinarians are sick. Liseriosis is found in all countries in Europe and in many countries of other continents.

Pathogenesis and Patanatomy

Listeria can penetrate the body through the mucous membranes of the digestive tract, the oz, eyes, the nose, the respiratory organs, through damaged skin. From the deployment sites of lettering are distributed along with lymph and blood flow. As the causative agent progresses lymphatic system There is an increase in lymph nodes, but usually without suppuration. If the causative agent is hit, a sharp feverish disease is developing. In the future, the pathogen is fixed in the reticullendothelial system (liver, spleen, lymph nodes) and in the nervous system with the development of meningitis and meningoencephalitis. Listeria can continue to be kept in the kidneys, which matters for intrauterine fetal infection.

Lymphogenic and hematogenous dissemination (distribution) into parenchymal bodies (almonds, liver, spleen, adrenal glands, brain) is accompanied by the development of miliar nodules with necrosis in the center. The latter are represented as granuloma (sheets). This, as well as intoxication, explains the development of the common process in the form of angiosseptic (with mononucleosis), glazesheezed, nervous and typhoid forms. At the same time, from the blood, from the decks of lymph nodes or from the spinal cord fluid can be allocated with lettering.

With an anginal and septic form, an increase in spleen, almonds, deep cervical and top (above and connectible) lymph nodes, ulcerations in almonds, on the gum mucosa, oral cavity, nose, pharynx, esophagus are described. With a tissue study in the pharynx wall, in the area of \u200b\u200bthe ulcers, in the liver, the lungs are mainly detected by the perivascular (around vessels) infiltrates from lymphoid cells. In the liver, along with them, bright reticular cells are observed. In the spleen and lymphatic nodes - growth reticular cells, places to form peculiar foci from large light cells.

In the glazeclause-shaped form in the material of biopsy, the conjunctivations are found with abundant lymphocytic infiltration with the formation of a follicle from bounded clusters of lymphoid cells.

With nervous uniform, along with inflammatory changes on a soft brain shell, there may be small whitish nodules, mainly along the blood vessels. In the substance of the brain, except for edema, hyperemia, diapered (as a result of silence) of hemorrhages, grayish red hotels are detected in the brain bridge, the cerebel, less often in the cerebellum and the trunk kernels. With a tissue study, perivascular infiltrates made of polynuclear cells, dead sections, with a large number of leukocytes containing the pathogen, are surrounded by multi-structured cells, sometimes granuloma of histiocytic cells, among which are listed.

Tiffoid (septic-typhoid) form is characterized by a similarity with an angin-septic form with the exception of lesions of the almonds and the lymphoid apparatus of the nasal part of the pharynx.

With leaferiosis of pregnant women, along with the damage in the internal organs, lemaryiizic granulomas are found in the placenta. With the opening of those who died from the laborn, the well-drawn whitish nodules, which are constantly visible in the liver, often in the lungs, spleen, less often in adrenal, mucous membranes of pharyes, esophagus, intestines, almonds, lymph nodes, in brain, kidney , testicles, myocardium, skin. Often amazed brain shellsBut granulomas can also be in any part of the nervous system.

Characteristic changes are expressed in the formation of granuloma (sheets) with a variety of structure depending on the duration of the disease. In the development of granulum distinguish between several stages:

* I Stage - focal cell leaning due to infection with them with letters spreading in the body along with blood flow;

* II stage - the appearance of cellular elements around deaths with the subsequent formation of granuloma consisting mainly of polymorphous-nuclear leukocytes and lymphoid cells;

* III Stage - necrobiotic changes in the center of granuloma with the addition of exudative processes;

* IV Stage - Organization of necrotic foci with subsequent scarring.

Clinical picture

The incubation period during lesteriosis ranges from 3 to 45 days. The duration of the incubation period depends on the site of the introduction, pathogens of the pathogen, the reactivity of the body.

Four main clinical forms of lumberiosis:

* anginal-septic;

* nervous;

* Tiffoid;

* Eye-iron.

Listeriosis can be the character of the acute, subacute, chronic and abortive form. There are cases of long-term asymptomatic carriage of lettering.

3Aburizing begins acutely with headache, chills, pain in the muscles, general weakness, insomnia, raising the temperature in the first days to high digits. The duration of fever is different: from 3 days to 3 weeks and more. Temperature curve of the wrong type. Often, patients have a rash of erythematous nature, especially in the joints of the joints, the figure "Butterfly" is formed on the face. Appetite decreases, nausea appears, constipation. In some cases, leading symptoms are vomiting, stool disorder. The liver and spleen increase not always. Separate lymph nodes can increase and painful. The fever continues from 10 to 25 days.

An angino-septic form of lumberiosis is most common. It is manifested in the form of light catarrhal and follicular angins without noticeable shifts in the blood formula or anginal and septic forms with typhoid flow and nervous syndrome.

Listeriosis angina for clinical manifestations is close to Streptococcal Angry. With a catarrhal or follicular lemary sinking, the population is observed, an increase in almonds, an increase in lymph nodes. The temperature rises to 38.5 ° C and keeps at this level 5-6 days. The disease is usually completed with complete recovery. With a jazvenenthore threshing, bright hyperemia appears (redness) of the oz, the almonds are formed by film raids and ulcers covered with films; Regional lymphatic nodes increase and become painful.

The temperature reaches 39 ° C. The liver and spleen increase. The disease lasts 10-12 days. Both with catarrhal and other lemary sinks, catarrhal (inflammatory) symptoms (cough, runny nose) can be expressed. The progression of the process leads to the development of an angin-septic form of meteorism, which is observed mainly in adults. Remiterative fever with evening temperature lift to 38-39 ° C for 15-20 days. Facial redness, conjunctivitis, runny nose. In Zev, hyperemia (redness) is revealed, an increase in almonds and raids on them white color. The cervical lymph nodes are enlarged and sealed. Littlely enlarged liver and spleen. The skin arises rash by type of urticaria. Mononuclears appear in the blood. In the midst of the disease, the development of meningeal symptoms (rigidity of the occipital muscles), the symptoms of Kerniga are not excluded. With modern therapy, the disease ends with complete recovery, but there are mortal outcomes. One complication is endocarditis.

With the nervous form of meniosis, meningitis arise, meningoencephalitis, encephalitis, brain abscess. Peripheral nervous system is affected. Clinically lemary meeningitis is expressed by a sharp headache, multiple vomiting, the rigidity of the occipital muscles, a positive symptom of Kerniga. Hyperesthesia is noted ( increased sensitivity), clonic convulsions, voltage of all muscles, violation of consciousness, nonsense. When meningoencephalitis, focal symptoms are added: Ptosis (edition of the eyelid), anisocorium, rybism, the appearance of pathological reflexes, impaired skin sensitivity. There may be paralysis and mental disorders. AT early period Monocytosis is noted in peripheral blood in peripheral blood, leukocytosis and granulocytosis are found in the late periods of the disease.

Spinal brain fluid leaks under increased pressure. It is found in it increased content protein, neutrophils, lymphocytes; Sugar and chlorides are contained in normal quantities. In the late period of the disease, the spinal brain fluid becomes purulent. The temperature at the nervous form of lisheriosis may not exceed 38 ° C (letteriosis of the central nervous system is most often found in children under the age of month and in adults over 40 years old). In old age, the disease is manifested as a secondary infection on the basis of the body's weakening by other diseases (diabetes, cardiovascular diseases, tuberculosis). As residual phenomena In some parts of the recoverable, who have undergone sheets of central nervous system, there are violations of coordination of movements and psyche. The lesions of the peripheral nervous system of the lesteriosis passage are manifested mainly by paresis and paralysis. In some cases, the disease is characterized by polyradiculoneuritis.

The eye-iron shape occurs more often as a result of contact with infected animals. For eyeminiosis, the phenomena of conjunctivitis, pronounced edema, narrowing the eye slit. The cornea in the pathological process is not involved. The acuity of vision is reduced. Easy and submandibular elevatric nodes increase, they are painful. In the blood increases the number of monocytes and lymphocytes. Temperature is usually normal or elevated. Duration of the disease - 1-3 months.

Tiffoid (septico-typhoid) is characterized by a typhoid flow with a long-term fevering reaction, often accompanied by the appearance of a rash of an indefinite nature, arterial hypotension (reduced pressure), an increase in liver and spleen, in which necromatic granulomas are detected during mortal outcomes. It often happens hepatitis with jaundice. The angina is not observed or poorly expressed, the lymph nodes do not increase. It is described polyperozit (inflammation of serous shells) with pericarditis and pleurite, thrombocytopenia (decrease in blood platelets), lowering blood coagulation, bleeding. Some clinicians are related to this form and an angin-septic shape if a rash appears with it.

Chronic form of lumberiosis is often clinically not manifested. The exacerbations of the disease are often accompanied by a short-term fever, catarrhal (inflammatory) phenomena; Sometimes the disease occurs in the type of chronic pyelonephritis, often observed disorders of the digestion. In persons with a reduced immunity, the aggravation of chronic letteriosis can acquire the character of a serious common septic process.

The abutient flow of listeriosis is characterized by acute principle of the disease, the development of symptoms of one of its forms, but the disease ends quickly, with full fussing of all symptoms.

Often there are mixed forms of flow of lesteriosis infection. Endocarditis is also described, urethritis in men, primary atypical pneumonia and insulated abscesses, encephalomyelitis, whose leveriosis is diagnosed only with the help of bacteriological and serological tests.

Liseriosis in pregnant women occurs atypically or erased without a certain clinical picture, according to the type of influenza, sharp respiratory viral diseases, angina, diarrhea, pelitis, difficulty urination. Blood almost does not change. The birth of a dead fetus should cause suspicion of lesteriosis. The possibility of long habitat of sheets in the vagina with re-incidence is allowed. A significant number of illness registers still-up.

With congenital lesteriosis, the fetal infection can occur both in the early and in recent months of pregnancy or during childbirth during aspiration (inhalation) and swallowing accumulating waters with letteries in them.

When infection B. early deadlines Pregnancy may occur spontaneous abortion or a child to be born with defects. When infected in the second half of pregnancy, a child is born with signs of congenital lisheriosis. Clinical manifestations Diseases in these cases do not differ in strict specificity.

Septic-granulomatous form is observed in fruits and newborn children. The structural basis of this form of infection is a septic-granulomatous process with nodule rebirths - luriomas of the liver, lungs and other internal organs, as well as zea, larynx, esophagus. In the propagation of infection on the brain, purulent meningitis and hydrocephalus (brain water can) occur. Liseriosis of newborns, which appeared to light prematurely, is usually not recognized. General signs Diseases are manifested by respiratory disorders and blood circulation. In addition, vomiting is observed, the mucous stool roseolopapulous rash, purulent meningitis, which ends with death. With early defeat of the fetus, deformities are developing.

In infants, laminidizes begins in the form of a sharp respiratory disease: the temperature rises, runny nose, cough appear, small foci of bronchopneumonia appear. Pneumonia sometimes flows as an interstitial (intercellular). Listeria can cause purulent pleurisy. At the same time, digestion disorders are developing. The liver increases, often the jaundice occurs. The spleen does not always increase. Part of the patients has a rash. Numerous granulomas are visible on the wall of the pharynx. The increase in heartbeat, deafness of heart tones, meningeal symptoms, cramps, paralysis are noted. In the event of recovery in children, after a transferred disease, there are sometimes disorders of the peripheral and central nervous system. In pregnant women, letteriosis can flow in chronic form asymptomatic, remaining unrecognized. Fruit infection occurs from the 4-5th month of pregnancy and in a later date.

COMPLICATIONS

The most commonly observed pneumonia, developing due to the addition of secondary microflora in the foci of obscure sheets. Described subacute lemary and endocarditis.

With congenital lisheriosis, the most frequent hydrocephalus, purulent meningitis, lag in mental development.

DIAGNOSTICS

In connection with the diversity of clinical manifestations of the disease, the main importance in the diagnosis is given to the results laboratory studies. To do this, sowing the material from the patient to the nutrient media. The material for the study is mucus from the nasopharynx and the oz, purulent discontinued conjunctiva, blood, spinal brain fluid, a degree of lymphatic node. From the corpses of the died of leaferiosis take pieces of liver, spleen, brain. Sevings are made on meat broth with 0.5% content of potassium teleuritus or on blood agar.

For the estimated detection of sheets in the infected material, the method of fluorescent microscopy is used. From serological methods of diagnostics of lumberiosis, an agglutination reaction and a complement binding response using antigens in paired serum are used. The sick serum takes no earlier than the 7th day of the disease, the second trial takes 10-14 days after the first. The evidence is only a very high titer of it (1: 400 - 1: 800) and the increase in the titer in the dynamics of the disease 4 times or more. This reaction can not be considered strictly specific. Complete response is more specific (RSK). The diagnostic titer of RSK is considered to be 1: 10 (not lower) with the obligatory increase in the titer in the process of the disease. Auxiliary value is a biological sample (infection with the material from the patient intraperitoneally white mice). The known value for the diagnosis has a skin allergic test in response to the introduction of patients with intracutaneously 0.1 ml of the murdered suspension of lettering.

Differential diagnosis

Differential diagnosis of lumberiosis is carried out with many diseases, depending on its clinical manifestations.

An angin-septic shape of lumberiosis differentiate with the thorough angins of the other genesis, infectious mononucleosis, diphtheria, streptococcal angns, agonylocitar angina, angiosnial-iron form of Tularemia, etc.

The eye-iron form of lumberiosis on clinical manifestations is similar to the eye-glazed form of Tularemia, conjunctivities of various origin. Listeriosis flowing with the lesion of the central nervous system requires careful differentiation with meningococcal, leptospyrosine, pneumatic and staphylococcal and other serous meningitis, etc.

Tiffoid form differentiate from abdominal typhoid, sepsis, pseudotuberculosis, etc.

The encephalitic form of luriosis is differentiated from viral and other encephalitis, meningoencephalite, abscesses and brain tumors, etc.

Listeriosis abortions in women in the form of origin are differentiated from abortion during brucellosis and toxoplasmosis. The diagnosis is raised taking into account the data of epidemiology.

Congenital letteriosis differentiate from congenital cytomegalia, toxoplasmosis, syphilis, staphylococcal sepsis, hemolytic disease Newborn, intracranial injury, etc.

TREATMENT

Sick leaferiosis requires careful care and full nutrition. Treatment of lumberiosis is carried out in accordance with its clinical form. Effective etiotropic drugs are tetracycline antibiotics. Levomycetin, erythromycin, penicillin or ampicillin, and other treatment continue the whole fevering period and another 5-7 days amid normal temperature Under the extinction of others clinical symptoms. Under the defeat of the central nervous system, tetracycline-row preparations with streptomycin are prescribed.

In addition, dehydration therapy is carried out. In the case of severe flow, lesteriosis antibiotics are combined with prednisone (5-10 mg 4 times a day with a gradual decrease in dose). Prednisolone is used for 7-14 days. Antihistamines (Dimedrol, Supratin, Diprazine, etc.) are recommended in ordinary doses. For the purpose of disintellation, a large amount of fluid is administered intravenously (5% glucose solution, ringer solution, isotonic sodium chloride solution of 500-1000 ml) with the simultaneous use of means of forced diuresis (reinforcing remedies). In the glackeeper-shaped form, it is also used to be applied into the eyes of a 2% solution of albuchis, 1% hydrocortisone emulsion. In chronic listeriosis, antibiotics are prescribed in the same dose as acute formFor 7-10 days, after which sulfadimezin is prescribed 0.5 g 4 times a day for 7 days. With significant exacerbations of chronic lumberiosis therapy is similar to the acute course of it.

Prevention

Specific methods of prevention of listeriosis are not developed. Currently, prevention is reduced to a set of sanitary and veterinary measures.

In settlements, a systematic extermination of house rodents (mice, rats), as well as the destruction of stray cats and dogs is carried out. Patients with letteriosis are hospitalized. Behind the settlements, where patients were identified, they establish epidemiological observation. Pregnant women with a burdened obstetric history are subject to a lesteriosis survey, the chemoprophylaxis of fetal lumberiosis is carried out. In natural foci, lesteriosis, it is necessary to fight rodents and take measures to prevent personal prevention from the attack of bloodsowing arthropods - possible carriers of licenses.

Forecast in adults is more favorable. In newborns and older people, the disease can occur very hard and end with mortal. In pregnant women, letteriosis can lead to severe fetal damage.

Iraciniosis and pseudotuberculez

Ierisiniosis I.Pseudotuberculez - These are intestinal saprosoons caused by rations characterized by the lesion of the gastrointestinal tract, expressed by toxic-vasary symptoms and inclinations (the most pronounced during pseudotuberculosis) to generalized flow. Both diseases have a distinct tendency to induce the development of immunopathology.

ETIOLOGY

The causative agents of Iersiniosis (Y. Enterocolitica) and pseudotuberculosis (Y. pseudotuberculosis) belong to the family of intestinal bacteria, venture ^ a.

Iracinium is gram-negative sticks that grow both on ordinary and depleted nutrient substances environments. The latter are used in a bacteriological study by Peterson and Cook (1963).

Many strains of Irancini produce exotoxin (thermostable enterotoxin). When destroying bacteria, endotoxin is distinguished. Iracinium also possess the ability of cadgesia, invasion and intracellular reproduction. Invasive properties in Y. pseudotuberculosis is largely expressed than y. entero-coltica.

Iracinium belongs to KPSihrophilas. At the refrigerator temperature (4-8 ° C), they are able to continue and multiply in vegetables, rootes and other food products. At the same time, some of the strains of bacteria have increased thermal resistance to high temperatures And you can withstand pasteurization mode. When boiling (100 ° C), all strains of Irancini die after a few seconds. Sensitive to the action of ordinary disinfectants.

Epidemiology. Iracinium is widespread in nature. They were found in the soil, water, isolated from the body of many animal species. However, the main reservoir of the pathogen in nature, obviously, are small rodents, which, examining various objects of the external environment, food products, water, contribute to the spread of infection among other animals. Another reservoir of Iranse is soil. The frequent detection of disease pathogens in it is associated not only with pollution of animal feces, but also with the presence of source of saprophytic properties. Based on this disease, it can be attributed to saprosing views.

The main source of infection for a person with yersiniosis is agricultural animals, less often - synanthropic rodents. The sick person as a source of infection has an incomparably smaller value. With pseudo-tuberculosis, the main sources of infection are synantropic and wild rodents. A person, as a rule, is not a source of pseudotuberculosis.

The main way of distributing both infections is food. Transmission factors Y. Enterocolitica are most often infected with meat products, milk, vegetables, root, water. To the transfer factors Y. pseudotuberculosis includes vegetable dishes (cabbage salads, carrots, etc.) and dairy products used in food without prior heat treatment. The water transfer path has in both infections inextensively smaller meaning. It is usually implemented when drinking water from open reservoirs. Other transmission paths are not essential in the epidemiology of yersiniosis.

The disease is found in all age groups, but more often in children firstwill life. The seasonal raising of the incidence of Iersiniosis is celebrated during the cold season with a peak in November. In some regions, there are two seasonal lifts - autumn and spring. The peak of the incidence of pseudotuberculosis falls on the spring months (March-May). Iraciniosis and pseudotuberculosis flow in the form of sporadic and group diseases.

PATHOGENESIS

The entrance gate for causative agents of Iersiniosis and pseudo-tuberculosis is the gastrointestinal tract. The maximum pronounced local response in response to the invasion of items is recorded on the side of the mucous membrane of the ileum and its lymphoid formations. In the ileum, various severities are developing inflammatory process-terminal Ileit. In the lymphatic vessels, it is penetrated into mesenterical lymph nodes and cause meseadenite. The pathological process can be involved in a black-shaped process and the blind intestine.

Against the background of infectious-inflammatory changes, toxic and toxic-vasary (vasotor paresis) are developing (Vasotor's paresis) processes associated with toxiny.

At this stage, the infectious process, acquiring the features of the localized form, can be completed.

In the event of a breakthrough of the lymphatic barrier of the intestine, bactema arises, which causes the development of generalized forms of the disease.

Bacterial-toxic lesion of many organs and systems is observed, primarily the liver and spleen, the development of polylim flowenitis, polyarthritis, myositis, jade, urethritis, meningitis, etc.

With long-term finding of the heersin and their toxins in the blood and the organs of the patient, the body sensitization occurs. Part of the patients, as a rule, with HLA-B27 phenotype, yersiniosis and pseudo-tuberculosis can be an impetus to the emergence of immunopathological reactions and states.

The final link of pathogenesis is the liberation of the body from the causative agent leading to recovery.

The development of specific immunity during yersiniosis and pseudo-tuberculosis occurs slowly and it is not quite strong, with which the increasing development of exacerbations and recurrences of the disease is connected.

CLINIC

The duration of the incubation period during heersiniosis ranges from 1 to 7 days, and pseudotuberculese-from 3 to 21 days.

Based on the general pathogenetic patterns of intestinal zoomosis and clinical and pathogenetic features of Iraciniosis and pseudotuberculosis, localized (gastro-intestine-beanterterial) and general and dioxide forms can be highlighted. They may be eliminated (less often) asymptomatic flow.

Localized (gastrointerestic) shape of the manifestic flow includes the following options: gastroentero-colitis, gastroenteritis, enterocolitis, enteritis, acute terminal Ileit, mesadenitis, appendicitis. The asymptomatic flow of localized (gastrointestinal substationine) form switches subclinical and reconvalued options. The latter is not characteristic of pseudotuberculosis.

The gene of the yawned shape of the manifesto flow can have two varieties: toxicobacterotic and septic. Depending on the prevalence of one or another symptoms, the toxicobacterium variety of general and the dwelled form can flow in the following options: exconna, arthritic, yellow (yersiniose hepatitis), meningeal, catarrhal, mixed and in the form of heersiniosis (pseudotuberculosis) of rare localizations. In rare cases (for example, immunokompromverted persons with chronic liver pathology and signs of thesauryism of iron) is developing a yersiniosis sepsis. Asymptomatic flow during generalized form can be represented by a reconvalued option. The latter is usually not typical for pseudo-tuberculosis.

In terms of the severity of the manifest course of the disease, there is a lightweight, medigative and serious flow. According to the nature of the flow - smooth and complicated, including with exacerbations and relapses. For the duration of the disease and its outcomes - acute (up to 3 months), chronic (more than 3 months) and the consequences clinic (residual phase).

Localized (built-in-seinerian) form is found in 70% of cases of yersiniosis and almost 30% pseudotuberculosis. The most frequent manifestations of this form are aosaerentherocolitic, aosarogenic, enterocolitic and enteritis the orient variants of the course of the disease. They are registered in all age groups, but mostly in children under the age of 10 years.

The clinical picture of these options is characterized by the presence of intoxication syndrome and symptoms of the lesion of the gastrointestinal tract on one or another level. The disease begins sharply: chills occur, an increase in body temperature up to 38-38.5 "S. Patients are worried about headache, weakness, Malgia and Arthralgia. Simultaneously with intoxication syndrome, nausea occurs, from part of patients - vomiting, stomach pain, which wear grabs or a permanent character. Localization of pain - in the epigastria, around the navel, in the right iliac region, sometimes in the right hypochondrium. The chair is liquid, viscous, with a sharp smell. In some patients, a mixture of mucus, cutters, rejects are detected in the pathological sector. The stool frequency is from 2-3 to 15 times a day. Duration of the disease from 2 to 15 days. Along with a benign flow, severe forms of disease are found with sharply pronounced intoxication, dehydrating the body.

The acute terminal effect is accompanied by an increase in body temperature to 38-39 "C, intense pains in the ileocecal region and diarrhea.

Patients tend to describe two types of pain: constant and on their background - grabs-like types. With a radiological examination, the affected part of the ileum is sharply narrowed and has a smooth relief of the mucous membrane ("symptom of the cord"). Terminal Ileit has a long and often complicated flow. Among possible complications: Infarction and necrosis of the mucous membrane, followed by limited or (rarely) spilled peritonitis, baking process intestinal obstruction and others. The development of the consequences of the consequences in the form of chronic granulomatous-ulcerative damage to the ileum is possible, morphologically not distinguvented from the Crohn's disease.

Acute meseadenite is characterized by moderately pronounced intoxication, subfebrile temperature, less than with terminal iley by the force of grapple-shaped and constant pain. In the debut of the disease, there may be nausea, vomiting, liquid stools up to 3-5 times per day. In the future, a significant part of the patients have a development (in 4-6 days) "infiltrate" in the ileocecal region, which is a group of increased mesenteric nodes, and peritoneal symptoms. Reveal positive symptoms of Mac-Fadden, Klein, Padlocks, "Cross" Sterberg Symptom. The course of acute mesadenite is often accompanied by exacerbations and relapses. Possible transition of disease in a protracted and chronic current. Part of the patients are subject to surgery.

A sharp yersiniosal (pseudo-tuberculosis) appendicitis, unlike vulgar, has a slower pace of development from catarrhal to destructive forms. As a result of this, a high frequency of detection of a catarrically changed dwarf-like process during surgery than the attained appendicitis. However, this option is not distinguished by a smooth flow. Often, after surgery, signs of generalization are developing: high fever, polylimphajenitis, hepatosplegalye, examine.

All variants of the localized form are not only characteristic of the abdominal (gastrointestinal), but also outbdominal symptoms, due to the effect of toxin and excessive products of prostaglandins on vasomotors and endothelium of blood vessels: the injection of spool vessels and conjunctive hyperemia, "raspberry" language, hyperemia of a soft sky, arthralgia, Malgia and others.

In peripheral blood, leukocytosis, neutrophileenesis, a halochanger shift, an increase in ESO, sometimes eosinophilia is observed.

The generalized form occurs about 30% of cases of the manifestine course of Iersiniosis of 70% of pseudotuberculosis cases. It has two varieties of flow: toxicobacterotic and septic. Both in the rationisiniosis and the pseudo-tuberculosis, the toxicobactermic course of the generalized form is usually observed. The septic flow for both diseases is extremely rare.

The toxicobactermic current of the generalized form is most well studied by testing an atomsic version of the pseudotuberculosis, described earlier as Far Eastern Scarlarty. The disease is characterized by sharp start. Patients complain about chills, headache, Malgia and Arthralgia. The body temperature rises to 38-40 ° C and keeps at this level for 5-7 days, and with severe and longer. In the first days of the disease, nausea are noted, sometimes vomiting, liquid chair, abdominal pain. Often observed catarial symptoms From the side of the upper respiratory tract: Moderate pain in swallowing, swallowing, runny nose.

With an objective examination in the 1st week of the disease, the skin of patients dry, hot, the face is thought-out. There is a hyperemia of conjunctive, the injection of the spool vessels. Often, especially in children, a pale nasolabial triangle is determined. The mucous membrane of the rotogling is diffusely hyperemic. Part of the patients on the soft sky is detected by a point enantore. The cardinal signs of this disease include dotted scarlatin-like exammatime in combination with the symptoms of the "Hood" (hyperemia of the face and neck), "gloves" and "socks" (limited hyperemia of the brushes and stop). These cardinal symptoms appear most often on the 2nd day of the disease. The duration of the existence of a rash -1-7 days. After her disappearance, from the 2nd week of the disease, most patients appear a seven-party peeling of the skin of the body, face and neck and lamellar (least) - skin of the palms and stop.

It should be noted that such a type of exammatime is practically not occurring during heersiniosis. It is more characteristic of a small-scale rash on symmetric skin of the body and / or limbs, which disappears on time from several hours to 3-4 days.

When palpation, moderately enlarged and painful peripheral lymph nodes are found. The lability and increase in the pulse corresponding to the body temperature are determined. Arterial pressure somewhat reduced.

Organs digestive system naturally involved in the pathological process. The language, covered in the first days of the disease with a white bloom, often to the 5-7th day cleaned and becomes "Malinov". With palpation of the abdomen, there is a soreness and a rumbage in the Ileocecal region, with less constancy in epis and mesobastria. Positive symptoms of the fallows, the "cross" Sternberg are revealed. In patients with reduced nutrition, you can face enlarged and painful mesenteric lymph nodes. Usually the pathological process is involved in the liver. It increases, becomes available for Palpation by the end of the 1st week of the disease. In some patients, the lesion of the liver parenchyma leads to the appearance of scler and skin, hyperbilirubinemia, urobilin and bilirubinuria, moderately pronounced hypertransaminsemia.

In some cases, Splenomegaly occurs. In peripheral blood - neutrophilic leukocytosis, Yu-Zhuyu ^ l, a halochanner shift, sometimes eosinophilia, an increase in ESP to 25-50 mm / h.

The disease is often accompanied by the development of signs of infectious-toxic interstitial nephritis. In some cases, severe diseases are observed signs of serous meningitis.

Part of the patients with the 2nd and 3rd weeks of the disease are characterized by the appearance of symptoms indicating immunopathological restructuring. Upholstery, poppy and maculophaulous rashes with localization on the torso and limbs, often appear in this itemiod. Arrives noded erythema. Some patients develop a reactive polyarthritis, Reiter's disease.

Sometimes in this period of the disease, myocarditis, nephritis, urethritis, cystitis, conjunctivitis, iridocyclitis and other damage internal organs are detected.

According to a predominance of one or another symptoms, the following options are distinguished in the limits of the cobacteriummic flow of the general and the dwelled form of the disease: Exandtematous, arthritic, jaundice (yersiniosis / pseudo-tuberculosis hepatitis), meningeal, catarrhal and yersiniosis (pseudotuberculosis) of rare localizations.

Exacerbations and relapses often complicate the course of heersiniosis and pseudo-tuberculosis. They are found in 1 / patients and are characterized by a repeated wave of fever and symptoms of local lesions.

During the reconstruction period, the body temperature is reduced to normal, the symptoms of intoxication disappear, the functions of the internal organs are normalized.

The severity of the flow of Iraciniosis and pseudo-tuberculosis is determined by the severity of intoxication syndrome and the degree of involvement in the pathological process of internal organs. More often, the disease occurs in light and moderate forms.

The septic course of the generalized form of Iraciniosis and pseudotuberculosis is very rare. It, as a rule, is developing with pronounced immunodeficiency, in individuals with chronic liver pathology and signs of iron thezauryism. The course of the disease is characterized by severe intoxication, microabscing of internal organs, hepatosplegegaly, often diarrhea, long recurrent flow and, despite treatment, high mortality.

With all the forms of the manifesting flow of the yersiniosis infection, the duration of the disease usually does not exceed 1.5 months. However, sometimes a protracted course of the disease (from 1.5 to 3 months) and in rare cases are chronic (more than 3 months). The presence of a disease, etiological associated with suffered by yersiniosis, but with a proven bacteriologically and serologically, the absence of a causative agent in the patient's body should be regarded as a clinic of the consequences of the heersiniosis (residual phase).

Asymptomatic flow can be sharp (up to 3 months) and chronic (more than 3 months). The latter is not typical for pseudotuberculosis. In addition, with the difference between pseudotuberculosis, it is not only subclinical, but also a reconvalued bacterial excretion of causative agents of the disease. Persons with an asymptomatic course of the disease are revealed actively when examining food workers and contact - in the foci.

The forecast in most cases, with the exception of the septic course of the disease, favorable.

Diagnostics. From clinical signs, the greatest diagnostic value is the combination of the lesion syndrome of the gastrointestinal tract and the "extra intechestic" toxic-vasary symptoms. The data of epidemiological history, especially with the group nature of morbidity, is also of great importance in the recognition of Iersiniosis and pseudotuberculosis. However, the specific methods of diagnosis are decisive in establishing the final diagnosis - bacteriological and serological.

Basic materials and for bacteriological research are feces, blood, cerebrospinal fluid, ledated lymph nodes and a heart-shaped process. To determine the presence of pseudo-tuberculosis antigens in feces and other material uses an immunoassimensional analysis (ELISA).

Serological diagnostics is of great importance to confirm not only the clinical diagnosis, but also the etiological role of the allocated Iranse. It is carried out with the help of RA and RING by the method of paired sera. Investigate blood serums taken at the beginning and in the 3rd week of the disease. The diagnostic for RA is considered to be the titer of antibodies 1:80 and above, and for RNA-1: 160 and higher.

In the rapid diagnosis of Iraciniosis, rng is used with immunoglobulin diagnosticum and MFA.

A certain value in diagnostics also has histological examination biopsyttes of lymph nodes and other organs.

Differential diagnosis of Iraciniosis and pseudo-tuberculosis depends on the clinical option of the disease. Most often there is a need to differentiate these diseases with sharp intestinal infections, appendicitis, various diseases joints, viral hepatitis, sepsis of other etiology, etc.

TREATMENT

Antibiotics, sulfonamides and chemotherapy are used as etiotropic agents. Fluoroquinolones belongs to the preparations of choice in the generalized form of diseases. For the preparations of the reserve -toofalosporins of the 3rd generation, tetracycline and leftomycetin. Aminoglycosides are usually used in the treatment of patients with yersiniosal (pseudo-tuberculosis) hepatitis. For the treatment of patients with a gastrointestinal substationine form (options: gastroenterocolitis, gastroenteritis, enterocolitis, enteritis), preparations from the Kotrimoxazole group and nitrofuran can be used. The duration of etiotropic therapy depends on the form of the disease. With a localized form, it is 7-10 days, with a generalized one, less than 12-14 days.

Pathogenetic therapy provides for the appointment of disintellation, constructive and stimulating, as well as desensitizing agents. In some cases, glucosoelectric polyionic solutions are used to rehydrate.

Patients with septic flow of the disease are coated into compliance with the principles of treatment of sepsis, using 2-3 antibiotics (fluoroquinolones, aminoglycosides, cephalosporins) intravenously in combination with intensive pathogenetic therapy.

Patients with asymptomatic flow are obtained by therapy depending on the variant (subclinical or reconvalued) and the duration of the bacterial excretion. Treatment of an acute subclinical variant corresponds to the therapy of a light flow of localized form. In the therapy of chronic subclinical and reconvalued options, fluoroquinolones, aminoglycosides, rifampicin in a complex with immuno-oriented means are used.

According to the testimony, the operationality is carried out.

Prevention

Control over the state of vegetable stores, fighting rodents. Sanitary and hygienic events in food enterprises and food prices - compliance with the rules for transportation, storage, preparation and sale of food products. Standing sanitary supervision of water supply

Posted on Allbest.ru.

Hemorrhagic fever with renal syndrome (GLPS) and measures of its prevention.
(Memo for the population)

GLPS- A particularly dangerous viral natural focal infectious disease.
The natural-focal disease is characterized by the fact that the causative agent of the disease is constantly circulating among animals in natural conditions in certain territories.
First clinical signs The HLPS in people were described in the 30s of our century during outbreaks in the Far East, and the virus causing the disease was allocated by scientists in 1976.
Flares of GLPS in the Far East, in China, Korea, in the Caucasus and the Carpathians were associated with wild mood and forest Asian mice; in China, Japan, Korea, USA - with various types of rats; In Europe - with red pools.
It should be noted that the virus causing a disease in humans is found almost 60 types of mammals.
The main tanks, the keepers of the GLPS virus in nature are miserable rodents, in which the infection is more likely proceeding in the form of healthy carrier, not leading to the death of the animal. Among the carriers of the GLPS should be highlighted with a red fifth, field mouse, gray and black rats and different types Gray voles that distinguish the virus into an external environment with feces, urine and saliva.
The GLPS virus is distributed among rodents with direct contact of the animals in natural conditions.
The natural foci of the GLPS is most often located in wet forests, in forest ravines, forest floors of rivers, where infected rodents live. The development of natural foci of the GLPS most often contribute to the Burls, unclean areas of forestwings, understand the rivers, where favorable conditions are created for habitat of infected rodents.
In the Russian Federation, HLPS people are registered at 48 administrative territories. Moreover, up to 90% of all cases of diseases of people fall on the Urals, Volga and Volga-Vyatsky districts. The most disadvantaged are territories of the Republics of Bashkortostan, Tatarstan, Udmurtia, Chuvashia and Mari El, as well as Penza, Orenburg, Ulyanovsk, Chelyabinsk and Samara regions.
The GLPS causative virus can penetrate the human body from infected rodents with different ways: through damaged skin Covers, mucous membranes of respiratory tract and digestive organs.
People infection most often occur with the use of products infected with rodent secretions or through dirty hands during meals.
It is also possible to infection with the bite of rodent during the catch or when fresh discretions (excrets) of animals on damaged skin covers.
Through the light causative agent, the GLPS enters the body of a person with dust when cleaning and repairing premises, during the carriage of hay and straw while working on farms, on a forestry, a collapse of the twigs for a fire, overnight stays in stacks, etc.
Most often, the infection of people occurs in the territories of natural foci:

when visiting the forest during walks and tourist hiking;
on hunting and fishing; when collecting mushrooms and berries;
when harvesting firewood and twigs, individual haygoes;
during work in collective gardens and gardens, dachas, apieges;
during their stay in recreational institutions;
when working at the production and enterprises (construction, drilling, oil fields, leshozes);
when carrying out earthworks with the destruction of the holes and nests of rodents, in the buildings located near the forest.

GLPS is characterized by pronounced seasonality As a rule, Spring-autumn.
Late in the fall and winter infection of the GLPS can be associated with the transportation of straw and hay, when disassembling the bright and potatoes, etc.
The greatest number of patients in the European part of Russia is registered in August-September, single diseases arise in May, the lowest incidence rate falls in February-April.
In the Far East, the disease appear at the beginning of summer, the main rise in the incidence is at the end of autumn and the winter, when the migration of field mice in the settlements begins.
Incubation (hidden) GLPS period averages 2-3 weeks.
The disease begins, as a rule, acutely, occasionally the disease is preceded by weakness, chills, insomnia.
For the acute start of the disease, the temperature increase (up to 39-40 degrees), painful head and muscle pain, pain in the eyes, sometimes worsening vision, thirst and dry mouth. The patient at the beginning of the disease was initiated, and in the future Izmal, apatic, sometimes rags. The face, neck, the top of the chest and spins are brightly hyperemic (redness), there are hyperemia of mucous membranes and the extension of the spool vessels. A hemorrhagic rash may appear on the skin of the brachial belt and in the armpits in the form of single or multiple small hemorrhages. Injectations arise subcutaneous hemorrhages. Possible nasal, uterine, gastric bleeding, which can cause fatal outcomes.
Especially typical for GLPS renal syndrome: sharp pain in the stomach and lower back, the amount of urine released sharply decreases, blood may appear in it.
With severe and moderate clinical forms Disease flows may occur such complications as acute cardiovascular failure with the development of pulmonary edema; kidney break, brain hemorrhage and heart muscle; Massive bleeding in various organs.
Deadly outcomes for the disease of the GLPS are on average from 3 to 10%, including 15-20% in the Far East, and in the European part -
1-3%.
GLPS directly from person to man is not transmitted. The susceptibility of the population towards infection is very high. Urbled GLPS has a resistant immunity, repeated infection is not marked.
In the city of Moscow, annually registers from 25-75 cases of GLPS diseases, which are browseed. Infection occurs when leaving the dysfunctional territory of the Russian Federation: Moscow, Ryazan, Voronezh, Kaluga, Yaroslavl, Smolensk and other areas. Muscovites infection occurs in the active period, more often - during summer holidays.
GLPS prevention.
Currently, the specific prophylaxis of the GLPS, unfortunately, is absent, the vaccine has not yet been developed.
Preventive measures are directed mainly to the extermination of rodents in places where there are foci of GLPS, and to protect people when contacting rodents or objects contaminated with their discharges.
Nonspecific preventive actions Provide:

observation of the number and reproduction of rodents (especially in the territories of active natural foci);
cleaning urban forest parks and territories of green plantings from a dog, shrub, garbage;
destruction of rodents in buildings adjacent to natural foci.

Muscovites, in the spring-autumn period of mass recreation and work in the household plots, should be remembered and measures of prevention dangerous disease GLPS.

What you need to know about leptospirosis

choose for swimming known, safe reservoirs;
ensure food storage and drinking water in places inaccessible for rodents;
carry out the cleaning of country rooms after the winter period only by a wet way, using household disinfectants;
apply protective masks and gloves when disassembling sheds, cellars and other buildings;
strictly follow the rules of personal hygiene.

Remember that the implementation of these simple prophylaxis prophylaxis will allow you and your loved ones to warn this serious infectious disease!

How to warn the disease of lesteriosis
(Memo for the population)

Liseriosis - The infectious disease of man and animals is widespread.
Sources of diseases of the lesteriosis of people are many species of wild and domestic animals, including rodents and birds. Sick animals with their secretions infect the environment, soil, household items in homes, as well as food and water.
The pathogens of lumberiosis - microorganisms (listera), resistant in the external environment. They are not only lasting for a long time, but also multiply in foods at low temperatures, even in refrigerator conditions. Definitely acts on sheets of boiling and household disinfectants.
Human infection It occurs as a result of eating infected products or water, inhalation of dust when cleaning the rooms inhabited by rodents, when contacting patients with animals.
Listeria penetrate the human body through the gastrointestinal tract, the respiratory organs, the mucous membranes of the oz, nose, eye, damaged skin. In addition, the causative agent of listeriosis has the ability to penetrate the placenta, which leads to the intrauterine death of the fetus and newborn children in the first days of life. Concerning listeriosis disease is most dangerous for pregnant women.
Clinical manifestations of letteriosis are quite diverse. The disease begins sharp, two or four weeks after infection. A high fever is noted, in the future alarg can develop, conjunctivitis, lesion of the gastrointestinal tract, meningoencephalitis and sepsis. Liseriosis is one of the reasons for miscarriage and premature genera in pregnant women.Perhaps prolonged carriage of sheets in the human body without clinical manifestations.
Each pregnant should know that in order to prevent the development of lesteriosis in the fetus and a newborn, it is necessary to register as soon as possible in female consultation for observation, and if necessary, for a survey on lemberiosis and timely treatment.

Liseriosis heal!
At the first signs of the disease, you must immediately consult a doctor.

For the prevention of sheets, it is necessary to perform prevention and personal hygiene measures, especially strictly women during pregnancy.
Use food only until the expiration date, thoroughly rinse fruits and vegetables, especially used for the preparation of salads. During rest or work in the country areas, it is necessary: \u200b\u200bthe cleaning of the premises is carried out with a wet method, using household disinfectants; store food and water in places inaccessible for rodents; After contact with pets thoroughly wash hands with soap.

The execution of these simple rules will allow you and your loved ones to warn the disease with letteriosis.

Prevention of pseudotuberculeza
(Memo for the population)

Pseudotuberculosis -acute infectious bacterial disease with a polymorphic clinical picture from a scarlatin-like fever, lesions of the joints to food toxicoinfection and septic states.
Sources of infection - Various types of rodents (rats, mice, voles, etc.).
Pathoom: bacterium that remains for a long time and breedingin the external environment and food products (vegetables, fruits, milk, etc.), in a humid environment, even in cold conditions (+ 4 ° C). Often, such conditions can be created in vegetable stores, where the causative agent remains for a long time and accumulates in rotting vegetables.
Ways transfer - Food (infected products) and contact.

The most significant factors of transmission of infection are food products infected with rodents and used without heat treatment. Vegetables may be infected (potatoes, carrots, onions, cabbage), greens, less often fruit, as well as other products where rodents can penetrate. Violation of sanitary and hygienic standards and rules leads to an examination of causative agents of premises, inventory, dishes and secondary infection of food products (milk, cottage cheese, compotes, side disk, etc.) in violation of technology and the rules of cooking, storing and implementing dishes from raw vegetables in organized teams , including children's, public catering points, the use of infected products often leads to outbreaks. Most often, the causes of infection are pre-prepared salads of poorly purified and washed vegetables that were stored in the refrigerator.

Given the peculiarities of pseudotuberculosis pathogens, for the prevention of diseases of people, it is necessary:

carry out improvement and cleaning of the territory of households, in order to prevent favorable conditions for the life of rodents;
carry out the extermination of rodents (deratization) and disinfection of premises;
measures to prevent rodents in residential premises, as well as premises where vegetables and other foods are stored, cooking (kitchens, storage rooms, cellar);
carry out prophylactic disinfection of vegetable stores before each laying of vegetables;
comply with the rules for processing vegetables (thorough cleaning and washing in running tap water);
not to disturb the technology of making salads (prevent preliminary soaking of vegetables);
comply with the conditions for the storage and timing of the sale of salads from raw vegetables, to use them immediately after cooking;
conduct regular cleaning, sink and disinfection of kitchen equipment (refrigerators, combines, etc.), tools (knives, boards).

Compliance with the listed measures of prevention will allow to protect themselves from infection with pseudotuberculosis!

What you need to know about Tularemia
(Memo for the population)

Tularemia - Infectious disease, sources of which are various types of wild animals. In natural conditions, more than 60 types of small mammals are sick, mainly rodents (water rats, toilets, mice, etc.).
Sick animals with their secretions infect the environment, food, vegetables, grain, hay, household items. Finding into continuing reservoirs (lakes, ponds, etc.), they infect water.
The Tularemia causative agent is a microbe (bacterium), which has high resistance in the external environment: in water and crude soil at low temperature is able to survive and cause people's disease during three months old and more. A person is extremely susceptible to Tularemia and infects in various ways:
- the skin, including intact, in contact with sick animals and their corpses;
-Ares the respiratory tract with the burden of hay, straw, vegetables, etc.
- In hand, the digestive tract, with the use of infected water for drinking or not sufficiently worn meat Zaitsev and others. Small mammals;
- When biteing with bloodsowing insects (mosquitoes, blind, pliers).
The most common infection of Tularerey occurs when the contaminated mosquitoes, blindders and ticks in natural foci of infections.
Clinical manifestations of the disease appear after 3-6 days after infection. The disease begins suddenly: the body temperature rises to 39-40 degrees, severe headache appears, sharp weakness, muscle pain, strong sweating at night. The disease is accompanied by soreness and an increase in lymph nodes in a particular part of the body (in the neck area, under the arm, in the groin) is always near the place where the microbes penetrated the body. If the infection occurred through the skin, then redness, suppuration, ulcer appears at the place of penetration of the microbes, and at the same time increases and becomes painful closest lymph node. If the infection occurred through the mucous membranes of the eye, the conjunctivitis and the lymphadenitis of the varnish and submandibular lymph nodes. When the causative agent hit the body through the respiratory tract, the inflammation of the lungs is developing through the mouth, in the almonds - angina with a sharp increase in submandibular and cervical lymph nodes.

Tulyarani Heal!
If suspected the disease, you must immediately consult a doctor.

drink water from outdoor reservoirs or unfavorable wells in summer cottages;
places to rest in the haystacks (straws), a favorite habitat of rodents;
catch wild animals and take into the hands of small mammals corpses;
swim in unzoping reservoirs in an unknown area where the natural focus of Tularemia is possible.

It is necessary to use repellents against mosquito bites, blinding, Tularemia mites.

Tularevia can be warned!
To do this should be done preventive vaccinationwhich will reliably protect against infection. The vaccination is made from deepening, easily ported and operates for 5-6 years.
In the city of Moscow, vaccinations are conducted by certain contingents of the population: participants of student detachments, labor associations of high school students and students of secondary special educational institutions, traveling to disadvantaged terrain; employees of disinfecting stations operating on enzyotic tularemia sites of the city; employees of special laboratories. Vaccinations are carried out in the clinics of the city of Moscow.

Oligotrophic reservoirs

revolutions with a low level of primary products. The oligotrophic belongs to the waters occupying large spaces in the central subtropical areas of the World Ocean, the primary productivity of the corks is low due to lack of biogenic elements are low. Among the continental reservoirs, the oligotrophic reservoirs include lakes and mountain rivers with cold, saturated oxygen, poor biogenic elements, transparent water. The maximum primary products of oligotrophic reservoirs is 0.1-0.3 Gs / m2 per day. The mass of phytoplankton in oligotrophic reservoirs is small, but its species diversity can be large. The hydrobionts are represented by oxilic forms: tanitarisus is common from the larvae, from fish - sigovy and salmon. Fresh oligotrophic reservoirs are valuable as a source of pure water.

The doctrine of natural focal diseases

In the late 30s. XX century E. N. Pavlovsky formulated the doctrine of the natural foci of diseases, the essence of which is to open the phenomenon of the natural focus.

The natural source of the disease is the smallest part of one or several geographic landscapes inhabited by a given infection with wild warm-blooded animals and arthropod and insect carriers, among which the circulation of the pathogen proceeds indefinitely due to the continuous epizootic process. Natural foci of the disease arose on Earth long before the appearance of a person and exist independently of him.

Important epidemiological feature Natural focal diseases is the territorial deritment of them to certain geographical landscapes, which are attached by natural foci. For example, the foci of tick-borne encephalitis are confined to the forest and forest-steppe zones, the foci of the mite rickettsiosis of Northern Asia - to the steppe landscapes of Siberia and the Far East, the yellow fever - to the zone of wet tropical forests, etc. The natural focal infections are divided into endemic zoonoses, the area of \u200b\u200bwhich Located with the area of \u200b\u200banimals - hosts and carriers (for example, tick-borne encephalitis), and endemic metaxenosis associated with the arral of animals, passing through the body of which is an important condition for the propagation of the disease (for example, yellow fever). If at a certain time appears in the human center, carriers can infect its natural focal disease. So zoonogenic infections becomes anthropozonous.

Classification of natural foci

1. By the nature of the landscape development

Anthropurgic foci.

Distribution of pathogens is carried out by domestic and wild animals. It occurs when the territory is mastered by the person. Such a character may acquire the foci of Japanese encephalitis, skin leishmaniosis, tick-free returning typhus, etc.

Synanthropic foci.

Circulation of pathogens is connected only with pets. Foci toxoplasmosis, trichinosis.

2. By the number of owners

Monogostal.

Polygostal.

The reservoir are several types of animals (gopters, surs, tarbagans, gerbils in the natural focus of the plague).

3. By the number of carriers

Montector.

The pathogens are transmitted only by one type of carriers. It is determined by the species composition of carriers in a particular biocenosis (only one type of ixodic ticks in a certain focus of the taught encephalitis).

PolyVector.

The pathogens are transmitted by various types of carriers. (In Tularemia - Carriers: various types of mosquitoes, blinding ixodic ticks).

Transmissible diseases

Transmissive diseases are infectious diseaseswhose carriers are bloodsowing insects and representatives of the type of arthropods. Infection occurs when a person's bite or an animal infected insect or tick.

It is known about two hundred official diseases that have a transmissive transmission path. They can be called different infectious agents: bacteria and viruses, simplest and rickettsias *, and even helminths. Some of them are transmitted through the bite of blood-sized arthropods (malaria, typhus, yellow fever), part of them is indirectly, when the carcass of an infected animal is separated, in turn, branched insect carriers (plague, tularemia, Siberian ulcer). Such diseases are divided into two groups:

Bonds transmissive diseases are transmissive diseases that are transmitted only with the participation of the carrier.

Japanese encephalitis;

Raw (seam and mite) Tiff;

Returnal (sewn and mite) Tiff;

Lyme and others disease.

Optional transmissive diseases are transmissible diseases that are distributed in different ways, including with the participation of carriers.

Brucellosis;

Ticky encephalitis;

Anthrax;

Tulyarai, etc.

Carrier Classification:

Specific carriers ensure the transfer of the pathogen from the blood

patients of animals or man in blood healthy. In organism

specific carriers The pathogen multiplies or accumulates. In this way, flea is transferred to the plague, lice - a rapid tit, mosquitoes - Papataji fever. In the body of some carriers, the causative agent passes a certain cycle of development. Thus, in the body of a mosquito genus Anopheles plasmodium malaria makes a sexual cycle of development. Along with this, in the body of the ticks, the causative agents of tick-borne encephalitis and some ricketersiosis are not only multiplied and accumulated, but also transmitted to the new generation through an egg (serval). Therefore, the pathogen in the body of a specific carrier can be maintained (for some exception) throughout the life of the carrier;

Nonspecific (mechanical) carriers performing

mechanical transfer of the causative agent of the disease without its development and reproduction (blind, autumn gallows and ixodic ticks for tularemia causative agents, brucellosis, Siberian ulcers).

And transmissive diseases are divided into two groups depending on the causative agents:

Invasion (pathogens - animals such);
Infections (pathogens - viruses, rickettsia and bacteria).

Transmissive epidemics and their causes

The territorial and seasonal limitation of transmissive diseases is determined by the prevalence of the carrier. The greatest epidemiological hazard for a person is bleasting arthropods (type of arthropoda), which includes a) class of spider and b) insect class. Two-handed arthropods are more active in nature, therefore, they are able to cause large outbreaks of a number of diseases among people in a short time (tularemia, skin leishmaniasis, mosquito fever, Japanese encephalitis, etc.). These insects from foci can be wetted over long distances and transmit disease there. Ixodic and argasy ticks mainly represent an epidemiological hazard when visiting the territories of foci and pets for pets (CRS, etc.).

Flying insects mosquitoes, mosquitoes, midges, blind, hoarse, bloodsowing flies are the most active carriers. So, mosquitoes are able to fly up to 3-5 km from their place of payment. Blood, pursuing animals, can move on tens of kilometers, alternating active flight with passive transportation on the animals themselves. Mosquitoes are carriers of malaria pathogens, Tularemia, Lzn *, mosquito encephalitis. Moshki, hoarse, blindfold capable of participating in the transfer of the pathogens of Tularemia, Mosquitoes - pathogens of Leishemaniosov.

Of the non-flying arthropods, pincers and fleas are the greatest epidemiological hazard. Ticks attack a person with its active penetration into the zone of their habitat and transfer to the man of causative agents of hemorrhagic fever of Crimea Congo, fever ku, ticky encephalitis. Fleas are transmitted pathogens of plague, flea-rat rickettsiosis. The lice are carriers of pathogens of epidemic rapid and sewn returns, trench fever.

The concept of natural focal infections. Prevention of natural focal infections (GLPS, leptospirosis, lesteriosis, pseudotuberculosis, tularemia)

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