Typhus fever is a disease of infectious origin from varieties of rickettsiosis, caused by tick bites, characterized by a relatively mild course with lesions mainly of the lymph nodes and skin rashes. Other names of the disease that are found in medical practice and everyday life can be: tick-borne rickettsiosis, Siberian tick-borne typhus, oriental typhus.
The disease belongs to typical zoonoses, because the circulation of the pathogen and the incidence is recorded only among small rodents in natural conditions. It can be gophers, hamsters, field mice, chipmunks, voles. A person falls into this natural circle by accident after. Therefore, tick-borne typhus refers to diseases with natural foci and is tied to certain areas where pathogens constantly circulate. These are some regions of Siberia, Krasnoyarsk, Khabarovsk, Primorsky Territory, Turkmenistan, Armenia, Kazakhstan, Mongolia.
The carriers of infection between healthy and sick animals are ixodid ticks. The prevalence of the disease in natural conditions is so wide that every fifth representative of ticks is infected. This explains the relatively high incidence of tick-borne typhus among people living in pandemic areas. It averages 200-300 cases per 100,000 population per year. A significant number of residents have strong natural immunity, so mostly visitors and people with weakened immunity get sick.
The pathogenesis of the disease is determined by the pathogenic properties of rickettsiae. They enter the human body through the skin wound that remains after a tick bite. This place is called the primary affect, since the first inflammatory changes occur here when tissues come into contact with pathogens. In this case, pathogens spread along the lymphatic tracts to the collectors of the lymph nodes of the regional order. The result of such processes can be lymphangitis next to the primary affect, and an increase in lymph nodes. In them, rickettsia multiply with regular release into the systemic circulation and spread throughout the body.
The peculiarity of infectious agents in tick-borne typhus is the preservation of tropism for the vascular endothelium, as in epidemic typhus, but much less pathogenic and toxigenic properties. The main pathogenetic links of the disease are microcirculatory disorders as a result of capillary damage, inflammation in them and increased permeability, as well as minor intoxication that occurs when pathogens are destroyed by the body's immune cells. Therefore, their distribution in the body proceeds relatively favorably and never causes serious complications.
The period of incubation of pathogens of tick-borne typhus, which lasts from the moment the tick bites until the first manifestations of the disease appear, ranges from 3-4 days to a week. At this time, in addition to a slight inflammation of the skin at the site of the bite, nothing bothers the patients anymore. The clinical picture develops suddenly and quite sharply.
In this case, the following symptoms of typhus appear:
hyperthermic reaction. In most cases, constant or intermittent. The duration of the febrile period can be up to two weeks if the patient is not treated. A few days after the appearance of the temperature figure decreases slightly, it acquires constancy;
Tick-borne rickettsiosis (Tick-borne rickettsiosis North Asian) is an infectious natural focal disease caused by Rickettsia sibirica, characterized by a feverish state, a primary focus, an increase in regional lymph nodes, and a rash. The causative agent of infection - R. sibirica - Gram-negative rod-shaped bacteria are cultivated in the yolk membranes of chicken embryos, in cell cultures. They multiply in the cytoplasm and nucleus of affected cells. Rickettsia are not resistant to heat, are unstable to the action of disinfectants. Rickettsiae of tick-borne typhus are inhabitants of various types of ixodid ticks. Experimentally, the disease is reproduced in male guinea pigs, golden hamsters, and white mice. Tick-borne rickettsiosis occurs only in certain geographical areas in Siberia and the Far East.
The main source and carrier of the pathogen are naturally infected ixodid ticks, which are capable of long-term preservation of rickettsiae and their transmission to offspring. Human infection occurs only as a result of suction of rickettsia-infected ticks. Infection occurs only in a transmissible way, so patients do not pose a danger to others. In the place of the entrance gate, the pathogen multiplies. Rickettsia enter the bloodstream, affecting mainly the vessels of the skin and brain, causing symptoms of fever with a rash; lethal outcomes are not noted. Those who have been ill develop strong immunity. Relapses and repeated diseases are not observed. Microbiological diagnostics based on the serological method: RNGA, RSK, RIF. Developed by ELISA. Treatment carried out with tetracycline antibiotics. Prevention includes a set of measures: individual protection against attack and suction of ticks, destruction of ticks. Specific prophylaxis has not been developed.
1. Antibiotics.- chemotherapeutic substances produced by microorganisms,
animal cells, plants, as well as their derivatives and synthetic products, which have a selective ability to inhibit and retard the growth of microorganisms, as well as suppress the development of malignant neoplasms.
Opening history: 1896 - B. Gozio from a liquid containing a culture of a fungus from the genus Penicillium (Penicillium brevicompactum), isolated a crystalline compound - mycophenolic acid, which inhibits the growth of anthrax bacteria. 1899 - R. Emmerich and O. Low reported an antibiotic compound produced by the bacterium Pseudomonas pyocyanea and named it pyocyanase; the drug was used as a local antiseptic. 1929 - A. Fleming discovered penicillin, however, he failed to isolate a sufficiently stable "extract". 1937 - M. Welsh described the first antibiotic of streptomycetic origin - actinomycetin.
1939 - N.A. Krasilnikov and A.I. Korenyako received mycetin; R. Dubos - tyrothricin. 1940–E. Cheyne isolated penicillin in crystalline form. 1942-Z. Waksman coined the term "antibiotic" for the first time.
Sources of antibiotics. The main producers of natural antibiotics are microorganisms that, being in their natural environment (mainly soil), synthesize antibiotics as a means of survival in the struggle for existence. Animal and plant cells can also produce some substances with a selective antimicrobial effect (for example, phytoncides), but they have not been widely used in medicine as antibiotic producers. Thus, the main sources for obtaining natural and semi-synthetic antibiotics have become:
Actinomycetes (especially streptomycetes) are branching bacteria. They synthesize the majority of natural antibiotics (80%).
Molds - synthesize natural beta-lactams (fungi of the genus Cephalosporium and Penicillium) H fusidic acid.
Typical bacteria - for example, eubacteria, bacilli, pseudomonas - produce bacitracin, polymyxins and other substances that have an antibacterial effect.
2. Immune sera. Classification. Receiving, cleaning. Application.Immune sera: immunological preparations based on antibodies.
obtained by hyperimmunization of animals with a specific antigen, followed, during the period of maximum antibody production, by the release of immune serum from the blood. IS obtained from animals are called heterogeneous because they contain foreign proteins. To obtain homologous non-alien sera, sera of recovered people or specially immunized human donors are used, containing antibodies to a number of pathogens of infectious diseases due to vaccination or past illness.
Native immune sera contain unnecessary proteins (albumin), and specific immunoglobulin proteins are isolated and purified from these sera.
Cleaning Methods: 1. precipitation with alcohol, 2. acetone in the cold, 3. enzyme processing. Immune sera create passive specific immunity immediately after administration. Used for therapeutic and prophylactic purposes. For the treatment of toxin infections(tetanus, botulism, diphtheria, gas gangrene), for the treatment of bacterial and viral infections (measles, rubella, plague, anthrax). For medicinal purposes serum preparations in / m. prophylactically: in / m to persons who had contact with the patient, to create passive immunity.
3. The causative agent of influenza. Taxonomy. Characteristic. Laboratory diagnostics. Influenza is an acute respiratory disease characterized by damage to the mucous membranes of the upper respiratory tract, fever, symptoms of general intoxication, and impaired activity of the cardiovascular and nervous systems. Influenza is characterized by a tendency to epidemic and pandemic spread due to the high contagiousness and variability of the pathogen. Taxonomy: genus Influenzavirus - influenza viruses types A and B, genus Influenza C is represented by influenza virus type C., classification: RNA-containing viruses belong to the Orthomyxoviridae family (from the Greek orthos - correct, rot - mucus). The family includes two genera. Laboratory diagnostics. The material for the detection of a virus or viral antigen is swabs-imprints from the mucous membrane of the nasal cavity, nasopharyngeal discharge, in case of death - pieces of lung tissue or brain. Express diagnostics is based on the detection of viral antigen using RIF; a test system for ELISA was developed. Chicken embryos are used for virus isolation. The indication of influenza viruses is carried out when setting up the hemagglutination reaction. The isolated viruses are identified step by step: the type affiliation is determined using RSK, the subtype is determined by RTGA. Serodiagnostics is carried out using RSK, RTGA, PH in cell culture, gel precipitation reaction, ELISA. Specific prevention and treatment. For specific prophylaxis, live and inactivated vaccines from influenza A (H1N1), A (H3N2) and B viruses cultured in chicken embryos are used. There are three types of inactivated vaccines: virion (corpuscular); split, in which the structural components of the virion are separated using detergents; subunit containing only hemagglutinin and neuraminidase. A vaccine of three influenza viruses is administered intranasally in one vaccination dose according to a special scheme. Vaccination is indicated for certain contingents at high risk of infection. A culture-inactivated vaccine is being tested. Developments are underway to create a new generation of influenza vaccines: synthetic, genetically engineered. Unfortunately, in some years there is a rather low efficiency of vaccination due to the high variability of influenza viruses. For treatment, as well as emergency prevention of influenza, chemotherapeutic antiviral drugs (remantadine, virazole, arbidol, etc.), interferon preparations and immunomodulators (dibazole, levamisole, etc.) are used. In severe influenza, especially in children, the use of donor anti-influenza immunoglobulin, as well as drugs that are inhibitors of cellular proteases: Gordox, contrical, aminocaproic acid, is indicated. Morphology and chemical composition. Virions are spherical in shape. The core contains a single-stranded linear fragmented minus-stranded RNA, a protein capsid surrounded by an additional membrane - a matrix protein layer. Cultivation. For cultivation, chicken embryos, cell cultures, and sometimes laboratory animals are used. Epidemiology. The source is a sick person with a clinically pronounced or asymptomatic form. The route of transmission is airborne (when talking, coughing, sneezing). Influenza is characterized by an acute onset, high body temperature, general intoxication, expressed in malaise, headache, pain in the eyeballs, and respiratory tract damage of varying severity. A feverish state with influenza without complications lasts no more than 5-6 days.
1. Stages of development and characteristic signs of an infectious disease. An infectious disease should be understood as an individual case of a laboratory and / or clinically determined infectious state of a given macroorganism, caused by the action of microbes and their toxins, and accompanied by various degrees of homeostasis disturbance. This is a special case of the manifestation of the infectious process in this particular individual. For an infectious disease, certain stages of development are characteristic:
1. Incubation period - the time that passes from the moment of infection to the onset of clinical manifestations of the disease. 2. Prodromal period - the time of appearance of the first clinical symptoms of a general nature, non-specific for a given disease, such as weakness, fatigue, lack of appetite, etc.; 3. The period of acute manifestations of the disease is the height of the disease. At this time, symptoms typical of this disease appear: temperature curve, rashes, local lesions, etc.; 4. The period of convalescence - the period of fading and disappearance of typical symptoms and clinical recovery. The contagiousness of an infectious disease- the ability to transmit the pathogen from an infected to a healthy susceptible organism. Infectious diseases are characterized by the reproduction (multiplication) of an infectious agent that can cause infection in a susceptible organism.
2. Preparations of immunoglobulins. Obtaining, purification, indications for use. Native immune sera contain unnecessary proteins (albumin), and specific immunoglobulin proteins are isolated and purified from these sera.
Immunoglobulins, immune sera are divided into: 1. Antitoxic - serums against diphtheria, tetanus, botulism, gas gangrene, i.e. sera containing antitoxins as antibodies that neutralize specific toxins. 2. Antibacterial - sera containing agglutinins, precipitins, complement-fixing antibodies to pathogens of typhoid fever, dysentery, plague, whooping cough. 3. Antiviral sera (measles, influenza, anti-rabies) contain virus-neutralizing, complement-fixing antiviral antibodies. Cleaning Methods: cold precipitation with alcohol, acetone, enzyme treatment, affinity chromatography, ultrafiltration. The activity of immunoglobulins is expressed in antitoxic units, in titers of virus-neutralizing, hemagglutinating, agglutinating activity, i.e. the smallest amount of antibody that causes a visible reaction with a certain amount of a specific antigen. Immunoglobulins create passive specific immunity immediately after administration. Used for therapeutic and prophylactic purposes. For the treatment of toxin infections (tetanus, botulism, diphtheria, gas gangrene), as well as for the treatment of bacterial and viral infections (measles, rubella, plague, anthrax). For therapeutic purposes, serum preparations in / m. Prophylactically: in / m to persons who had contact with the patient, to create passive immunity.
If it is necessary to urgently create immunity, immunoglobulins containing ready-made antibodies are used to treat a developing infection.
3. The causative agent of rabies. Taxonomy. Characteristic. Laboratory diagnostics. specific prophylaxis. Rabies is a particularly dangerous infectious disease of humans and warm-blooded animals, transmitted by contact with an infected animal, characterized by damage to the central nervous system and death. Taxonomy. The causative agent of rabies is an RNA-containing virus that belongs to the family Rhabdoviridae, the genus Lyssavirus. Laboratory diagnostics. Laboratory studies are carried out posthumously. Pieces of the brain and spinal cord, submandibular salivary glands are used as the test material in accordance with the rules for working with especially dangerous infectious material. Express diagnostics is based on the detection of a specific antigen using RIF and ELISA and Babesh.Nefy bodies. The virus is isolated using a bioassay on white mice.
Specific prevention and treatment. Vaccines derived from the brains of infected animals - rabbits, sheep, can cause complications, so they are rarely used. In our country, an anti-rabies cultural concentrated vaccine is used, obtained from the Vnukovo-32 strain (derived from the fixed Pasteur virus), inactivated by UV or gamma rays. Treatment-and-prophylactic vaccination is carried out on persons bitten or licked by sick or suspicious animals for rabies. Vaccinations should begin as soon as possible after a bite. In severe cases, a combined administration of anti-rabies immunoglobulin and a vaccine is used. Genetically engineered anti-rabies vaccines are being developed. Treatment is symptomatic.
Morphology and chemical composition. Bullet-shaped virions consist of a core surrounded by a lipoprotein envelope with glycoprotein spines. RNA is single stranded, minus stranded.
Cultivation. The rabies virus is cultivated in the brain tissue of white mice, rabbits, rats, etc. Infected animals develop paralysis of the limbs, then they die. The rabies virus can be adapted to primary and transplantable cell cultures and chick embryos. Epidemiology. Man is a random link in the epidemic process and does not take part in the circulation of the virus in nature. The rabies virus accumulates and is excreted through the salivary glands of the animal during the illness and in the last days of the incubation period. . Transfer mechanism pathogen - direct contact, mainly with bites, to a lesser extent with abundant salivation of the skin with scratches and abrasions. The role of a sick person as a source of infection is minimal, although his saliva contains the rabies virus. Pathogenesis and clinical picture. The rabies virus has pronounced neurotropic properties. From the site of introduction, the viruses enter the central nervous system via peripheral nerve fibers, multiply in it, and then spread centrifugally, affecting the entire nervous system, and are excreted with saliva into the environment. In the clinical picture of rabies in humans, the following periods are distinguished: precursors (prodromal), excitation and paralysis. The disease begins with the appearance of a feeling of fear, anxiety, irritability, insomnia, general malaise, and an inflammatory reaction at the site of the bite. In the second period of the disease, reflex excitability sharply increases, hydrophobia (fear of water), spasmodic contractions of the muscles of the pharynx and respiratory muscles appear, making breathing difficult; increased salivation, patients are excited, sometimes aggressive. After a few days, paralysis of the muscles of the limbs, face, respiratory muscles occurs. The duration of the 3-7 days. Lethality 100%.
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Tick-borne typhus of North Asia- acute zoonotic rickettsiosis with a transmissible mechanism of transmission of the pathogen, which is characterized by fever, the presence of primary affect, lymphadenitis, rash and a benign course of the disease.
History and distribution
The disease was described and studied by Soviet researchers in 1934-1948. Pathogen open O.S. Korshunova in 1938. The disease is recorded from the Urals to the Primorsky Territory, as well as in Mongolia, Kazakhstan, Turkmenistan and Armenia. In Russia, up to 1,500 cases per year have been registered in recent years.
Etiology
Epidemiology
The source of the pathogen is rodents (ground squirrels, voles), the carrier and reservoir are ixodid ticks. Infection occurs when bloodsucking infected ticks. Seasonality spring-summer. Postinfectious immunity is stable.
Pathogenesis and pathomorphology are similar to those of other tick-borne rickettsiosis.
Clinical picture
The incubation period is 3-7 days. The onset is acute, but a prodrome is possible. An increase in body temperature is accompanied by chills and increasing intoxication. Within 2-3 days, the body temperature reaches 39-40 ° C and acquires a constant or relapsing character, lasting from several days to 2 weeks. Characterized by hyperemia and puffiness of the face, injection of the sclera and conjunctiva. At the site of the bite, a primary affect is formed in the form of a mildly painful infiltrate, covered with a necrotic crust with a halo of hyperemia. In many cases, regional lymphadenitis develops.
A profuse polymorphic roseolous-papular rash is characteristic, which often appears on the 2nd-4th day. The rash covers the entire trunk and limbs. It is rarely seen on the palms and soles. By the end of the febrile period, the rash becomes pigmented.
They note arterial hypotension, bradycardia, in some patients an increase in the liver and spleen.
Possible complications: serous meningitis, pneumonia, myocarditis.
Diagnosis and differential diagnosis
To confirm the diagnosis, RPHA, RSK, NRIF are used. Differential diagnosis is carried out with other rickettsiosis, typhoid fever, leptospirosis.
Treatment
Antibacterial therapy is carried out with tetracycline antibiotics in average therapeutic doses until the 2nd day of normal body temperature.
The prognosis is favorable, but isolated deaths have been described.
Prevention is aimed at protecting against the attack of ixodid ticks and their destruction. In natural foci, protective clothing, repellents, self- and mutual examinations after visiting the forest are used.
Yushchuk N.D., Vengerov Yu.Ya.
- dermatitis;
- urticaria;
- pathological rash accompanied by itching.
In addition to skin manifestations, insect bites provoke nervous disorders. A person has excessive irritability and rapid weight loss, sleep is disturbed, appetite disappears.
Conducting clinical studies, experts came to the conclusion that in humans, a decrease in immunity is directly related to the consequences of the bites of blood-sucking insects. Being carriers of infectious diseases, insects contribute to the fact that pathogenic forms penetrate the human body, weakening the immune system.
Fleas
The human flea is very significant for medicine, since it is a carrier of the most dangerous diseases for humans - tularemia and plague, to which a person has absolute susceptibility. In addition, the adult flea is an intermediate host of the dog tapeworm.
Lice
Lice are highly prolific with a three-week life cycle. During this period, the female is able to lay close to three hundred eggs.
The presence of lice in the scalp is called pediculosis, popularly called the disease of vagrants. From a medical point of view, lice are dangerous carriers of such complex infectious diseases as typhus and relapsing fever.
Diptera
Flies family
Not all flies belong to the same species of annoying indoor insects. There are more than a dozen species, but only those species that pose a threat to humans are considered important for physicians:
Insect bites mostly affect children. It is they who become the targets of myiasis of varying degrees of intensity. With an unfavorable prognosis, almost complete destruction of tissues in the bite occurs. As a rule, these are soft tissues of the facial part of the head and orbit. Such a clinical picture can cause death.
Intestinal myiasis in humans occurs when the larvae of blowflies or houseflies accidentally enter the gastrointestinal tract.
Ticks
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What is tick-borne typhus (rickettsiosis)
Description of the disease
Other names: ixodoricketsiosis (Ixodoricketsiosis Asiatica), tick-borne typhus of Siberia (Ricketsiosis Sibirica), seaside rickettsiosis, etc. There are many names, but the essence is the same: this is a disease from the group of transmissible zoonoses, which occurs with an acute febrile syndrome. It is found locally in various countries. In Russia, rickettsiosis is more common in the Far East and Eastern Siberia.
Pathogen
Tick-borne rickettsiosis is caused by the bacterium Rickettsia. It was discovered by American pathologist Howard Taylor Ricketts in 1909. A year later, the doctor died of typhus, the study of which he devoted the last years of his life. They decided to immortalize the bacteriologist by naming a bacterium by his last name.
The rickettsia cell is rod-shaped. But as environmental conditions change, the bacterium can become filamentous or irregularly shaped. The cell is protected by a microcapsule that prevents certain antibodies contained in human blood from reaching the bacterium. The capsule is unstable only to those antibodies that are formed after a person has been ill with tick-borne rickettsiosis. The disease creates immunity, so there are no relapses.
Method of infection
The infection is transmitted with blood, through invasive ticks. The insect bites through the skin, and with its saliva, bacteria enter the lymphatic tract, and then into the bloodstream. This immediately leads to the development of lymphangitis (inflammation of the lymphatic vessels) and local lymphadenitis (inflammation of the lymph nodes).
The transmissible (through the blood) route is the main mode of transmission of tick-borne rickettsiosis. But there are several other ways of infection:
- blood transfusion - through blood transfusion (rarely, because the symptoms of the disease are so obvious that no doctor will agree to take blood from such a donor);
- transplacental - from mother to fetus (only if the woman became infected in the 1st trimester or 2-3 weeks before delivery);
- aspiration - airborne (for such infection, it is necessary that particles of the saliva of an infected person or animal fall directly on the mucous membrane of another person);
- contact - when rickettsiae are rubbed into the skin (for this, an infected animal must, for example, lick the area of \u200b\u200bhuman skin where it has a microwound);
- alimentary - when swallowing the feces of an infected person or animal (for example, along with fruits, berries).
Symptoms
The incubation period for tick-borne rickettsiosis is only 3-5 days. After this time, it is no longer possible to ignore the symptoms. The disease begins acutely: chills, a rapid rise in temperature to 39-40 degrees. Sometimes there is a prodromal syndrome with general malaise, aching bones and headaches. Such a fever lasts up to 8 days, during the last of which the temperature begins to decrease (before that, it can only be knocked down for a few hours).
Also during the febrile period, a person experiences muscle pain (especially in the lower back); his blood pressure drops and his pulse slows down. Sometimes the liver increases, reacting to intoxication of the body. The appearance of a person infected with tick-borne rickettsiosis also changes: his face swells, and his sclera turns red (“rabbit eyes”).
By the way! In children, the febrile stage of typhus is more acute, with vomiting and critical temperature. But the duration of this period is almost 2 times less. Tick-borne rickettsiosis is most severely tolerated by the elderly.
There are also problems with tick-borne rickettsiosis with the site of a tick bite. A dense infiltrate (small bulge) is formed on the skin, covered with a brownish necrotic crust and surrounded by a border of hyperemia. Nearby lymph nodes are enlarged. Due to the fact that ticks often stick to the neck or head (the most open areas), the main "blow" is taken by the cervical lymph nodes.
A characteristic symptom of tick-borne rickettsiosis is a skin rash all over the body. It resembles urticaria, but with a more contrasting color. In the late period of the disease, a pinpoint hemorrhage may occur in the center of each papule, which also indicates that the person has had typhus, and not another ailment.
Diagnostics
The symptoms of tick-borne rickettsiosis are quite pronounced, so making a diagnosis is usually not difficult. The survey begins with a survey and examination of the patient. A rash on the body gives out an infection, and the discovery of a tick bite indicates that the disease was transmitted by a transmissible route. A blood test for infection can also show typhus.
By the way! If tick-borne rickettsiosis is suspected, differential diagnosis is necessary, which will allow to exclude diseases with similar symptoms: influenza, water fever, etc.
The most accurate way to determine tick-borne rickettsiosis is by a tick pulled out of the body. Doctors always warn that the removed insect should be taken to the laboratory so that specialists can determine its invasiveness. If you find a tick almost immediately after sucking, remove it (or better, go directly to a doctor with it) and take it for examination, you can quickly identify the infection and start treatment without waiting for symptoms to appear or worsen.
Treatment
The tactics of treating a patient with tick-borne rickettsiosis requires not only taking certain medications, but also specific care. The more thorough it is, the faster the person will recover, and the easier the course of the disease will be.
Medicines
Tetracycline is the most common and topical treatment for typhus. It is a broad-spectrum antibiotic that can destroy Rickettsia bacteria. The patient should start receiving the drug even before the temperature rises (if tick-borne rickettsiosis was detected in a tick that bit a person). Duration of tetracycline intake: 3 days. This is enough to kill the infection, but the symptoms of intoxication will persist for some time.
The treatment of typhus with chloramphenicol is sometimes mentioned. This tactic is less successful, but it is appropriate when it is impossible to use antibiotics of the tetracycline group.
Patient care
Throughout the treatment, the patient should drink plenty of water and eat small meals frequently. The liquid will allow you to quickly cleanse the blood and remove toxins from the body, and nutrition will restore strength. There is no special diet, but food should be varied and high-calorie.
It is important to maintain oral hygiene of the patient. If a person is able to brush their own teeth, that's great. Otherwise, you need to help him. A nurse or relative wraps a finger with a sterile bandage, soaks it in a solution of boric acid (2%) and wipes the patient's teeth, gums, palate and cheeks from the inside. It is also desirable to wash the patient after each bowel movement, as well as at least once a day.
The room where the person infected with tick-borne rickettsiosis is located is regularly ventilated. The patient himself all the time while the temperature is kept, observes bed rest. It is allowed to get up if you have the strength to do so and only to go to the toilet.
Attention! Active movements at high temperatures threaten a variety of complications, incl. on the heart.
The prognosis of the disease is favorable. The antibiotic inhibits the action of the bacteria, and the temperature gradually decreases. In the absence of treatment, the disease also passes, but with possible complications against the background of a long-lasting high temperature and a strong weakening of the patient. It can be pyelonephritis, bronchitis, myocarditis, thrombophlebitis. Immunity to tick-borne rickettsiosis persists for the rest of your life.
Prevention
Yet the most common route of infection with typhus is through a tick bite. Therefore, the main rule for the prevention of tick-borne rickettsiosis is protection from these insects. During the seasons of their activity (spring, summer), you need to be especially careful: visit endemic areas only in full ammunition (in special protective suits), use repellents, and make preventive vaccines.
Prevention also consists in the mandatory hospitalization of an infected person in the infectious diseases department. Observation is also established for all persons with whom the patient has been in contact after infection.
TIC-BASED TYPHUS
Tick-borne typhus (North Asian rickettsiosis) is an acute infectious disease with a benign course, characterized by the presence of a primary affect, fever and skin rashes.
Pathogen - Rickettsia prowazekii.
Epidemiology. The source of infection is the patient. The transmission mechanism of the pathogen is transmissive, realized through the bite of lice (mainly body lice).
Clinic.
Incubation period 6-22 days. The beginning is sharp.
Syndrome of intoxication. Temperature 39 - 40 C for 7-14 days, often with characteristic "cuts" on the 4th, 8th, 12th days of illness; persistent headache, weakness, anorexia, insomnia, anxiety, euphoria, agitation.
Skin hot, dry, lips hyperemic, bright; hyperemia and puffiness of the face.
Rash appears on the 4-5th day of illness, roseolous-pegechial, localized on the chest, lateral surfaces of the body, flexion surfaces of the limbs.
hemorrhagic syndrome. Rosenberg's enanthema - punctate hemorrhages on the mucous membrane of the soft palate and tongue, appearing on the 2nd - 3rd day of illness. Chiari-Avtsyn's symptom - hemorrhages on the transitional fold of the lower eyelid - appears on the 3rd - 4th day. Endothelial symptoms: Rumpel-Leede-Konchalovsky, "twist", "pinch".
Symptoms of meningoencephalitis: headache, dizziness, nausea, insomnia, deviation of the tongue, dysarthria, Govorov-Godelier symptom (jerky protrusion of the tongue), smoothness of the nasolabial fold. Psychiatric disorders, delusions, and meningeal symptoms are possible.
Hepatosplenomegaly.
Complications: infectious-toxic shock, infectious-toxic encephalopathy, vascular complications: thrombosis, thromboembolism, thrombophlebitis, heart attacks, pneumonia.
Differential Diagnosis carried out with influenza, meningitis, hemorrhagic fevers, typhoid fever and paratyphoid fever, ornithosis, trichinosis, endovasculitis.
Laboratory diagnostics.
In the blood test, neutrophilic leukocytosis, eosinopenia, thrombocytopenia, moderately accelerated ESR. Serological diagnostics - RSK with Provachek's rickettsiae in titer 1/160 and above, RNGA at a dilution of 1:1000, ELISA.
Treatment.
Etiotropic therapy: the drug of choice is tetracycline 1.2 -1.6 / day. during the entire febrile period and 2 days of normal temperature.
Pathogenetic therapy: detoxifying, cardiovascular agents, anticoagulants. Symptomatic treatment: sedatives, antipsychotics, antipyretics, analgesics.
Measures for patients and contact persons.
Hospitalization. according to clinical indications.
Contact isolation. Not carried out.
Release conditions. Clinical recovery not earlier than 10 days from the onset of the disease.
Admission to the team. After clinical recovery.
Medical examination: Restriction of physical activity for 3-6 months is recommended
specific prophylaxis.
Not developed.
nonspecific prophylaxis.
Deratization and pest control in epidemic foci. Wearingoveralls and examinations of clothing and body surfaces to detect and remove ticks. Removed ticks are destroyed, the bite site is treated with solutions of iodine, lapis or alcohol.
BRILL'S DISEASE
Brill's disease is a recurrence of epidemic typhus in those who have recovered from it after many years and is characterized by sporadic diseases in the absence of a source of infection, lice and focality. It flows more easily than typhus. Clinical manifestations, diagnosis and treatment, see the section "Typhus". Characterized by high titers of antibodies in RNHA, RSK in the first days of the disease (antibodies of the class of immunoglobulin G).
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