Tularemia

Tularemia is an acute infectious disease characterized by fever, general intoxication, damage to the lymphatic apparatus, skin, mucous membranes, and with aerogenic infection-lungs: refers to zoonoses with natural foci. It is common in many parts of Russia, many rodents serve as a source of infection.

Etiology, pathogenesis. The causative agent is small coccoid-like rods, gram-negative, resistant in the external environment. Tularemia is characterized by a variety of gate infection. There are following ways of infection: through the skin (contact with infected rodents, transmissible transmission by bloodsucking insects), through the mucous membranes of the digestive organs (use of infected water and food) and the respiratory tract (inhalation of infected dust). Clinical forms of the disease are closely related to the collar of infection. When contact and transmissible infection develop bubonic and dermal-bubonic forms of the disease, with aspiration - pneumonic, with alimentary - intestinal and anginous-bubonic forms of tularemia. When infected through a conjunctiva, an eyeball-bubonic form arises. After the transferred disease, immunity develops. Symptoms, course. The incubation period lasts from several hours to 14 days (usually 3-7 days). The disease begins acutely: chills appear, body temperature rises rapidly to 39-40 ° C. Patients complain of severe headache, weakness, pain in the muscles, insomnia, may be vomiting. The skin of the face and neck is hyperemic, the vessels of the sclera are injected. A part of patients from the third day of the disease develop a rash, often of an erythematous nature. In bubonic forms, a marked increase in regional lymph nodes, often cervical and axillary. In abdominal forms, there may be symptoms of acute mezadenitis. With tularemia buboes, periadenitis is absent, bubonic abscesses are rare and occur late in late (at the end of week 3 of the disease): The duration of fever varies from 5 to 30 days (2-3 weeks in the long run). In the period of convalescence, a prolonged subfebrile condition may persist. For the ocular bubonic form, in addition to the typical lesion of the lymph node, sharply expressed conjunctivitis with edema of the eyelids, ulcers on the conjunctiva is characteristic. Usually one eye is affected. The process lasts for several months, the vision is restored completely. With anginal-bubonic form, in addition to typical buboes, specific tonsillitis is characteristic. It is manifested by pain during swallowing, necrotic measurements of tonsils, palatine arches, appearance of fibrinous plaque resembling diphtheria on affected areas. Ulcers heal very slowly.

Abdominal pain is characterized by abdominal pain, flatulence, stool retention, palpation - soreness in the mesenteric lymph nodes. The pulmonary form of tularemia is characterized by a prolonged fever of the wrong type with a repeated chill and plentiful sweat. Patients complain of chest pain, cough, initially dry, then with a mucus-purulent, and sometimes bloody sputum. X-ray reveals focal or lobar infiltration of the lung tissue. Pneumonia is characterized by a slow lingering course (up to 2 months or more), recurrence. Diagnosis of tularemia in the early days of the disease (before the appearance of buboes) presents significant difficulties. With the advent of buboes, diagnosis is facilitated. It is necessary to differentiate from the bubonic form of plague, illness from cat scratch, soda and purulent lymphadenitis. To confirm the diagnosis, serological reactions (agglutination reaction, RNGA) and skin-allergic tests with tularin are used.

Treatment. Assign streptomycin in / m at 0.5 g 2 times a day, tetracycline at 0.4 g after 6 hours or levomycetin for 0.5 g after 6 hours. Antibiotic therapy is carried out until the 5-7th day of normal temperature. In protracted course, the killed tularemia vaccine is used (in a dose of 1 to 15 million microbial bodies at intervals of 3-5 days, in total 6-10 sessions). When the fluctuations of buboes appear, they are cut and emptied of pus. The prognosis is favorable.

Prevention: fighting rodents, protecting them from food and water. According to epidemiological indications - specific prevention.