Brucellosis is a disease characterized by a lesion of the musculoskeletal system, nervous, sexual and other systems.
Brucella resistant in the environment. They remain in water for more than 2 months, in milk – 40 days, in brynze – 2 months, in raw meat – 3 months, in salted – up to 30 days, in wool – up to 4 months. Brucella die when heated and under the influence of many disinfectants.
From a sick person to a healthy brucella are not transmitted. The reservoir and source of infection are domestic animals (sheep, goats, cows, pigs, less often dogs).
Infection with brucellosis from sick animals occurs through contact, food and air routes. Contact infection is particularly common when the amniotic fluid comes into contact with the skin (help with calving, lambing, and caring for newborn calves, lambs). Veterinary workers, calf-bearing shepherds, and others often become infected. Infection can also occur upon contact with the meat of infected animals, with manure.
Brucella penetrate the slightest damage to the skin. Food contamination often occurs through raw milk, as well as the use of dairy products (cheese, cheese, butter). Infection by air can occur when dust containing brucella (in grazing areas and in sheep pens), as well as in laboratories for safety violations , enters the respiratory tract . This route of infection is relatively rare. Often sick persons of working age (18 ~ 50 years). In most cases, this is an occupational disease.
Brucellosis occurs when ingested from 10 microbes. Gates of infection are microtrauma of the skin, mucous membranes of the digestive organs and respiratory tract. At the site of the gate of infection, no changes develop. By the lymphatic ducts, brucella reach the lymph nodes. Reproduction and accumulation of microbes in brucellosis occurs mainly in the lymph nodes, from which brucella periodically enter the blood.
Brucellosis is characterized by severe allergic alteration of the body. Brucellosis is characterized by a tendency to a chronic course, which is associated with a long stay of brucella in the body.
After suffering brucellosis, immunity is formed, but it is not very long and re-infection is possible after 3-5 years. Not every infection leads to the development of the disease. The response probably depends on the state of the immune system. In some individuals, the infection proceeds without any manifestations, while others develop a stormy infectious process or, from the very beginning, it proceeds as chronic. Streets with very weak immunity, even a live Brucella vaccine can cause a reaction resembling a disease.
Manifestations of acute brucellosis
The incubation period for the acute onset of brucellosis can last about 3 weeks, however, the incubation can last several months.
The osteoptic form is characterized by high fever (39-40 ° C and above). Despite the high and very high body temperature, the patient feels good (at a temperature of 39 ° C and above, the patient can read books, play chess, watch TV, etc.). This form of brucellosis does not threaten the life of the patient, even without treatment, it ends in recovery.
Manifestations of chronic brucellosis
Chronic forms are characterized by a syndrome of general intoxication (weakness, headache). Common signs include prolonged low temperature, weakness, increased irritability, poor sleep, loss of appetite, decreased performance. Almost all patients have an increase in lymph nodes. Often revealed an increase in the liver and spleen. Against this background, there are lesions of the joints, nervous and reproductive systems. With brucellosis, there may be other lesions ( pneumonia, myocarditis, eye damage, etc.), but they are less common.
The defeat of the musculoskeletal system is the most frequent manifestation of chronic brucellosis. Patients complain of pain in muscles and joints, mainly in large ones. Often affects the knee, elbow, shoulder, hip joints, rarely – small joints of the hand and foot. The joints swell, their mobility is limited, the skin above them, as a rule, normal color. Impaired mobility and deformation of the joints due to the growth of bone tissue. Spine is affected, often in the lumbar spine.
Affection of the nervous system in chronic brucellosis is most often manifested.
Central nervous system damage (myelitis, meningitis, encephalitis, meningoencephalitis) are rarely observed, but they take a long time and are quite difficult.
Changes in the reproductive system in men appear in
- decrease in sexual function.
- arises amenorrhea,
- infertility may develop.
Pregnant women often have miscarriages, stillbirths, preterm labor, congenital brucellosis in children.
Eye changes are sometimes observed (iritis, chorioretinitis, uveitis, keratitis, optic nerve atrophy, etc.). When aerogenic infection often develop sluggish current Brucella pneumonia, which are unsuccessfully treated with antibiotics. There may be myocarditis,endocarditis, aortitis and other lesions of the cardiovascular system.
Principles and methods of treatment depend on the form of brucellosis. Antibiotic therapy can only have an effect in the acute (acute) form of brucellosis, in chronic forms the administration of antibiotics plays a secondary role, vaccine therapy is of primary importance.
Treatment of acute brucellosis
In this form, it is necessary to prescribe antibiotics in fairly large doses. Insufficient doses and premature withdrawal of drugs determine the further development of the chronic form of brucellosis. Antibiotics must be given continuously.
Tetracycline — 0.5 g every 6 hours for 3–6 weeks; during the first 2 weeks, moreover, streptomycin was used (intramuscularly) at a dose of 1 g after 12 hours. Tetracycline is contraindicated in pregnant women and children under 8 years of age.
If it is impossible to use the above scheme, you can prescribe Biseptol (co- trimoxazole ), 6 tablets per day for 4 weeks. The combination of Biseptol rifampicin (900 mg per day) gives the best results. When conducting a full course of relapses are rare. Vitamins are prescribed.
Antibiotics for chronic forms of brucellosis have been ineffective. The main role in these forms is played by the prescription of drugs with non-specific and specific desensitizing effects. In chronic forms, vaccine therapy is most effective, which is not only a desensitizing measure, but also stimulates the immune system.
Patients are prescribed a complex of vitamins, non-specific stimulators of blood formation ( pentoxyl, sodium nucleic acid, metacyl ). In winter, it is imperative to carry out general ultraviolet irradiation. Apply antihistamines ( pipolfen, suprastin, etc.). In cases of marked inflammatory changes (orchitis, neuritis, etc.), corticosteroids are prescribed (40–50 mg of prednisolone for 2–3 weeks or comparable doses of other corticosteroids).
Vaccine therapy is used for specific desensitization and immunity enhancement. With a pronounced allergic restructuring, brucellin is used , but most often a special (killed) therapeutic vaccine. Live vaccine is prescribed only for prophylactic purposes. Various vaccine administration methods have been proposed: intravenous, intramuscular, subcutaneous and intracutaneous. It must be remembered that inaccurate vaccine dosage can lead to an exacerbation of the disease (with overdose) or to the absence of a pronounced effect (with an insufficient dose). In this regard, the choice of method of administration and the calculation of the individual dose plays a big role.
The greatest prevalence in the treatment of chronic brucellosis was subcutaneous and intracutaneous administration of the vaccine. Subcutaneously, the vaccine is prescribed for the deterioration of the course of brucellosis and in the pronounced process. An important principle of vaccine therapy is the individual selection of the drug dose. To some extent, the severity of the reaction is judged by the intensity of the sample Byrne. Subcutaneous injection often start with 10-50 million microbial cells. If there is no local and general reaction, then the vaccine in an increased dose is administered the next day. For treatment, select a dose that causes a moderate reaction. The next vaccine injection is done only after the reaction to the previous administration of the vaccine disappears. A single dose administered at the end of the course is adjusted to 1–5 billion microbial cells.
Intradermal vaccine therapy is more benign. This method is used in the compensation stage, as well as in the transition of brucellosis to a latent form. According to the severity of the skin reaction, a working dilution of the vaccine is selected (it should cause a local reaction in the form of reddening of the skin with a diameter of 5 to 10 mm). The vaccine is injected intracutaneously into the palmar surface of the forearm on the first day with 0.1 ml in 3 places, then 1 injection is added every day and adjusted on the 8th day to 10 injections. If the reaction to the vaccine is reduced, then take a more concentrated dilution.
It should be borne in mind that even with the complete disappearance of all clinical manifestations, 20-30% may further exacerbate the disease.
The prognosis for life with brucellosis is favorable.
Disease prevention is based on the fight against farm animal brucellosis.
Compliance with preventive measures for the care of animals.
Vaccination and revaccination with live anti-brutal vaccine for persons at risk for brucellosis.