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Tularemia


Zoonotic infection with natural foci. It is characterized by intoxication, fever, lymph nodes. The causative agent of the disease is a small bacterium. When heated to 60 ± C dies in 5-10 minutes. Tularemia sticks reservoirs - hares, rabbits, water rats, voles. In natural foci, epizootic periodically occur.
The infection is transmitted to humans either directly through contact with animals (hunting), or through contaminated food and water, less often by aspiration (when processing grain and fodder products, threshing bread), blood-sucking insects (gadfly, tick, mosquito, etc.).
Symptoms and course:
The incubation period is from several hours to 3-7 days. Distinguish between bubonic, pulmonary and generalized (distributed throughout the body) form. The disease begins acutely with a sudden rise in temperature to 38.5-40 ± C. There is a sharp headache, dizziness, pain in the muscles of the legs, back and lumbar region, loss of appetite. In severe cases, there may be vomiting, nasal bleeding. Characterized by severe sweating, sleep disturbance in the form of insomnia, or vice versa drowsiness. Often there is euphoria and increased activity on the background of high temperature. There is redness and swelling of the face and conjunctiva in the first days of the disease. Later, point hemorrhages appear on the oral mucosa. The tongue is covered with a grayish bloom. A characteristic feature is an increase in various lymph nodes, the size of which can be from a pea to a walnut.
On the part of the cardiovascular system, bradycardia, hypotension. Blood leukocytosis with a moderate neutrophilic shift. The liver, spleen does not increase in all cases. Abdominal pain is possible with a significant increase in the mesenteric lymph nodes. Fever lasts from b to 30 days.
Bubonic form of tularemia. The pathogen penetrates through the skin, leaving no trace, after 2-3 days of illness regional lymphadenitis develops. The buboes are a little painful and have clear contours of up to 5 cm. Subsequently, either the bubo softens (1-4 months) or its spontaneous opening with the release of thick creamy pus and the formation of a tularemia fistula. Axillary, inguinal and femoral lymph nodes are more often affected.
The ulcer-bubonic form is characterized by the presence of a primary lesion at the site of the entrance gate of the infection.
The eye-bubonic form develops when the pathogen enters the mucous membranes of the eyes. Appearance of follicular growths of yellow color in size to millet grain on conjunctiva is typical.
Bubon develops in the parotid or submandibular regions, the course of the disease is long.
Anginal-bubonic form occurs during the primary lesion of the tonsils mucosa, usually one. Occurs in the food route of infection.
There are forms of tularemia with a primary lesion of the internal organs. Pulmonary form - often recorded in the autumn-winter period. The generalized form proceeds as a general infection with severe toxicosis, loss of consciousness, delusions, severe headache and muscle pain.
Complications can be specific (secondary tularemia pneumonia, peritonitis, pericarditis, meningoencephalitis), as well as abscesses, gangrene, due to secondary bacterial flora.
Diagnosis is based on a skin allergy test and serological reactions.
Treatment:
Hospitalization of the patient. The leading place is given to antibacterial drugs (tetracycline, aminoglycosides, streptomycin, chloramphenicol), treatment is carried out up to 5 days of normal temperature. In case of prolonged forms, a combination treatment with antibiotics and a vaccine is used, which is injected intracutaneously, intramuscularly at a dose of 1-15 million microbial cells per injection at intervals of 3-5 days, a course of treatment is 6-10 sessions. Vitamin therapy, repeated blood transfusions are recommended. At emergence of fluctuation of a bubo - surgical intervention (a wide incision to emptying of a bubo). Patients are discharged from the hospital after a complete clinical recovery.
Prevention:
Elimination of natural foci or reduction of their territories. Protection of dwellings, wells, open ponds, products from mouse-like rodents. Conducting mass routine vaccination in foci of tularemia.