INFECTIOUS DISEASES : PARTYPHONE DISEASE - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Pathogens - a large group of microbes Salmonella. The generally accepted classification Kaufman, based on the analysis of the antigenic structure of individual representatives difoperational group. The most important representatives of salmonell playing a role in the pathology of man:
group A: S. paratyphi A - pathogen abdominal paratyphoid A.
Group: S. paratyphi B (of Schottmuller is the causative agent of abdominal paratyphoid; S. typhi murium (wand Breslau or Artic) is the most frequent causative agent of acute gastroenteritis (food intoxication); differs from previous cultural characteristics and sharp pathogenicity for mice; S. Heidelberg is a causative agent of gastroenteritis, the host sometimes nature shortened abdominal forms and peculiar parainfectious in patients with dysentery children: S. essen - the causative agent of food poisoning.
Group: S. suipestifer (wand N1 Ivashentsov is the causative agent mainly septic diseases (parathyromatosis); S. cholerae suis Kunzendorf - the causative agent of gastroenteritis, the host sometimes nature shortened abdominal forms and septic peripeteia; S. newport is the causative agent of food poisoning.
Group D: S. typhi (wand Ebert-Gapki is the causative agent of typhoid fever; S. enteritidis (wand Gertner is the causative agent of foodborne disease; S. dublin (fin) - the causative agent of diseases and parainfectious when illness Vasiliev-Weyl; S. moskow (paratyphoid N2 Ivashentsov) - the causative agent of parathyromatosis; agglutinated serum of patients with typhoid fever in the early days of the disease.
Epidemiology of abdominal forms similar to the epidemiology of typhoid fever in relation to a reservoir of the virus (the man is sick and ballooneval)and routes of transmission (contact-household, water, food, and flies through). Other forms artifoni diseases are caused biopathogens microorganisms, usually pathogenic for animals, and only under special conditions - for person (pre-breeding for food or a sharp decrease in the resistance of the human body). The virus reservoir artifoni of gastroenteritis are animals: slaughter cattle (cows, calves, pigs, horses), among which occur the epidemic, sporadic disease and intestinal germ-carriers, and poultry - ducks, chickens, turkeys. Sick animals usually suffer septic forms of salmonellas; their meat and relevant food authorities are infected during the life of the animal (intrauterine infection). At slaughter sick animals partyphone microbes remain in the meat, and under favorable temperature conditions, they multiply vigorously. Animals-ballooneval distinguish microbes from faeces (infection of milk from contaminated manure udder contamination of meat intestinal contents after slaughter - postmortal infection). Animals-baillonella often observed bacteremia after a big race or train transportation. Birds, especially ducks, are often infected eggs; microbes are well preserved in the blend (frozen, canned) and multiply during storage of eggs and egg warm. When outbreaks artifoni poisoning infections of man from man is usually not observed and it is believed that the intestines of sick people is rapidly cleared from the pathogen; however, the latter provision shall be impeachable, as set baculoviridae the convalescents to 30 days. Thus, the possibility of contamination of food people-bazillionaires not excluded. Epidemiology of septic forms the least studied. The main factor is probably the lower resistance of the human body on the basis of malnutrition, acute (relapsing fever, icteric leptospirosis, dysentery, influenza) and chronic infectious diseases (malaria, tuberculosis).
The pathogenesis of abdominal paratyphoid a and b is the same as typhoid fever (cm). Clinical manifestation of foodborne disease is preceded by infection with such a huge number of microbes that reaction starts after a very short time after exposure (hours to days). Microbes, penetrated into the upper intestine, and endotoxin released when their partial disintegration, cause severe local and General reaction. Local reaction is manifested acute catarrhalis inflammation of the mucous membrane of the stomach and small intestines with swelling of the solitary follicles and Meyerovich plaques sharp increase peristalsis and separate spastic contractions of the intestinal muscles. General phenomena associated with transient bacteremia (reaction temperature, enlargement of the spleen and liver) and toxicity (damage to the Central and autonomic nervous system, cardiac muscle, blood and parenchymal organs). When releasing very large amounts of endotoxin may occur extensive desquamation of the intestinal epithelium with subsequent development cholerophobia attack (see Cholera Asian) and severe degenerative changes in parenchymatous organs. The pathogenesis of forms, occupies a middle position between gastroenteritis and abdominal form, is poorly understood; it appears that the basis of bacteremia. In septic forms of proceeding by type of hemorrhagic sepsis, internal organs are multiple foci of hemorrhagic inflammation (hematuria, bloody vomiting and diarrhea, hemoptysis). The main role is played by the nature of the underlying disease, which is superimposed paratifizna infection, and the condition of the patient.
Symptoms. When the abdominal form - see typhoid fever. When foodborne diseases have severe abdominal pain, severe weakness, repeated vomiting, diarrhea; further, the symptoms change. When gastroenteritis - high fever, redness of the face, repeated painful fetid diarrhea, sometimes jaundice; blood - often leukopenia with sharp neutrophilic degenerative left shift. Intoxication - temperature normal and subnormal, paleness of the face, cyanosis, weak pulse, indomitable risovidnym dehydrating diarrhea. In septic forms - remitting or irregular fever, chills, sweats, tachycardia, enlarged spleen.
For. Paratyphus abdominalis In. Compared with typhoid fever in some cases has a more acute onset, sometimes with vomiting and diarrhea; rash more abundant, often papular character. The duration of the disease is somewhat shorter. Paratyphus A. abdominalis Clinical course is more gravity than paratyphoid, the abundance roseolous-papular exanthema and very frequent recurrences. When both paratyphoid is often observed herpes. Gastroenteritis paratyphosa. Incubation of about a day. The beginning of a very sharp, with the above symptoms. The rapidly increasing temperature the reaction lasts 1 to 2 days. The most pronounced pattern of gastroenteritis is deployed on the first day, and only in severe cases, the effects are not subsiding and on the 2nd day of illness. Strongest weakness lasts for several days. In severe cases, jaundice appears. Sometimes after 10 to 14 days may start a new temperature rise - the beginning of the abdominal form. Sticks Breslau and Gertner sometimes provide a transition in cholerophobia form. Some food poisoning caused by S. Heidelberg and S. Kunzendorf, along with typical disease acute gastroenteritis, there are cases occurring during longer reaction temperature and giving the course, the average between gastroenteritis and abdominal form. When such forms is celebrated germ-carriers for up to a month or more. Gastroenteritis paratyphosa acutissima, s. cholera nostras. Incubation is particularly short. The temperature and if it appears in the beginning of the disease, then quickly drops to subnormal numbers; the face is pale, sometimes attacks of pain type of pain. Vomiting and diarrhea uncontrollable. With the advent of risovidnym chair reduced skin turgor, there is cyanosis and wrinkling of the hands (hand laundress). Blood pressure falls, the pulse becomes threadlike, anuria. Mortality is significant, while the previous form quo ad vitam favorable. Influenza-like form found in food poisoning, along with others, almost exclusively from immunized. The mechanism is the reaction from the side of the neck ring and bronchial glands. Runs quite favorably with moderate fever, hoarseness of voice, cough and slight redness of the throat. Duration 2 - 3 days. Septic form, as in typhoid fever, are observed only rarely. When the epidemic development proceed as haemorrhagic septicaemia. In blood cultures often sticks paratyphoid N (Orient, Moscow) and Kunzendorf. As an independent disease is relatively rare, although there were a number of cases, clinically similar to a mild form of typhoid fever, with the sowing of the stool sticks paratyphoid S. Kunzendorf. Observed similar diseases and foodborne. Described as secondary infections, particularly if recurrent epidemics of typhus (N-parathyromatosis), influenza, icteric leptospirosis and in some cases of malaria.
Recognition is made on the basis of clinical symptoms, accurate history, perform a comparison of the individual diseases and bacteriological examination of feces, vomit and wash water; a very desirable hemoculture; necessarily bacteriological examination of foods that cause infection. All studies must be made on the first day of illness. Differential diagnosis cholerae nostras cholerae and asiaticae impossible not only clinically, but also on the sectional table, although at home cholera is pronounced hyperplasia of the follicles and Meyerovich plaques. Because of the motion of cholera widely informed on an international scale, the cases of cholera etiology may not be unexpected, however, in every suspicious case, you need the most careful bacteriological examination. The septic form of the above signs, blood cultures. Abdominal form, see typhoid fever.
Prevention is the steady sanitary and veterinary oversight of the food industry - from abattoirs, meat processing plants and commercial kitchens to small cafes and retail shops (see typhoid fever). Upon detection of food poisoning to collect accurate anamnesis food regime prior to the disease of the day: where to eat and what and where you purchased the suspect product. Special attention should be paid to the sausage meat, especially the so-called "national dishes" (goulash, etc.,), jellies, and creams. Comparison of background of a few cases can give the exact reference to a specific table and on a certain dish. Faeces and vomit of patients urgently as possible fresh sent to the laboratory for bacteriological examination and biological samples for the presence of toxin. At the food enterprise suspicious dishes to select from, the samples should be locked and directed to the study. The presence of microbes, is not peculiar to man, says more about the contamination of the carcass or infection dishes flies; detection of paratyphoid In will indicate the presence of media in the enterprise. A detailed inspection of food establishments proyzvodylsya in an extraordinary manner with personnel check on presence of bacilli.
L h v and e with abdominal forms, as in typhoid fever; when I drug Factoria x: heat on my stomach, close, warm blankets, hot-water bottle to the feet. Gastric lavage. In severe condition, heart drugs, saline infusion. In the acute period, despite the pain, not to give opium and the national Assembly to give a laxative. Saline laxative is contraindicated. Therapy cholera nostras see the Asian Cholera. In septic forms: treatment of the underlying disease or pathological condition; symptomatic therapy.
Treatment with abdominal forms, as in typhoid fever; with gastroenteritis: a warm belly, close, warm blankets, hot-water bottle to the feet. Gastric lavage. In severe condition, heart drugs, saline infusion. In the acute period, despite the pain, not to give opium and the national Assembly to give a laxative. Saline laxative is contraindicated. Therapy cholera nostras see the Asian Cholera. In septic forms: treatment of the underlying disease or pathological condition; symptomatic therapy.