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Tularemia


Zoonotic infection with natural foci. It is characterized by intoxication, fever, damage to the lymph nodes. The causative agent of the disease is a small bacterium. When heated to 60 ± C, it dies after 5-10 minutes. Tularemia stick tanks - hares, rabbits, water rats, field voles. Epizootics periodically occur in natural foci.
The infection is transmitted to humans either directly in contact with animals (hunting), or through contaminated food and water, less often by aspiration (when processing cereals and feed products, threshing bread), blood-sucking insects (horsefly, tick, mosquito, etc.).
Symptoms and course:
The incubation period from several hours to 3-7 days. There are bubonic, pulmonary and generalized (common throughout the body) forms. 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, nosebleeds. Pronounced sweating, sleep disturbance in the form of insomnia, or vice versa drowsiness, are characteristic. Often there is euphoria and increased activity against a background of high temperature. Redness and swelling of the face and conjunctiva are noted in the first days of the disease. Later, point hemorrhages appear on the oral mucosa. The tongue is covered with a grayish coating. A characteristic sign is an increase in various lymph nodes, the sizes of which can be from a pea to a walnut.
From the side of the cardiovascular system, bradycardia and hypotension are noted. Blood leukocytosis with moderate neutrophilic shift. The liver, spleen does not increase in all cases. Abdominal pain is possible with a significant increase in mesenteric lymph nodes. The fever lasts from b to 30 days.
Bubonic form of tularemia. The causative agent penetrates the skin without leaving a trace, after 2-3 days of the disease, regional lymphadenitis develops. Buboes are not very painful and have clear contours of up to 5 cm in size. Subsequently, either the bubo softens (1-4 months), or it spontaneously opens 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 entry gate of infection.
The eye-bubonic form develops when the pathogen enters the mucous membranes of the eyes. Typically, the appearance of follicular growths of yellow in size up to millet grain on the conjunctiva.
Bubo develops in the parotid or submandibular areas, the course of the disease is long.
The angina-bubonic form occurs with a primary lesion of the mucous membrane of the tonsils, usually one. It occurs with the foodborne infection.
There are forms of tularemia with a primary lesion of the internal organs. Pulmonary form - more often recorded in the autumn-winter period. The generalized form proceeds as a general infection with severe toxicosis, loss of consciousness, delirium, severe head and muscle pain.
Complications can be specific (secondary tularemia pneumonia, peritonitis, pericarditis, meningoencephalitis), as well as abscesses, gangrene, caused by 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. With prolonged forms, combined antibiotic treatment with a vaccine is used, which is administered intracutaneously, intramuscularly at a dose of 1-15 million microbial bodies per injection at intervals of 3-5 days, the course of treatment is 6-10 sessions. Vitamin therapy, repeated transfusion of donated blood is recommended. With the appearance of fluctuations of the bubo - surgical intervention (wide incision to empty the 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 reservoirs, products from mouse-like rodents. Conducting mass routine vaccination in the foci of tularemia.