Leptospirosis: etiology, pathogenesis, classification, transition, clinical manifestation, diagnosis, differential diagnosis, treatment, prophylaxis. leptospirosis
Зміст statty
leptospirosis(Synonyms: Vasil'ev-Veil's ailment, water fever) - gostra infection ailment from a group of bacterial zoonoses; to be infected with leptospira, transmitted by alimentary, contact and graduate paths, characterized by hot, mialgia, scleritis, lesions of nirok, liver and central nervous system, In a number of vipadkiv - zhovtyanitsyu and hemorrhagic syndrome.Historical data on leptospirosis
At the beginning of the day of the sickness nosological form They blazed respect just one form of one A. Weil (1886) and M. P Vasil'ev (1888), who described the hospice of infectious ailment with zhovtyanitsy and hemorrhagic syndrome.Zbudnik іcterohemorrhagic leptospirosis buv vіdkritiy in 1914-1915 pp. Japanese ancestors of R. Inada and Y. Ido and I will call Spirochaeta icterohaemorrhigae. At the beginning of rock in the literature, there was information about the emergence of morphologically advanced in the provinces of the country, albeit for their antigenic powers of leptospira. In 1973, the Department of the Organization for Health Protection divided Leptospira into two species: Leptospira interrogans (pathogenic leptospira), a reservoir of creatures; Leptospira biflera (free-living saprophies).
Ethiology of leptospirosis
. The pathogens of leptospirosis lie down to the genus Leptospira, the birthplace of Spirochaetaceae. Leptospiri - aerial microorganisms of spiralepodibnoy forms, crumbling, from 34 to 40 microns and larger than the head, 0.3-0.5 microns of the food. In our country, 13 serological groups have been established, which combine 26 leptospira serovars. In the pathology of people, the most significant may be: L. icterohaemorrhagiae, L. grippotyphosa, L. pomona, L. tarassovi, L. canicola, L. hebdomadis.Leptospiri grow vigorously in wild and watery (water-rich) living areas at temperatures of 28-3 ° C. ... Directly sleepy and ultraviolet viprominuvannya on them is nasty, as it is, like acids and meadows, to be found at the lowest concentrations (0.1 -1.0%), and disinfected. Three laboratory creatures are most efficient to leptospira guinea pigs.
Epidemiology of leptospirosis
Dzherelom infection in case of leptospirosis, ailments and overtakes of wild, domestic and industrial animals, which see leptospirosis from the cross and infect the community of the middle, incapacitating the middles of nature:For natural midpoints, the ethiological style and summer-autumn season are characteristic of the sickness of people. Epidemiology of natural alternatives to leptospirosis is non-vividly linked to epizootic. The main noses of leptospira are shuri, polovi mish, zemleriyki, izhaki, in some leptospirosis, it is latent infection, but leptospiruria is more likely to be missed.
The expansion of leptospirosis in the middle of the Silk-Gospodar animals with the statements of the anthropurgic mid-term has led to the formation of an independent type of ailment, which can now be called the Silk-Gospodar zoonosis without a link to the natural midges of infection. Anthropurgic midges can also be found in mice, de reservoir of infection - shchurii, great thinness, pigs, dogs. From people to people, ailments, as a rule, cannot be transmitted.
Іnu kіlka mechanizmіv іnfіkuvannya leptospіrosis: alimentary through water and harchuvannya ,іnfіkovanі leptospіrosis; contact - for an hour bathing in waters, young species of silskogospodarsky robots ("bathing", "pislyazhnivnyh" sleepers), in times of being bitten by sick creatures; aspirating - when harvesting seed and agricultural products. Significant to the drunken vagueness may be professional illicit among the workers of the Silskoy state, in the places of the sanitary technicians, robotic men and meat-packing workers, sometimes at the miners (dzherelo).
Pathogenesis and pathomorphology of leptospirosis
The entrance gates of the infection є shkіra and mucous membranes of the empty mouth, eyes, nose, grass channel. During the active decay of leptospira, it is possible to quickly get rid of the shkiri (especially vologo) and mucous membranes and penetrate into the shelter, not getting into the place of penetration of any kind of wintry snakes fiery character... In the pathogenesis of leptospirosis, there are five main phases (P.M.Barishev, 1979):I. Penetration of leptospirosis into organisms, їх reproduction, asymptomatic primary bacteremia, dissemination into organisms. The first phase is related to the incubation period of the ailment.
II. Secondary leptospiremia and parenchymal dissemination (cob period of ailment).
III. Toxemia with lesions of small organs, capilaropathy, hemolysis too (Period of ailments). The triggering mechanism of the third phase is cytotoxic and hemolyzing the leptospira effect. Often, there is a lack of intravascular blood loss, which can lead to a variety of clinical variants of hemorrhagic syndrome. At this stage, an important role is played by the development of toxic diseases of small organs and tissues (liver, supra-nirkovy zalozas, nyrkovy lobules, proximal forms of nephrons).
IV. The phase of non-sterile immunity, accumulation of antibodies. Leptospiri are found in various organs (nirkah, selezintsi, pechintsi, sudins of the heart and in.). The phase of pathogenesis is caused by the period of extinguishing of clinical manifestations of ailments.
V. The phase of strong immunity, when there is an intensive accumulation of specific antibodies, the function of the body is renewed (period of wear).
Pathomorphology of leptospirosis in case of severe forms of ailments with provincial syndromes of deficiency of nirok, liver and hemorrhagic syndrome. If there is a lack of nirok in the section, an increase in nirok appears, hemorrhaging under the capsule and in the tissue of the organ. Histologically, there is a decrease in the vivistic tubules of the nephrons with signs of degeneration and necrosis of the necrotic epithelium. Also, in the clinic, hemorrhagic syndrome occurs, there are many hemorrhages on the skin, mucous membranes, and in the internal organs. Thrombocyte-fibrin microthrombi in the found vessels is histologically susceptible. In the case of liver failure syndrome, the liver failure syndrome is characterized by zhovtyanitsya. Histologically, there is a discomplexation of pechinkal patches, an enlargement of the colossal spaces, hyperplasia of the diet of the gallbones, cholestasis, granular and fatty degeneration of the hepatocytes. For leptospirosis, atypical total necrosis of hepatocytes (on the basis of viral hepatitis).
clinika leptospirosis
Polymorphism of clinical manifestations of leptospirosis and developmental stages of the development of the disease syndrome, or, near the symptom, complicate the development of the clinical classification of ailments. It is important to develop a bezhovtushny and zhovtyanichny form of leptospirosis.The incubation period is 7-14 days. Ailments can be repaired with chills, with a chill, sharp temperature fluctuations up to 39-40 ° С. Remaining can be one of the diagnostic signs. On palpation of a sore throat. In some cases, in the muscles of the anterior cranial wall, it is possible to differentiate with the surgical pathology of the organs black empty.
For the first few days, ailments are characteristic signs of hyperemia and puffiness of an individual, conjunctivitis, scleritis. On the 3rd-6th day, a third of the sick children and tulubae may have a polymorphic roseolous-papulogenous viscous, often with a hemorrhagic component, in important cases - hemorrhage in the sclera, conjunctiva, and shkira. In bagatokh ailments there is micropolyadenitis.
Mova of depositions with bilo-syrim nalot, dry. When palpation of the abdomen, one can see the soreness, the liver is sick, sensitive. 50% of ailments have a spleen. Flatulence is common.
In a hot period, there is a tachycardia, as it changes with bradycardia when the temperature is normalized (Fazhe's symptom).
In addition, a decrease in the tone of the sudin і arterial vise і toxic lesion myocardium of mossy development hostile lack blood circulation. In some cases, pneumonia develops, in the case of leptospiral hemorrhagic pneumonia, there are heavy inheritances.
In most ailments, there are signs of deterioration of nirok: oliguria, positive symptom of Pasternatsky, the manifestation of a bile, an increased number of leukocytes, erythrocytes, innocent cereals; allotment of excess nitrogen, creatine, sequins and calories in the blood. Destruction of glomerular filtration to produce anuria. Symptoms of the disease are most characteristic for the period of the disease. In the course of the improvement of the pathological process, the onset of polyuria is indicative of the development of the pathological process. The reduction of nirok with leptospirosis is not supervised by the development of hypertension and hypertension.
In children with ailments with scargias for boredom and vomiting, meningeal symptoms appear (upper and lower symptoms Brudzinsky, the rigidity of the muscles of the disease, the symptom of Kernig and in.). Cerebrospinal pleocytosis with leptospinal changes can be neutrophilic, as well as lymphocytic pleocytosis, some of them grow in number.
With the zhovtyanichny form of leptospirosis, already in the first days of the ailment, the sclera will appear, the zhovtyanitsya shkiri with the maximum development up to the 4th-6th day of the ailment. Zhovtyanitsa can be from a little bit to intensive (not often from carrots). Vaughn often supravodzhutsya viniknennyam (feasible) hemorrhagic syndrome - blood circulation in the shkіra, mucous membranes. However, when the color is dark, the calories are very difficult to win over at one intensive zhovtyanitsa. The liver and spleen all grow, sensitive to palpation. The stove is becoming more and more hotter than the period і, in the form of viral hepatitis, there is no tendency to a sharp change. For leptospirosis, the development of intensive necrotic processes in hepatocytes is not characteristic (to relieve dystrophic processes), but the transition from severe hepatitis to liver cirrhosis. To navigate in the thermal stage of ailments, with the presence of a significant and clinical picture of hepatitis, the liver will become abnormal, and the activity of cytolytic enzymes in the blood is often growing. In such cases, a coma can be seen not as a pechinko-klinna coma, but as a result of the lack of nirok and pechinka.
In the blood, the number of erythrocytes and hemoglobin changes, a significant leukocytosis appears up to 10-20-109 in 1 liter, neutrophilosis is caused by the destruction of the leukocyte formula up to small blood cells, thrombosis, thrombosis Anemia is associated with a toxic infusion of ribbons on cystic brain, And also we cause hemolysis.
In most ailments, sickness insists on the 3-4th sickness, the protesting hour is spared to the weakness, asthenia. Some of the ailments have recurrences (3-4 each), stretching out some lighter ones, lower than the main period of the ailment, ale oduzhannya insist on - on the 8-12th. Vipisuyut ailments for a clever clinical day not earlier than at the 10th day of the normal temperature, at normal performance zalnogo doslіdzhennya krovі, sichі. Dozіlno, before the vipiskuyu ailments bully looked around by an ophthalmologist and a neuropathologist.
accelerated leptospirosis
Characteristic accelerated leptospirosis є lesions of the eyes are irit, ridocyclitis, uveitis, which occur most often after 3-4 times from the cob of ailment. In the case of the state of the art, the period of ailment may be accelerated by the lack of any or all of the liver, uremia, bleeding, myocarditis, cerebral arthritis, pneumonia, and lack of blood circulation.The prognosis is in times of anicteric form and an accelerated daytime, which, as a rule, is friendly. The main reason for the lethal result is the lack of any type of liver disease, and more - leptospirosis hemorrhagic pneumonia, an important form of meningoencephalitis. Le, tality become close to 1-3%, even before the hour of epid-demic sleepers can reach 30 -35%.
diagnosis of leptospirosis
The basic symptoms of clinical diagnostics of leptospirosis are the ear of ailment, hot, bile in myases, especially litkov, hepatosplenomegaly, zhovtyanitsya, hemorrhagic manifestations (visip), symptoms of uterine disease (oliguria) More important May I give an epidemiological history. I respect for such a change of mind, as the possibility of the professional nature of the disease in the workers of the meat-processing industry, animal farms, the hospitality industry, in the veterinary and in the world. In places of infection, they can often be tied to the implantation of food products, which are blended with a cross-section of informational creatures.Specific diagnosis of leptospirosis
Specific diagnostics is based on detected leptospires, antigens or antigens before them. material for laboratory dosageє shelter, slaughter, cerebrospinal ridina. With a stretch of the first five days, leptospira ailments can emerge with microscopy of citrate blood in a dark field, or if you drink 0.2-0.5 ml of blood in 5-10 tubes with a vital heart, as if you can eliminate the inactivated blood flow (from the onset mіsyats) repeatedly microscopic in a dark field. Microscopic siege can be a positive effect, as it should be carried out from the 8-10th day for 3 months from the ear of ailment, and cerebrospinal birth - from the 15-20th day of the ailment. For the confirmation of the clinical diagnosis, the most widespread serological dosage I mark the appearance of agglutinin and lizin, which appear in the blood of ailments already from the 5th-6th day of the ailment. The whole reaction of microagglutination and lysis. Diagnostic titer є 1: 100, until the end of the day is carried out with the boys of the sick blood (interval 3-7 days).Inodi vikoristoyut RNGA.
The biological test is stagnant, there are a lot of pathogenic leptospires for humans (for example L. icterohaemorrhagiae, L. pomona, L. bataviae) in animals, the disease is not vicious. Blood, CSF, I slaughter the sick, inject intramuscularly guinea pigs, and even on the 2-3rd day of infection in the peritoneal exudate, leptospir can be detected.
Differential diagnosis of leptospirosis
In the cob period, leptospirosis is differentiated from influenza, infectious mononucleosis, malignant fever, typhoid fever ailments, hemorrhagic fever with nircoid syndrome, viral hepatitis. As a result of influenza, leptospirosis develops as a result of catarrhal manifestations from the side of the upper dikhalnyh nobles, Early improvement of liver and spleen, signs of deterioration of the function of nirok.On vidminu vid infectious mononucleosis with leptospirosis, angina does not develop, it is uncharacteristic for the development of lymphatic universities, there is a desire for micropolyadenitis in the surrounding regions. Principle of vidmіnnіst majut snakes in peripheral blood. In the case of infectious mononucleosis in the case of leukocytosis, the number of lymphocytes and monocytes (and not neutrophils, as with leptospirosis), in some cases, can reach 80%, and more monocytes.
With Ku-garyachtsi mildly swelling, signs of deterioration and hemorrhagic syndrome, uncharacteristic intensive muscle, zhovtyanitsya, scleritis, meningeal syndrome, leukopenia with neutropenia appears in the blood.
The form of typhoid ailments leptospirosis grows into a burly development toxic syndrome, An early appearance of a polymorphic visip, a significant mialgia, a syndrome of urazhennya nirok.
From hemorrhagic fever with nirkovy syndrome, leptospirosis is caused by hepatolienal syndrome, more intense myalgia, frequent lesions of the central nervous system. Most importantly, there are specific diagnostic methods.
On the basis of leptospirosis, in case of viral hepatitis, an ear of ailments develops, there are no signs of hemorrhage, there is a decrease in the temperature of the disease, there is a lack of "carrot" symptoms, the calories are often abnormal, not typical, malignant hostile liver shortcomings. Hemograms are characterized by leukopenia, changes in SHOE.
lykuvannya leptospirosis
Ethiotropic transmission of antibiotics and antibiotics to immunoglobulin. Antibiotic therapy should be carried out by stretching the hot air for more than 5-7 days as the temperature returns to normal. Perevaga is given to penicillin sodium in a dose of 100,000-200,000 OD / kg for extra in the fallow of a form of ailment, which requires the introduction of skin for 3 years. It has been experimentally shown that tetracycline, polymixin, streptomycin, levomycetin, and cephalosporin are used to inflict antibacterial action on leptospira. Polyvalent protyleptospiral immunoglobulin in important drops should be injected internally 10-15 ml on the first day and 5-10 ml on the next two days.With the appearance of the first, perhaps insignificant, manifestations of deficiencies of any or all of the liver, it is necessary to take into account the intensive and reanimation therapy.
The smell of detoxification, correction of homeostasis and function of vital organs and systems. With the method of disintoxication, reopolyglucin, reogluman, and also concentrated glucose concentration on aphrodisiac dyuresis (with oligoanuria) from high doses of furosemide (lasix) - 10-20-40 ml of 1% 400 mg per dose (100-200). Reducing the level of azotemia is used for washing the slurry and intestines with Amburzhe, for storing lespenephryl, enterosorption podibne.
We are sick with manifestations of a hostile deficiency of a liver and an extracorporeal detoxification - hemosorption, hemodialis. Indicated before hemosorption є anuria, a high rate of growth of azotemia, encephalopathy, hypercalcemia, intensive hypertension. Before hemodialysis is carried out, there is a progressive nature of the hostile deficiency of nirok, hyperhydration, and the ineffectiveness of sorption detoxification. Stagnation of hemodialysis is shown in various hemorrhagic syndrome, thrombocytopenia (less than 60-50-109 in 1 liter), significant hypotension, impaired cerebral blood circulation, heart rhythm, a set of legends, komi.
Priznachayut antiplatelet (Curantylum, Trental) antigіstamіnnі, sudinorozshiryuvalnі zasobi, reopolіglyukіn, anticoagulants (heparin) іngіbіtori proteolіzu (pantripina, contrycal, gordoks, trasilol, antagozan) and takozh glіkokortіkosteroіdov scho pіdvischuyut toleration klіtin to gіpoksії, blokuyut sudinozvuzhuvalnu dіyu i zapobіgayut development of a shock organ. hormonal drugs Priznachayut in short courses, the dose should be used as a clinically effective and in the case of severe deficiencies of nirok and stove, you can reach 1000 mg per dose (for prenizolone).
In case of significant hypotensiveness, the order with glucocorticosteroids does not contain dopamine. Stop introducing internally in droplets from decilcoh years up to 30 days without interruption.
prevention of leptospirosis
An important role is to play the veterinary and sanitary come in, how to transfer the sickness to leptospirosis tvarin, іkh іsolyatsіyu і lіkuvannya, carried out quarantine go to ?? state gifts, de є ailments of the creature, vikonannya rules of pastoral and styling thinness of thinness, sanitary examination of meat. You will be able to get an extended leptospirosis of Cepeda from silskogospodarsky creatures, in mid-term to carry out vaccination with an injected polyvalent leptospirosis vaccine. Systematic deratization come in to reduce the epidemic activity in the fires, before important prophylactic visits, food products are taken away from food products.In case of contamination of people infected with leptospirosis (scho pratsyuyut on farms, enzootic for leptospirosis, pratsivnikov canalisation leptospirosis and others), it is recommended to prophylactic vaccination with the injected polyvalent leptospirosis vaccine.
LEPTOSPIROSIS
leptospirosis - zoonotic bacteral natural-mediated gostra infection of ailment with fecal-oral mechanism of transmission of an animal. It is characterized by fever, intoxication, manifestations of universal capillary toxicosis and important lesions of the liver, of the nervous system.
Historical add-on. Leptospirosis of vidomy for a long time, however, the first description of this nosological form was given in 1886. nimetskiy lykarem Weyl. Through 2 rockets, our spіvvіtchiznik N.P. Vasil'ev, on the great key material, showing the legitimacy of the vision of this disease in an independent nosological unit. At the zyazyka z cymus Leptospirosis, the trivial hour was called Vasil'ev-Weil's ailment; in the surrounding regions, they also called "the feverish fever", the "water fever", "the autumn fever", the "seven-day fever" for the designation of the anicteric form of ailment.
Epidemiology. Leptospirosis of enlargements is everywhere; Vipadi of ill-health have been registered on all continents of the Earth, the territory of Antarctica. However, there is a lot of disease in which to lie among the natural and climatic minds: the wine is the most prominent in areas with dense rychkovy floodplain, frequent bagatoraz floods, as well as a large number of large populations of the world. Leptospirosis is observed to the number of the most widespread natural infections in the Russian Federation. On the territory of Russia, there are three main districts that are unfavorable in terms of leptospirosis and are characterized by a strong tendency to growing incapacitation: Pivnichno-Zakhidny, Central and Pivnichno-Kavkazky.
The ethiological structure of leptospirosis of the 80s was characterized by the rapid growth of the ethiological role of leptospira serogroup Icterohaemorragia, a pitoma of the vagina in some regions (Rostov region, Krasnodar region) reaching 86-90%. Significant world price has become a legacy of the expansion of the area and the increase in the number of gray shchur as a result of the state dyyalnosti people (rice, industry, fish breeding, etc.). On the ear of the 90s on some territories (Rostov region), the situation did not know the hundred times, on the ones (Krasnodar Territory) in 1990-1991. due to the growth of the etiological role of leptospira serogroup Grippotyphosa. The change in the ethological structure of ailment due to significant improvements in the nursery vagi L. icterohaemorragia, especially in the Rostov region, called for a more important change in the development of hospitality. At the same hour there is a critical diagnosis of illness, especially on pre-hospital stage, Zalishak bazhaty short: only 10-12% of ailments enter hospitals with a diagnosis of "leptospirosis", and then a third of them after the 6th day of ailment.
Leptospirosis is a regional zoonosis. Dzherela zbudnikiv leptospirosis infection is divided into two groups. Until the first time, the greenbacks and comahoids, as the main rulers (reservoir) of natures in nature, are recognized; to the other - domestic creatures (pigs, great thinness, vivtsi, goats, horses, dogs), as well as farmsteads of animals of the cellophane (foxes, foxes, nutria), which form anthropourgical (agricultural) vigilante.
Leptospira of the cutaneous serovar is the head rank of the population of singing species of creatures, and the ethiological structure of the disease in the skin midsection in the main form is the dominant species of creatures - the gentlemen of the animal. So, on the territory of Russia, shuri є noses Icterohaemorragia, pigs - Pomona, great thinness - Grippotyphosa, dogs - Canicola, etc. In animals, become ill, chronically, without visible clinical manifestations, supervise the carriage of leptospira and visions from the cross.
Lyudin's ailment is not an epidemiological problem.
Fecal-oral transmission mechanism; shlyakh gear - water; You can safely use leptospira through the pockmarked skin and mucus shells, as well as grubs (with the implantation of leptospira, contaminated with a cross-section of information gryzuniv). Most often the information of people is seen when bathing, victorious for by-and-by and state needs with water, with ribolovl, during an hour of silly and swampy soils, when
The preoccupation with leptospirosis is seasonal in nature with a period in summer and autumn (especially in lime and serpentine), the protector of the middle of the village farm, meat-breeding, ceremonial, veterinarian, etc. the possibility of a diagnosis of sporadic symptoms of ailments in any hour of fate. An analogous situation is possible when there are misses, shchurivs, who can inflict objects and popping and food products into the booth.
Pathogenesis. In the pathogenesis of leptospirosis, 5 phases are accepted.
Phase I - penetration of the bud into organism with a short-term bacteremia and primary dissemination. The entrance gates of the infection are both pockets and malignancies and mucous membranes of the eyes, nose, mouth, and intestinal tract. The leaders of the leptospira rotting decay quickly penetrate through the skin and the mucous membrane, not wandering into the mischief of any kind. With the flow of blood, the stench is consumed in various organisms, ale to be found in the head rank in nirkas, pechintsi, supra-nirkovy vines, legends, selesins; can penetrate through the hematoencephalic bar. The phase of the ailment is asymptomatic, usually in the middle 7-10 days (up to a maximum of 20 days) and appears in the incubation period.
ZVUZ "Zaporizka Medical College" ZOR
Self-operation of the robot
On the topic: "Leptospirosis"
Type of robot: Abstract.
pіdgotuvala:
student III- On course
Likuvalna on the right
Sukhanova Ganna
Vikladach all categories:
L. Vdovichenko
2014 r
Zagalny characteristic of an affliction
Ethiology
Epidemiology
Pathogenesis and pathomorphology
clinika
accelerating
diagnosis
specific diagnostics
differential diagnostics
lykuvannya
prophylaxis
leptospirosis(Synonyms: Vasil'ev-Veil's ailment, water fever) - gostra infection ailment from a group of bacterial zoonoses; suffer from leptospira, be transmitted by alimentary, contact and aspirant paths;
Ethiology of leptospirosis
The pathogens of leptospirosis lie down to the genus Leptospira, the birthplace of Spirochaetaceae. Leptospiri - aerial microorganisms of spiralepodibnoy forms, crumbling, from 34 to 40 microns and larger than the head, 0.3-0.5 microns of the food. In our country, 13 serological groups have been established, which combine 26 leptospira serovars. In the pathology of people, the most significant may be: L. icterohaemorrhagiae, L. grippotyphosa, L. pomona, L. tarassovi, L. canicola, L. hebdomadis. Leptospiri grow vigorously in wild and watery (water-rich) living areas at temperatures of 28-3 ° C. ... Directly sleepy and ultraviolet viprominuvannya on them is nasty, as it is, like acids and meadows, to be found at the lowest concentrations (0.1 -1.0%), and disinfected. Three laboratory creatures are most suitable for the leptospira of the guinea pig.
Epidemiology of leptospirosis
Dzherelom infection in case of leptospirosis, ailments and overtakes of wild, domestic and industrial animals, which see leptospirosis from the cross and infect the community of the middle, incapacitating the middles of nature: For natural midpoints, the ethiological style and summer-autumn season are characteristic of the sickness of people. Epidemiology of natural alternatives to leptospirosis is non-vividly linked to epizootic. The main noses of leptospira are shuri, polovi mish, zemleriyki, izhaki, in some leptospirosis, it is latent infection, but leptospiruria is more likely to be missed. The expansion of leptospirosis in the middle of the Silk-Gospodar animals with the statements of the anthropurgic mid-term has led to the formation of an independent type of ailment, which can now be called the Silk-Gospodar zoonosis without a link to the natural midges of infection. Anthropurgic midges can also be found in mice, de reservoir of infection - shchurii, great thinness, pigs, dogs. From people to people, ailments, as a rule, cannot be transmitted. Іnu kіlka mechanizmіv іnfіkuvannya leptospіrosis: alimentary through water and harchuvannya ,іnfіkovanі leptospіrosis; contact - for an hour bathing in waters, young species of silskogospodarsky robots ("bathing", "pislyazhnivnyh" sleepers), in times of being bitten by sick creatures; aspirating - when harvesting seed and agricultural products. Significant to a drunken vagueness may be professional ailments among the workers of the Silskoy state, in the places of sanitary technicians, robotic men and meat-packing plants, and sometimes at the miners.
Pathogenesis and pathomorphology of leptospirosis
The entrance gates of the infection є shkіra and mucous membranes of the empty mouth, eyes, nose, grass channel. In addition to the active decay of leptospira, it is possible to quickly get rid of the shkiri (especially vologo) and mucous membranes and penetrate into the shelter, without leaving any kind of fiery snakes on the point of penetration. In the pathogenesis of leptospirosis, there are five main phases (P.M.Barishev, 1979): I. Penetration of leptospirosis into organisms, їх reproduction, asymptomatic primary bacteremia, dissemination into organisms. The first phase is related to the incubation period of the ailment. II. Secondary leptospiremia and parenchymal dissemination (cob period of ailment). III. Toxemia with lesions of small organs, capilaropathy, hemolysis too (Period of ailments). The triggering mechanism of the third phase is cytotoxic and hemolyzing the leptospira effect. Often, there is a lack of intravascular blood loss, which can lead to a variety of clinical variants of hemorrhagic syndrome. At this stage, an important role is played by the development of toxic diseases of small organs and tissues (liver, supra-nirkovy zalozas, nyrkovy lobules, proximal forms of nephrons). IV. The phase of non-sterile immunity, accumulation of antibodies. Leptospiri are found in various organs (nirkah, selezintsi, pechintsi, sudins of the heart and in.). The phase of pathogenesis is caused by the period of extinguishing of clinical manifestations of ailments. V. The phase of strong immunity, when there is an intensive accumulation of specific antibodies, the function of the body is renewed (period of wear). Pathomorphology of leptospirosis in case of severe forms of ailments with provincial syndromes of deficiency of nirok, liver and hemorrhagic syndrome. If there is a lack of nirok in the section, an increase in nirok appears, hemorrhaging under the capsule and in the tissue of the organ. Histologically, there is a decrease in the vivistic tubules of the nephrons with signs of degeneration and necrosis of the necrotic epithelium. Also, in the clinic, hemorrhagic syndrome occurs, there are many hemorrhages on the skin, mucous membranes, and in the internal organs. Thrombocyte-fibrin microthrombi in the found vessels is histologically susceptible. In the case of liver failure syndrome, the liver failure syndrome is characterized by zhovtyanitsya. Histologically, there is a discomplexation of pechinkal patches, an enlargement of the colossal spaces, hyperplasia of the diet of the gallbones, cholestasis, granular and fatty degeneration of the hepatocytes. For leptospirosis, atypical total necrosis of hepatocytes (on the basis of viral hepatitis).
RCHRH (Republican Center for Development of Health Protection of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016
Leptospirosis (A27)
Short description
caught
Ob'ednanoi komisієyu for yakistyu medical services
Ministry of Health Protection and Social Development of the Republic of Kazakhstan
from "16" serpnya 2016 to rock
protocol No. 9
Leptospirosis (Vasiliev-Weil's ailment)- state-of-the-art zoonotic natural infection, infectious disease, leptospirosis in young serological variants, which can be transmitted by a waterway, which is characterized by a general toxicity, fever, sickness syndrome,
Specialized codes ICD-10 and ICD-9
| ICD-10 | ICD-9 | ||
| code | Naymenuvannya | code | Naymenuvannya |
| A27 | leptospirosis | - | - |
| A27.0. | Leptospirosis zhovtyanichny-hemorrhagic | - | - |
| A27.8. | Іnshі form leptospirosis | - | - |
| A27.9. | Leptospirosis not specified | - | - |
Date of release to the protocol: 2016 rik.
to the protocol: Likari shvidkoi inconvenient help, Paramedic, lykary home practice, Therapeutics, infectious diseases, gastroenterologists, nephrologists, ophthalmologists, neuropathologists, cardiologists, surgeons, dermatovenerologists, allergologists, anesthesiologists-resuscitators, obstetricians-gynecologists.
Evidence scale:
| A | A high-quality meta-analysis, a systematic survey of PCI, or a greater PCI with an even low efficiency (++) systematic reduction of the results, which can be expanded to the general population. |
| V | High-quality (++) systematic survey of cohorts, or even low-risk control, or high-low-level (++) cohort, low-low-low-risk control, systematic sweeping, or PCI, with a low (+) low risk of systematic low-risk, results in the population ... |
| Z | The cohort is not as long as vypadk-control or is not monitored until the end without randomization with a low risk of systematic gratification (+), the results of which can be expanded on the basis of the possible population, or PCI with a low level, but not too systematic risk without any broadening to the general population. |
| D | A description of a series of vipadkiv or uncontrolled until recently abo thought experts. |
Classification
Classification
Clinical classification of leptospirosis ( V.I. Pokrovsky and spivavt., 1979).
Behind the type:
· Zhovtyanichna;
· Anicteric.
According to the provincial syndrome:
Renal;
· Hepatorenal;
· Meningeal;
· Hemorrhagic.
By severity:
Easy (feverish, ale without a swivel internal organs);
Moderately severe (feverish and horny key picture ailments);
Vazhka (zhovtyanitsya, thrombohemorrhagic syndrome, meningitis, gostra nirkova lack).
For the obvious acceleration:
· Without acceleration;
3 accelerated:
- infectious toxic shock;
gostre poshkojennya nirok (OPP);
-guest pechinkovo-nirkova lack;
- thrombohemorrhagic syndrome і ін.
For the nature of the perebіgu:
· No relapses;
· Relapsing.
Apply the diagnosis formula:
Leptospirosis, zhovtyanichna form, severe degree of severity. Arrangement: GOSTR Nirkov lack.
Leptospirosis, anicteric form, of the middle degree of severity.
Leptospirosis, zhovtyanichna form, receding with a broach, severe degree of severity. Folding: disseminated intravascular coagulation syndrome.
Diagnostics (outpatient)
DIAGNOSTICS ON THE AMBULATOR RIVNI
diagnostic criteria
Skargi and anamnesis:
· Gostriy ear of corn;
· Khvilepodіbna fever;
Chills;
· Head b_l;
· More in dilyantsi nirok;
· Signal weakness;
• tediousness of blues;
· Appetite visibility;
· Swelling pains in the lithic meat, as well as in the joints of the transverse area, less intensive - in the joints of the shoulder, back, abdomen;
· Perebіg sickness is more trivial, not very sickly.
Epidemiological history:
physical condition:
· Riska soreness of muses during palpation, especially litkov;
· Zbіlshennya pechіnki;
· Zbіlshennya spleenki;
· Urazhennya nirok (soreness when postukuvanni across diameters), lowering dobovy diuresis;
· Urazhennya of the central nervous system (serous meningit);
Laboratory Doslidzhennya: dumb.
dumb.
diagnostic algorithm:
Diagnostics (stationary)
DIAGNOSTICS at the stationary РІВНІ
Diagnostic criteria at the stationary hospital
Skargi and anamnesis:
· Incubation period from 2 to 30 days, often 7-14 days.
· Gostriy ear of corn;
· Adjustment of temperature up to 39-40 ° С;
· Khvilepodіbna fever;
Chills;
· Head b_l;
· More in dilyantsi nirok;
· Signal weakness;
• tediousness of blues;
· Appetite visibility;
· Swelling pains in the lithic meat, as well as in the joints of the transverse area, less intensive - in the joints of the shoulder, back, abdomen;
· Stronger myazovykh boliv before the hour of palpation that walking, which complicates self-reliance;
· Zhovtyanichne farbuvannya shkіrnyh curves and visible mucous membranes (with zhovtyanichnіy formі);
· Bleeding from the nose, clear, intestinal bleeding, hemoptysis (with the development of thrombohemorrhagic syndrome);
decrease in direzu (with the development of a state-of-the-art nirok);
· Perebіg sickness is more trivial, not very sickly.
Epidemiological history:
· Contact with water with critical water (fishing, bathing, water sports, tourism, etc.);
· Contact with wild and domestic critters, gruns;
· Appearance in the booth of dogs, shchurіv, mish;
· Perebuvannya in natural and anthropurgic medium leptospirosis;
· Rysics of professional infection with leptospirosis (workers of the tvarinnytsky state gifts, meat processing plants, boon, canalization, warehousing, industrial robots, myslivtsi and others).
Physical details:
· Hyperemia, puffiness of an individual;
· Hyperemia of shkiri shi and the upper half of the breast;
· Ін'єкція sudin sclera, hemorrhage, scleritis;
Visipka (on the 3rd-6th day of ailment of polymorphic character (scarlet-like, bark-like, hemorrhagic), symmetric;
· Zhovtyanitsya (with zhovtyanichn_y form_);
· Rizka soreness of muses during palpation;
· Hemorrhagic syndrome (hemorrhagic visipa, hemorrhage on the skin and mucous membranes);
· Zbіlshennya pechіnki;
· Zbіlshennya spleenki;
· Signs of urazhennya nirok (soreness during postproduction along the crosswise delays), decrease in dobovy diuresis;
· Exercise of the central nervous system (signs for menіngіtu);
· Urazhennya heart-vascular system (tachycardia, hypotonia, muffled heart tones).
Laboratory dosage :
UAC: neutrophilic leukocytosis, zsuv leukocyte formulas, aneosinophilia, lymphopenia, improvement of SHOE. With an important form of leptospirosis: anemia (decrease in hemoglobin, erythrocytes), thrombocytopenia.
OAM: Decrease of the pets' vagi section, proteinuria, leukocyturia, cylindruria, microhematuria, macrohematuria (with an important form), gummy pigments (with an important form).
Biochemical analysis of blood:
· In case of zhovtyanichny form of leptospirosis: a decrease in the level of zagalny bіlka, albuminіv, gіperbіlіrubіnemiya is important for the rakhunok bіlіrbіnu, ALT, AST, puddle phosphatase, amylazi;
· With the development of OPP: advancing in the place of sechovina, creatine, hyperkaliєmiya;
In case of pancreatitis: pidvischennya instead of amilazi;
With changes in the clinical analysis of the spinal cord: cytosis with a number of neutrophils, sometimes - lymphocytes, an increase in the level of blood, with hemorrhagic syndrome - the disease is important.
Coagulogram: an increase in the hour of blood loss and triviality of bleeding, a decrease in the level of prothrombin, prothrombin index, an increase in the prothrombin hour, an increase in the APTCH, an increase in MNO, reduction;
· Feces on a prikhovannu shelter (with an increase in slunk-intestinal bleeding).
Criteria for assessing the degree of severity of illness based on the results of laboratory diagnostics.
| sign | without acceleration | With accelerated |
| riv leukocytosis | pomirny leukocytosis | High leukocytosis with neutrophilia and stab lesions |
| rіven thrombocytopenia | Not less than 50 × 10 / l 9 | Up to 50 × 10 / l i less than 9 |
| рівень ШОЕ | Pomirne Zbilshennya SHOE | Significantly improved SHOE |
| riv to hemoglobin | In addition to the decrease in hemoglobin level | Decrease in hemoglobin level |
| Rivine of erythrocytes in peripheral blood | Minor decrease in erythrocytes | Virazhene reduction of erythrocytes |
| Rіven bіlka in the out-of-the-box analysis of the sech | Between the norms | vishche normmi |
| Rivn of cylinders in a zagalny analysis of the sech | Between the norms | vishche normmi |
| The level of leukocytes in the zahal analysis of the section | Between the norms | vishche normmi |
| Rivn erythrocytes in the zalny analysis of the sech | Between the norms | vishche normmi |
| Rivn erithrocytes in coprogram | onsutnі | Appear at the great number |
| Rivn of the zahalnye bleak of blood | Between the norms | lower norms |
| Blood albumin | Between the norms | lower norms |
| Rivine of C-reactive protein, liver transferases, pool phosphatase, bilirubin, amylase in syrovatz blood | Between the norms | vishche normmi |
| Rivn bіlka in the cerebrospinal rіdini | Between the norms | vishche normmi |
| Rіven cytosis in the cerebrospinal rіdini | Between the norms | vishche normmi |
| Rivn amylazi in the village | Between the norms | vishche normmi |
Special methods of advancement:
-Microscopic dosage of citrate blood, slaughter, liquor (with meningіtі) in a dark field (detection of leptospіr).
-Serological methods:
Reactions of microagglutinations of leptospires (PMA) (from 6-12 days from the ear of ailment): Leptospirainterrogans(Diagnostic titer 1: 100 for losing the growth of yogi in the fake);
RPGA (diagnostic titer - 1:80);
· IFA (detection of specific IgM antibodies from 3-4 days of ailments, IgG in convalescents).
-PCR of blood, liquor (with meningitis), section: detection of specific fragments of leptospira DNA.
Instrumental doslіgennya:
· Radiography of the organs of the breast cancer (as shown): signs of pneumonia (in the diagnosis of infiltration in the legends), bronchitis;
· Electrocardiography (for shown) for revealing signs of heart damage: signs of diffuse myocardial damage, disruption of the rhythm and conductivity, in important cases, signs of infectious-toxic myocarditis;
· Echocardiography (shown): for diagnostics of myocarditis;
· ultrasound dosage organs of worms emptying: signs of hepatitis, cholecystitis, pancreatitis;
· UZD nirok: viyavlennya sign urazhennya nirok;
· Ultrasonic scanning of nadnirnik_v (behind shown): detection of signs of urazhennya nadnirkovy vines;
· Fibroezophagogastroduodenoscopy (behind shown): signs of shlunkovo-intestinal bleeding;
· CT / MRI of the brain (as shown): when the central nervous system is affected with the help of differential diagnostics, it is a sign of subarachnoid hemorrhage.
Diagnostic algorithm: outpatient r_ven.
Clinical criteria for the diagnosis of leptospirosis.
| sign | characteristic | UD * |
| ear of sickness | gostre | V |
| feverish woman | Visoka remituyuchim or postyna with repeated dangerous hvili | V |
| intoxication syndrome | V | |
| malgic syndrome | In the first years of illness, there are spontaneous spontaneous pains in the muscles, especially in the lithic ones, the mialgia is supervised by hyperesthesia of the shkiri. Palpation of m'yaziv homilok, stegon, across a sharp sore, oversupply difficult. | A |
| exanthemi syndrome | As a result of the generalized education, the endothelium of capillaries is characteristic signs vasculitis: hyperemia and swelling of the appearance, shia, upper part of the breasts, hyperemia of the pharynx, papulopapulogenous and petechial visip on tulubs and kintsivka (appear on the 3-5th day of the disease on the 1st-7 ). For the zhovtushny form, leptospirosis is more characteristic of hemorrhagic elements of the visipu, for the anicteric form - plyamisto-papulosis. | V |
| Eye pain syndrome | V | |
| Syndrome of lesion of the heart-vascular system | Tachycardia, abnormally bradycardia, impaired heart rhythm, decreased arterial vise, muffled heart tones, in the case of infectious cardiopathy and development of leptospiral myocarditis | Z |
| Hepatitis Syndrome | On the 3-5th day of ailment, ailment, liver damage, darkening of the liver, darkening of the liver, increasing of ALT, AST, puddled phosphatase, in addition to the increase in blood loss in blood Splenomegaly, as well as gostra pechinkova deficiency in mild and moderate forms of leptospirosis, is obviously rather rare. With important forms of sickness, the processes of synthesis in the liver of the factors of the larynx of blood will be disrupted, as well as the manifestation of the thrombohemorrhagic syndrome. | V |
| Thrombocytopenia and thrombocytopathy | In case of important forms of leptospirosis, the development of thrombocytopenia (up to 50 × 109 / L and less) and thrombocytopathy, such as hypocoagulation and hypocoagulation, as in the sclera, nasal bleeding, shlunkovo-intestinal bleeding, subarachnoid hemorrhage, hemorrhage in the nasal cavity). | V |
| Nirock lesion syndrome | Є typical and the most frequent manifestation of leptospirosis, the reduction of nirok is manifested in the first 2-7 dib oliguria (anuriyuyu) with some polyuria; proteinurієyu; cylindruria; the growth of azotemia (stop to inform about the development of a hostile nirkova disadvantage). In some cases, it means hematuria, for example. When pyuria appears, talk about the admission of secondary infections. The genesis of anuria does not include the value of a rotated decrease in the arterial grip. The renewal of the function of a person who has been transferred to leptospirosis is more likely to develop more and more chronically negative deficiency. | V |
| Central nervous system lesion syndrome | At the hospital stadia of ailments, ailments are turbulent, headaches, sleeplessness, for children with ailments sudominal syndrome... Leptosprotic serous meningitis may develop with high pleocytosis and malaise. | V |
| With important forms of leptospirosis, toxicity is indicated, hemorrhage in the pleura, hemoptysis, hemorrhagic hemorrhage, respiratory distress syndrome. | Z | |
| Shlunkovo-intestinal tract lesion syndrome | Appear with pains in the abdomen, some attacks on the character and dyspeptic disorders, enlargement of the development of pancreatitis, cholecystitis, in children, on the mind of old adults, it is not meant unreasonably. | Z |
| anemia syndrome | V |
Criteria for assessing the severity of leptospirosis for key signs.
| sign | characteristic sign | ||
| Easy step of gravity | Middle step of gravity | The importance of the steps of gravity | |
| ear of sickness | gostre | gostre | douger gostre |
| feverish woman | Visoka remituyuchim, for a post-feverish woman, with repeated praises | Visoka remituyuchim, for a post-feverish woman, with repeated praises | |
| intoxication syndrome | Headaches, decreased appetite, nudota, blues | Headaches, decreased appetite, nudota, blues | Decreased appetite, nudota, blues |
| malgic syndrome | Spontaneous pain in the muscles, especially in the lithic muscles, supravodzhuyutsya hyperesthesia of the shkiri. M'azi homilok, stegon, across the sharp sore, oversupply difficult. | Risky spontaneous pains in myases, especially in litkovny muscles, are supervised by hyperesthesia of the shkiri. m'yazi lower kintzivok, Across it is very painful, oversaturation is not difficult. | M'yazy lower kintzivok, across the sharp sore, oversupply difficult. |
| shkirny syndrome | Often referred to as zhovtyanitsya. Hyperemia and swelling of the appearance, shia, upper part of the breasts, hyperemia of the pharynx, papulopapulogenous and petechial visip on tulips and kinsivka (appear on the 3-5th day of the ailments and trim, on the top of 1-7 days More characteristic hemorrhagic elements of the visipu, for anicteric - plyamisto-papulosis. | Often referred to as zhovtyanitsya. Hyperemia and swelling of the appearance, shia, upper part of the breasts, hyperemia of the pharynx, papulopapulogenous and petechial visip on tulips and kinsivka (appear on the 3-5th day of the ailments and trim, on the top of 1-7 days More characteristic hemorrhagic elements of the visipu, for anicteric - plyamisto-papulosis. | |
| Syndrome urazheniya conjunctiva of the eyes, episklerita | Conjunctivitis, episcleritis with photophobia. | Conjunctivitis, episcleritis with photophobia. | Conjunctivitis, episcleritis with photophobia. |
| Syndrome of infectious cardiac disease, leptospiral myocarditis | Tachycardia, abbreviated as bradycardia, disrupting the rhythm of the heart, lowering the arterial clutch, muffling the tone of the heart - as if it were an infectious cardiac disease. | Manifest an infectious cardiac disease: tachycardia or obvious bradycardia, disruption of the rhythm of the heart, decreased arterial pressure, muffled heart tones. In some cases, the development of leptospiral myocarditis is indicated. | Variety show infectious cardiac disease: tachycardia, or obvious bradycardia, impaired heart rhythm, lower arterial grip, muffled heart tones. It is not uncommon to indicate the development of leptospiral myocarditis. |
| Hepatitis Syndrome | Improvement of liver, increase of ALAT, ASAT, pool of phosphatase, in addition to the promotion of blood in syrovatz blood. Obviously, there is a lack of pechinkov failure. | Decrease of liver, darkening of slaughter, increase of ALAT, ASAT, puddle of phosphatase, development of blood in the blood of blood. Signs of the destruction of the processes of synthesis in the furnace of the factors of the throat of blood appear. | |
| Thrombohemorrhagic syndrome, thrombocytopenia, thrombocytopathy | Thrombocytopenia and thrombocytopathy, apparently rarely, are superimposed on the appearance of signs of thrombohemorrhagic syndrome. | Thrombocytopenia and thrombocytopathy, not very often, supervised by the appearance of signs of thrombohemorrhagic syndrome. | Thrombocytopenia (up to 50.109 / L or less) and thrombocytopathy, which are associated with the appearance of early signs of thrombohemorrhagic syndrome. |
|
Syndrome of lesions of nirok and sehovivi shlyakhiv |
З 2-7 add ailments polyuria; proteinurієyu; cylindruria. In some cases, it means hematuria, for example. Piuria inform about the admission of the secondary infection. |
З 2-7 add ailments to the meaning of oliguria, anuria z fake polyuria; proteinurієyu; cylindruria; growth of azotemia. In some cases, it means hematuria, for example. Piuria inform about the admission of the secondary infection. Functional upgrades are more common. |
З 2-7 add ailments, it means oliguria, anuria with a little more polyuria; proteinurієyu; cylindruria; the growth of azotemia, which will put on the development of a hostile nirkova disadvantage. In some cases, it means hematuria, for example. Pyuria appears as a secondary infection. The renewal of the function of nirok will be more often, more possible development of chronic nirkova deficiency. |
|
Central nervous system lesion syndrome |
Headaches, sleeplessness, sudom syndrome is not frequently observed. Leptospiral serous meningitis results in high pleocytosis and malaise. | ||
| Respiratory tract syndrome | Specific leptospirosis is not typical for leptospirosis. | Specific leptospirosis is not typical for leptospirosis. Mossy development of pneumonia for rakhunok admission of secondary infection. | Possibly specific urazhennya legen (pneumonia). It is indicative of a toxic backwardness, hemorrhage in the pleura, hemoptysis, hemorrhagic leggings, respiratory distress syndrome. You can also develop a league battle for a second infection |
| Organ poisoning syndrome | Appear with pains in the abdomen, some attacks on the character and dyspeptic changes, zooming in development functional breakdowns shlunkovo-intestinal tract. | Appear with pain in the abdomen, some attacks on the character and dyspeptic changes, zooming in the development of functional damage to the intestinal tract. Symptoms in deyak vipadkami are poured into pancreatitis, cholecystitis. | Appear with pains in the abdomen, in some attacks on the character and dyspeptic disorders, zooming in the development of functional damage to the intestinal tract, ale - in the development of pancreatitis, cholecystitis. |
| anemia syndrome | The development of anemia is very rare. | In clinical analysis, blood does not have enough blood to indicate a decrease in hemoglobin, but it is similar to signs of heat (leukocytosis, SHOE). | In the clinical analysis of blood, a decrease in hemoglobin is meant, as well as signs of heat (leukocytosis, adduction of SHOE). |
| accelerating |
Irit, ridocyclitis, uveit. Asthenic syndrome. |
Irit, ridocyclitis, uveit. Noses of blood. Secondary pneumonia. Transient breakdown of the rhythm of the heart. Chronic nirkova lack. |
Meningitis, encephalitis, myelitis, polyneuritis, myocarditis, iritis, ridocyclitis, uveitis. Gostra and chronic nirkova lack. Shlunkovo-intestinal bleeding. Bloodstained in the nadnirniki. Subarachnoid covocation. Breaking the rhythm of the heart. Secondary pneumonia. Cholecystitis. Pancreatitis |
Switching of the main (general) diagnostic entries:
· UAC;
OAM;
· Biochemistry analysis of blood;
· Coagulogram;
· Acid-lush mill, blood electrolyte;
· Microscopic dosage of citrate blood (1 day of illness), slaughter (from 2 days), liquor (behind shown) in a dark field (detection of leptospir);
· Reactions of microagglutinations of leptospires (PMA);
· IPA;
· PLR blood, liquor (with menіngіtі);
· Spinal puncture with the analysis of liquor (with the presence of extra brain symptoms and meningeal symptoms);
· EKG;
· Ultrasonic inspection of organs of the worms;
· Ultrasound nirok.
Change of additional diagnostic entries:
· PLR slash (for 2-3 ailments);
· X-ray of the organs of the breast cancer (in case of adolescence for pneumonia);
Echocardiography (in case of adolescence for myocarditis);
· Fibroezophagogastroduodenoscopy (when there is an increase in slunk-intestinal bleeding);
Ultrasonic scanning of nadnirnikiv (in case of urazhennі nadnirnikiv);
· CT scan of the brain, MRI of the brain (with lesions of the central nervous system);
· Feces on a prikhovannu shelter (with an increase in slunk-intestinal bleeding).
Differential diagnosis
| diagnosis | Gruntuvannya for differential diagnostics | thoroughness | Diagnosis criteria |
| grip | Evidence of out-of-the-box symptoms: ghost ear, intoxicating syndrome, fever. | Fluorescent antibody method, IFA, PLR | Leading - catarrhal syndrome (laryngotracheitis), localization of a headache in the frontal dylyantsi, meningeal signs become overwhelmed with meningism, nemaє visipu, leukopenia, normal SHOE. |
| Tropic painting | Gostre cob, feverish, zhovtyanitsya, improvement of liver and spleen. | Significant improvement of liver and spleen, types of malar paroxysms, rapidly progressing hemolytic anemia in the presence of bleeding, acute renal failure of the sinus is susceptible to aphids of hemoglobinuric fever; Possibility of development of cerebral Komi, improvement to bilirubin for an indirect fraction, leukopenia, not characteristic hemorrhagic syndrome. | |
| Viral hepatitis (VH) | Gostre (pidgostriy) ear, zhovtyanytsya, zbіlshennya pechinka, spleenki | Identification of specific markers of VH (IFA) | Lichomaniacs only in the pre-period with HAV, non-recurrent ailments, naturally growing liver and spleen, parenchymal with high activity ALAT and ASAT, hemorrhagic syndrome are important in case of non-important forms of leukemia |
| GNS | Nif, IFA, PLR | Strong beel across from the first days with the appearance of a severe pain in the lithic tissues, macrohematuria; Not the character of bleeding is clear, uterine. | |
| toxic hepatitis | Zhovtyanytsya, zbіlshennya pechinki | toxicological dosage | On the step of the ear, in the anamnesis - ligaments with toxic factors. Chi is not characteristic fever, hemorrhagic syndrome, spleen reduction, anemia, thrombocytopenia. |
| Separated with salts of important metals | Gostre ear, fever, hemorrhagic syndrome. | The value of the salts of important metals in the blood, in the section |
Gostre cob, first symptoms appear after 4 years or more, after the yak has penetrated into the body. Inodi incubation period three times dobi. The main skargi in case of ingestion of toxic speech from the skin: pain in the abdominal area, dabbled with metal in the mouth, feeling sick, nudity, bloating, often crooked or blue colora, slime and diarrhea, symptoms of intoxication: headache, foulness, weakness, tachycardia, Rizke Padinnya vice, zhovtyanitsya as a result of hemolysis and development of liver failure, state of the art nirkova lack, judgment and deterioration of the situation. If you get rid of the anguish until the symptoms are overwhelmed, the signs of “youthful fever” can be seen: teasing of the eyes, chhannya, lachrymation, chills as a result of an increase in temperature up to 38-39 ° C, dry flushing, , perhaps, showing an allergic visipa. In peripheral blood, anemia, leukopenia, thrombocytopenia. The coagulogram has a deficiency of factors in the laryngeal tissue |
Differential diagnosis of non-malignant forms of leptospirosis
| exponent | leptospirosis | grip | hemorrhagic fever | ricketsiosi |
| Seasonality * | Litno-osinnya | Leaf fall-birch | Litno-osinnya | Litno-osinnya |
| The triviality of a feverish woman (dobu) | 3-15 | 3-6 | 3-10 | 3-18 |
| catarrhal manifestations | weak turn | characteristic laryngotracheitis | dumb | Mobility, a little bit of a turn |
| visip | Polymorphic, often | dumb | Hemorrhagic, with tropical - bark-like | Polymorphic, with a hemorrhoid component |
| hemorrhagic syndrome | bends | Ridko (nosebleeds) | sharp turns | Ridko, weak bends |
| improvement of ovens | characteristically | dumb | can | characteristically |
| improvement of the spleen | often | dumb | ridko | often |
| nirok battle | characteristically | dumb | characteristically | dumb |
| proteinuria | temple | Mozhliva, insignificant | masivna | Mozhliva, insignificant |
| hematuria | microhematuria | Ridko microhematuria | Micro-, macrohematuria | dumb |
| leukocyturia | Mozhliv | dumb | Mozhliv | dumb |
| cylindruria | often | dumb | often | Mozhliv |
| meningeal syndrome | often | ridko | ridko | often |
| CSF pleocytosis | Often, lymphocytic, dementia | dumb | dumb | Moist lymphocytic |
| anemia | Mozhliv | dumb | often | dumb |
| Platelet-topenia | often | dumb | often | dumb |
| Number of leukocytes in the blood | bends leukocytosis | leukopenia | leukopenia | pomirny leukocytosis |
| SHOE | temple | norm | unwisely adjudicated | unwisely adjudicated |
| specific diagnostics | Micro-hemaglutination reaction, microscopy | Fluorescent antibody method, RSK and other serological methods | Nif, IFA, PLR | Nif, RSK, RNGA |
Differential diagnosis of zhovtushnoy form of leptospirosis
| exponent | leptospirosis | viral hepatitis | painter | toxic hepatitis |
| ear | gostre | Gostre, pidgostriy | gostre | deed |
| zhovtyanitsya | From the 5th to the 7th day, it is quiet or intensive | From 3 to 20 days, wake up or intensive | On the 5-10th day, weak, pomyrna | Pomirna abo intensive |
| feverish woman | Visoka, 3-15 dib | Pomirna, up to 3-4 dB | Visoka, repeat the chills | dumb |
| Shkira denounced | hyperemovated | blida | hyperemovated | blida |
| visip | Polymorphic, often | Mozhliva, urticar | dumb | dumb |
| dyspeptic syndrome | Bluvannya, anorexia | Nudota, heaviness in the right side, anorexia | diarrhea | anorexia |
| improvement of ovens | step by step | step by step | step by step | step by step |
| improvement of the spleen | often | can | step by step | Відсутнє |
| hemorrhagic syndrome | often | Ridko, in important vipadki | Chi is not characteristic | Chi is not characteristic |
| anemia | often | Chi is not typical | step by step | Chi is not typical |
| thrombocytopenia | often | Chi is not typical | can | Chi is not typical |
| leukocytosis | step by step | leukopenia | leukopenia | normocytosis |
| SHOE | promoted | Normal, low | slightly adjusted | Is normal |
| bilirubin | Allowed, offended factions | More dressings | Pidvischeno, more vilny | added dressings |
| transferase | slightly advised | quick adjustments | slightly advised | In the norm |
| KFK | promoted | In the norm | slightly adjusted | In the norm |
| proteinuria | temple | insignificant | pomirna | Mozhliv |
| hematuria | microhematuria | Chi is not typical | hemoglobinuria | Mozhliv |
| leukocyturia | often | Chi is not typical | Chi is not typical | Chi is not typical |
| cylindruria | often | Mozhliv | Mozhliv | ridko |
| specific diagnostics | Reactions microhemagglyutinatsii, microscopic | Specific markers of GV | Microscopic smear and blood drops | Toxic-logical dosage |
Differential diagnosis of leptospirosis and gostrich viral hepatitis
| symptoms | leptospirosis | Gostri virus hepatitis |
| ear of ailment | gostre | deed |
|
temperature |
visoka stretching 5-9 days, inodi dvohvilova | in most cases normal or subfebrile |
| chills | often | no boo |
| Head bill | often | ridko |
| Boli in litkovo m'yazy | often | no boo |
| herpes | often | no boo |
| Hyperemia of disguise | often | no boo |
| hemorrhagic manifest | often | only with an accelerated guest pechinka lack |
| zhovtyanitsya | to appear for 3-5 days, quickly growth | there is a rise, growth, step by step |
| nirok battle | even more often, important | Ridko, insignificantly |
| meningeal signs | often | no boo |
| Zagalny blood analysis | often neutrophilic leukocytosis іf ssuvom formulas vivom, anemia, thrombocytopenia, thrombocytopenia, thrombocytopenia is accelerated | normocytosis abo leukopenia, lymphocytosis, SHOE in between norms |
| activity of aminotransferases | slightly moved | advised abruptly |
Likuvannya beyond the cordon
Take a lykuvannya in Korea, Izrail, Nimechchin, USA
Otrimati the consultation on medturism
lykuvannya
Preparations (such as speech), which can become stagnant during treatment
| Albumin human |
| Amoxicillin |
| Aprotinin (Aprotinin) |
| Benzylpenicillin (Benzylpenicillin) |
| Heparin sodium |
| Hydrocortisone |
| Dexamethasone |
| Dextrose |
| Diclofenac (Diclofenac) |
| Doxycycline |
| Dopamine |
| Potassium chloride |
| Calcium chloride |
| Ketoprofen (Ketoprofen) |
| Mannitol (Mannitol) |
| Meglumin (Meglumine) |
| Menadione sodium bisulfite |
| Meropenem |
| Sodium acetate |
| Sodium hydrocarbonate |
| Sodium chloride |
| Omeprazole (Omeprazole) |
| Paracetamol (Paracetamol) |
| Pentoxifylline |
| plasma is frozen |
| Prednisolone |
| Famotidine |
| Furosemide |
| Cefepime |
| Cefotaxime |
| Ceftriaxone |
| Ciprofloxacin (Ciprofloxacin) |
| Epinephrine (Epinephrine) |
| erythrocyte mass |
| Etamsylate |
Likuvannya (outpatient clinic)
LIKUVANNYA ON AMBULATORNY RIVNI
tactics of addiction: In outpatient minds, do not treat ailments with leptospirosis. Those who are sick are heading for hospitalization in the hospital to receive special medical aid.
· Consultation of a gastroenterologist: in case of severe liver failure of non-infectious etiology;
· Consultation of a nephrologist in case of severe nirok and development of an OPP;
· Consultation of a therapist in the development of pneumonia and bronchitis;
professional come in:
· Sanitary - veterinary go to tvarinnytskyy state gifts, regular deratization, protection of waters from obrudnennya vidіlennyy tvarin, control over dzherels water supply, people bathing places, watering thinness і t. P;
· Riziku vaccination group (pratsіvniki tvarinnitskih Gospodarstwa, zooparkіv, zoomagazinіv, canine rozplіdnikіv, zvіrіvnitskih Gospodarstwa, of companies of pererobki tvarinnitskoї sirovini, spіvrobіtnikіv laboratorіy, SSMSC pratsyuyut of cultures leptospіr) of 7 rokіv іnaktivovanoї Leptospira vaccine 0.5ml pіdshkіrno, disposable, revaktsinatsіya through pik.
· Vaccination of silskogospodarsky creatures and dogs.
Monitoring the patient's stance: Carried out by the KIZ / doctors of the out-of-house practice at the medical examination.
|
N p / p |
Frequency of inspecting people КІЗ / GP |
triviality of caution | Shown and periodicity of consultations on specialties |
| 1 | 1 time per month |
6 months during the day, accelerated |
Nephrologist, ophthalmologist, neuropathologist, therapist in the obovasculature order in the 1st month of the month postponed affliction... At the beginning of the month of the university, the faculty will be awarded for the profile of clinical manifestations. |
| 2 | 1 time per month for 6 months. time to sleep, once every 3-4 msec. | 2 rocky when developing faster. | ophthalmologist, neuropathologist, nephrologist and doctors of other specialties (as shown) |
|
N p / p |
Periodicity of laboratory and preparatory methods in advance | Criteria for knowledge of the dispensary region | The procedure for the admission of perekhvorіlikh on the robot |
| 1 |
The country’s analysis of blood and blood, and the ailments have suffered the form of ailment and biochemistry before the last blood loss for 6 months per month, once every 3-4 months. v Stretching the offensive 2 rock_v (with the obviousness of the acceleration) and with the knowledge of the "D" field. Dodatkovі doslіdzhennya-planned for showing. |
Clinical examination, normalization of laboratory parameters (ALT, AST, creatinine, sechovina, etc.) small organs and systems (with an accelerated relocation of illnesses). |
classroom |
· Stiyka normalization of the temperature of thyl;
· Sanation of the spinal cord during meningitis.
Likuvannya (shvidka dopoga)
DIAGNOSTICS І LIKUVANNIA AT STAPS SHVIDKOЇ NEVIDKLADNOЇ HELP
diagnostics come in
Zbir skarg and anamnesis:
Detection of skarg on the adjusted temperature, intoxication ( head b_l, Weakness, mіalgії, pain in the lithic meats, nudity, etc.).
· Epidemiological history data: contact with water with critical waters (fishing, bathing, water sports, tourism, etc.); the appearance of dogs, shchuriv, mish in the booth; perebuvannya in epidemiologically susceptible to diagnosed leptospirosis, the appearance of risk of occupational infection with leptospirosis.
With physical dosage assessment of the status of the disease, malformations and visible mucous membranes, the appearance / visibility of the hyperemia of the individual, the onset of the sclera, the symptoms of the liver of the heart-pulmonary system, the central nervous system stan_v.
Unavailable assistance
When changing:
We are sick with leptospirosis when there is a change in the appearance of a single injection:
Prednizolone: 90-120 mg internally or internally (UD-S);
Furosemid: 2-4 ml internally or internally; (UD - B)
In case of ІTSh (all come in for an hour, the patient is transported to the hospital):
· Negayne vnutr_shnyovenna introduction of 0.9% NaCl solution - 800.0 ml (UD-S);
Prednizolone 120 mg (UD-S),
· Make sure the food is served sour.
Likuvannya (stationary)
LIKUVANNYA at the stationary РІВНІ
tactics of addiction
The main methods of treatment are antibiotics. Likuvannya of ailments of important forms of leptospirosis, accelerated hospitality to diseases of nirok, health due to the presence of pathogenetic therapy. by ourselves effective antibioticє penicilin, with its intolerance, it can be replaced by antibiotics of the tetracycline group, cephalosporins, fluorochinolones.
Non-drug treatment:
· Postіlny mode by stretching the hot air period;
· Diet: with urazhenny nirok-style No. 7, with urazhennі stove - style No. 5, with the same urazhennya - style No. 5 with an interchangeable salt or a style No. 7 with intermixed fat.
Drug treatment(In fallowness from the degree of severity of illness):
Ethiotropic therapy:
| Treatment scheme for mild forms | Scheme of the middle forms lіkuvannya | Standard scheme for the treatment of important and accelerated forms | The standard scheme for the treatment of leptospiral meningitis |
|
1.0 million OD x 6 times / dob / m (UD-A), Preparations reserve: doxycycline 0.1 g x2 times / add all the way (UD-A) amoxicilin - 0.5 g x 4 times for dob, all in the middle (UD-V) or ciprofloxacin 0.5 g x 2 times for doba in the middle (UD-V). |
benzylpenicillin natrієva sil 1.0-1.5 million OD x 6 times / day. i / m (AD-A). Preparations reserve: doxycycline 0.1 g x 2 times / dobu (UD-A) abo ceftriaxone 1.0 - 2.0 g x 2 times / dobu, i / m, i / v (UD-A), abo cefotaxime 1-2 g / dobu in 2-4 priyomi i / v, i / m (UD-V) or ciprofloxacin 500 mg x 2 times / add vseredin (UD-B). Ethiotropic therapy is carried out for 5-7 days. |
Benzylpenicillin sodium sil 1.5 million-2.0 million OD x 6-8 times / dob / m, / in (UD-A). Reserves preparations: ceftriaxone 4.0 - 6.0 g / dob, i / m, i / v (UD-A), or cefotaxime 2 g x 2-3 times for dob i / v, i / m (UD-V), abo ciprofloxacin 200 mg x 2 times / dobu. i / v, (single dose may be taken up to 400 mg) (UD-V) or cefepim 2.0 g 2-3 times per dose / v, i / m (UD-V). Ethiotropic therapy is carried out for 7-10 days. |
Benzylpenicillin sodium sil 3.0 million OD x 8 times / add / m / m, / in (UD-A); with non-efficacy ceftriaxone 2.0-3.0 g. 2 times for doba, inject through skin 12 years, intramuscularly, intravenously (UD-A), abo cefotaxime 2.0 gr. 2-3 times for dobu i / v, i / m (UD-V), or ciprofloxacin 200-400 mg x 2 times / dobu. i / v (UD-V); abo cefepim 2.0 g 2-3 times for dob, i / v, i / m (UD-V). In case of intolerance to β-lactam antibiotics: ciprofloxacin 0.2% - 200 mg / 100 ml 2 times per dose IV (UD-V). Reserve drugs in case of a daytime effect: meropenem at 40 mg / kg skin for 8 years (UD-V). Ethiotropic therapy is carried out for 7-10 days. |
As soon as there is a need for a repeated course of antibiotic therapy, then it’s stagnant to use synthetic penicilli, cephalosporin.
Preparations for the treatment of important forms of leptospirosis with non-efficacy or intolerance to penicilin and cephalosporins - carbapenemi (imipenem, meropenem), glycopeptides (vancomicin, teicoplanin).
Ethiotropic therapy for leptospirosis in vaginal ( in the fallowness of the severity level): ampicilin 500 mg 4 times in the middle for 5-7 days;.
for benzylpenicilin sodium sil 1-1.5 million OD x 6 times / add i / m, i / v (UD-A).
Preparations reserve: ceftriaxone 1.0 - 2.0 g x 2-3 times / dobu, i / m, i / v (UD-A),
abo cefepim at 1.0-2.0 g 2 times for dobu i / m, i / v (UD-V).
pathogenetic therapy
Desintoxication therapy:
Internally introduced 0.9% sodium chloride (UD-S), 2% sodium hydrocarbate (UD-S), 5% glucose (UD-S), reamberin (UD-D). Spіvіdnіtіnіa and a number of times the number of problems in viz. electric piston, Stan funk-tsy nirok.
Osyag infusion therapy to get rid of the additional consumption of the body in water - 30 ml / kg body weight. The average volume is injected for people weighing 60-80 kg to become 1200-1500 ml / day + pathological losses + renewed diuresis.
It is not recommended to use synthetic coloids (dextran, hydroxyethyl starch, etc.).
When changing:
There is a bit of a line, which is introduced interchangeably.
· Dehydration therapy: manit (15% of solutions) with furosemide (UD-B) under control of Na + blood. When Na + blood is reduced at the level of the upper range of norms and in food, the introduction of manite is shown to be due to the change in osmolarity of the blood and the threat to the development of swelling of the blood cells to the brain. In cich vipadkah, the introduction of concentrated glucose (10%, 20% or 40%) and 0.45% NaCl is shown.
Hormone therapy (with the help of the prevention of important neurological acceleration, reduction of the risk of hearing loss): dexamethasone 0.2-0.5 mg / kg (in the presence of the severity level) 2-4 times, and for no more than 3 days brain and decreased penetration of hematoencephalic bar) (UD-S).
Likuvannya ІTSh:
... renewal of the wickedness of the nobility, if necessary - intubation of the trachea and transfer to the SHVL;
... post-oxygenation by way of feeding the fluid through a mask or a nasal catheter;
... protection of venous access (catheterization of central / peripheral veins);
... insertion of the catheter into sechovy mikhur for a term before a sick person is in shock for the purpose of a weather-based treatment with the help of a correction of the therapy;
... monitoring of the sick person - hemodynamics, dichannya, level of svidomostі, character and growth of visipu.
The sequence of the introduction of the drug in the case of ІTSh:
· Obsyag should be injected razchiniv (ml) = 30 ml * weight of sick person (kg);
Intensive infusion therapy: physiological breakdown(UD-S), acesol (UD-S), chlorosalt (UD-S)) and coloidal (hydroxyethylcrochmal) solutions in the ratio 2: 1.
(!) Fresh frozen plasma should not be injected into the starting point.
Introduce hormones in doses:
· With ITSH 1 step - prednizolone 2-5 mg / kg / dob (UD-S) or hydrocortisone - 12.5 mg / kg / dob (UD-S);
· With ITSh 2 steps - prednizolone 10-15 mg / kg / dob (UD-S) or hydrocortisone - 25 mg / kg / dob (UD-S);
With ITSH 3 steps - prednizolone 20 mg / kg / dobu (UD-S) or hydrocortisone - 25-50 mg / kg / dobu (UD-S).
Heparinotherapy (through skin 6 years) (UD-V):
ІТШ 1 step - 50-100 OD / kg / add;
ІТШ 2 steps - 25-50 OD / kg / add;
· ІТШ 3 steps -10-15 OD / kg / add.
When outside, the effect is hormonal therapy Most of the introduction of catecholamine of the first order - dopamine from 5-10 μg / kg / xv under the control of AT (UD-S);
Correction of metabolic acidosis;
When there is a lack of hemodynamic reaction to dopamine (at a dose of 20 mcg / kg / hv), the administration of adrenaline / noradrenoline at a dose of 0.05-2 mcg / kg / hv (UD-V);
Re-introduction of hormones in a large dose - after 30 minutes - with compensated ITSh; after 10 khilin - with decompensated ІTSh;
Ingibitori proteases: gordox, counterkal, trasilol.
With stabilization of the arterial vise - furosemide 1% - 40-60 mg (UD-V);
With the presence of a congestion to the brain - manit 15% - 400 ml (UD-V), intravenously dripped; the maximum dose for older adults is 25 ml / dobu); dexamethasone according to the scheme: pochatkova dose 0.2 mg / kg, after 2 years - 0.1 mg / kg, after 6 years of skin for 6 years, dobi - 0.2 mg / kg; dal 0.1 mg / kg / dobu with sparing signs of the brain;
Transfusion of SZP (UD-S), erythrocyte mass (UD-S). Transfusion of SZP 10-20 ml / kg, erythrocyte mass, if it is evident, is indicated by order of the Ministry of Health of the Republic of Kazakhstan No. blood, її components and preparations "
Albumin - 10% solution, 20% solution for infusions in case of manifestation, indicated by the order of the Ministry of Health of the Republic of Kazakhstan No. 501 dated 26.07.2012 to the rock "About the hardening of the Nomenclature, the Rules for Procurement, Recycling, Protection, Realization of Blood rules for the selection, blood transfusion, components and preparations. "
Systemic hemostatics: etamzilate 12.5% solution, 2 ml (250 mg) 3-4 times / dob. i / v, i / m (UD-S)
Prophylaxis of steroids and stress damage to the intestinal tract (famotidine (Kvamatel)) 20 mg i.v. x 2 times per dose (UD-V); omeprazole 40 mg IV x 1 time per dose (UD-V).
With disseminated intravascular coagulation syndrome:
With an increase in the aggregation activity of thrombocytes - pentoxifyline 100 mg IV 2 times per dose (UD-D).
In the presence of antithrombin III deficiency - infusion of FFP at a dose of 3-3.5 ml / kg / add.
In case of fibrinolytic variants of ICS, the main component of therapy is іngibitori proteases (aprotinin in a dose of 70-100tis. 4-6 times for dobu (UD-S).
When coagulopathy resuscitation - plasmapheresis with infusion of high doses of FFP (up to 30 ml / kg / dob) with plasma exchange, inhibition of proteases and non-fractionation of heparin.
lykuvannya OPP(It is important to the protocol of diagnostics and diagnostics of OPP (state standardization)).
Symptomatic therapy:
In case of fever, one of the lower drugs:
... acetaminophen (paracetamol) - tablets of 0.2 і 0.5 g, rectal suppositories 0.25; 0.3 і 0.5 m Single dose of 500 mg, maximum single dose - 1 g, multiplicity up to 4 times per dose. The maximum dose is 4 g, the maximum dose is 3-5 days. (UD-A);
... diclofenac - tablets, pills 25 mg, 50 mg, 75 mg, 100 mg, 150 mg; ointment, gel; rozchin for ін'єкцій 75 mg / 3 ml, 75 mg / 2 ml. Assign 25-50 mg 2-3 times for doba. To achieve a therapeutic effect, the dose is gradually changed and switched to an additional therapy at a dose of 50 mg / day. The maximum dose is 150 mg. If necessary, additional dobovy dose diclofenac retard from 100 to 150 mg can be taken in addition to 1 tablet (50 mg) (UD-V);
... ketoprofen - rozchin for ін'єкцій 100 mg / ml, 100 mg / 2 ml; solutions for internal testicles 50 mg / ml; capsule 50 mg, 150 mg; tablets, in a shell 100 mg, 150 mg. Take internally every hour: pills and drops for taking all in the middle, 100 mg each 3 times for dobu; retard tablets - 150 mg / day for 2 doses with an interval of 12 hours; capsules - 50 mg each day, 100 mg in the evening; granules - 80 mg (instead of one sachet) 2-3 times a day.
Intrinsically, inject 100 mg 1-2 times per dob, vnutrishnovenno drop by 100-200 mg. The solution for internal infusion is prepared, the preparation is available in 100-500 ml of 0.9% solution for sodium chloride (UD-V)
The change of the main lykarsky zoobіv:
· Benzylpenicilinu natriєva sil - a powder for preparing a bottle for the first bottle of 1000000 OD (UD-A);
Doxycycline - 100 mg capsules (UD-A);
Amoxicclin - capsules 500 mg (UD-V);
· Ceftriaxone - powder for preparation of razchino for ін'кцій for internal and internal introduction in a bottle of 1 g (UD-A);
· Cefotaxime - a powder for preparing a rosette for ін'єкцій for internal і internal introduction in a bottle of 1 g (UD-V);
· Cefepime - powder for preparation of razchin for ін'єкцій for internal і internal administration in a bottle of 500 mg, 1.0 g, 2.0 g (UD-V);
· Ciprofloxacin - for infusion 0.2%, 200 mg / 100 ml; 1% in 10 ml ampoules (concentrate for dilution); tablets, vkrit_ shell 250 mg, 500 mg, 750 mg (UD-V);
· Meropenem - powder for preparation of infusions of 1000 mg in bottles of 100 ml (UD-V).
The transfer of pre-existing licars:
· Prednizolone - razchin for ін'єкцій in ampoules 30 mg / ml 1 ml (UD-S);
Dexamethasone - rozchin for ін'єкцій in ampoules 4 mg / ml 1 ml (UD-S);
· Hydrocortisone - vials with lyophilized powder for preparing an in-box with a razchinnik in ampoules of 2 or 4 ml (UD-S);
Dopamine - a concentrate for preparing an in-line solution in ampoules of 25 mg (5 ml), 50 mg (5 ml), 100 mg (5 ml), 200 mg (5 ml) (UD-S);
· adrenaline -
razchin for ін'єкцій in ampoules of 1 ml (1 mg) (UD-V);
Rozchin NaCl 0.9% - 100, 200, 400 ml (UD-S);
Dextrose (glucose) 5%, 10% 40% - 100, 200, 400 ml (UD-S);
Rozchin sodium bicarbonate 5% - 200.0 ml, 400.0 ml (UD-V);
Ringer's Roschin for infusions, 200 ml and 400 ml (UD-S);
Acesol - for infusion 400.0 ml (UD-S);
Trisol - for infusion 400.0 ml (UD-S);
Chlosalt - for infusion 400.0 ml (UD-S);
· Roschin megglumin succinate for infusions 400.0 (UD-D);
Albumin - for infusions - 10%, 20% - 100 ml;
· Fresh frozen plasma for infusions (UD-S);
Erythrocytic mass - razchin for internal introduction (UD-S);
Mannitol - solution for ін'єкцій 15% 200ml і 400 ml (UD-V);
Furosemid - razchin for ін'єкцій in ampoules 1% 2 ml (UD - V);
· Acetaminophen (paracetamol) - tablets of 0.2 і 0.5 g, rectal suppositories 0.25; 0.3 і 0.5 g (UD-A);
Diclofenac - tablets, pills 25 mg, 50 mg, 75 mg, 100 mg, 150 mg; ointment, gel; rozchin for ін'єкцій 75 mg / 3 ml, 75 mg / 2 ml (UD-V);
Ketoprofen - rozchin for ін'єкцій 100 mg / ml, 100 mg / 2 ml; razchin for internal yazovyh ін'єкцій 50 mg / ml; capsule 50 mg, 150 mg; tablets, vkrit_ shell 100 mg, 150 mg (UD-V);
· Heparin, 1 ml / 5000 OD, ampoules 1.0 ml, 5.0 ml, vials of 5.0 ml (UD-V);
Pentoxifillin - 2% solution 100 mg / 5 ml, 100 mg in 20-50 ml 0.9% sodium chloride, ampoules (UD-D);
· aprotinin - razchin for ін'єкцій in ampoules of 10 ml (100,000 OD) (UD-V);
Etamzilat - rozchin for ін'єкцій in ampoules 12.5%, 2 ml (250 mg) (UD-S);
Famotidine - rozchin for ін'єкцій in ampoules 20 mg (5 ml) (UD-V);
· Omeprazole - powder for preparation of razchin in vials of 40 mg (UD-V);
· Menadion sodium bisulfite - rozchin for ін'кцій in ampoules of 1 ml, 2 ml (UD-V).
Table of medicines:
| class | INN | perevagi | shortcomings | UD |
|
antibiotic group biosynthetic penicilin |
Benzylpenicillin sodium sil | Vyavlya bactericidal activity for rakhunok inducing the synthesis of microorganisms. |
Non-resistant to beta-lactamase. Low activity is very large gram "-" m / o. |
A |
| Antibiotic group tetracycline | doxycycline | bacteriostatic antibiotic wide rangeдії. They penetrate into the middle of the clitini, and go to the internal production of plants. |
side by side: on the side of the nervous, herbal, heart-vascular, hepatobiliary systems, organs in the hearing and vestibular apparatus, zoru, hematopoiesis, damage exchange of rechovin, functions nirok i sečovyh nobles, Allergic reactions. |
A |
| Antibiotic, cephalosporin III generation | ceftriaxone |
Active gram "+", gram "-" m / o. Stable to beta-lactamase enzymes. Good penetrates into fabrics and ribbons. |
low activity to some anaerobic pathogens. | A |
|
antibiotic, cephalosporin III generation |
cefotaxime | Dіє is bactericidal. Mechanism of dressing for damaging the synthesis of mucopeptide of the microorganism. Volodya with a wide range of antimicrobial activities. |
Stable to large beta-lactamase gram (+) and gram (-) microorganisms. Side effects: On the side of the nervous system, secular, herbal, heart-vascular systems, on the side of the blood-forming organs, allergic reactions. |
V |
| fluorohinoloni | ciprofloxacin |
An anti-microbial drug of a wide spectrum of diu, can be bactericidal, induces DNA-gase and induces synthesis of bacterial DNA. Shvidko gets wet from the shlunkovo-intestinal tract. Bioavailability for oral administration becomes 70%, penetrating through the hematoencephalic bar |
side effects on the side of the grass, sechid, heart-vascular systems and systems,Central nervous system, on the side of the hematopoietic system, allergic reactions. |
V |
| Antibiotic, penicilin napivsynthetic | amoxicology | Drinksynthetic penicilin, volodya with a wide range of bactericidal action. Porusu synthesis of peptidoglycan in the period of time and growth, viklikє lizis bacteria. |
Vicious Effects: Allergic reactions, from the side of the herbal, nervous systems, from the side of the hematopoietic system, allergic reactions |
V |
|
antibiotic, cephalosporin IV generation |
cefepime | The drug can be used for a wide range of diets, including gram-negative and gram-positive microorganisms, stikis to aminoglycosides and cephalosporins of 3 generations. |
bitter appearances: Allergic reactions, on the side of the nervous, secular, mental systems, ССС, shlunkovo-intestinal tract, organs of blood |
V |
| Antibiotic group carbapenemi | meropenem | It is bactericidal against a wide range of aerobic and anaerobic bacteria, which are tied to a high degree of meropenem to penetrate through the cell line of bacteria. |
side effects: phlebitis, thrombophlebitis, allergic reactions, pain in the abdomen, nudity, anorexia, blues, penetration, pseudomembranous colitis, eosinophilia, thrombocytopenia, leukopenia, neutropenia (including agranulocytosis), cholestatic hepatitis. |
V |
Hirurgicne involvement: dumb.
Інші vidi lіkuvannya:
· HBO right away for reasons and acceleration;
· Hemodialis in AKI without shock and hemorrhagic syndrome;
· Plasmapheresis in case of severe interruption of OPPN.
Shown for consulting fahivts:
· Consultation of an ophthalmologist with severe eyes;
· Consultation of a gastroenterologist: with hepatitis, pancreatitis, cholecystitis;
Consultation of a surgeon for a victim stubborn belly;
· Consultation of a nephrologist in case of severe deficiency and development of a negative deficiency;
· Consultation of a neuropathologist in the case of uzhenny central nervous system;
· Consultation of a cardiologist with a heart attack;
· Consultation of a therapist in the development of pneumonia and bronchitis;
· Consultation of a dermatologist with severe curvatures;
· Consultation of an anesthesiologist-reanimatologist: when developing non-removable stanіv;
· Consultation of an obstetrician-gynecologist: with leptospirosis in vaginal women.
Indicated for transfer to the form of intensive therapy and reanimation:
· Important form of leptospirosis with a threat to the development of accelerated;
· Non-adherent: infectious-toxic shock, AKI, central nervous system damage, pechinkov deficiency, heart-and-dysfunctional deficiency, disseminated intravascular coagulation syndrome, polyorganic deficiency and deficiency.
Indicators of efficiency of treatment:
· Stiyka normalization of temperature;
· Visibility of intoxication;
· Visibility or change in symptoms;
· Sanation of the spinal cord during meningitis.
further away
Individuals who have been infected with leptospirosis will go to the dispensary for 6 months with a nephrologist, ophthalmologist, neuropathologist and therapist in the first month of the disease. At the beginning of the month of dispensaries, caution is advised to come up with infectious diseases / GPs for the study of patients for the profile of clinical manifestations. Also, control blood and blood tests were carried out, and they were transferred to the form of a biochemical analysis of blood. The analysis should be carried out for the first two months of growth, and in the near future - in the fallowness as a result of the situation.
Education from the field of completion of the term of dispensary caution is carried out with repeated clinical examination (normalization of laboratory and clinical indicators). In case of persistent overwhelming symptoms, they transfer to the eyes of the fakhivtsy (ophthalmologist, neuropathologist, nephrologist, etc.) Not less than 2 rocks.
hospitalization
Indicated for planned hospitalization: dumb.
Indicated for the emergency hospital: All ailments with leptospirosis and adolescents at the time of illness, right at the stage of severity, are required for a viscous hospitalization in an infectious hospital.
information
Dzherela and Literature
- Protocols of the United Committee for the quality of medical services of the Ministry of Health and Social Development of the Republic of Kazakhstan, 2016
- 1) Infectious diseases: national health / Ed. N. D. Yushchuk, Yu. Ya. Vengerova. // M .: GEOTAR-Media, 2009. - S. 503-513. 2) Pokrovskiy V.I., Illinskiy Yu.A., Chernukha Yu.G. that in. Methodical recommendations from clinics, diagnostics and treatment of leptospirosis - M., 1979. - S. 37-58. 3) Certainty of infectious ailments (2 volumes). / Yu. Lobzin, K. Zhdanov. // SPb., Foliant, 2011 p - 664 p. 4) Avdєєva M.G. Leptospirosis as a result of becoming ill with prolonged accelerated transition (immunopathogenesis, diagnostics, prognosis, treatment, rehabilitation): Abstract of the thesis. dis. ... Doctor of Medical Sciences - Moscow, 1997.-32 p. 5) Lebedev V.V., Avdeva M.G., Shubich M.G., Ananyina Yu.V., Turyanov M.Kh., Luchshev V.I. Icterohemorrhagic leptospirosis (edited by V.V. Lebedev). - Krasnodar: "Radianska Kuban", 2001. - 208 p. 6) Stoyanova N.A., Tokarevich N.K., Vaganov A.N. that in. Leptospirozi: a handbook for lykariv / ed. Yu.V. Ananyinoy.-SPb .: НІІЕМ ім. Pasteur, 2010, 116 p. 7) Pokrovsky V.I., Akulov K.I. Epidemiology, diagnostics and prevention of leptospirosis. Methodical recommendations. - M., 1987 .-- 56 p. 8) Moisova D.L., Lebedev V.V., pidsadnykh A.A. Loss of hemostasis in leptospirosis // Infectious ailments. - 2012. -T.10, No. 3. - S. 67-74. 9) Ambalov Yu.M. Diagnostics and the principle of leptospirosis treatment: lectures for medical students. - Rostov-on-Don, Neoprint, 2014 .-- 17 p. 10) Leptospirosis in adults. CLINIC RECOMMENDATIONS... - M., 2014 .-- 96 p. 11) Clinical recommendations (protocol of treatment) for providing medical assistance to children with leptospirosis // St. Petersburg, 2015 .-- 74 p. 12) V.N. Gorodin, V.V. Lebedov Treatment of leptospirosis // Russian medical journal. - 2006. - No. 1. - p. 45-50. 13) Gorodin V.N., Lebedev V.V., Zabolotskiy І.B. Optimization of intensive therapy of important forms of leptospirosis (medical technology is well understood). - Krasnodar, 2007 .-- 54 p. 14) Lebedev V.V., A.Yu. Zhuravlyov A.Yu., Zotov S.V., P.V. P.V. Lebed that in. Gagging infusion remaxol in the complex treatment of ailments for leptospirosis // Therapeutic archives. - 2013. -T. 85, no. 11.- S. 58-61. 15) The Great Doctorate of the Likarsky Zasobiv / ed. L. Є. Ziganshina, V.K. Lepakhin, V.I. Petrova, R. U. Khabrіev. - M .: GEOTAR-Media, 2011 .-- 3344 p. 16) Diagnosis, Case Management Prevention and Control of Leptospirosis / Jagdish Prasad. // Program for Prevention and Control of Leptospirosis. National Guidelines.-2015.- 18 p. 17) Leptospirosis./CPG, 2010. - 66 p. 18) Brett-Major DM, Coldren R. Antibiotics for leptospirosis. / Cochrane Database Syst.-Rev. 2012. -Feb 15 .-- 21 p. 19) British National Formulary (BNF 67) - 2014 .-- 1161 p.
information
Fast, as vikoristoyutsya in the protocol
| AT | arterial vise |
| ALAT | alanine aminotransferase |
| ASAT | aspartate aminotransferase |
| ATCH | assets partial thromboplastin hour |
| i / v | internally |
| in / m | internal |
| VG | viral hepatitis |
| GP | foreign practice license |
| BP | hourrecalcifications |
| HBO | hyperbaric oxygenation |
| GNS | hemorrhagic fever with nirkovy syndrome |
| hematoencephalic bar'єr internal combustion engine |
hematoencephalic bar desemination of the internal vascular laryngeal |
| SHVL | piece ventilation lungs |
| ІТШ | infectious toxic shock |
| ІFA | enzyme immunoassay |
| КІЗ | cabinet Infectious diseases |
| CT scan | Computer tomography |
| KShchR | acidic pudding |
| INR | internationally normalized relations |
| MRI | Magnetic resonance tomography |
| UAC | zagalny analiz blood |
| OAM | zagalny analysis of the sech |
| OARIT | anesthesia and intensive care reanimation |
| OPP | gostre poshkojennya nirok |
| OPPN | state standard pechinkovo-nirkova lack |
| Bcc | volume of circulating blood |
| PMSD | first-class medical-sanitary assistance |
| PLR | polymerase lantsyugov reaction |
| RMA | microagglutination reaction |
| Nif | reaction of indirect immunofluorescence |
| RPGA | reaction of passive hemaglutination |
| RSK | complement ring reaction |
| SZP | fresh frozen plasma |
| CSF | spinal cord ridina |
| SHOE | the rate of accumulation of erythrocytes |
| SPON | multiple organ failure syndrome |
| Ultrasound | ultrasound dosage |
| CVP | central venous vise |
| EHC | electrocardiography |
List of reports in the protocol:
1) Kosherova Bakhit Nurgalievna - Doctor of Medical Sciences, Professor, Republican State Enterprise at the RK "Karaganda State Medical University"
2) Kulzhanova Sholpan Adlgazievna - Doctor of Medical Sciences, AT "Medical University Astana", head of the Department of Infectious Diseases and Epidemiology.
3) Mukovozova Lidiya Oleksiyivna - Doctor of Medical Sciences, State Medical University of the City of Semey, State Medical University, Professor of the Department of Neurology, Psychiatry and Infectious Diseases.
4) Mazhit Talgat Mansurovich - Doctor of Medical Sciences, AT "Medical University Astana" Professor of the Department of Clinical Pharmacology.
Conflict of interests:Відсутнє.
List of reviewers: Duysenova Amangul Kuandikovna - Doctor of Medical Sciences, Professor, Republican State Enterprise at the REM “Kazakh National Medical University imeni S.D. Asfendiyarova ", head of the department of infectious and tropical ailments.
Take a look at the protocol: re-examining the protocol through 3 years of writing and publishing it and from the date of joining it, or if new methods are evident with sufficient proof.
Attached files
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Leptospirosis is a state of zoonotic infection, which is characterized by signs of capillary toxicosis, lesions of nirok, liver, central nervous system, skeletal musculature, which are superfluous with intoxications, severe lychomania,.
Ethiology. Lesions of ailments - leptospira interrogans, are spiralepid microorganisms, attached to life by the water.
In a given hour, there are more than 200 serovariants of leptospira, which are found in 23 serological groups. Among them: Canicola, Grippotyphosa, Icterohaemorrhagiae, Hebdomadis, Tarasovi і ін. Leptospiri є aerobics, swiftly move with bumps, hanging and diy direct sleepy light. Sensitive to acids, penicilin, tetracycline, streptomycin and stiyky to low temperatures, Zalishayutsya life with trivial frozen. It is trivial to get away from the most popular middle ground (water, vologous soil), on grub products - from many years to some days.
Epidemiology. Dzherel іnfektsії creatures. In natural vognischa - greece and comahoide (polivka, patsyuki, mish, zemleriyki, yizhaki), in some infections there are no symptoms, and leptospira is seen in a trivial hour. In anthropourgical (synanthropic) inognischa - great and other horny thinness, shchure, dogs, pigs, which can also tolerate Leptospirosis without any clinical manifestations. In the rest of the rock, the epidemiological significance of dogs and syrihs in the transmission of people who are ill.
Infected people are seen with small paths - percutaneous (through the skin and mucous membranes) and alimentary. In natural areas, people become infected, as a rule, in summer and autumn period, before the hour of the silkskogospodarsky robots (mowing the green meadows, tidying up the snow, etc.), Polyuvannya, ribolovli, hydromeliorative tourist trips, When bathing, implanting water from vipadkovich impervious to waters, etc. Sporadic illness is reestablished by stretching out the rock. The workers of breeding farms, meat processing plants, dog workers, veterinary workers, zootechnicians, and the masters of thinness in individual state gifts are not frequently informed.
Lyudin's sickness is not safe for people who feel sick.
Pathogenesis. Zbudnik penetrates into the human organism through the skin, mucous membranes of the mouth emptying, eyes, nose, and intestinal tract.
Expanding on lymphatic paths and hematogenously, leptospira all increase their presence in lymphatic universities, Viklikayuchi hyperplasia, capillaries, leading to endothelial development and development of capillary toxicosis, and also in the small spaces of adult organs and tissues, develops actively to reproduce. All the tse summarizes the polymorphism of clinical symptoms, the polyorganic nature of the lesion and determination of numerical acceleration. The pupils fix themselves up to the epithelium of vibrant tubules of nirok, cells of the liver and other organs, contaminate the vast expanses of these organs. Posshkozhennya toxins leptospira nyrok to produce nirok to the destruction of the processes of sechouvorennya, the development of nirkova deficiency. Parenchymal liver disease in the presence of hemolysis of erythrocytes, viclicane of hemolysis of leptospir, to develop to the development of zhovtyannyh forms of disease. Penetration of leptospira through the hematoencephalic bar'єr of the formation of a diagnosis. V skeletal meat It is characteristic for leptospirosis to develop in the presence of necrotic symptoms.
Taste of massive leptospiremia, toxemia, extended lesions of the endothelium of the brain and disseminated intravascular coagulation syndrome can be caused by the ITS.
The transfer of the disease to a trivial immunity is only before the serologic version of leptospira, which is a test of infection.
The pathogenesis of leptospirosis is the same in cases of sickness, vicious serovars of leptospir.
