Tif - nothing but a violation of the mental state of man. But how is it caused? Bacteria cause disease Returns of raw tit. Epidemic suction tit: symptoms, treatment, prevention. Symptoms and the course of the disease of the bacteria cause a fee

A) low workplace lighting;
B) reading lying;
C) high illumination of the workplace;
D) reading sitting.
21. For the prevention of cardiovascular diseases, it is necessary to use ...
A) sports at the professional level;
B) optimal physical exertion;
C) rest lying;
D) board games.
22. Nutrition of patients with diabetes should be 5-6 times a day with restriction ...
A) carbohydrates;
B) water;
C) salt;
D) proteins
23. What should be the water temperature in the bath when bathing a child?
A) 33-35 ° C.
B) 37-38 ° C.
C) 43-48 ° C.
D) 30-32 OS
24. The causative agents of children's infections cannot be ...
A) Viruses
B) mammals
C) simplest
D) microbes
25. What disease gives a shortage of vitamin D?
A) Pellagra;
B) take-take;
C) rickets;
D) qing.
26. Select the definition of health recommended by the World Health Organization:
A) the implementation of biological and social functions by man;
B) vitality;
C) the state of full physical, mental and social well-being, and not only the absence of diseases and physical disadvantages;
D) The problem is recognized on time.
27. It does not apply to hygienic principles of hardening:
A) complexity;
B) monofactivity;
C) graduality;
D) systematically.
28. Improvement is customary to call a process aimed at ...
A) Return of Lost Health
B) adaptation of the body to changing conditions
C) the increase in human physical abilities
D) change of the reserve capacity of the body
29. Anaphylactic shock occurs more often when the patient is introduced:
A) blood-forming drugs
B) diuretic drugs
C) cardiovascular drugs
D) vaccines and serums
30. When attacking bronchial asthma, the sick child takes the position:
A) lying on the side
B) lying on his back with a raised lower end
C) Orel (sitting on the bed with lowered legs, relying about her edge)
D) sitting squatting
31. Indication to the closed heart massage is ...
A) complete absence of breathing
B) loss of consciousness
C) heart cuts less than 20 UD / min
D) full cessation of cardiac activity
32. After stopping the breath and cardiac activity, the main exchange in the crust of large hemispheres ...
A) continues within a few days
B) continues for 3-5 minutes
C) immediately stops
Continues for 30-40 minutes
33. Boiling linen, toys, baby dishes, patient scarletin, is ______ by disinfection.
A) mechanical
B) chemical
C) biological
D) physical
34. False cereal is most often developing for several ...
A) seconds
B) minutes
C) watch
D) day
35. Versh are not carriers ...
A) return title
B) Equal fever
C) infectious hepatitis
D) suction typhus
36. Entrance gates for the pertussis causative agent is the mucous membrane ...
A) stomach
B) esophagus
C) Nasopharya
D) intestine
37. To strong asthmogenic allergens among food products belongs ...
A) cabbage, carrots
B) eggs, milk
C) green apples, pears
D) sugar, cook salt
38. Preparations made of blood from the blood infectious diseases of people or animals are called ...
A) interferon
B) vaccines
C) serum
D) Anatoksyn
39. To products rich in vitamins A, include ...
A) crude grains of cereals, bean plant seeds, egg yolk
B) fish oil, butter, milk, egg yolk, liver, kidney, fish caviar
C) Cooking salt, canned meat, salted nuts
D) Rosehip, Cranberry, Black Currant, Cabbage, Lemons, Onions, Garlic
40. The process of resuscitation implies ____________ organism.
A) breathing normalization
B) improving performance
C) recovery of cardiac activity
D) recovery

1. What is such a digestion? a) pre-processing of food; b) Mechanical processing of food; c) Mechanical and chemical processing of food. 2.Kone

Does the body have food? a) building function; b) energy function; c) Construction and energy function. 3. Where is bile produced? a) in the liver; b) in the pancreas; c) in the stomach. 4. For infectious diseases of the intestine? a) liver cirrhosis; b) gastritis; c) dysentery. 5. Where does the digestion process begins? a) in the intestine; b) in the oral cavity; c) in the stomach. 6. How is the soft part in the center of the tooth? a) enamel; b) pulp; c) dentin. 7. Where is the center of swallowing? a) in the oblong brain; b) in large hemispheres; c) in the intermediate brain. 8.pysterry system consists of: a) from organs forming a digestive channel; b) from organs forming the digestive channel, and digestive glands; c) from digestive and allocation organs. 9. Scientific, studied the work of the digestive system: a) I.P. Pavlov; b) I.M. Sechens; c) I.I. Swords. 10. The source of the disease with worm diseases may be: a) non-wood fish, poorly roasted; b) poor-quality fish; c) non-freight products. 11. Where is the splitting of some proteins and milk fat? a) in the stomach; b) in the small intestine; c) in a 12-point intestine. 12. Where is the disinfection substance produced - lysozyme? a) in salivary glands; b) in gastric glands; c) in intestinal glands. 13. The function of the enzymes of the salivary glands is: a) the splitting of complex carbohydrates; b) splitting of fats; c) Split cleavage. 14. Where is the splitting of nutrients? a) in the stomach; b) in the small intestine; c) in a thick intestine. 15. What is the function of the enzymes of intestinal glands? a) splitting proteins, fats and carbohydrates; b) crushing of fats on the droplets; c) suction of splitting products. 16. Where is the absorption of water? a) in the stomach; b) in the small intestine; c) in a thick intestine. 17. The function of the nervous tissue in the intestinal walls: a) wave-like cutting of the muscles; b) produces enzymes; c) spends food. 18. What is the cause of salivation? a) reflex; b) chopping of food; c) Establishment. 19. What conditions are needed to split proteins in the stomach? a) an acidic medium, the presence of enzymes, t \u003d 370; b) Alkaline medium, enzymes, t \u003d 370 c) weakly alkaline medium, the presence of enzymes, T \u003d 370. 20. In which alcohol is absorbed in the digestive tract? a) in the small intestine; b) in the thick intestine; c) in the stomach. 21. Why are the rings in the oral cavity quickly heal? a) due to the weakly alkaline environment; b) due to the enzyme lysozyme; c) due to saliva. 22. Due to what is the suction of substances in the small intestine? a) long; b) the small intestine festive; c) a lot of enzymes in the small intestine. 23. Why do physiologists liver called food warehouse? a) produced bile and stored; b) regulates the exchange of proteins, fats, carbohydrates; c) Glucose is converted into glycogen and is stored. 24. What kind of gastric juice enzyme is the main and which substances he splits? a) amyloza, cleaves proteins and carbohydrates; b) pepsin, breaks proteins and milk fat; c) maltose, breaks fats and carbohydrates. 25. Why not digest the walls of the stomach? a) thick muscular layer; b) thick mucous membrane; c) Big abundance of mucus. 26. Branch of the gastric juice by the action of food in the oral cavity is: a) unconditional juice reflex; b) conditional reflex; c) humoral regulation. 27. Where the intestinal chopstick is inhabited, name it is valid. a) in the small intestine, help the cleavage of carbohydrates; b) in the colon, splits fiber; c) in a blind intestine, causes a disease of appendicitis. 28. Why do physiologists figuratively call the liver of the "chemical laboratory"? a) the harmful substances are neutralized; b) the bile is formed; B) enzymes are produced. 29. What is the importance of bile in the process of digestion? a) squabble proteins, fats and carbohydrates; b) neutralizes poisonous substances; c) crushing fats on the droplets. 30. What is the correspondence between the structure of the esophagus of its function? a) walls muscular, soft and mucous membranes; b) walls dense, cartilage; c) walls dense, the presence of connective tissue, inside the mucous.

In connection with the general symptoms of pathology caused by different pathogens and insufficient learning of these pathogens, the whole group of diseases called the typhoid. All these states are associated with high body temperature and impaired psyche against the background of pronounced intoxication. The typhoid is still traditionally called some diseases. In the English-language literature, typhoid is called abdominal typhus, sometimes refundable title. In Russian medicine, it is historically accepted to allocate rapid typhus, abdominal typho and returning typhus. The international classification of diseases belongs to these diseases, respectively, to rickettsios, salmonellosis and borroeliosis based on the excreted pathogen. For a long time, these diseases did not differ and only after the selection of Salmonelle in 1829, they decided on the abdominal typho, and in 1843 they decided on returning typho. Outdated title of typhoid - "rotten maritime" and "nervous maritime".

Typhus

There are several diseases of the rickettsios, from the causative agent, bacteria of Rickettsius to the rap typhus. Insect infection carriers, lice, fleas, mites and some mosquitoes. In the saliva and the insect hemolyimf contain these bacteria and during the bite they go to the person. Ubuys, as a rule, itchy and combing them leads to an additional invasion of the pathogen. The most famous epidemic suction title is called by Rickettsia of the province. In the era of epidemics of a rapid typhus, he could cause damage to the state during the war no less than the enemy. The great merit of the Soviet state during the civil war was the introduction of strict hygienic rules and a significant reduction in the incidence of raw tit.

Relapsing fever

Currently, the return title includes a group of diseases caused by twisted bacteria, spirochetes. A person's infection is also happening when insect bite. The spirochta includes borrelia. Burreliosis can be infected with ticks and lice bite. For spirochetes, our body produces imperfect immunity and the disease passes into protracted and chronic forms with the formation of inflammatory foci - granuloma and destruction.

Typhoid fever

In this case, the Tif is a special case of a group of diseases caused by bacteria - salmonella, namely Salmonella Tifi. Infection occurs when eating and liquid with these bacteria, an alimentary way. Also to salmonellosis include parathy and salmonellosis itself.

Distribution zone: Australia, South Asia (India), South, Central and North America, Europe, North and South Africa

Under the rapted typho, they understand the acute anthroponous disease for which the cyclic flow and defeat in the patient predominantly nervous and cardiovascular systems are characteristic.

Severe two types of raw type - endemic and epidemic. They differ from each other in the following characteristics.

Endemic raw tit is common among wild small rodents - mice, gray and black rats, which in nature are the reservoir of the pathogen Rickettsiosis Murina. The infection is transmitted by contact path or when eating food, which was contaminated with the urine infected animals through the feces of infected rats.

Most often, the disease occurs in port cities or regions with a large number of rats and mice. These are mainly the coastal cities of Australia, India, South and North America. Endemic suction typhus in Europe was observed in isolated cases in the Basps of the Caspian, Baltic and Black Seas.

Theoretically endemic suction typhus from a person is not transmitted to a person, but some experts allow the possibility of transmitting the disease through insertion in the conditions of assuming.

Epidemic (sewn) rap

The causative agents of sewing suction typhus are Rickettsiosis Prowazekii, common, and Rickettsiosis Canada, characteristic of North America.

Ricketcies of the provider in a wet environment will quickly die, but in the dried state and in the feces of lice, a long time is saved. Low temperatures are transported well, but when heating up to 100 ° C is dying for 30 s. (up to 58 ° C - for 30 minutes). Also dying when exposed to ordinary disinfectants (formalin, phenol, lysol). Have high sensitivity to tetracycles.

The source of infection is an infected person in the period from 2-3 days of the incubation period up to 7-8 days from the beginning of the normalization of body temperature. And then, although Ricketcies can remain in the body for a long time, the danger suffered for others does not represent. Epidemic suction type is transmitted to man through, mainly through the payments, rarely through the heads. Lobcovaya louse carrier is not. 5-6 days after the power supply, the blood infected becomes contagious until the end of his life (30-40 days). A healthy person is infected through rubbing in mass and other damage to the skin of the feces of lice. Sometimes there is a contact path of transmission when Rickettsia falls on the conjunctival, and the respiratory path, when inhaled together with the dust of the dried feces of lice. There were also cases of infection from blood donors when overflowing in the last days of the incubation period. In North America, Rickettsia (R. Canada) is transmitted.

Symptoms and course of the disease

The duration of the incubation period of the raw tit is from 6 to 25 days, but more often two weeks.

The disease occurs cyclically, and highlight the initial period, the period of ripping and the period of recovery.

Initial period

For the initial period, headache is characterized, an increase in body temperature to high values, lubrication in muscles and symptoms of intoxication. In some cases, it is possible to progressively with the severity in the head, a decrease in working capacity and insomnia.

In the future, the condition of the fever is fixed, the body temperature is held at the level of 39-40 ° C. Perhaps on 4-5 days a short-term decline in temperature, but the general condition does not improve, and the fever resumes. Inxication increases, headaches and dizziness are enhanced, disorders (hyperesthesia) arise from the senses organs, insomnia continues. The patient torments vomiting, its tongue is dry, with a white bloom. There is a violation of consciousness, sometimes to the twilight.

During the inspection, hyperemia is observed, the edema of the skin of the neck, face, and conjunctivans, as well as the injection of the scler. Skin to the touch dry and hot. On the 2-3rd day, positive endothelial symptoms are developing. For the 3-4th day in the transitional folds of the conjunctiva, hemorrhages are observed (symptom of Kiaari-Avtsina). For 4-5 days, a simultaneous moderate increase in liver and spleen (hepatosplegegaly) is characterized. The fragility of the vessels increases, as evidenced by the point hemorrhages of the mucous phantage and the sky (Enanthema Rosenberg). At 5-6 day of the disease, rash appears during the rank. Remiterative or constant fever and symptoms of intoxication are preserved and exacerbated, and the headache becomes especially pulsating, intense.

On the limbs and the torso, the roseless-phetechial examine is manifested. The rash is thick, most pronounced on the sides and on the inner surfaces of the limbs. Localization for palms, soles and face is not characteristic.

The collapse in the language becomes dark brown, progresses the increase in the liver and spleen, often appear bloating and constipation.

Due to the pathology of the kidney vessels, painfulness in the field of the belt, and when the positive symptom of Pasternatsky) is possible, the progressive oliguria appears. The defeat of urination organs leads to urinary incontinence, the absence of urethra reflex, urine is distinguished by drop.

Period of delight

During the rank of the disease, the bulbar neurological clinic is activated: the violation of the facial expressions and speech, the tremor of the tongue (when tonging, the tongue hits the teeth - the symptom of saying avenue), smoothed nasolabial folds. Dysphagia, the weakening of pupil reactions, anisocorium, nystagm is possible. Meningheal symptoms may be observed.

With a serious flow of rapid typhus, in 10-15% of cases, the development of typhoid status is characterized: a violation of self-consciousness, gaps in memory, speaking, mental disorder with accompanying psychomotor excitation.

Further aggravation of sleep disorder and consciousness occurs. Easy (shallow) sleep can cause the appearance of frightening visions in the patient, there is a challenge, nonsense, hallucinations.

The period of tipherty is ends with a decrease in the normal body temperature after 13-14 days from the beginning of the disease and the weakening of the symptoms of intoxication.

Period of recovery

For the period of recovery, the slow disappearance of clinical symptoms is characterized, as a rule relating to the nervous system. However, the deterioration of memory, the lability of cardiovascular and nervous activity, apathy, weakness is preserved for even 2-3 weeks. Retrograde amnesia is extremely rare.

For rapid typhus, early recurrence is not peculiar.

Complications of raw typhus

During the rapid tip, a hazardous complication may arise, such as infectious-toxic shock. It can occur either on 4-5 days of illness, or by 10-12. At the same time, as a result of the appearance of acute cardiovascular failure, the body temperature drops to normal.

Also, the raw tit can cause thromboembolism, thrombosis and myocarditis.

Regarding the nervous system with complications of the disease, meningoencephalitis or meningitis can be.

Adding a secondary infection can provoke thrombophlebitis, furunculosis, pneumonia.

The long-term term of the bed regime may cause the formation of laying out that for this pathology, the destruction of peripheral vessels will help the development of gangrenes.

Diagnostics of raw typhus

The usual diagnosis for determining the suction typhus includes a general analysis of urine and blood (identification of signs of bacterial intoxication and infection).

The fastest method of obtaining information about the pathogel - rf. You can also reveal antibodies with IFA or RNIF.

RNIF is the most common method of diagnosing this disease. This method is simple and relatively cheap, with its sensitivity and specificity. But bacteriological sowing of blood, due to the complexity of evicting the separation of the pathogen, do not produce.

Treatment of raw typhus

In the case of suspicion of the raw tit, the hospitalization is sick. It is appointed by the permanent bed regime, as long as the body temperature is normalized and five more days. For 7-8 days after sinking the fever can be inserted. The strict bed regime is caused by the high risk of orthostatic collapse. The patient needs to carefully care for, exercise hygienic procedures, fight straggle, stomatitis, eyed glands. For patients with suction typhus, a shared table is prescribed - a special diet is not provided for them.

The etiological therapy includes the use of chloramphenicol or tetracycline antibiotics. At 2-3 y-day of treatment, with the use of antibiotic therapy, patients have a positive dynamics.

The therapeutic course covers the entire fever period and two more days, as soon as the body temperature is normalized. Since the degree of intoxication is high, the patient shows the infusion intravenous administration of disinfect solutions during the forcing diuresis.

The patient's integrated effective therapy with the patient with the complications of the rapid typhus, a cardiologist and neurologist are engaged.

If there are signs of developing cardiovascular failure, the patient is prescribed ephedrine, nickelamide.

Depending on the pronounced relevant symptoms, anesthetic, sedatives, sleeping equipment are prescribed.

In the event of severe rapid patiff with severe intoxication and adrenal insufficiency with the threat of infectious-toxic shock, prednisolone is used.

The patient is discharged from the hospital for the 12th day from the moment the temperature of the body is normalized.

Prediction and prophylaxis of suction

The use of modern antibiotics in the treatment of suction typhoid is quite efficient. They suppress infection in almost 100% of cases. Cases of mortality rare and caused by insufficient and untimely assistance provided by the victim.

For persons living in dysfunctional relative to the epidemiological situation of areas or coming into contact with patients, specific prophylaxis with the use of living and killed vaccines of the pathogen is made.

Also at a high risk of infection within 10 days, an emergency prevention can be carried out using tetracycline antibiotics.

At all times, infectious epidemics were causes of mass lethal outcomes. The raw tit is infectious and manifests itself with strong intricensication of the organism, skin rashes, damage to nerves and vascular system. Today, the disease is rarely found in developed countries, foci of the disease is localized in developing states and are noted at the peak of emergency disasters and emergency situations.

The main pathogens of the rapid typhoid

The disease is able to quickly spread among people. The causative agent of the disease is the bacteria of the rickettsia of the province. They are withstanding high temperatures. The death begins with an increase in temperature to 50 ° C. The rapid type is divided into 2 species.

Epidemic Tiff:

• A man occurs in the bite of fleas, which treated rat blood;
• Epidemics are characteristic of warm countries;
• Plugs of the disease are wrapping and headwear.

Peeling the blood of a sick person, they become sources of infection. In the intestines of insects there is an increase in rickettsies. A healthy person is infected with bite and getting into the wounds of the excrement of lice.

Endemic typhus is provoked by Ricketer and is also transmitted from a sick person to healthy, through the feces of lice.

The causative agent has a distinctive feature, even in the dried state it survives. This contributes to the penetration of the virus into the body through clothing and bed linen. Doodling actions for bacteria is the disinfection of chlorine, formalin, acids and alkalis.

Symptoms of rapid typhus at different stages

The incubation period lasts from 1 to 3 weeks. The disease occurs cyclically and has 3 stages: the initial period, the midst of the disease and the complication of the disease. The initial stage is characterized by a temperature rise of up to 39 ° C, the depressed state, lubrication in the muscles, headache. A person begins a sleep disturbance and overall poor well-being. After 3 days, a feverish state occurs. On the 5th day, the body temperature is reduced to 37 ° C. Inxication of the body continues to increase. Disorders appear on the part of the senses, consciousness is disturbed, the tongue is covered with a flaw, dryness is dry in the mouth. There are frequent vomit urge.

Symptoms of the initial stage:

• Reduced blood pressure;
• Redness of the skin;
• Rapid pulse;
• Bloodmeys appear when skin plug.

The brown sprockets of the sky and the mucous membrane of the oral cavity say about the brittleness of blood vessels. The skin is dry and hot to the touch. A symptom of Kiaari-Avtsina appears, hemorrhage of small eye vessels. On the 6th day comes the midst of the disease.

Expansions are manifested on the limbs that gradually go to the body.

Incitization of the body is enhanced with the symptoms of poisoning and permanent fever. Headaches become pulsating. Language is painted in brown. Speech violation, a tremor of the disease is characterized by a violation of a speech, a chipping of one pupil, oscillations of eyeballs with high frequency, swallowing disorder. A further breakdown of sleep occurs, with vision and hallucinations. Heavy stage is characterized by clouding consciousness, mental excitation, high spelling, dips in memory. There is a sharp period from 4 to 10 days. Then the symptoms smoothly pass, and the stage of recovery comes.

Epidemic Dryph Tiff: Complications, Diagnostics and Treatment

With raw typhoids, complications often arise. Under the threat there are vessels and a human nervous system. Diagnostics lies in laboratory and instrumental studies. Blood fence and spinal fluid is carried out. Elevated ESP in blood speaks of inflammatory processes. The quantitative composition of platelets is reduced. The spinal fluid determines the lymphocytic cytosis.

As a result, it may occur:

• Myocardial development;
• Thrombose stagnation;
• Meningitis;
• Pneumonia;
• Furunculosis.

With the defeat of the limbs vessels, Gangrena can develop. Tool research includes ECG, ultrasound and lung radiography. More often, experts resort to specific analysis. Serological tests with high reliability determine the presence of antibodies to Ricketsia.

The maximum accuracy of the method is observed in a week of development of pathology.

For treatment, drug therapy is used, including a tetracycline drug group, antibacterial drugs, pathogenic techniques to reduce intricensication of the body, antihistamines. Additional preparations are painkillers.

Relief Tiff Porters - Insects

The carrier of the disease is lice. Moreover, ramp individuals are the main carriers of the virus, rapidly heads. Lobilee insects do not distribute tit. Handling lich prefers the conditions of antisanitation, pleasant smells and natural fabrics.

A comfortable habitat is dirty clothing, so the part of the population that has adverse living conditions is infected.

Processing of personal belongings requires compliance with certain rules:

• Washing at high temperature modes;
• Adding insecticidal tools to powder, in their absence, it is possible to replace the ingredients on vinegar or arable soap;
• Dry clothes at ultraviolet rays;
• The obligatory method of disinfection is ironing linen;
• For the body it is necessary to use pediculic drugs.

You can prevent the disease, observing the rules of hygiene and sterilization. The carrier of the rapid typhoid must be destroyed. In order to prevent the head lice, you must often wash your head and comb your hair. Infeitation, conduct procedures for removing lice and emergency room from the hair. The prevention of rapid typhoid is in observing personal hygiene, frequent shift of linen, the use of only personal clothing, regular ventilation and washing pillows and blankets.

How type is transmitted: sources of infection

Raw tit can be transmitted only by wrapping and heads. An animal and infected person can become a source of infection. Peeling blood with bacteria rickettsia, insects fall into the skin and hair sections of the body. By exercising their livelihood, they lay eggs and excrement.

After the penetration of Rickettsia, the Bacterium in the insect body begins to multiply rapidly. The incubation period is 4-5 days.

The insect bites a person, injecting toxins in the epidermis. With each sucking of blood, the lice has a defecation. The skin irritates from injected toxins, causing itching and combing. If the Epidermis feet in the wound surface hit, the bloodkeeping system is infected with a circuitry.

Ways of infection:

1. In some situations, infection can occur by air. Shaking bed and underwear with dry ticks can lead to an infection. Finding into the pulmonary paths, the bacteria wakes up and begins to actively multiply, hitting the blood and nervous system.
2. There are known infection in the donor blood transfusion, taken in the last periods of the incubation period of an infected person.
3. The lice is very sensitive to the fluctuations of the body temperature and are quickly moved from the diseased owner with a temperature or a deceased person, overwhelming on other people.

The dried feces retain a long time life, with mass and long-lasting accumulations of people and long-term non-treatment of things, the chain mechanism of transmission of the disease occurs in 90% of cases.

Incubation period of lice: how to avoid disease

After infection with Rickecia, the insect continues to live and function normally. In the body of the insect bacteria begin to multiply at high speed. Viruses Ricketcy Stubby and are able to resume their activities even in a dry condition. If you get into the human body, they begin to multiply quickly.

Already 5 days of feces allocate a huge number of rickettsies that are deposited on:

• Fabric surfaces;
• Epidermis;
• And hair parts of the body.

The patient's immune system reaction occurs only in 2 weeks, while symptoms caused by intoxicating the body, damage to the vascular shells and the nervous system. Flusted with skin manifestation of the disease. From the moment of infection until the first symptoms take about 2 weeks, so the appeal to the specialists occurs already in the stage of the sickness of the disease.

• Diagnosis of epidemic suction typhus

What is epidemic suction title

Epidemic rapid typhus (Synonyms: liner suction typhus, military title, hungry, European typhoid, prison fever, camp fever; Epidemic Typhus Fever, Louse-Born Typhus, Jail Fever, Famine Fever, War Fever-English, Flecktyphus, Flec-Kfieber - it .; Typhus Epidemique, Typhus ExanthematIQue, Typhus Historique - Franz.; Tifus Exantematico, Dermotypho - UCN.) - Acute infectious disease, is characterized by cyclic flow, fever, roseless-petechial test, damage to nervous and cardiovascular systems, the possibility of saving rickettsiys in The organism of Reconvolescent for many years.

What provokes epidemic suction title

Pathogens of epidemic suction typhoid Are R. ProWazekii, common in all countries of the world, and R. Canada, the circulation of which is observed in North America. Ricketting Supply is somewhat larger than other rickettsies, gram-negative, has two antigen: superficially located video suction (common with the rickettsies of the museum) Thermostable, soluble antigen of lipoidopolisaccharium-protein nature, there is a visual-specific insoluble thermolabile protein-polysaccharide antigenic complex. Rickettsi rickens are quickly dying in a wet environment, but are still kept in the feces of lice and in the dried state. Well tolerate low temperatures are dying when it is warming up to 58 ° C for 30 minutes, up to 100 ° C - for 30 s. Distant under the action of usually used dissenters (lysol, phenol, formalin). Highly sensitive to tetracycles.

The release of rapid typhus in an independent nosological form was first made by Russian doctors Ya. Schirsky (1811), Y. Govorov (1812) and I. Frank (1885). A detailed distinction between abdominal and rapids (clinical symptoms) was made in England Merchison (1862) and in Russia S. P. Botkin (1867). For the first time, the role of lice in the transfer of a suction typha was installed for the first time in 1909. The infectiousness of the blood of patients with suction typhoid proved the experience of Self-Research O. O. Mochevkovsky (the blood of the patient with a raw tit was taken on the 10th day of the disease, introduced into the cut of the leather forearm, O. O. Mochevkovsky's disease came on the 18th day after self-effects and proceeded in severe). The incidence of rapted typhoid increased dramatically during wars and folk disasters, the number of patients was calculated by millions. Currently, high incidence of rapted typhoid has been preserved only in some developing countries. However, many years of preservation of rickettsis in the previously overwhelmed with a raw title and the periodic appearance of relapses in the form of a disease of Brill-Cinsels does not exclude the possibility of epidemic outbreaks of rapid typhus. This is possible with a worsening of social conditions (increased population migration, pediculosis, power worsening, etc.).

Source of infection It is a sick person, starting with the last 2-3 days of the incubation period and until the 7-8 days from the date of normalization of the body temperature. After that, although Rickettsii can continue to be kept in the body, the reconstruction medal is already dangerous for others. The raw tit is transmitted through lice, mainly through the payments, less often through the heads. After supplying the blood with blood, the patient becomes contagious in 5-6 days and until the end of the life (i.e. 30-40 days). A person's infection occurs by rubbing the feces of lice in skin damage (in comb). There are cases of infection when blood transfusion, taken from donors in the last days of the incubation period. Ricketcy, circulating in North America (R. Sapda), is transmitted by ticks.

Pathogenesis (What is happening?) During epidemic suction typhus

The gates of infection are small damage to the skin (more often combing), after 5-15 minutes, rickettsi penetrate the blood. Rickening reproduction occurs intracellular in the endothelium of vessels. This leads to swelling and desquamation of endothelial cells. The cells that have fallen in blood flow are destroyed, the new endothelial cells are affected by rickettsiy. The most rapid process of reproduction of Rickettsius occurs in the last days of the incubation period and in the first days of fever. The main form of vessel damage is warthy endocarditis. The process can capture the entire thickness of the vascular wall with segmental or circular necrosis of the vessel wall, which can lead to a blood clogging of the vessel. So there are peculiar zeepphous granulomas (nodules Popov). In severe disease, necrotic changes are dominant, with light - proliferative. Vascular changes are especially expressed in the central nervous system, which gave the basis of I. V. Davydovsky to believe that every rapid typhoid is a unmargin Meningoencephalitis. With the defeat of the vessels, not only clinical changes on the part of the central nervous system are associated, but also skin changes (hyperemia, exammatime), mucous membranes, thromboembolic complications, etc. After the suffered suction typhus remains quite durable and long-term immunity. Part of the reconvaluents, this is non-sterile immunity, since the rickettsies of the province can be kept in decades in the organism of reconversion and at the weakening of the body's protective forces to determine distant relapses in the form of Brill's disease.

Symptoms of epidemic suction typhoid

Incubation period ranges from 6 to 21 days (more often than 12-14 days). In the clinical symptoms of suction typhus, the initial period is distinguished - from the first signs to the appearance of the rash (4-5 days) and the period of the right of the body - until the temperature of the body is dropped to the norm (it lasts 4-8 days from the moment of the appearance of the rash). It should be emphasized that this is a classic course. When prescribing antibiotics of the tetracycline group, after 24-48 hours, the body temperature is normalized and other clinical manifestations of the disease disappear. It is characterized by a sharp start for a raw tit, only in some patients in the last 1-2 days of incubation can be long-term manifestations in the form of a breakdown, fast fatigue, the depression of mood, gravity in the head, in the evening there is a small increase in body temperature (37.1-37 , 3 ° C). However, most patients with suction sick begins acutely with an increase in temperature, which is sometimes accompanied by cognition, weakness, severe headache, decreased appetite. The severity of these signs is progressively increasing, the headache is enhanced and becomes unbearable. It is too early to detect a peculiar excitation of patients (insomnia, irritability, multi-resistance of answers, hyperesthesia of senses, etc.). With severe forms there may be a violation of consciousness.

With an objective examination, there is an increase in body temperature to 39-40 ° C, the maximum level of body temperature reaches in the first 2-3 days from the beginning of the disease. In classical cases (i.e., if the disease is not stopped by the appointment of antibiotics) on the 4th and 8th day in many patients, there were "cuts" of the temperature curve, when for a short time the body temperature decreases to a subfebrile level. The duration of fever in such cases varies more often within 12-14 days. When examining patients, since the first days of the disease, there is a peculiar hyperemia of the skin of the face, neck, upper chest departments. Scoler vessels are injected ("Red eyes on a red face"). Early (from the 3rd day), a symptom characteristic of the raped typhoid appears - Kiairi-Avtsina spots. This is a kind of conjunctive rash. The elements of the rash with a diameter of up to 1.5 mm with blurry fuzzy borders are red, pink-red or orange, the number of them is 1-3, but maybe more. They are located at the transitional folds of the conjunctive, more often of the lower eyelid, on the mucous membrane of the cartilage of the upper eyelid, the conjunctivation of the scool. These elements are sometimes difficult to consider due to pronounced hyperemia Scler, but if in a conjunctival bag, you can order 1-2 drops of 0.1% of the adrenaline solution, then hyperemia disappears and the Kiairi-Avtsina spots can be revealed from 90% of the patients with raw title (Avtsina's adrenaline test ).

An early sign is both Enanthenta, which is very characteristic and is important for early diagnosis. It is described by N. K. Rosenberg in 1920 on the mucous membrane of a soft sky and tongue, usually at its base, as well as on the foreheads you can notice small petechia (up to 0.5 mm in diameter), the number of them is more often 5-6, And sometimes more. With a careful inspection, Enatet Rosenberg can be revealed from 90% of patients with a raw tit. It appears 1-2 days before the appearance of skin rashes. Like the stains of Kiairi-Avtsina, it remains until the 7-9th day of the disease. It should be noted that in the development of thrombohemorrhagic syndrome, similar races may appear with other infectious diseases.

With pronounced intoxication in patients with a raw tit, there may be a peculiar color of the skin of the palms and the stop, it is characterized by an orange tint, it is not the yellowness of the skin, especially since there is no subicterity of the scool and mucous membranes (where, as it is known, the jaundice is manifested earlier). Associate Professor of the Department of Infectious Diseases I. F. Filatov (1946) proved that such a painting is due to a violation of caroten metabolism (Carotenic Xanthromia).

The characteristic rash, which led the name of the disease, appears more often on the 4-6th day (most often they are noticed in the morning of the 5th day of the disease), although the most typical period of appearance is the 4th day. The appearance of rash testifies to the transition of the initial period of the disease during the period of ripping. A characteristic feature of the Syroval Exanthemia is its petechial-rose-sized character. Consists of a roseol (fine red spots with a diameter of 3-5 mm with blurred boundaries that are not towering above the skin level, the roseolates are disappearing at the pressure on the skin or stretching it) and petechia - small hemorrhages (diameter of about 1 mm), they do not disappear when skin stretching . There are primary petechies that appear against the background of previously unchanged skin, and secondary petechia, which are located on roselas (when stretching the skin, the roseless component of the examine disappears and only point hemorrhage remains). The predominance of petechial elements and the appearance on most roseol secondary petechia indicates a serious flow of the disease. Exanthema with a rapid tit (unlike typhoid typhoid) is characterized by an abundance, the first elements can be noticed on the side surfaces of the body, the upper half of the chest, then on the back, buttocks, less rash on the hips and even less on the legs. Extremely rarely rash appears on the face, palms and soles. Roseolats quickly and disappearly disappear from the 8-9th day of the disease, and in the place of Petechia (like any hemorrhage) there is a change in color, first they are bluish-purple, then yellowish-greenish, disappear more slowly (for 3-5 days). The course of illness without rash is rarely observed (8-15%), usually in patients with children's age.

There are usually no significant changes in respiratory organs in patients with suction typhoids, there are no inflammatory changes in the upper respiratory tract (the redness of the pharynx mucosa is due not to inflammation, but the injection of blood vessels). In some patients, there is an increase in breathing (due to the excitation of the respiratory center). The appearance of pneumonia is a complication. Changes in blood circulation bodies are observed in most patients. This is manifested in tachycardia, decreased blood pressure, muffling of heart tones, ECG changes, a picture of infectious toxic shock may develop. The defeat of the endothelium causes the development of thrombophlebitis, sometimes thrombus are formed in the arteries, in the reconvaluation period there is a threat of pulmonary artery thromboembolism.

Almost all patients are pretty early (from the 4-6th day) an increase in the liver is revealed. The increase in the spleen is detected somewhat less frequently (in 50-60% of patients), but in earlier deadlines (from the 4th day) than in patients with abdominal typhoid. Changes in the central nervous system are characteristic manifestations of rapid typhus, which Russian doctors have long paid ("Nervous Clapory Frame", on the terminology of Ya. Gonova). From the first days of the disease, the appearance of a strong headache is characterized by the appearance of patients, which is manifested in Multili, insomnia, the patients annoying light, sounds, touching the skin (hyperesthesia of the senses), may be attacks of violence, attempts to escape from the hospital, disturbing, delicious State, violation of consciousness, nonsense, development of infectious psychosis. For patients from the 7-8th day of the disease, meningeal symptoms appear. In the study of the cerebrospinal fluid, there is a small Pleocytosis (not more than 100 leukocytes), a moderate increase in protein content. With the defeat of the nervous system, the appearance of such signs such as hymiformism or amymia, the smoothness of the nasolabial folds, the deviation of the tongue, the difficulty when heating it, dysarthria, a violation of swallowing, nystagm. With severe forms of suction typhoid, a symptom of saying avenue is detected. For the first time, I was described by J. Govorov in 1812, avenue described it later (1853). The symptom lies in the fact that the request to show a language, the patient is putting it with difficulty, silent movements and further the teeth or the lower lip of the language cannot be narrowed. This symptom appears pretty early - before the appearance of the examine. Sometimes it is detected and with easier the disease. Part of the patients appears a total tremor (trembling of the language, lips, fingers of the hands). At the height of the disease, pathological reflexes are detected, signs of violation of oral automatic (reflex Marine-Radovichi, trump and distant reflexes).

Duration of the course of the disease (If antibiotics did not apply) depended on the gravity, with light forms of the rapid typhoid fever lasted 7-10 days, the recovery occurred quite quickly, complications, as a rule, was not. With moderate forms, the fever reached high numbers (up to 39-40 ° C) and lasted for 12-14 days, the examtember was characterized by the predominance of phetechial elements. It is possible to develop complications, however, the disease, as a rule, ended with recovery. With severe and very serious flow of rapid typhus, a high fever was observed (up to 41-42 ° C), sharply pronounced changes in the central nervous system, tachycardia (up to 140 ° C / min and more), decreased blood pressure to 70 mm Hg. Art. and below. The rash has a hemorrhagic character, along with petechia, larger hemorrhages and pronounced manifestations of thrombohemorrhagic syndrome (nasal bleeding, etc.) can appear. Observed and worn

forms of rapid typhus, but they often remained unrecognized. The above symptomatics is characteristic of classic raw typhus. When prescribing antibiotics, the disease is stopped for 1-2 bitches.

The diagnosis of sporadic cases in the initial period of the disease (before the appearance of a typical examination) is very difficult. Serological reactions become positive as soon as from 4-7th day from the beginning of the disease. During epidemic outbreaks, the diagnosis is facilitated by epidemiological data (information about the morbidity, the presence of assuming, contact with the patients with raw title, etc.). When the examine appears (i.e. from the 4-6th day of the disease), the clinical diagnosis is already possible. The deadlines for the appearance and character of the rash, hyperemia of the face, Enanthema Rosenberg, the stains of Kiairi-Avtsina, changes from the nervous system - all this allows you to differentiate first of all from the abdominal typhoid (gradual start, the inhibition of patients, changes from the digestive organs, and later the appearance of Exanthem In the form of a rose-papular monomorphic rash, no pechery, etc.). It is necessary to differentiate from other infectious diseases that occur with the examined, in particular, with other rickettsiosis (endemic suction title, mite rickettsiosis of Northern Asia, etc.). Some differential diagnostic value has a blood pattern. With a rapid title characteristic of moderate neutrophilic leukocytosis with a harsh shift, eosinopenia and lymphopianization, a moderate increase in ESP.

To confirm the diagnosis use various serological reactions. Sore a certain value of the wave-felix reaction is a reaction of agglutination with Oxig protein, especially when the antibody titer is increasing during the disease. RCCs are more often used with a rickettsiosis antigen (prepared from the rickettsi ricakes), the diagnostic titer is considered to be 1: 160 and higher, as well as the increase in antibody titer. Other serological reactions are used (microaglutination reaction, hemagglutination, etc.). In the Memorandum of WHO's meeting on Ricketsios (1993), an indirect immunofluorescence reaction is recommended as the recommended diagnostic procedure. The acute phase of the disease (and reconvalue periods) antibodies are associated with IGM, which is used to distinguish between antibodies as a result of previously suffered disease. Antibodies begin to be detected in serum from the 4-7th day from the beginning of the disease, the maximum titer is reached after 4-6 weeks from the beginning of the disease, then the titers are slowly decreasing. After the suffered typhus of rickettsi rickens, a reconnaissance is preserved in the reconvaluation body for many years, this determines the long-term preservation of antibodies (associated with IgG also for many years, although in low-credits). Recently, with diagnostic purposes, test therapy with antibiotics of the tetracycline group is used. If, when appointing tetracycline (in conventional therapeutic doses) after 24-48 hours, the normalization of the body temperature does not occur, this makes it possible to exclude the raw tit (if the fever is not associated with any complication).

Treatment of epidemic suction

The main etiotropic drug is currently antibiotics of the tetracycline group, and levomycetin (chloramphenicol) is also effective in intolerance. Tetracycline is prescribed more often in terms of 20-30 mg / kg or for adults 0.3-0.4 g 4 times a day. The course of treatment lasts 4-5 days. Legeless is prescribed leftomycetin at 0.5-0.75 g 4 times a day for 4-5 days. With severe forms, the first 1-2 days can be prescribed leftomycetin sodium succinate intravenously or intramuscularly at 0.5-1 g 2-3 times a day, after normalization of the body temperature, go to oral use of the drug. If against the background of antibiotic therapy, a complication due to the layering of secondary bacterial infection (for example, pneumonia), then, taking into account the etiology of complications, the corresponding chemotherapy preparation is prescribed.

Ethiotropic antibiotic therapy It has a very quick effect and therefore many methods of pathogenetic therapy (vaccine therapy, developed by Professor P. A. Alisov, long-term oxygen therapy, justified by V. M. Leonov, and others) currently have only historical significance. Of the pathogenetic drugs, the appointment of a sufficient dose of vitamins, especially ascorbic acid and p-vitamin preparations, which possess a vessel reinforcing effect, is mandatory. To prevent thromboembolic complications, especially in risk groups (they are primarily among the elderly), it is necessary to appoint anticoagulants. The appointments are necessary for preventing the development of thrombohemorragic syndrome. The most effective drug for this purpose is heparin, which should be appointed immediately after establishing a diagnosis of suction typhus and continue its reception within 3-5 days.

Heparin (neragotit), synonyms: Heparin Sodim, Heparin Sun, Heparoid. Produced in the form of a solution in bottles of 25,000 units (5 ml). It should be borne in mind that tetracyclines to some extent weaken the effect of heparin. Enter intravenously in the first 2 days at 40,000-50,000 units / day. The drug is better to introduce drip with a solution of glucose or divide the dose on 6 equal parts. From the 3rd day, the dose reduces to 20,000-30,000 units / day. When the embolism has already arisen, the daily dose on the first day can be increased to 80,000-100000 units. The drug is administered under the control of the blood coagulation system.

Forecast. Before the introduction into the practice of antibiotics, the forecast was serious, many patients were dying. Currently, when treating patients with tetracycles (or leftomycetin), the forecast is favorable even with the serious course of the disease. Female outcomes were observed very rarely (less than 1%), and after the introduction into the practice of anticoagulants of fatal outcomes is not observed.

Prevention of epidemic suction typhus

For the prevention of suction typhus, the struggle with seeriness, early diagnosis, insulation and hospitalization of patients with suction typhoid are of great importance, careful sanitary treatment of patients in the receiving rest of the hospital and disinsection of the patient's clothing is necessary. For specific prophylaxis, an inactivated vaccine formaline, containing the killed rickettsia of the provision, was used. Vaccines were used during increased morbidity and were effective. Currently, in the presence of active insecticides, effective methods of etiotropic therapy and low morbidity, the importance of anti-infannotifoic vaccination significantly decreased.

What doctors should contact if you have an epidemic suction type

Infectious

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- Rickeciosis flowing with destructive changes in the endothelium of vessels and the development of generalized thrombovasculitis. The main manifestations of rapid typhoid are associated with ricketsemia and specific changes in vessels. They include intoxication, fever, typhoid status, roseless-phetechial rash. Among the complications of the rapid typhoid - thrombosis, myocardits, meningoencephalitis. Diagnosis confirmation promotes laboratory samples (RNG, RNIF, IFA). The etiotropic therapy of the rapid typhoid is carried out by antibiotics of a group of tetracycline or chloramphenicol; Active disintellation is shown, symptomatic treatment.

MKB-10

General

The rapid tit is an infectious disease caused by the rickettsia of the provider, manifested by a pronounced fever and intoxication, a roseolese-phetechial test and preferably damage to vascular and central nervous systems. To date, in developed countries, rapid typhus is practically not found, cases of disease are registered mainly in developing Asian countries, Africa. Epidemic rates of morbidity are usually noted against the background of social disasters and emergencies (wars, hunger, destroying, natural disasters, etc.), when there is a massive commodity of the population.

The reasons

Rickettsia Prowazeki is a small polymorphic gram-negative fixed bacterium. Contains endotoxins and hemolysin, has a typical specific thermolabile antigen and somatic thermostable. It dies at a temperature of 56 ° in 10 minutes, at 100 degrees in 30 seconds. In the feces of lice rickettsia, there may be a vitality of up to three months. It is well amenable to disinfectants: chlorine, formalin, lizol, etc.

The reservoir and the source of the infection of the rapid typhoid is a sick person, the transfer of infection is carried out by a transmissive path through lice (as a rule, by paying, less frequently head). After the bloodsucms of the sick person, it becomes contagious in 5-7 days (with a minimum life of 40-45 days). A person's infection occurs during rubbing of feces of lice when combing skin. Sometimes there is a respiratory path of transmission when inhalation dried feces of lice together with the dust and the contact path when rickettivia getting into conjunctiva.

The susceptibility is high, after transferring the disease, persistent immunity is formed, but it is possible to recurvement (Brill's disease). Winter-spring seasonality of morbidity is noted, the peak falls on January-March.

Symptoms of raw typhus

The incubation period can continue from 6 to 25 days, most often 2 weeks. The rapid tit is cyclically, in its clinical flow, periods are distinguished: initial, ripping and reconvalues. The initial period of suction typhoid is characterized by the rise of temperature to high values, headache, fragmentation in muscles, symptoms of intoxication. Sometimes there may be progressal symptoms (insomnia, reducing performance, heaviness in the head).

In the future, fever becomes constant, the temperature is maintained at 39-40 ° C. For 4-5 days, the temperature reduction can be occurred briefly, but the state does not improve, and in the future the fever is renewed. Intoxication increases, headaches are enhanced, dizziness, disorders arise from the senses (hyperesthesia), stubborn insomnia, sometimes vomiting, a dry language, covered with a white bloom. Development of consciousness up to twilight.

In case of inspection, hyperemia and swelling of the skin of the face and neck, conjunctiva, the injection of the scler. On the touch, the skin is dry, hot, from 2-3rd days there are positive endothelial symptoms, and for the 3-4th day, the symptom of Kiairi-Avtsina (hemorrhages in transitional folds of conjunctivations) is detected. For 4-5 days, moderate hepatosplegegaly develops. The dotted hemorrhages of the sky, the mucous pharynx (Enanthera Rosenberg) speak about the increased fragility of the vessels.

The period of fusion is characterized by the appearance of rashes on the 5-6th day of the disease. At the same time, a constant or remitting fever and symptoms of pronounced intoxication is preserved and aggravated, headaches become particularly intense, pulsating. Roseolese-phetechial Exanthema is manifested simultaneously on the body and limbs. The rash is thick, more pronounced on the side surfaces of the body and internal - limbs, localization on the face, palms and soles are not characteristic, as the subsequent additional rashes.

The collapse in the language acquires a dark brown color, the progression of hepatomegaly and splenomegaly (hepatolyenal syndrome) is noted, there are often constipation, bloating. In connection with the pathology of the kidney vessels, soreness in the zone of their projection in the area of \u200b\u200bthe belt, a positive symptom of Pasternatsky (soreness during phableing), appears and progresses Oliguria. The toxic damage to the ganglia of the vegetative innervation of urination organs leads to the atony of the bladder, the absence of reflex to urine, paradoxical diabetes (urine stands out dropped).

In the midst of the raw title, an active deployment of the bulbar neurological clinic takes place: a tremor of the tongue (symptom of saying-avenue: tongue tongue taking care of the teeth), speech disorders and facial expressions, smoothed nasolabial folds. Sometimes anisocoria, nystagm, dysphagia, the weakening of pupil reactions are noted. Meningheal symptoms may be celebrated.

The serious flow of suction typhoid is characterized by the development of typhoid status (10-15% of cases): a mental disorder, accompanied by psychomotor excitation, spoken, memory impairment. At this time, there is a further deepening of sleep disorders and consciousness. A shallow sleep can lead to the appearance of frightening visions, hallucinations, nonsense, challenge can be celebrated.

The period of rapid typhoid rank ends with a decrease in body temperature to normal numbers after 13-14 days from the beginning of the disease and facilitating the symptoms of intoxication. The reconstruction period is characterized by the slow disappearance of clinical symptoms (in particular from the side of the nervous system) and gradual recovery. Weakness, apathy, nervous and cardiovascular lability, memory deterioration is saved to 2-3 weeks. Sometimes (quite rare) Retrograde amnesia arises. The rapid tyif is not inclined to early recurrence.

Complications

In the midst of the disease, an infectious and toxic shock may become an extremely dangerous complication. Such a complication can usually occur at 4-5 or 10-12 days of illness. At the same time, the body temperature drops to normal numbers as a result of the development of acute cardiovascular failure. The rapid typhus can contribute to the development of myocarditis, thrombosis and thromboembolism.

Complications of the disease from the nervous system can be meningitis, meningoencephalitis. The addition of a secondary infection can cause pneumonia, furunculosis, thrombophlebitis. Long-term bed mode can lead to the formation of layers, and characteristic of this pathology, the defeat of peripheral vessels can contribute to the development of gangremen terminal limbs.

Diagnostics

Non-specific diagnosis with a rapid typhoid includes a general analysis of blood and urine (there are signs of bacterial infection and intoxication). The fastest method of obtaining data on the pathogel - rland. Almost at the same time, you can reveal antibodies in RNIF or with IFA.

RNIF is the most common method of diagnosing a rapid title due to the simplicity and relative cheapness of the method when sufficient specificity and sensitivity. Bacposev blood does not produce excessive complexity of the selection and sowing of the pathogen.

Treatment of raw typhus

In suspected of a suction typhus, hospitalization is subject to hospitalization, it is assigned a bed mode flesh to the normalization of body temperature and five days after. You can get up on the 7-8th day after fever. Strict bed regime is associated with a high risk of developing an orthostatic collapse. Patients require careful care, exercise of hygienic procedures, prevention of layers, stomatitis, eye inflammation. A special diet for patients with a raw tit is not prescribed a shared table.

Antibiotics of a group of tetracycline or chloramphenicol are used as etiological therapy. Positive dynamics when using antibiotic therapy is celebrated on the 2-3rd day after the start of treatment. The therapeutic course includes the entire fevering period and 2 days after the normalization of body temperature. Due to the high degree of intoxication, an intravenous infusion administration of disinfect solutions and forcing diuresis is shown. To appropriate effective therapy, a neurologist and a cardiologist advise the patient complications.

In the signs of the development of cardiovascular failure, Netamid is prescribed, ephedrine. Anesthetic, sleeping pills, the sedatives are prescribed depending on the severity of the corresponding symptoms. With severe suction title with pronounced intoxication and the threat of the development of infectious-toxic shock (with pronounced adrenal insufficiency), prednisolone is used. The extract of patients from the hospital is made on the 12th day after establishing normal body temperature.

Prediction and prevention

Modern antibiotics are fairly effective and suppressed infection in almost 100% of cases, rare cases of mortality are not associated with insufficiently remedy. The prevention of suction typhus includes measures such as the fight against pediculose, sanitary treatment of distribution foci, including thorough treatment (disinsection) of housing and personal belongings of patients. Specific prophylaxis is made by persons who come into contact with patients living in districts in the epidemiological situation in areas. It is performed using the killed and live vaccines of the pathogen. With a high probability of infection, it is possible to make an emergency prevention of tetracycline antibiotics for 10 days.

Typhus

epidemic (Typhus Exanthematicus; synonym for a typhoid) - infectious, characterized by cyclic flow, fever, pronounced intoxication, roseless-phetechial rash, damage to vascular and central nervous systems.

Epidemiology. The source of the causative agent of infection is only a person who is infected with the last 2-3 days of the incubation period, the entire fever and until the 7-8th day of normal temperature. The causative agent of infection is predominantly wrapped. It is infected with the sucking of the blood of the patient S. t. And it becomes contagious for the 5-6th day. Ricketcies of the shipyard, who fell into the Versh, together with blood penetrate into the epithelial cells of the intestinal wall, where they breed and go into the intestinal lumen. When sucking blood on a person, Versh occurs, along with the feces there is a large number of rickettsies. At the site of the bite arises, a person combines the skin and rubs into it the lice containing.

S. t. It is more often noted in moderate latitudes in the winter-spring period. The mass spread of S. t. It is usually observed during wars, hunger and other social shocks, causing a sharp deterioration of hygienic living conditions. The dissemination of the disease contributes to the crowding of people.

Pathogenesis. Ricketcies rubbed in the skin of the rickettsia penetrate and spread through the body. In the cells of the endothelium of the vessels, they intensively multiply, the cells swell and are descaming, thrombovasculites and the peculiar vascular disease are developing, especially characteristic of brain vessels, skin, adrenal glands, myocardium. An important role in the pathogenesis of the disease is played not only by Ricketsky themselves, but also allocated by them, which has a pronounced vasodilatory action. Specific ricketer and vascular granulomatosis lead to a violation of the activity primarily by the vascular system and the Ts.N.S.

Immunity. After transferred to S. T. remains persistent; However, after many years, due to the activation of the rickettsia persistent in the body, repeated diseases are sometimes observed - the so-called Brill's disease.

Clinical picture. The incubation period is 5-25 days (more often than 10-12). With the most typical medium-duty course, the disease usually begins sharply: rises, heat, weakness, and headache, pain in everything, decreased appetite. And insomnia to the 3-4th day become painful, the temperature rises sharply (up to 39 ° and higher) and keeps at a constant level for 6-9 days. The total duration of the feverish period is 12-14 days. Persons, conjunctiviv, skin of the neck and the upper part of the body are observed, the endlessness of the face (a person who came out of the steam room). To the touch is hot and dry. On the 3-4th day of the disease in the transitional folds of the conjunctive, it is possible to detect the characteristic point spots of red or dark red with a cyanotic tinge with a diameter of 0.1-1.5 mM. (Kiari - Avtsina). The same formations are possible on the mucous membrane of the soft sky, as well as the root of the tongue. Herpetic on lips and wings of the nose can be marked. Symptoms pinch and harness positive. Dry, covered with a dirty gray raid, are observed. From the 3-4th day, the spleen is usually increasing, later -. Excitation appear, it is possible, less often - the state of the inhibition, hands, language, head. When trying to narrow, it is noted by his arms - the symptom of saying - avenue. On the 4-6th day, one of the most important clinical signs arises - the roseless-petechial. Typical rash - on the side surfaces of the body, flexing surfaces of the hands, back, the inner surface of the hips. The elements of the rash are in a state of "flowering" (pink, bright red or somewhat cyanotic) for 3-5 days, after which they begin to pale and after 7-10 days gradually disappear. Sizes of elements rashes 1 to 3 mM. In diameter, the edges are uneven. Repeated rashes are not observed. In the midst of the disease it is possible to drop a vascular tone right up to the collapse. Almost always marked, deaf, shortness of breath. In the blood, moderate leukocytosis is found. It is characterized by a decrease in temperature from the 9-11th day of the disease within 2-3 days in the form of accelerated lysis to the norm.

With a light course of the disease, the head is moderately expressed, the temperature usually does not exceed 38 ° and lasts 7-10 days, the rash wears the roseolese, nonophice. The spleen and the liver are enlarged only in some patients. With severe flow, the fevering period is observed (up to 14-16 days). Characteristic nonsense, excitation, pronounced tachycardia and, often shortness of breath, develop signs of meningoencephalitis, which are manifested by a violation of consciousness, meningeal and delicious syndrome, urination delay.

The raw tit in children is characterized easier than in adults, a shorter fever. , nonsense, hyperemia of the face, Tremor is usually found only in older children. more scarce, but can spread to the head of the head. The duration of the disease is significantly less than in adults. Often there is an atypical, which in these cases is hardly recognized.

In the blood in the midst of the disease, moderate neutrophilic leukocytosis with a neutrophilic formula shift to the left, trunk cells, a moderate increase in ESO appear. Possible.

Complications There are late and insufficiently effective treatment. These include, which occurs in any period due to the revitalization of secondary microflora; and meningoencephalitis (including purulent), myocarditis, thrombophlebitis, thromboembolism, and breakdown.

Diagnosis Based on a clinical picture, data of epidemiological history (stay in 1-3 weeks before the development of the disease in adverse sanitary and hygienic conditions, the presence of pediculosis (pediculosis)), the results of laboratory research. Specific serological reactions are used: agglutination with rickettsia, indirect hemagglutination (), complement binding (see Immunological research methods). These reactions become positive on the 3-5th day of the disease in most patients with S. t. Weyl - Felix reactions due to insufficient specificity for the diagnosis of S. t. Not used.

Catarial phenomena are expressed with influenza, the duration of the feverish period is 3-5 days, there is no rash ,. For brute pneumonia, shortness of breath, pain in breathing, with "rusty" sputum, physical signs of pneumonia, there is no rash, syndrome. When meningococcal infection, hemorrhagic rash appears on the 1st day of the disease, is localized mainly in the distal limbs. Meningheal symptoms occur in a few hours and quickly progress, 2-4th day of illness are celebrated. For hemorrhagic fevers, the appearance of rashes and signs of increased bleeding on the background of a decrease in temperature, a short fever, an increase in the spleen is not observed. In the abdominal title, the disease begins gradually, pale, patients are injected and adamic, rash appears on the 8-10th day of the disease, the roseolese, localizes mostly on the stomach, is found in the blood leukopenia. For trichinelosis, the poverty, pain and muscles, in the blood are characteristic.

Treatment. The patient is hospitalized, transportation is carried out on stretchers accompanied by a health worker. Apply tetracycline groups or leftomycetin until the 2-3rd day of normalization of temperature, cardiovascular tools (Cordiamine, caffeine or ephedrine,), as well as when the patients are excited, sleeping pills. With severe headaches and high temperatures, the cold is shown on the head ,. In pronounced intoxication, intravenously 5% solution of glucose, polyionic, hemodez, refooliglucin is administered. Similar pathogenetic is carried out in the provision of first medical examinations to the patient before hospitalization.

Patient S. t. Must be under the special observation of medical staff, because He suddenly may have a strong excitement, nonsense, he can jump off bed, run, jump out of the window. Collapse au is possible. More often, these manifestations occur at night, and during this period it takes special to the patient. The nurse should more often enter the ward, airing her, follow the pulse and the patient. They write off the hospital after clinical recovery, but not earlier than on the 12-14th day of normalization of temperature.

Prevention Includes early detection, insulation and hospitalization of the patient, as well as the fight against pediculosis. According to epidemic testimony, regular inspections are carried out on pediculous children in preschool institutions, schools, patients entering medical institutions, as well as other populations. When detecting pediculosis, sanitary processing is carried out. The patient received in or hospital with a rapid appearance or suspicion of it, as well as persons who were in contact with the patients are subject to complete sanitation. The premises are simultaneously carried out, where the sick, clothes and bedding lived.

In the village, where there are cases of S. t. Enveloped for pediculosis with mandatory sanitation of all family members, in which pediculosis is found. Persons whose temperatures are improved isolate and hospitalized. With the emergence of repeated cases of S. T., the presence of pediculosis among the population is carried out with a re-complete sanitation in the focus.

For specific prophylaxis S. T. Used a suprotinotic vaccine; - by epidemic testimony. Also the vaccinations of the medical staff working in epidemics S. tons are shown. Persons aged from 16 to 60 years old. Propaganda measures to prevent pediculosis and raw materials are important in the prevention of pediculosis.

Brill's disease (repeated, endogenous suction title) - acute infectious disease, manifested in many years in persons who have surpassed S. t., is characterized by sporadicity of diseases (in the absence of pediculosis). S. t. Differs easier and short flow. The methods of laboratory studies are the same as at S. t. After the disease, persistent and long-term immunity develops. The same as at S. tons. In the event of Brill's disease, activities are held to prevent the spread of rapid typhus, because In the presence of pediculosis, patients may be a source of diseases with a raw tit.

Bibliography: Zdodovsky pf And Golinevich E.M. The doctrine of rickettsies and rickettsiosis, M., 1972; Loban K.M. The most important person, with. 31, 121, L., 1980; Guide for infectious diseases, under the hands. IN AND. Pokrovsky and KM Lobana, p. 183, M., 1986.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First medical care. - M.: Large Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

Synonyms:

Watch what is "suction typhus" in other dictionaries:

TYPHUS - Raw tit. Content: Experimental S. T ................ 182 Syroval virus ................. 185 Ways and ways of distribution S. T ....... 188 Specific prevention and serotherapy Art. 192 Statistics and Geographical ... ... Big medical encyclopedia

Typhus - the disease is caused by the rickettsia of the province, it is distinguished by a cyclic flow with a fever, a typhoid state, a peculiar rash, also by the damage to the nervous and cardiovascular systems. The source of infection is only a sick person from which weed ... ... Handbook of Diseases

Syrnia (talk.) Dictionary of synonyms of the Russian language. Practical directory. M.: Russian. Z. E. Alexandrova. 2011. Rapid Tiff Soul., Number of synonyms: 2 Disease ... Synonym dictionary

A rapid tit, acute infectious disease of a person: fever, damage to the vessels, central nervous system, rash. Caused by bacteria (rickettsia); Transmitted by lshami ... Modern encyclopedia

Acute human infectious disease: fever, heart lesion, vessels, central nervous system, rash. Caused by rickettsia; Transmitted by lshami ... Big Encyclopedic Dictionary

- (Epidemic, sewn) sharp oo, due toR. Prowazekii. The causative agent refers to the roottyttsia (see), orderlyttsiales (see) and is characterized by the inherent in them. Plugs in the cytoplasm of the endothelium of vessels, mononuclear man and ... Dictionary of microbiology

Do not be confused with abdominal typhoid. Sapboard ... Wikipedia

Epidemic, or stitched, suction typhoid, acute infectious diseases of a person from a group of ricketsiosis (see Ricketsiosis). The causative agent S. t. Ricketcies of the province. The source of infection is a sick person (which contains the causative agent) ... ... Great Soviet Encyclopedia

Acute infectious disease person; Fever, heart lesion, vessels, central nervous system, rash. Caused by rickettsia; Transferred to Vshami. * * * Raw suction typhus, acute infectious disease man: fever, ... ... encyclopedic Dictionary

Synonyms: stitched raw tit, military typhoid, hungry, European typhoid, prison fever, camp fever; epidemic Typhus Fever, Love-Born Typhus, Jail Fever, Famine Fever, War Fever-English, Flecktyphus, Fleckfieber - it.; Typhus Epidemique, Typhus Exanthematique, Typhus Historique - Franz.; Tifus Exantematico, Dermotypho - Span.

Epidemic suction type - acute infectious disease, is characterized by a cyclic flow, fever, a roseless-phetechial test, the damage to the nervous and cardiovascular systems, the possibility of preserving rickettsiys in the reconvalued organism for many years.

Etiology. The causative agents of the disease are R. PROWAZEKII, common in all countries of the world and R. Canada.whose circulation is observed in North America. The rickettsia of the province is somewhat larger than other rickettsies, gram-negative, has two antigen: the surface-sided visions ofvisifical (common with the rickettsiums of the Museum) Thermostable, soluble antigen of lipoidopolisaccharium-protein nature, under it there is a visual-specific insoluble thermolabile protein-polysaccharide antigenic complex. Rickettsi rickens are quickly dying in a wet environment, but are still kept in the feces of lice and in the dried state. Well tolerate low temperatures are dying when it is warming up to 58 ° C for 30 minutes, up to 100 ° C - for 30 s. Distant under the action of usually used dissenters (lysol, phenol, formalin). Highly sensitive to tetracycles.

Epidemiology. The release of rapid typhus in an independent nosological form was first made by Russian doctors Ya. Schirsky (1811), Y. Govorov (1812) and I. Frank (1885). A detailed distinction between abdominal and rapids (clinical symptoms) was made in England Merchison (1862) and in Russia S. P. Botkin (1867). For the first time, the role of lice in the transfer of a suction typha was installed for the first time in 1909. The infectiousness of the blood of patients with suction typhoid proved the experience of Self-Research O. O. Mochevkovsky (the blood of the patient with a raw tit was taken on the 10th day of the disease, introduced into the cut of the leather forearm, O. O. Mochevkovsky's disease came on the 18th day after self-effects and proceeded in severe). The incidence of rapted typhoid increased dramatically during wars and folk disasters, the number of patients was calculated by millions. Currently, high incidence of rapted typhoid has been preserved only in some developing countries. However, many years of preservation of rickettsis in the previously overwhelmed with a raw title and the periodic appearance of relapses in the form of a disease of Brill-Cinsels does not exclude the possibility of epidemic outbreaks of rapid typhus. This is possible with a worsening of social conditions (increased population migration, pediculosis, power worsening, etc.).

The source of infection is a sick person, starting from the last 2-3 days of the incubation period until the age of 7-8 days from the moment the body temperature is normalized. After that, although Ricketcies can continue to be kept in the body, the reconstruction medal is already dangerous for others. The raw tit is transmitted through lice, mainly through the payments, less often through the heads. After supplying the blood with blood, the patient becomes contagious in 5-6 days and until the end of the life (i.e. 30-40 days). A person's infection occurs by rubbing the feces of lice in skin damage (in comb). There are cases of infection when blood transfusion, taken from donors in the last days of the incubation period. Ricketcy, circulating in North America ( R. Canada.) is transmitted by ticks.

Pathogenesis. Gate infection There are minor damage to the skin (more often comb), after 5-15 minutes, rickettsi penetrate the blood. Rickening reproduction occurs intracellular in the endothelium of vessels. This leads to swelling and desquamation of endothelial cells. The cells that have fallen in blood flow are destroyed, the rejection of the rickettsia is affecting new endothelial cells. The most rapid process of reproduction of Rickettsius occurs in the last days of the incubation period and in the first days of fever. The main form of vessel damage is warthy endocarditis. The process can capture the entire thickness of the vascular wall with segmental or circular necrosis of the vessel wall, which can lead to a blood clogging of the vessel. So there are peculiar zeepphous granulomas (nodules Popov). In severe disease, necrotic changes are dominant, with light - proliferative. Vascular changes are especially expressed in the central nervous system, which gave the basis of I. V. Davydovsky to believe that every rapid typhoid is a unmargin Meningoencephalitis. With the defeat of the vessels, not only clinical changes on the part of the central nervous system are associated, but also skin changes (hyperemia, exammatime), mucous membranes, thromboembolic complications, etc. After the suffered suction typhus remains quite durable and long-term immunity. Part of the reconvalued fees is non-sterile immunity, since the rickettsia of the dispatch can be kept in decades in the organism of reconversion and at the weakening of the body's protective forces determine distant relapses in the form of Brill's disease.

Symptoms and current. Incubation period ranges from 6 to 21 days (more often than 12-14 days). In the clinical symptoms of suction typhus, the initial period is distinguished - from the first signs to the appearance of the rash (4-5 days) and the period of the right of the body - until the temperature of the body is dropped to the norm (it lasts 4-8 days from the moment of the appearance of the rash). It should be emphasized that this is a classic course. When prescribing antibiotics of the tetracycline group, after 24-48 hours, the body temperature is normalized and other clinical manifestations of the disease disappear. It is characterized by a sharp start, only some patients in the last 1-2 days of incubation may be long-term manifestations in the form of general breakdown, fast fatigue, the depression of the mood, gravity in the head, in the evening there is a small increase in body temperature (37.1-37 , 3 ° C). However, most patients with suction sick begins acutely with an increase in temperature, which is sometimes accompanied by cognition, weakness, severe headache, decreased appetite. The severity of these signs is progressively increasing, the headache is enhanced and becomes unbearable. It is too early to detect a peculiar excitation of patients (insomnia, irritability, multi-resistance of answers, hyperesthesia of senses, etc.). With severe forms there may be a violation of consciousness.

With an objective examination, there is an increase in body temperature to 39-40 ° C, the maximum level of body temperature reaches in the first 2-3 days from the beginning of the disease. In classical cases (i.e., if the disease is not stopped by the appointment of antibiotics) on the 4th and 8th day, many patients marked the "cuts" of the temperature curve, when for a short time the body temperature decreases to a subfebrile level. The duration of fever in such cases varies more often within 12-14 days. When examining patients, since the first days of the disease, there is a peculiar hyperemia of the skin of the face, neck, upper chest departments. Scler's vessels injected ( "Red eyes on a red face"). Early (from the 3rd day), a symptom characteristic of the raped typhoid appears - Kiairi-Avtsina spots. This is a kind of conjunctive rash. Elements of rashes with a diameter of up to 1.5 mm with blurry fuzzy borders of red, pink-red or orange, the amount of them is more often 1-3, but maybe more. They are located at the transitional folds of the conjunctive, more often of the lower eyelid, on the mucous membrane of the cartilage of the upper eyelid, the conjunctivation of the scool. These elements are sometimes difficult to consider due to the expressed skeler hyperemia, but if in a conjunctival bag, you can order 1-2 drops of 0.1% of the adrenaline solution, then hyperemia disappears and Kiairi-Avtsina spots can be revealed from 90% of patients with raw tit ( avtsyna's adrenaline test).

An early sign is both Enanthenta, which is very characteristic and is important for early diagnosis. It is described by N. K. Rosenberg in 1920 on the mucous membrane of a soft sky and tongue, usually at its base, as well as on the foreheads you can notice small petechia (up to 0.5 mm in diameter), the number of them is more often 5-6, And sometimes more. With a careful inspection, Enatet Rosenberg can be revealed from 90% of patients with a raw tit. It appears 1-2 days before the appearance of skin rashes. Like the stains of Kiairi-Avtsina, it remains until the 7-9th day of the disease. It should be noted that in the development of thrombohemorrhagic syndrome, similar races may appear with other infectious diseases.

With pronounced intoxication in patients with a raw tit, there may be a peculiar color of the skin of the palms and the stop, it is characterized by an orange tint, it is not the yellowness of the skin, especially since there is no subicterity of the scool and mucous membranes (where, as it is known, the jaundice is manifested earlier). Associate Professor of the Department of Infectious Diseases I. F. Filatov (1946) proved that such a painting is due to a violation of caroten metabolism (Carotenic Xanthromia).

The characteristic rash, which led the name of the disease, appear on the 4th-6th day (most often they are noticed in the morning of the 5th day of the disease), although the most typical period of appearance is the 4th day. The appearance of rash testifies to the transition of the initial period of the disease during the period of ripping. A characteristic feature of the Syroval Exanthemia is its petechial-rose-sized character. It consists of roseol (fine red spots with a diameter of 3-5 mm with blurred boundaries that do not rise above the skin level, the roseolates are disappearing at a pressure on the skin or stretching it) and petechy - small hemorrhages (diameter of about 1 mm), they do not disappear when skin stretching . There are primary petechies that appear against the background of previously unchanged skin, and secondary petechia, which are located on roselas (when stretching the skin, the roseless component of the examine disappears and only point hemorrhage remains). The predominance of petechial elements and the appearance on most roseol secondary petechs indicates a serious flow of illness. Exanthema with a rapid tit (unlike typhoid typhoid) is characterized by an abundance, the first elements can be noticed on the side surfaces of the body, the upper half of the chest, then on the back, buttocks, less rash on the hips and even less on the legs. Extremely rarely rash appears on the face, palms and soles. Roseolats quickly and disappear from the 8-9th day of the disease, and on the spot of petechs (like any hemorrhage), the color is noted, first they are bluish-purple, then yellowish-greenish, disappear more slowly (for 3-5 days). The course of illness without rash is rarely observed (8-15%), usually in patients with children's age.

There are usually no significant changes in respiratory organs in patients with suction typhoids, there are no inflammatory changes in the upper respiratory tract (the redness of the pharynx mucosa is due not to inflammation, but the injection of blood vessels). In some patients, there is an increase in breathing (due to the excitation of the respiratory center). The appearance of pneumonia is a complication. Changes in blood circulation bodies are observed in most patients. This is manifested in tachycardia, decreased blood pressure, muffling of heart tones, ECG changes, a picture of infectious toxic shock may develop. The defeat of the endothelium causes the development of thrombophlebitis, sometimes thrombus are formed in the arteries, in the reconvaluation period there is a threat of pulmonary artery thromboembolism.

Almost all patients are pretty early (from the 4-6th day) an increase in the liver is revealed. The increase in the spleen is detected somewhat less frequently (in 50-60% of patients), but in earlier deadlines (from the 4th day) than in patients with abdominal typhoid. Changes in the central nervous system are characteristic manifestations of raw typhus, Russian doctors have paid attention to ( "Nervous Clapper", in terms of terminology, I. Govorova). From the first days of the disease, the appearance of a strong headache is characterized by the appearance of patients, which is manifested in Multili, insomnia, the patients annoying light, sounds, touching the skin (hyperesthesia of the senses), may be attacks of violence, attempts to escape from the hospital, disturbing, delicious State, violation of consciousness, nonsense, development of infectious psychosis. For patients from the 7-8th day of the disease, meningeal symptoms appear. In the study of the cerebrospinal fluid, there is a small Pleocytosis (not more than 100 leukocytes), a moderate increase in protein content. With the defeat of the nervous system, the appearance of such signs such as hymiformism or amymia, the smoothness of the nasolabial folds, the deviation of the tongue, the difficulty when heating it, dysarthria, a violation of swallowing, nystagm. With severe forms of suction typhoid, a symptom of saying avenue is detected. For the first time, I was described by J. Govorov in 1812, avenue described it later (1853). The symptom lies in the fact that the request to show a language, the patient is putting it with difficulty, silent movements and further the teeth or the lower lip of the language cannot be narrowed. This symptom appears pretty early - before the appearance of the examine. Sometimes it is detected and with easier the disease. Part of the patients appears a total tremor (trembling of the language, lips, fingers of the hands). At the height of the disease, pathological reflexes are detected, signs of violation of oral automatic (reflex Marine-Radovichi, trump and distant reflexes).

The duration of the course of the disease (if antibiotics were not applied) depended on gravity, with light forms of the rapid typhoid fever lasted 7-10 days, the recovery was pretty quickly, complications, as a rule, was not. With moderate forms, the fever reached high numbers (up to 39-40 ° C) and lasted for 12-14 days, the examtember was characterized by the predominance of phetechial elements. It is possible to develop complications, however, the disease, as a rule, ended with recovery. With severe and very serious flow of rapid typhus, a high fever was observed (up to 41-42 ° C), sharply pronounced changes in the central nervous system, tachycardia (up to 140 ° C / min and more), decreased blood pressure to 70 mm Hg. Art. and below. The rash has a hemorrhagic character, along with petechia, larger hemorrhages and pronounced manifestations of thrombohemorrhagic syndrome (nasal bleeding, etc.) can appear. There were also erased forms of rapid typhus, but they often remained unrecognized. The above symptomatics is characteristic of classic raw typhus. When prescribing antibiotics, the disease is stopped for 1-2 bitches.

Diagnosis and differential diagnosis. The diagnosis of sporadic cases in the initial period of the disease (before the appearance of a typical examination) is very difficult. Serological reactions become positive as soon as from 4-7th day from the beginning of the disease. During epidemic outbreaks, the diagnosis is facilitated by epidemiological data (information about the morbidity, the presence of assuming, contact with the patients with raw title, etc.). When the examine appears (i.e. from the 4-6th day of the disease), the clinical diagnosis is already possible. The deadlines for the appearance and character of the rash, the hyperemia of the face, Enanthema Rosenberg, the stains of Kiairi-Avtsina, changes from the nervous system - all this allows differentiated primarily from abdominal typhoid (The gradual beginning, the inhibition of patients, changes from the digestive organs, and later the appearance of an examine in the form of a rose-papular monomorphic rash, the absence of petechs, etc.). It is necessary to differentiate and from other infectious diseases leaking with Exanthem, in particular, with other ricketersios (endemic suction tit, tick-ricketer rickecosis of Northern Asia, etc.). Some differential diagnostic value has a blood pattern. With a rapid title characteristic of moderate neutrophilic leukocytosis with a harsh shift, eosinopenia and lymphopianization, a moderate increase in ESP.

To confirm the diagnosis use various serological reactions. Sore a certain value of the wave-felix reaction is the reaction of agglutination with the protema OH 19, especially when the antibody titer is increasing during the disease. RCCs are more often used with a rickettsiosis antigen (prepared from the rickettsi ricakes), the diagnostic titer is considered to be 1: 160 and higher, as well as the increase in antibody titer. Other serological reactions are used (microaglutination reaction, hemagglutination, etc.). In the Memorandum of WHO's meeting on Ricketsios (1993), an indirect immunofluorescence reaction is recommended as the recommended diagnostic procedure. The acute phase of the disease (and reconvalue periods) antibodies are associated with IGM, which is used to distinguish between antibodies as a result of previously suffered disease. Antibodies begin to be detected in serum from the 4-7th day from the beginning of the disease, the maximum titer is reached after 4-6 weeks from the beginning of the disease, then the titers are slowly decreasing. After the suffered typhus of rickettsi rickens, a reconnaissance is preserved in the reconvaluation body for many years, this determines the long-term preservation of antibodies (associated with IgG also for many years, although in low-credits). Recently, with diagnostic purposes, test therapy with antibiotics of the tetracycline group is used. If, when appointing tetracycline (in conventional therapeutic doses) after 24-48 hours, the normalization of the body temperature does not occur, this makes it possible to exclude the raw tit (if the fever is not associated with any complication).

Treatment. The main etiotropic drug is currently being antibiotics tetracycline groupIn case of intolerance, the leftomycetin (chloramphenicol) is also effective. Tetracycline is prescribed more often in terms of 20-30 mg / kg or for adults 0.3-0.4 g 4 times a day. The course of treatment lasts 4-5 days. Legeless is prescribed leftomycetin at 0.5-0.75 g 4 times a day for 4-5 days. With severe forms, the first 1-2 days can be prescribed leftomycetin sodium succinate intravenously or intramuscularly at 0.5-1 g 2-3 times a day, after normalization of the body temperature, go to oral use of the drug. If against the background of antibiotic therapy, a complication due to the layering of secondary bacterial infection (for example, pneumonia), then, taking into account the etiology of complications, the corresponding chemotherapy preparation is prescribed.

Ethiotropic antibiotic therapy has a very quick effect and therefore many methods of pathogenetic therapy (vaccine therapy developed by Professor P. A. Alisov, long-term oxygen therapy, justified by V. M. Leonov, and others) are currently only historical significance. Of the pathogenetic drugs, the appointment of a sufficient dose of vitamins, especially ascorbic acid and p-vitamin preparations, which possess a vessel reinforcing effect, is mandatory. To prevent thromboembolic complications, especially in risk groups (they are primarily among the elderly), it is necessary to appoint anticoagulants. The appointments are necessary for preventing the development of thrombohemorragic syndrome. The most effective drug for this purpose is heparin, which should be appointed immediately after establishing a diagnosis of suction typhus and continue its reception within 3-5 days.

Heparin ( Heparinum), synonyms: Heparin sodim, Heparin Sun, Heparoid. Produced in the form of a solution in bottles of 25,000 units (5 ml). It should be borne in mind that tetracyclines to some extent weaken the effect of heparin. Enter intravenously in the first 2 days at 40,000-50,000 units / day. The drug is better to introduce drip with a solution of glucose or divide the dose on 6 equal parts. From the 3rd day, the dose reduces to 20,000-30,000 units / day. With an embolism already arising, the daily dose on the first day can be increased to 80,000-100,000 units. The drug is administered under the control of the blood coagulation system.

Forecast. Before the introduction into the practice of antibiotics, the forecast was serious, many patients were dying. Currently, when treating patients with tetracycles (or leftomycetin), the forecast is favorable even with the serious course of the disease. Female outcomes were observed very rarely (less than 1%), and after the introduction into the practice of anticoagulants of fatal outcomes is not observed.

Prevention and events in the focus. For the prevention of suction typhus, the struggle with seeriness, early diagnosis, insulation and hospitalization of patients with suction typhoid are of great importance, careful sanitary treatment of patients in the receiving rest of the hospital and disinsection of the patient's clothing is necessary. For specific prophylaxis, an inactivated vaccine formaline, containing the killed rickettsia of the provision, was used. Vaccines were used during increased morbidity and were effective. Currently, in the presence of active insecticides, effective methods of etiotropic therapy and low morbidity, the importance of anti-infannotifoic vaccination significantly decreased.

High incidence of typhoids is marked in developing countries with a warm climate and low sanitary culture of the population. In Russia, single, mainly browse, cases of typhoid are registered - more often in people who returned from trips to Africa, Southeast Asia or Latin America.

Different types of typhus are associated with infection with various microorganisms. Diseases differ in the method of infection, the mechanism of development and the characteristics of the clinical picture.

The name of the disease comes from ancient Greek Typhos - smoke, fog. Thus, in its very title, one of the most characteristic manifestations of typhoid - confusion of consciousness and impairment of psyche against the background of strong fever and pronounced intoxication is described.

The most common three types of typhus are most common: abdominal (BT), rapid (ST) and return (W).

Typhoid fever

Refers to a group of acute intestinal infections and is characterized by preferably lesion of the lymphoid tissues of the small intestine. In the midst of the abdominal typhus in the lower unit of the small intestine, ulcers are formed, which by the end of the disease are completely healing. Intestinal bleeding can be a dangerous complication of infection.

The causative agent of the abdominal typhoid is the Bacteria Salmonella Typhi (Salmonella Tifi). This is a moving wand with a lot of flagella. Bacteria is striking only people in the body of animals it does not survive.

The abdominal wand dwells in water and soil, it is fine tolerate low temperatures, it is easily saved and multiplied in food. Dies in boiling, under the influence of alcohol and disinfectants with chlorine. Flys that carry microorganisms from contaminated products can be promoted to the spread of infection.

Abdominal typhoid is predominantly children from 5 to 15 years. After the suffered infection, patients formed a long immunity to re-infection, however, with the weakening of the protective forces, there are cases of relapses.

Approximately 3-5% of people, abdominal silence, become chronic bacteria carriers, continuing to allocate Salmonella Typhi to the environment over several years, and sometimes all their lives.

How is infection?

The source of infection serve patients with abdominal typhoids or more often - asymptomatic bacteria carriers. Infection occurs when the use of water or products contaminated with the feces of an infected person (fecal-oral transmission path). A random source of infection can be a mollusc or fish caught in infected water.

Abdominal outbreaks are periodically recorded in cafes and restaurants, where bacteria carriers prepare food with dirty hands. Rarely typhoid salmonella spreads when using common utensils. It is mainly happening in the teams, where there is not enough attention to the observance of the sanitary regime.

Mass flashes of infections are recorded in the use of food products, in which the abdominal stick is still preserved: cottage cheese, milk, sour cream, minced meat, meat and fish salads. The peak of morbidity falls on the summer-autumn season.

Typhus

Raw typhus leaks with prevailing vessels. Its pathogens multiply in the walls of the vessels, which leads to their thickening, damage and clogging with blood closures (warthy endocarditis). Vascular changes are most pronounced in the skin, mucous membranes and brain.

There are several types of rapid typhus, among which the most famous epidemic and endemic:

• epidemic rapid typhus - can occur in any geographic region and spread over long distances, the pathogen of the epidemic station - bacterium from the Rickettsia ProWazekii Rickettsey Group (Rickettia Zavachak);
• endemic rapid typhus - Flares occur periodically in the same geographic regions, the causative agent of this form of the disease - Rickettsia Mooseri bacteria (Museum Rickettsia).

Both rapid appendizers are well transferred to low temperatures, for several months persist in the dried state, but quickly die in a wet medium, when heated and under the action of any disinfectants (chlorine, hydrogen peroxide, acids, alkalis, iodine solutions.

How is infection?

Epidemic suction type is transmitted to man. The patient becomes infectious in 2-3 days before the appearance of the first symptoms and continues to represent the danger to others within 7-8 days after the fever stop. On average, contagious period lasts from 10 to 21 days.

The carrier of infections serve the lice, so the epidemic station is also called sewn. The threat is more often posed by wraps, rarely heads. Lobkovoe sews are not transferred.

Peeling the patient's blood, it becomes infectious in 5-7 days and continues to distribute infection until the end of his life (30-40 days). When bloodsucked a healthy person, the loss highlights bacteria with feces. Man combines the place of bite and enters the infection in the rink.

The liner suction typhoid is equally registered among people of all ages, although some researchers believe that children are less susceptible to this infection. After the transferred disease, the rickettsia of the province can be kept for a long time in the body.

Bacteriamers of rapid typhus, in contrast to the abdominal, are not contagious. With a strong decrease in immunity, the bacteria can be activated again by bringing repeated infection - Brill's disease. As a rule, recurrence happens in elderly or old age.

The incidence rate of the raw title depends on the crowd of the population. Flashing infections are usually observed against the background of emergency situations: mass disasters, wars, natural disasters.

The source of infection of endemic suction typhoid is small rodents: gray, black rats and mice. A person can infamous from them in various ways:

Endemic suction typhoid is differently called flea, rat or ship. Flares of this disease are registered in port cities, where there is a large number of mice and rats (mainly in India and South America). From a person to a person flea of \u200b\u200ba rapid tyif is not transmitted.

After the suffering disease, patients formed a durable immunity. Unlike rickettsi ricakes, Ricketcies of the Museum in the body are not preserved, so the flea unit never recurrences.

Relapsing fever

A distinctive feature of this typhoid is the alternation of fever periods with periods of normal body temperature. The fevering period lasts from 2 to 6 days, then the temperature drops, the patient's condition is normalized, but after 4-8 days a new attack arises. The disease proceeds with preferably hemolytic impairment (blood violations).

Patients have:

• thrombocytopenia - reducing platelet levels, cells responsible for blood clotting;
• anemia - reduction of hemoglobin and red blood cells, red blood cells responsible for the transfer of oxygen to tissues;
• leukocytopenia - Reducing the level of leukocytes, white blood cells responsible for the fight against causative agents of infections.

Returning typhoid is two types:

• epidemic;
• endemic.

Both species cause bacteria - spirochetes belonging to the genus Borrelia (borrelia). The Epidemic WT is the Borrelia Obermeyer Burrelia, a tick-borne case, a group of borreli, which are common in certain geographic zones (V. Duttonii, V. Crocidurae, V. Persica, V. Hispanica, V. Latyschewii, V. Caucasica).

Bacteria are resistant to low temperatures, freezing, die during drying and heating.

How is infection?

Epidemic WT distribute sick people. Pathogenic bacteria are transferred through lice mainly through the wrapping (the second name of the endemic W - private).

The lice become contagious after 6-10 days after the bloodsucms of the sick person. During the fever, Vershi is intensively leaving the patient, moving on healthy people. Infection occurs at the time of the bite, when a healthy person combs itching place and crushes the infected loss.

The raverity of people and bad sanitary and hygienic conditions contributes to the rapid spread of infection. Just like a stitched raw tit, the sewn return takes the character of epidemics during wars and natural disasters.

Immunity after transferred to the sewed Wue unstable. Repeated disease is possible in a few months.

The source of the endemic W infection is different types of rodents. The carriers serve ticks of the Ornithodoros family, living in countries with tropical climates (Asia, Africa, Latin America). In nature, the infection is constantly circulating between animals. The tick remains contagious for 10 years after the bloodsuck of the patient rodent. Man infects after bite with infected tick.

The transferred tick-free Wo does not leave long immunity. The protective antibodies formed in the body are preserved no longer than a year.

Clinical manifestations

The incubation period (time from the moment of infection before the appearance of the first symptoms of the disease) under different types of typhus lasts from 5 to 30 days. The beginning of the disease is more often gradual, but happens to sharp.

Common for all types of typhoid are fever, signs of general intoxication (headache, weakness, pain in muscles), lethargy and inhibition. The development of these symptoms is due to the flow of typhoid bacteria and their toxins in the blood. Along with the blood, microorganisms are spread to various organs and tissues (liver, spleen, kidney), where intensively multiply.

Depending on the number of bacteria penetrated into the body, the age of the patient and immune status, the infection may occur in a light, medigative or severe form. With a light form, the temperature rises slightly (not higher than 38ºС), the symptoms of intoxication are expressed weakly, the disease passes without serious consequences. Heavy forms more often lead to complications, and in some cases - and to death.

Features of the clinical picture depend on the type of typhus. The symptoms below is characteristic of classical disease forms. In modern conditions, due to the appointment of antibiotics of infection, they will be stopped for 3-7 days and some of the symptoms simply do not have time to manifest.

Symptoms of abdominal typhoid

The incubation period continues on average for two weeks, although it can sometimes be delayed up to two months.

Clinical manifestations of abdominal typhoid are most pronounced between 5 to 25 years. In young children, the disease often proceeds in an erased form, which makes it difficult to properly formulate a diagnosis.

In a typical case, typhoid typhoid develops gradually. In the first days, patients complain of weakness, increased fatigue, decline in appetite, cognition. The body temperature increases to 38-39ºС for 4-7 days. In the middle or by the end of the first week, nausea, abdominal pain appear. Older children and adults can observe constipation, in young children - more often diarrhea. The patient looks pale, indifferent to the surrounding, sluggishly answers questions. His skin is hot and dry, the tongue is covered with a white bloom. In the acute beginning of the disease, the symptoms described are developing faster - within 2-3 days.

In the midst of the disease, the body temperature reaches maximum values \u200b\u200b- 39-40ºС. In 20-40% of patients, the oppression of the work of the brain (encephalopathy) is observed, which is manifested by infringement, delirium, hallucinations. This condition is called typhoid status.

For 8-9 days, rash appears in the form of rounded spots to 3 mm in diameter. The stains are more often located on the chest, abdomen, back, rarely - on the limbs and face. With light shapes of diseases of the rash, the scanty, with heavy - abundant. The rash is found more than half the patients and is saved up to 5 days, then completely disappears or for a short time leaves after itself easy pigmentation.

The language in the midst of the disease becomes dry, gray, sometimes covered with brown or dark brown raid. The liver and spleen increase (hepatosplegegaly). Meteorism appears, the chair becomes liquid and frequent (up to 5 times a day). Some patients develop bronchitis or pneumonia, which manifest a cough, shortness of breath, pain in the chest.

By the end of the second week, the disease reaches its peak. Patients have a pulse (bradycardia), reduced blood pressure, tumoring consciousness, nonsense, trembling of hands, involuntary urinals and defecation. Such a state is saved for about two weeks. With a mild and moderate form of BT violations from the nervous and cardiovascular systems, moderately is expressed.

In the fuzz of the symptoms, the body temperature gradually decreases. The patient's condition is noticeably improved: the appetite is returned, the meteorism, headaches disappear, restore the size of the liver and spleen.

The recovery period lasts 2-3 weeks. After the disease, the duration of time is preserved fatigue and irritability.

Approximately 10% of patients at 2-3 weeks recurrence occur. The exacerbations of the abdominal typhoid are faster and easier than the primary disease. The temperature rises slightly and keeps several days.

In a number of patients, the abdominal typhoid occurs atypic - in an erased form. Symptoms of intoxication (headache, malaise) in this case are very poorly expressed. The rash usually does not happen. The disease takes place in 5-7 days. During the whole period, patients remain able-bodied.

Symptoms of raw typhus

The incubation period of the sewing station continues from 6 to 21 days. The disease usually begins sharply with a sharp increase in temperature, chills, weaknesses, reducing appetite, strong headaches. Over the next 4-5 days, the severity of these symptoms is growing. Patients complain about insomnia, irritability, fog in the head.

When examining the patient, redness of the skin of the face, neck and chest is noted. Red eye squirrels. On 3-4 days of the disease, a characteristic rash appears on the mucous membrane of the lower eyelid. The elements of the rash are red or orange spots with a diameter of up to 1.5 mm (Kiairi-Avtsina spots). Typically, such stains are 1-3 in every century, but maybe more.

For about 4-5 days, rashes on the soft sky appear, and after them on the skin. Skin rash is abundant, usually located on the torso, limbs. Rarely amazed face. The rash consists of flat spots with a diameter of 3-5 mm, which are pale with pressing. The appearance of spots coincides with the transition of the disease in the stage of the groove.

In the midst of the raped typhoid fever and symptoms of intoxication are aggravated, headaches become the most pronounced. Patients are increasing the size of the liver and spleen. Improverage violations from the nervous system. Patients irritate light, sounds, touch, can occur nonsense, hallucinations, bay attacks.

The disease lasts 7-14 days. Symptoms gradually fade, body temperature comes back to normal. Over the course of 2-3 weeks, patients may remain weakness, plasticity, reduction of memory.

The flea unit also begins sharply with an increase in temperature, the sensation of weakness, breakdown. Fever keeps 8-12 days. Redness of the face and neck in patients are extremely rare. Spots on the mucous agence appear no more than 10% of patients.

Rash on the skin arise for 4-6 days and are usually located on the face, palms and soles, which does not happen with a seamy typhoid. In some patients, the rash is not observed at all. Violations from the nervous system are expressed moderately. In general, the flea of \u200b\u200bst occurs faster and easier than the stitching.

Brill's disease

Brill's disease (or Brill-Cinssera) is a relapse of a seamy typhus, which may arise several years later (from 1 to 50) after the suffering disease. The impetus to the development of the disease is usually the weakening of immunity - on the background of ARVI, stress, supercooling. Dormants in the body of Ricketsia are activated and re-enter the blood.

From the moment of the impact of the provoking factor before the appearance of the first symptoms of the disease passes from 5 to 7 days. According to the clinical picture, Brill's disease resembles the lungs and medium-free forms of seam suction typhus. The beginning is characterized by a temperature lift to 39-40ºС, weakness, headache. Patients irritate sounds, smells, light, touch. The face is blushing, but not as much as with a rapid tit. Spots on the mucous eye, as a rule, does not happen.

On 4-5 days of the disease, abundant skin rash appears. Fever is saved for another 8-10 days, then gradually goes to the decline.

The timely appointment of antibiotics will stop the symptoms of the disease within 1-2 days.

Symptoms of return typhus

The incubation period of the sewage WT continues from 3 to 14 days. The beginning of the disease is sharp: patients complain about chills, sharply increase body temperature up to 39-40ºС, severe headache, weakness. There are often intense pains in the lower back and legs. The activity is reduced, the appetite worsens, patients look sluggish and inhibited.

The skin of the face and neck at first the edema, red, in the future pale due to the development of anemia. Some patients red eye proteins are blushing. As a result of a reduction in blood coagulation, nasal bleeding, hemoptysis, hemorrhage under the skin and mucous membranes may develop.

On the second day of W, the patients increase the spleen, on 3-4 - liver. Typical decrease in blood pressure, shortness of breath, pulse cheating. The tongue is covered with a white chain, some have a rash - scarletin- or covenotic. In 10-40% of patients during fever, bronchitis or pneumonia and signs of heart lesions are noted. Typhoid status when wechive WT is rare and mostly among children.

Fever is saved 4-6 days, then the body temperature is sharply reduced to normal. At the same time, patients sweat greatly, their condition is noticeably improved. Only weakness remains.

On this disease, it can end, but most patients after 6-7 days a fevering attack repeats. It proceeds the same as the first, but faster. Total attacks can be repeated up to 5 times. At the same time, the duration of the faceless periods is gradually increasing, and feverish - shortening (the last attacks last no longer than a day). After 4-6 weeks from the beginning of the disease, there is a complete recovery.

The symptoms of the tick-borne title differs from the sewn of a large number of repeated fever attacks (up to 10) and their lesser duration. In general, the tick-free WT flows easier than the sewn, but late recurrences are possible. Repeated exacerbations happen in patients after 6-9 months after recovery.

Complications

Thanks to antibiotic therapy, the difficult course of typhoid diseases is observed extremely rarely, only if the treatment was not started on time.

The following complications are common to all infections:

• encephalitis - inflammation of the brain substance;
• acute bronchitis - inflammation of the bronchi;
• pneumonia - pneumonia;
• cholecystitis - inflammation of the gallbladder;
• pancreatitis - inflammation of the pancreas;
• meningitis - inflammation of the shells of the head and spinal cord;
• myocarditis - inflammation of the heart muscle;
• hepatitis - inflammation of the liver;
• rule spleen.

These states can develop for 2-3 weeks of the disease, when typhoid bacteria begin to spread through the body and affect individual organs. In addition, specific complications are characterized for different types of typhoids associated with the increased ability of the causative agent to damage certain organs and tissues.

Specific complications of abdominal typhoid

The abdominal wand has a damaging effect on the intestinal walls. In the iliac, less often in the colon, ulcers are formed, which can lead to bleeding. This usually happens at 3 week of the disease, but may occur before - by 10-12 days. Depending on the volume of bleeding, the patient's chair becomes aqueous or fresh blood appears in it. In the overwhelming majority of bleeding, they stop spontaneously and do not threaten the lives of patients.

Grozny complication of BT can be the intestine perforation - the formation of a through hole in its wall. The main symptoms of perforation: abdominal pain, respiratory gain and abdominal muscle tension. After a few hours, the picture of peritonitis (inflammation of the abdominal cavity) is developing. The patient's condition is aggravated - it appears nausea, vomiting, abdominal pain is enhanced. Treatment of peritonitis - surgical. The development of complications contribute to a pronounced meteorism, a shortage of body weight and violation of the bed regime.

• thrombophlebit - this is the inflammation of venous walls, which proceeds with the formation of a thrombus, thrombophlebitis is manifested by a seal, redness of the affected vein, soreness and edema;
• enermeritis - disease of arterial vessels (mainly of the arteries of the legs), which is accompanied by their narrowing up to the complete closure of the lumen, the main symptoms: pain in the legs, convulsions, fast fatigue when walking;
• pulmonary artery thromboembolism (TL) - represents the blockage of a pulmonary artery or its branches by tombami, classical manifestations of the tlation are cough, chest pain, shortness of breath, pulse, treatment, treatment of patients is carried out in resuscitation departments;
• hemorrhage in the brain (hemorrhagic stroke) - accompanied by nausea, vomiting, dizziness and severe headache, depending on the localization of hemorrhage, the patient may have violations of behavior, memory, sensitivity and speech, in 40% of cases, hemorrhagic strokes ends with a fatal outcome.

Specific Quantity Complications

Specific CT complications are thrombocytopenia and thrombohemorrhagic syndrome.

• thrombocytopenia - characterized by a decrease in the number of platelets - cells responsible for blood clotting;
• thrombohemorrhagic syndrome (DVS syndrome) - this is a violation of blood coagulation, which is accompanied by numerous bleeding into the internal organs, with a return TGS title, it takes more often in a favorable - local form, patients can observe stubborn nose bleeding, hemoptia, hemorrhage under the skin and mucous membranes, the skin becomes pale, marble, as The progression of the syndrome is developing numerous bleeding in the tissue of lungs, kidneys, liver, digestive tract, there are violations in the operation of the internal organs, the treatment of patients with DVS syndrome is carried out in hospitals.

Where to turn relatives and sick?

At the first signs of malaise, it is necessary to contact the clinic at the place of residence or cause a physician to the house. If a specialist has a suspicion of a typhoid illness, he will give direction to hospitalization.

Patients with typhoid isolate in separate boxes. When insertion of the patient's hospital, the patient's patient is treated with anti-playing agents in the receiving rest of the patient's hospital and dress up in clean clothing. Reminted clothes are subjected to disinsection.

The hospital employees convey information about patients with typhoids to the local center of hygiene and epidemiology, whose specialists are investigated in detail the case of such a disease. Brigades of epidemiologists are sent to the foci of infection for sanitary treatment (disinfection or disinsection).

For all people who closely communicated with a typhoid patient, a medical observation is established during the incubation period. At high probability of infection, emergency prevention can be carried out by antibacterial drugs.

Diagnostics

The diagnosis is assumed by the results of the inspection and polling of the patient. In favor of typhoid illness they say:

• pronounced fever, intense headaches, lethargy, populism of the patient;
• the appearance of rashes on the 4-10 day of the disease;
• the presence of specific types of signs (for example, the appearance of spots on the mucous membrane of the lower eyelid at ST; periodic attacks of fever at W; abdominal pain and meteorism at BT);
• contact with patients with pediculosis over the past 2-3 months (indicates the possible development of sewn forms of Art or W);
• recent departure to foreign countries with high incidence of typhus.

To confirm the diagnosis, bacteriological and serological (immunological) tests are carried out. In the course of bacteriological studies, the causative agent of the disease is revealed in the patient's biomaterials visually. Serological studies are based on the reaction of the interaction between antigens (proteins) of the pathogen and specific antibodies. Antibodies are protective cells that are produced by the immune system to combat infectious agents. With different infections, different types of antibodies are formed.

Depending on what kind of typhus is suspected, the patient assign a specific list of laboratory tests.

Abdominal laboratory diagnostics

The main method of diagnosing BT is bacteriological analysis. In the first week of the disease, the examination of the patient's venous blood is taken on the study, for 2-3 weeks - urine, calf or bile.

The material is sewn into a cup with a nutrient medium. A few days later the colonies of microorganisms grow in it. By the nature of their growth, the specialist determines whether this is Salmonella Typhi or the causative agent of another disease.

From 5-7 days of the disease, serological analysis can be completed. The serum is mixed with antigens of the abdominal stick adsorbed on erythrocytes. If serum has specific antibodies, they react with antigens and erythrocytes fall into precipitate (passive hemagglutination reaction, RPGA). The formation of a precipitate confirms the diagnosis of abdominal typhoid.

Laboratory diagnostics of rapid

To confirm Art, various serological tests are used - more often than RPGA or the reaction of indirect immunofluorescence. In the latter case, the patient serum is also mixed with the antigens of the pathogen, then the resulting immune complexes are manifested using fluorochrome.

To distinguish the serily station from flea, the reaction with antigens of rickettsi rickettsies and the museum put in parallel.

After transferring the disease of the antibody to rickettsiy, a long time is stored in the body. To confirm the acute infection, serological tests repeat several times. If the concentration of antibodies increases, it means the patient is really sick with a rapted typhoid (or his relapse - Brill's disease) at the moment. The constant concentration of antibodies in the blood means that the patient suffered Art in the past, and is now sick with another infection.

Bacteriological studies with rapid typhoids are not conducted.

Laboratory Diagnostics of Return Tip

Returnal type is confirmed by bacterioscopic analysis. The study takes the blood of the patient. A drop of blood is squeezed out of the finger, smeared on the glass (the "thick drop" method), then dried at room temperature. The drug is specially stained and considered under the microscope. Blood fence at W Make 2-3 times every 4-6 hours, since with a given disease, the causative agent periodically disappears from the blood.

Serological tests at W are not applied due to the large genetic diversity of borrelia.

To distinguish the private W from tick-borne, make a biological sample: the patient's blood infects guinea pigs or mice. If the animal is ill, it means the patient is the tick-free W.

Treatment of typhus

Patients with typhoid diseases are hospitalized into infectious hospitals. The patient is placed in a separate box, provide him with peace and proper care. During the entire fever period and 5-7 days after its completion, it is necessary to observe the bed regime. Hygienic treatments are spent in bed.

A high-calorie diet is prescribed sick typhoid. Food must be as small as possible for the intestines - rubbed, semi-liquid and liquid. From the diet, products contributing to gas formation (bean, cabbage, radishes, baking, fresh bread) are excluded. Meat and fish broths, soups, fermented milk products, steam cutlets, cereal cereals (except for millet), juices are allowed.

No special diet is required for sick and returnful typhoid. They may eat ordinary food.

The main method of treatment of typhoid diseases - antibiotic therapy. With abdominal typhoid, Levomycetin or ampicillin is appointed. With suction - antibiotics of the tetracycline group (tetracycline, doxycycline), less often of levomycetin. With a return - penicillin, ampicillin, leftomycetin or tetracycline drugs.

BT therapy continues throughout the feverish period and within 10 days after its completion. At ST and W, the course of reception of drugs lasts 5-7 days.

For a faster removal of bacterial toxins from the body, saline solutions (potassium chloride, sodium chloride), glucose solution are introduced intravenously. In severe cases, corticosteroids (hormonal anti-inflammatory means) are prescribed at increasing intoxication.

Patients with raw title with the aim of the prevention of thromboembolism introduced a drug that reduces blood coagulation - heparin. To strengthen the walls of the vessels shows ascorbic acid and vitamin R.

Depending on the severity of symptoms, in addition to typhoid patients, painkillers, soothing and hypnotics can be used.

Extract from the hospital is made on 10-12 days after setting the normal body temperature.

Preventive measures

Early diagnostics and timely insulation of patients are of great importance in the prevention of typhoid diseases. After the patient's hospitalization in the foci of infection, disinfection (or disinsection) is carried out. San Drops are engaged in the team of deductor specialists.

People who communicated with the sick, within 3 weeks from the moment of contact every day examines the district doctor. The specialist assesses the general condition, conducts inspections of the skin, mucous membranes and measures the temperature. Contact persons with signs of illness are immediately hospitalized.

People who communicated with the patient of Art or WT are examined for pediculosis. When you identify the wraising, anti-step treatment is carried out in sanitary bandwidters.

• consume only boiled or bottled water;
• thoroughly wash your hands after visiting public places and before meals;
• not to disrupt the conditions and terms of storage of products;
• there are no unwashed vegetables and fruits.

People traveling to countries with high incidence in abdominal typhoid, it is recommended to vaccinate.

Currently, there are two types of anti-foam vaccines:

• VI-polysaccharide (Wianwak, Typhim VI) - introduced in the form of injections - subcutaneously or intramuscularly, the injection is made once, immunity to BT develops after 7 days, to maintain immunity vaccinations must be repeated every three years, vaccine can be applied in adults and children over two years;
• Tu21A. - oral vaccine - introduced through the mouth in the form of capsules (for patients older than 5 years) or suspension (for children from 2 to 5 years), 3 doses of vaccines that need to be taken in a day are recommended, immunity is formed 7 days after the adoption of the latter Doses, persons permanently residing in hazardous regions, vaccination is recommended to repeat every 3 years, and travelers - every year.

Vaccines against abdominal typhoid can be administered simultaneously with other drugs designed for emerging countries (for example, with vaccines against yellow fever and hepatitis A).

The prevention of sewers and TW is reduced to the fight against the lice and avoiding contacts with the assuming patients.

The prevention of tick-boring W should be aimed at the destruction of ticks in natural foci of infections. Mass ticks are destroyed with acaricides. For individual protection, you can use repellents.