Первый слайд презентации
LEPTOSPIROSIS ( L. ) -canicola fever, harvest (mud) fever, the 7- the day s fever The a cute zoonotic disease is characterized by an intoxication and myalgia ( in a s eptic stage ) with sub - sequent d amage of kidneys, liver, nervous and vascular systems and possible development of a hemorrhagic syndrome and icterus ( in an immunological stage ) - 1886 - А. Weil described 4 cases o f leptospirosis from group of icteric disease s for the first time - 1888 – W.P. Vasiliev described 17 cases of leptospirosis - 1915 - А. Inado and со -authors revealed of the infectious agent of th e disease also described it s morphology
ETIOLOGY : The infectious agent – leptospira ( F. Spirochaetacea K. Leptospira ) a lso is subdivide d on pathogenic for the man ( L.icterrogans ) and saprophytic ( L. Biflexa ) Nowadays is revealed more 200 serotypes, united i n 23 serogroups L. are t hin ( 0. 1 – 0. 2 microns of width. ) spirally arched cells 3 - 30 microns of length with a plenty of the bends (more than 20) with the twirled ends having flagellae, are mobiling. Gram negative, but are staining on Giemsa have pink colour, and at are staining silver have black-brown colour.
Optimal conditions of the growth on the medium with addition 5 - 10 % s erum of the rabbit : temperature + 28- 30 d. C and рН 7. 0 – 7. 4 ( from 5-10 of days to 3-4 weeks. ) Survive at low temperature about 8 months, in fresh water from 1 to 30 days, in wet ground about 200 days, but in dry ground only 2- 3 hours ( hydrophilic ) L. fast inactivated by desiccation, low рН, disinfectants, at pasteurizing and boiling. At destruction L. is secret ed endotoxin with pyrogenic, skin- necrotic, lethal properties The main pathogenic factor - adhesiveness concerning epithelial cells and erythrocytes with use plasmocoagu-lase, fibrinolysinum, hemolysin, V- antigene.
L. have 2 antigenes: - genuspecific (deep) - and typespecific (surface). During illness will be derivated agglutinins, precipitins and complement - fixing of the antibodies EPIDEMIOLOGY: - wide-spread everywhere except for the northen districts and deserts of the earth The main source - wild small rodents ( mice, hedgehogs, rats ect.) and home animals ( cattele, pigs, dogs, rats) Modes of transmission: - nutritional ( nutrition, water, bathing ) - contact through a broken skin and mucous
Seasonal rise - summur - autumn ( superactivity rodents, frequent contact s of the people to FRESH water) Sporadic case rate - the year round Susceptibility - general, but more often the teenagers and adult men are sick Immunity after illness - proof, but homologous, therefore repeated diseases are possible!!! T he most important pathogene s anicteric of the forms of leptospirisis : - L. He b domadis - Japanese the 7- th day s fever - L. grippotyphosa - water fever - L. australis - Australian the 7- the day s fever - L. canicola - canicolosis - L. autumnalis - autumn fever - L. pomona - illness swine-herd
The main pathogene of an icteric leptospirosis - L. icterohaemorragie ( but the icteric form may be at any se vere leptospirosis !!! ) PATHOGENY: 1. Implantation through a injure skin and mucous, colonize and intensive reproduction in a place of implantation with the subsequent advance leptospiras on lymphatic vessel s without a lymphangitis, but with a lymphadenitis (increase of lymph nodes ), which, however delay their advance can not 2. Infiltration in blood flow with a dissimination in a liver, kidney s, the paranephroses, lungs, spleen, in a CNS Clinical this stage does not appear! But they are detected in CSF by a method PCR )
3. Reproduction in these bodies and secondary bacteriemia, which results in appearance of a SEPTIC phase of illness, at which toxic the syndrome is prevail. Duration of this phase is 2 - 7 days, then the bacteriemia terminates and the state of the patient on short time is improved (but maybe and not vary) 4. Then the IMMUNOLOGICAL phase of illness stipulated by appearance of antibodies in a blood and sign s of a d amage of the following bodies starts: - l iver - mesenchymal hepatitis without or with an icterus - k idneys - acute nephrosonephritis - С VS - hemorrhagic syndrome, DIC - CNS - meningitis or meningo en cephalitis The patient s free yourself from leptospira about 2 till 6-th week. With urine maybe allocated about 40 days! !
Transmission L. from man to man i s not registered ! CLINIC: ( incubation interval 5 - 12 days ) Septic stage: ( 5 - 7 days ) - a cute beginning : chill, rise of temperature up to 39 - 40 d. C - myalgia ( of muscles legs, neck, back, abdomen ) - s trong headache - conjunctivitis, hyperemia of the face and breast - e ruption on extremities and trunk with 3 for 10 days of illness ( roseolous, spotty, nettle rash for 20 - 40 %) Immunological stage: - n ausea, vomiting, abdominal pain - p ositive sign of a tapotement of kidneys - s plenomegaly (less often hepatomegalia)
a ppearance meningeal of a syndrome with a pleocytosis and b y increase of protein in CSF h yperleukocytosis in a blood hyper - ESR (40-65 mm /h ) - remittent a fever with possible relapses u p to 2 - 3 times ) Forecast favourable, but are possible complication : nephritises, pneumonias, iridocyclites etc. CLINIC of the ICTERIC FORMS of leptospirosis : Septic stage - as at anicteric the forms!! - w ith lowering of temperature occurs icteric c olouring of scleras and skin, dark colour of urine - t he liver and spleen is enlarged - sign s of a nephrosonephritis: albuminuria, hematuria, oliguria, anuria ( main cause of death of the patients!! )
- i ncrease conjugated (direct) bilirubin at m oderate rise А L Т (are not higher 2 - 4 norms) - i ntensifying an intoxication, nausea, vomiting, - p ain in the right upper quandrant of the abdomen For 30 % of the patients the icterus i ncrease, joins h emorrhagic syndrome with transition in DIC - t he syndrome, i ncrease nitrogenemia and anuria with subsequent b y death of the patients!!! At favourable current - from the end the 2 nd week t he state is gradually improved, but can appear l ate complications as : - paresis outside muscles e yes, - iridocyclites, uveites, neuritis visual n erve, - pneumonia etc.
LABORATORY DIAGNOSIS: - m icroscopy of a blood in a dark field ( positive to 10 %) m icroscopy smears from bodies perished painted b y method of silver plating seeding of a blood to the 7 th day of illness (in a septic phase) - b iological test AGGLUTINATION TEST w ith LISIS (since the 3 th day of i llness) - PCR - blood, urine, С SF - seeding of urine, CSF, bioptats of bodies with 10 - 18 days i llnesses ( in an immunological phase) DIFFERENTIAL DIAGNOSIS: anicteric of the form : influenza, epidemic typhus, serous meningitises, rickettsioses, brucellosis, tularemia, ornithosis, sepsis etc.
- t he icteric form: virus hepatitises, yellow fever, malaria, visceral leishmaniasis, yersiniosis, pseudotuberculosis, hemorrhagic fevers etc. TREATMENT: 1. Anti i nfectious therapy: - penicillin in a dose 8000 - 33000 IU / kg q4h IM,IV - tetracyclin 10mg / kg q6h PO - doxycyclin 2 mg / kg q12h PO (About 2 - 5 days of normal temperature!!) 2. Antiferment therapy 3. Antifibrinolytic therapy 4. Correction of a hemorrhagic syndrome ( coagulopathy or thrombocytopenic )
- a t acute renal unsufficiency – diuretics ( a t once osmotic, at anuria - saluretics, but if l evel of a urea of a blood more than 50 - 67 mmol/l at once h aemodialysis!!!. - t reatment hepatic of unsufficiency - t reatment of a meningo en cephalitis - s ymptomatic therapy The immunoglobulin will not be utillized now! PROPHYLAXIS: Veterinary measures - revealing, sanitation or l iquidation of the sick animal s or carriers, protection r eservoirs from pollution by fecal mass and urine of the animal s Medical - sanitary enlightenment and vacci nation u nder the indications only in groups of hazard
ANTHRAX – A. T he a cute infectious zoonotic disease described by development for the man of a serous -hemorrhagic and necrotic inflammation of skin and mucous (99 %) with a possible generalization of the process (1 %) Included in group of the especially hazard infections The mankind knows for a long time under the name "the « p ersian " or " sacred" fire - 1780г - С.С. Андриевский, studying large flashout of this disease in Siberia, has assigned to it s the name "«malignant anthrax" and in experience of an autoinfection has proved i dentity А. of the man and animal - 1849г - Pellender has detected of the A. in a blood t he sick animal - 1857г – F. Brauell has detected it in a blood of the man - 1876г – R. Koch - has allocated pure growth А.
ETIOLOGY: Bacillus anthracis - large rod with equal edges 3-8 microns of length and 1-1. 5 microns of width. In smears it is found out single, by pair s or chains Gram (+) T he v egetative form s А. maintain boiling no more than 1 minutes, disinfectants are inactivated in some minutes, in corpses survive from 2 to 7 days. The spores in ground are saved by years, but at boiling perish through 10 - 15 minutes. Dry fever and disinfectants them inactivate only in some hour s. The vegetative forms produce EXOTOXIN, consisting from a lethal toxin, hydropic factor and protective of an antigene Thermolabile encapsulated protein antigene - h as antiphagocytic activity
Thermo s table s omatic polysaccharide the antigene is durably saved in corpses (is discovered by response of a thermoprecipitation on А scolli ) EPIDEMIOLOGY : a main source - sick animal s, for which the disease proceeds in the septic form and all their bodies and the se cre tions contain of agents all period of illness!! The herbivorous animal s ( cattle, goats, sheep, camels, horse s, the deers etc.) sick often. Less often sick pig s, dog s, cat s, wild predatory animal s for which А. can proceed in the localized form with a defeat of a mucous oral cavity and lymphadenitis, but the dermal forms for animal DO NOT DEVELOP! Animal s more often sick since June to September, infecting : - c ontact way (through a grass, hay, water) - t hrough milk (at a feeding of descendants)
- eating corpses perished animal s (predators) - t hrough stings of insects ( gadflies, horseflies, fl ies ) Auxiliary source - GROUND, in which the A. agent support a population by chang ing of periods vegetation and sporulation The people are infecting: 1. By contact way (main way of infection ) - m aintenance the sick animal s - 50 % - a t processing animal skins and fur - 27 % - a t contact with infected by meat - 21 % - a t processing a wool - 6 % 2. Through stings of insects - ? 3. Nutritional way (crude force - meat, milk) - 3- 4 % 4. Aerogenic way (USA)
Cases of man-to man transmission i s not registered ! More often are sick cattle-breeder. The case rate both home and professional registers PATHOGENY: Implantation of the A. agent in skin (through microtrauma) with by appearance through 2 - 14 days in penetrating beds of a derma center of a hemorrhagic-necrotic inflammation with by the expressed edema around of its A lymph drainage from an anthrax not disturbed, that results in appearance of a lymphangitis and regional lymphadenitis with a serous- hemorrhagic inflammation From lymphatic nodi the A. is capable to penetrate into a blood with appearance of a bacteriemia or development of the septic form of disease ( secondary or primary)
3. The primary anthracic pneumonia does not develop! At aerogenic way of infection of spore s will penetrate in l ymph atic nod i of a mediastinum, and then in a blood, causing h ematosepsis about the subsequent lesion lungs 4. Of a primary anthracic defeat of an intestine is not observed. Penetrated from an intestine of spore cause a mesadenitis, then hematosepsis, which results in a defeat of an intestine. 5. Edema brain, lungs, cerebral coat s, ulcer in an intestine - consequence of a toxemia at an anthracic bacteriemia 6. Main reason of death of the patients - bacteriemia - toxemia - toxi co -infectious shock. PATHOMORPHOLOGY : F or perished from А. of the patients in bodies the sign s of a serous -hemorrhagic inflammation with a destruction and hemorrhagia are found out. The blood darkly red, is not coagulat ed. V eins are over full ed by a blood
CLINIC : (incubation interval from 2 about 14 days) The localized form of disease: in a place of implantation of the A. there is a stain with an itch, which is fast transmuted into a vesicle (some hour s), and then in a small ulcer with a plentiful serous -hemorrhagic secretion. On edges of a ulcer there are new bubbles ( crown Шоссье), which after destruction enlarge a size of a ulcer. The increase of a ulcer occurs about 5-6 days of illness, but in 1-2 days the bottom of a ulcer at centre dries up and is coated with a brown crust, which since 2 week is transmuted into black colour. Bottom of a ulcer painless at intubation. The casting-off of a crust occurs since 3-4 weeks. After itself leaves seams from inappreciable up to penetrating. More often ulcer single ( but can be multiple) are localized on open sites of a body
Simultaneously around of a ulcer the edema considerably exceeding size of a ulcer is shaped. At tapotement of area of an edema is defined jelly tremblihg ( s-m В.К. Стефанского) Regional the lymphadenitis at А. is always, but lymph atic nod i painless, not suppurate with sluggish regression. The toxi-infectious syndrome occurs for 2-3 days from a beginning of illness: a malaise, weakness, headache, giddiness, lowering of appetite, fever in limits 37,2 - 39 гр C. Duration of this syndrome 5 - 7 days. Then the fever is critically reduced also state of health is improved. The infrequent forms А. : edematous, erysipelatous, bullous - on a place of implantation not an anthrax, and edema and surface bubbles is shaped
The generalized form А. - The incubation interval can be reduced about 1 day Acute beginning with the expressed toxic manifestations (fever, headache, weakness, vomiting expressed hypotonia, tachycardia with an arrhythmia, thread pulse, expressed sweating,ect. ) Early manifestations of a lesion lungs ( rhinitis, tearing, at once dry cough, then with serous or serous -hemorrhagic sputum, dyspnea, pain in a chest, common cyanosis. X-ray sign s of a bronchoadenitis,, exudate in pleural cavities, pneumonia There are colicy pains in a stomach, liquid sanguinous a stool less often, which is replaced paresis of an intestine, the peritonitis and necrosis of an intestine is possible The general analysis of a blood, practically, does not vary!!!
Слайд 57: Anthrax : blood clot passed from anus
Chest radiograph showing widened mediastinum resulting from inhalation anthrax.
Слайд 59: Inhalational anthrax initially causes influenza-like symptoms, which progress to high fevers and severe respiratory distress. Typical findings on chest x-ray include a widened mediastinum caused by hemorrhagic necrotizing mediastinal lymphadenitis and bilateral pleural effusions. Pneumonic infiltrates are uncommon
- t he patients durably save consciousness in despite of gravity of a state, except for cases complicated by a meningo en cephalitis - t he illness by a toxi-infectious shock with the expressed violations of a hemodynamics, hypoxia, edema and bloating of a brain is ended Lethal outcome more often on 3 - 5 days of illness!! THE DIFFERENTIAL DIAGNOSIS: The dermal form (nonspecific anthrax, plague, t ularemia, erypsipelas, malleus etc.) The generalized form (se vere influenza, pneumonia, plague, fulminant sepsis, hemorrhagic fevers, mesenteric thrombosis of vessels, peritonitis, hypertoxical forms of a dysentery, septic form of a salmonellosis etc.
LABORATORY DIAGNOSIS - contents of pustules, discharge of an ulcer, blood, urine, sputum, stool, vomitive masses, material autopsy. 1. Microscopy after colouring on Gram, Rebiger ( detection of sheaths) IFT – immun fluor.test (answer in 1-2 hours) 2. Bacteriological research 3. Biological test (at negative bacteriological research ) 4. Immunological research ( CFT, IAT, ELISA ) 5. IC test with antraxin - infiltration more than 3 sm (+) 6. Response of a thermoprecipitation on Ascolli ( the corpses of animal or man) TREATMENT only in an infectious hospital Anti-infectious therapy: - penicillin G – 10000 – 20000 IU kg q4h IM - ampicillin 20 – 40 mg / kg q6h IM
- tetracyclin 8 - 10 mg/kg q6h РО doxycyclin 2 mg/kg q12h РО chloramphenicol 8-10 mg/kg q6h РО, IV ciprofloxacin 0. 75 g q12h РО cephalosporins 1 - 4 generations (in a spare) 2. Immunoglobulin anti А. - IM in a dose from 20 mls up to 80 mls ( local forms А. ) and up to 400 mls ( at a generalization) 3. Bandages on a ulcer with antibiotics, the surgical treatment of ulcers is prohibited ( threat to a generalization) 4. Desintoxication therapy 5. Adequate hydration, aeration, feeding tube or parenteral power supply (at serious current) 6. Glucocorticoids - at a toxi-infectious shock 7. Antiferment drugs and antioxidants
PROPHYLAXIS : Obligatory hospitalization of the patients ( EHI ) Overseeing contact s within 14 days Emergency chemoprophilaxis contact s at confirmation of the diagnosis for the patient Immunization of groups of hazard with the human anthrax vaccine Revealing and hospitalization suspicious on diseas is А. of the persons in the center Discharge of the patients only after convalescence and obtaining 2 (-) seeding with an interval 5 days Burning of corpses animals died from А. and correct burial of the people ( d ry, raised site of ground with a layer of chloride lime - 10 sm above and under a corpse) Veterinarianal of a measure (concern only sick and perished animal s )