Klishovy visipny typhus pathogenesis. Rottensive fever, symptoms and symptoms

Zagalna characteristic .

In natural minds, rickets are spared in bloodthirsty arthropods, in a number of wild (gryzuni and other creatures) and domestic animals (great horned thinness, dogs), as well as in humans.

In arthropods and ridge creatures, ricketsiosi develop against latent infections in vigilantes, but at the same time they are susceptible to lethal forms. In people ricketsiosi, as a rule, they have a very hot disease with the development of multiple vasculitis and thrombovasculature of other vessels of the developmental systems and organs, often with diseases of the central nervous systemі characteristic hemorrhagic visipom. Latent forms of Rickettsial infections are also promoted, as they appear serologically.

All zoonotic ricketsiasis are typical natural-vognischevny infections, nosoareal of which are caused by factors of the early middle, widespread sensitive creatures and blood-sour arthropods. Enzootic intermittent rickettsioses can cause epidemiological significance in times of consumption on the territory of non-immune individuals, so that they become infected through the bite of infected blood-bearing arthropods.

Ricketsiosi are widely expanded. Children from them are seen everywhere, for example Kul-likhomanka, they are encouraged to be promoted in quiet lands, de landscape-climatic minds, they took the form and appearance of natural conditions of infection. A significant increase in the stench was taken away in the lands with a hot climate.

The diagnosis of rickettsioses is based on a complex of epidemiological and clinical tributes. Great importance in the development of rickettsioses and the detection of abortive and latent forms of infection may be serological methods of dosage - RSK, RPHA, reaction of agglutination of rickets (PAP), RIF.

value .

Synonyms: tick rickets, tick typhus fever, tick typhus Go away, typhus typhus, typhus typhus Siberia.

Viscous typhus of Pivnichnoy Asia - hospitality of good natural disease in the region of transmucosal rickettsiosis, which is characterized by the appearance of the primary affection, hot reaction, maculopapulogenous disease

Historical views .

Khvoroba was described by E.I. Millem in Primorye in 1936 r In detail etiology, epidemiology and clinics were introduced in 1938 by special expeditions under the guidance of E. N. Pavlovsky. O. S. Korshunova's visions in 1938 with the cytoplasm of necrotic vognisch clines on a sick man's skin, like a cinnamon vine for the wetting of the oxo clays (Yatsimirskogo-Krontovskaya M.K., 1940).

Ethiology and Epidemiology .

Fetus of tick rickettsiosis RickettsiaSibirica to be related to the family Rickettsia, family Rickettsiaceae The similarity with the smaller rickettsiae, multiply in the cytoplasm and nucleus of the uterine cells.

In the midst of the seizure of the circulation of the animal, there are among the wild sowers and the ixodic cliffs ( Dermacentor, Haemaphysalis, Ixodes) - natural and main reservoirs R. sibirica... Clients have a trans-phase and trans-phase transmission of rickettsia. Infected people with clichus typhus are seen in natural habitats through the bite of infirm cliffs, and rickets occur in slopes.

Typhus typhus is seasonally ill. The maximum congestion is promoted to attachment and on the cob of lithium, which is summed up by the period most active klіshіv. Eight mighty other cause of illness, which is the beginning of another generation of arthropods. Sporadic ailments are made more importantly by the workers of the Silk state dignity. The distribution area of ​​the common typhus typhus extends from the Urals to the shores of the Pacific Ocean, including Dalekiy Shid, Transbaikal, Siberia, Altai Territory, Kazakhstan and Kyrgyzstan, as well as a part of Mongolia.

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At the meeting point of the infection, the first fault is the ignition reaction of the schoolchildren with regional lymphadenitis. Zbudnik vprovadzhutsya in the endothelium of dry ships, wicked in them fired up snakes. At the same time, proliferative processes overwhelm the destructive development of endoperivasculitis, which explains more lightly overwhelming incidence of typhus typhus. Rickettsiemia and toxinemia in case of clit rickettsiasis reduces symptoms of intoxication to the body.

key picture .

The incubation period is 3-7 days. If you are sick, you have to have a chill: there is a chill, the temperature rises quickly to 39-40 ° С. myazovykh boliv, Eat your appetite. It is not uncommon to refer to the hypothesis of revealing, shia, mucous membrane of the ziva, as well as the enanthem.

In the early period of incubation on the mice bite on the critical parts of the body (hairy part of the head, shoulder, shoulder girdle), the first symptom is the first, which is a painful infiltration, a slight painful toe. At the center of its growth there is a necrotic scorinka of dark brown color, along the periphery there is a red rim of hyperemia. Infiltration reaches 1-2 cm in diameter. The feisty remittance, earlier than the post-mortem type, is trivial in the middle 8-10 days (inodi 20) and ends politically. Falling from the turn of the disease and intoxication develop easily, average gravity and the importance of the formation of tick rickettsiosis.

spend in classy paintings ailments є symptoms of a lesion of the nervous system in vigilants in a lax, in one painful headache, in pain in the muscles and across. On vidminu from epidemic typhus with ticks statustyphosusВідсутнє. Meningeal symptoms appear. Conjunctivitis and scleritis, bradycardia and hypotonia are indicated.

A persistent symptom is a visip, which appears on the 2-5th day of ailment. Most of the ailments have a sprinkling of tulips, and then they expand on kintzivki, de localize very importantly on the extensor surface and in the circumference of the slopes. With a ryasny visipannya element, the visip can be found on the faces, lobes, pidoshes. Visip develops a polymorphism and may have an important roseolous-papular character. More important recession of ailments is supervised by hemorrhagic viscera. Through a few days a visip step by step zgasaє, you can find it in the region lower kintzivokі children from convalescents; On the other hand, the borax of pigmentation was trivial to pick up on the edge of the elements.

In the blood, there is a small amount of leukocytosis, lymphopenia, SHOE improvement. Zakvoryuvannya good, relapse and do not be spared.

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Specific diagnostics of pure culture transmission R. sibirica from the blood of the sick to the vicarians guinea pigs(Scrotal reaction). Serological diagnostics is helpful to seek the help of RSC due to the availability of the whole antigen R. sibirica... Diagnostic titers are not high (1: 40-1: 60). The hospitality period for the highest period of hemagglutinins (1: 800-1: 13, 200) has positive results and yes RNGA. The Weil-Felix reaction with the OX19 antigen, positive in 80% of ailments, can be used as an additional method.

Differentiation of mice rickettsiosis from epidemic typhus, Brill's ailment, lemongrass typhus and other rickettsioses from the group of mice rickettsiosis from the group of mice rickettsial fever is carried out.

Likuvannya and prophylaxis .

Treatment is successfully carried out by antibiotics of the tetracycline series in the hospital. The order of antibiotics will become symptomatic.

Prophylaxis є the hijacker is attacked by the cliffs.

value .

Synonyms: mid-sea cliffs are feverish, prickly feverish, Carducci-Olmer's ailments, typhoid fever.

Marsel'ska fever ( Ixodorickettsiosismarseliensis, Febrismeditterranes) - gostry transmisive zoonotic rickettsiosis. It is characterized by a good interruption, along with a generalized vasculitis, manifested by a warm, hot camp, a manifestation of the primary affection and maculo-papular enlarged exanthema.

Historical views .

Zagvoryuvannya vper described Conor, Bruck in Tunis in 1910, I called it "prischevaya fever". An analogous clinic with the so-called canine ailment was described D. Olmerі J. Olmer in Marseille in 1928, when the term "Marseilles' feverish woman" was used in literature. U 1930 p Durand, Conseil in Tunis they brought the role of a dog mite Rhipicephalussanguineus in transmission of infection, and Blanc, Caminopetros(1932) set up a transovarial transmission of the pupil at the cliffs.

Zbudnik of the Marseilles feverish woman Caminopetros(1932), and describing Brumpt (1932).

Ethiology .

The library of the Marseilles feverish woman - Dermacentroxenus conori - is all the power that rules the rickets for Dermacentroxenus. Reproduce in cytoplasm and nuclei of uterine cells. Immunological proximity D. conori from the patriarchs of the feverish fever of skeletal gir and pivnichno-australian clichus typhus. Described by geographic shtami D. conori, Scho viklikayut podbnі to Marseilles feverish envy.

Epidemiology .

Lyudin є Vypadkovym Lanka in the lantsyuz circulation D. conori... Win infected with Marseilles fever, if attacked and bitten Rh. Sanguineus, When sieve cells are squeezed out on the skirts, on the other side - when the inflated tissues of the carriers are introduced on the mucous membranes. The receptivity of people up to D. conori apparently not visually in the majority of groups.

Sickness is sporadic in nature, epidemiological sleepers are not. The transmission of infection in the paths of health extends throughout the whole fate, in areas with a small climate there is a growing peak of sickness, dressings with the maximum activity of carriers.

The Marseilles' feisty woman is widened in the lands with warm and hot climate. Reorganize in the basin of the Middle-Earth Sea (in Portugal, Spain, in France, Italy, Morocco, Tunisia, Algeria, Tripoli, Arabian Republic of Egypt), in the territory of the Caspian Sea of ​​the Russian Federation in the territory of the Caspian Sea

pathogenesis i pathological anatomy .

Rickets, which penetrated into the human body through the skin of a mucous membrane, multiply in the reticuloendothelial cells and when they go into the roof of the house, sounding specific endotoxemia. In the midst of penetration of rickets, the characteristic fiery-proliferative infiltration develops with the onset of necrosis and virazkoy - the first afect ("chorna plyama").

Endotoxin rickettsia morphological changes in nerves, heart-vascular, endocrine and other systems. In vessels, the proliferation of endothelium is prevented and the infiltration is expanded by lymphocytes, monocytes, and later by polynuclears, in the rest - endoperivasculature. The experience of the sudin shkiri is manifested in the viglyad of the characteristic exanthemi.

key picture .

Marseilles' feverish woman is good-naturedly ill. The incubation period is from 3 to 7 (from 1 to 18) days. An ear of fever gostry: there is a short-hour chill, the temperature rises quickly to 39-40 ° C, depending on head bill, General weakness, sleeplessness, pain in the muscles and transverse areas. In small cases, there may be a short-term disorder of the symptoms, a meningeal symptom complex. Zagalnotoxic manifestation is prevented by stretching a hot airborne period, the triviality of which varies from 10-14 to 22 days. Likhomaniac appeals to the remitting nature.

When you look at ailments in the first days of ailments, the hypothesis of exposure and in'єktsia of sclera is indicated; most of them have the first affect in the case of rickettsia. The primary effect of rosetting occurs in the middle of the bite of the mite on the screen of the closed windows, especially on the lower ones, and it is a small wrinkle with a diameter of 2-5 mm on the hyperemic infiltrated center of the window. In some cases, there are 2-3 primary faults. The scab is taken by a stretch of a hot, hot period and fall on the 4th-5th day of apirexia from the statements of a lower, one pigmented scar.

In cases of vascular rickettsia through the mucous membranes, conjunctivitis or keratoconjunctivitis develops, which is superimposed on chemosis.

Regional lymph nodes often improve, sore. Zvorotny development of lymphadenitis grows up to the ear of the ear.

On the 2-3rd day, a fall on the shkiri of revealing, tuluba and kintzivok, including valleys and papular surfaces, there is a great roseolous or papular-papular visip, as after 2-3 days the papulous papulosis appear in two or three days. 5 to 10 mm. Visip siberian until the end of a hot period and step-by-step in the period of apirexіі, to lose the pigmentation in a stretch of 2-3 times (before the miscellaneous).

damaged function heart-vascular system wake up and come to see the bradycardia. In some cases, there are tremors of movi, kintzivok, madder and meningism.

Splenomegaly spontaneously spontaneously, little by little, the stove is reduced. In the blood, often leukopenia with common lymphocytosis. SHOE zbіlshena.

It’s easy, as a rule, the Marseilles feverish woman doesn’t allow her to end up.

diagnostics that differential diagnosis .

Diagnosis is established at the presentation of epidemiological, clinical and laboratory data.

More important is the significance of the appearance of the primary affection, regional lymphadenitis, enlarged maculopapular vispus. Tsya triada led to a feverish man of Marseille from those who got sick, but they passed through the visips.

Specific diagnostics of the field in the seen culture of rickets with intraperitoneal infection of guinea pigs and serological dosages(RSK and RPHA with antigen purification D. conori).

Differentiation of Marseilles fever is necessary for ricketsiasis, typhoid and paratyphoid fever, hemorrhagic hot spots, medicinal dermatitis.

Likuvannya and prophylaxis .

The basis of lіkuvannya є stasosuvannya antibacterial drugs with counterparty activity. Tetracycline, macrolide, rifampicin, fluorochinolone, levomycetin are introduced to them. Tetracycline should be given 0.3 g 4 times a day, doxycycline - 0.2 g per first dose, dal - 0.1 g twice a day. Erythromycin, sumamed, rulid vikoristovyuyut for the treatment of vaginal and children for extravagant schemes. Rifampicin is given at 0.3 g per dobu, fluorochinolone - in average therapeutic doses of two per dobu, levomycetin - 0.5 g 4 times per day. Antibiotics take up to 2-3 days of normal temperature. In the case of hemorrhagic manifestations, preparations of calcium, vikasol are indicated. In more important cases, corticosteroids are indicated, if necessary - analgesics, antipyretics, sedatives.

Antiepidemic go in the middle of the Marseilles fever, to be built in the main to the end of the class Rh. Sanguineus for the help of acaricides. Great importance is the veterinary observation of dogs, looking at them not less than 2 times at the risk of wandering creatures. Specialist prophylactic polyagaє at vicorian repellents.

value .

Synonyms: gamasic rickettsiosis, rickettsial wispa. Smallpox rickettsiosis is a good transmissive rickettsial infection. It is characterized by a specific intoxication, a common fever, the manifestation of the primary defect and a specific papulo-vesicular visipus.

Historical views .

Zahvoryuvannya vper is described in 1946-1947 pp. in the outskirts of New York and in order to look at the similarities with the winters, I would call them Rickettsial wisps ( rickettsialpox). In the 50s, pp. The XX century became ill in other regions of the United States, in Central and Eastern Africa, in Uzbekistan, Turkmenistan and Kazakhstan.

Ethiology and Epidemiology .

Smallpox rickettsiosis RickettsiaakariHuebneretal, 1946 p. Dermacentroxenus... Behind his powers, the zabudnik is close to the first rickets from a group of clamorous, feisty feisty women.

Lyudin becomes infected with smallpox rickettsiosis in epizootic regions as a result of attack and contact with infirm gamase cells.

Infertility in sporadic vyglyadki vіdіvayutsya in mіskіlі sіlskie midwives stretching out the worms with the growth of indigestion in the period of activity of clams (grass-serpen). Often the choloviks are ill.

Ospovidny rickettsiosis of vidomy in Pivnichniy America, Central and Pivdenniy Afritsi, in the pivdenniy regions of Ukraine.

Pathogenesis and pathological anatomy .

Rickets, having penetrated into the human body when bitten by a mite, multiply in the reticuloendothelial cells, run out and go to the roof, viciously specific endotoxemia and morphological changes in the organs of the vessels. In the midst of penetration of rickets, an igniting reaction develops with lymphangitis and regional lymphadenitis - the first problem.

Sudden lesions are observed in perivascular infiltration of lymphocytes, proliferation of endothelium. Sudinni rozladi lie in the basis of the development of exanthemi.

key picture .

The triviality of the incubation period with smallpox rickettsiasis has not been established for sure, and it will become, mabut, close to 7-10 days.

Even in the incubation period (5-7 days before the development of the intoxication syndrome), an igniter appears in the middle of the bite of the bite, a fiery one for a dot of infiltration with a size of 1-2 cm in the eyes of the papuli. Then the papule is transformed into a gliboko penetrate into the bulb's skin, with wrinkling and psychoanalysis of a black scab. The primary effect of growing up is to start appearing on the dark parts of the body, or perhaps to the type of the hands, shia, face, and to join the regional lymphadenitis. The first afect is saved 3-3 1/2 performance; on zagєannі yogo zalishaєtsya lower hem.

After 5-7 days, if you have a primary problem, the ailments develop intoxication syndrome, a fever (39-4 ° C), chills, headache, sleeplessness, pain in the muscles and back. A lihomaniac of a remitting nature takes on high numbers for 6-7 days and ends in critical or critical low temperatures. In 2-3 days of a hot period, macular-papulogenous or erythematous viscosity appears.

After 1-2 days, the visip passes into the vesicular with the diameter of the elements up to 2-10 mm or more. Visip expands throughout the whole body, including the appearance, and some of them are also hollow and pedal surfaces. Elementi visipu is unclear, it is easy to fall into a pidrakhunka. In small vipads, visipu elements may not be transformed into vesicles, but rather simulate nodal erythema. Nadal vesicles are pissed, and on the other side of the day there are little bitches of black color, they fall on the 4-10th day of ailments without confirming the scars.

Signs of the defeat of the heart-vascular system i internal organs call me insignificant.

In the hemogram, insignificant leukopenia, neutropenia can be detected from the destruction of the leukocyte formula, thrombocytopenia. SHOE has been additionally promoted.

Zakvoryuvannya protokє without acceleration and end to oduzhannya.

Diagnostics and differential diagnostics .

Clinical diagnostics is based on a complex of epidemiological and clinical tributes, among which the most significant can be found in the primary problem with the further development of fever and vesicular exanthema.

Laboratory diagnostics is confirmed for the help of seeing rickets culture (on chicken membranes, in case of infected guinea pigs), as well as through the use of serological methods (RSK with rosin antigen R. akari). I'll look at antigenic spores R. akari with other representatives of pidrod Dermacentroxenus Serological reactions should be carried out in parallel with decilcom antigens.

Differential diagnostics of smallpox rickettsiosis is carried out frequently among other clichorous feverish feverish females and vitrioids.

Likuvannya and prophylaxis .

Vikoristovuyutsya etiotropny kosti, scho include old tetracycline or chloramphenicol in extra doses, by stretching out the hottest period and the first pressure of aprexia. You can also come in to see the secondary infection.

Pіvdenno-African clіschivі feverish woman

value .

Pivdeno-African clichus fever is a transmural clichus of zoonotic rickettsiosis. Against a typhoid fever in a viglyad, a fever-like fever is evident and often a roseolous-papulosic viscera.

Historical views .

The history of illness was described for the first time in Angola in 1911 Sant "Annaі Mcў Naught (tick-bitefever). Ailment is seen and described Pinkerton in 1942 p

Ethiology and Epidemiology .

Zbudnik of the pivdenno-african clichy of the feverish woman - D. rickettsi var. pijperi Pinkerton, 1942 p similar D. conori, However, in convalescents, homologous immunity is promoted with preservation of dryness before infection D. conori.

Yak in case of other illnesses from the group of clams of plumy fever, a natural reservoir of rickettsia Amblyommahebraum, haemaphysalisleachi that іnshі.

Lyudin becomes infected in the middle of rickettsiosis, when attacked by infirmities. Get into love with spontaneous vigilance during the hot weather in Angola, the lower regions of Holy Africa (from Misu Kei to Kenya).

Pathogenesis and pathological anatomy .

The pathogenesis and pathological anatomy of this rickettsiosis are similar to those in Marseilles fever.

key picture .

The clichés of the African-American clichés of fever in the wilderness of the severity of the affliction may be very similar to the cliché of the Marseilles fever. The incubation period is very close. When important i medium-heavy overrun Fever on the cob period grows badly, with a bit of a chill, temperature changes up to 4 ° C, this means an intense headache, sleeplessness, it is possible to catch symptoms, anxiety and malnutrition. temporal fever take a stretch of 10-12 days.

If you look at ailments in the first few days of ailment, you can see a first attack, a symptom of a bite of a tick, in a painless worm infiltrate with a size of 2-5 cm, with a central necrosis of a dark color or a regphonar. On the 5-6th day, roseolous visip is characteristic, which passes nezabar to maculopapular crimson-chervona exanthem. The elements of the visibility are widened in all the way, not very hostile to the valleys and surfaces. When the temperature is low, the visibility is noticeable, overflowing with pigmentation.

Easy forms of discomfiture are characterized by non-trivial feverishness, mild swelling by manifestations of intoxication, manifestation of the primary affection, small papular vispoma on tulub and upper ones. In a number of vipadks, visip is wide. Prognosis for all forms of ailments.

diagnostics .

Clinical diagnostics of ailments is based on epidemiological data and the results of clinical diagnostics of ailments. Differentiation from an African-American cliché of a fever from a Marseilles fever is important through the great similarity of both fever. Isnu pripuschennya, scho pivdenno-African fever є variant of Marseilles.

Specific diagnostics is carried out for the additional infection of guinea pigs using serological methods (RSK).

Likuvannya and prophylaxis .

Treatment and prophylaxis are identical to those in the case of other transmural ricket diseases.

Typhus typhus from Pivnichnoy Asia