ANTHRAX (Latin carbunculus a piece of coal) — acute is purulent - the necrotic inflammation of several hair follicles and sebaceous glands extending to skin and hypodermic cellulose with formation of the general extensive inflammatory infiltrate and a necrosis.
An etiology and a pathogeny
the Contagium at To. most often golden staphylococcus is. Quite often it meets in association other bacteria (colibacillus, proteas, etc.), at the same time inflammatory process is characterized by heavier current. More rare To. is caused by implementation in a hair follicle of a streptococcus. To emergence To. non-compliance a dignity promotes. - a gigabyte. norms in life, a dignity. - tekhn, conditions on production (dust content and impurity of the room, lack of overalls, etc.), disbolism (a diabetes mellitus, obesity), decrease in the general and immunol, reactivity of an organism owing to defective or a hyponutrient, avitaminosis, infectious diseases, diseases of skin.
Except immunobiol, features of a macroorganism, an important role in development of purulent process is played anatomo-fiziol. features of the center of implementation of microflora, in particular structure skin (see), napr, in occipital area, depth of a hypodermic fatty layer, change of fabrics in connection with age (big frequency of development To. in elderly people) etc. The important factor defining development To., also character, virulence and others biol, properties of microflora is.
The pathological anatomy
Defeat of several hair follicles can be simultaneous or consecutive as a result of transition of inflammatory process from one follicle to another. In some cases To. results from merge of several furuncles (see).
Development of inflammatory process leads to sharp hypostasis of fabrics in the center of defeat, to a prelum circulatory and limf, vessels, to a local circulatory disturbance. On the extensive site the necrosis of fabrics results. The suppuration strengthening process of disintegration of fabrics develops in circles of a necrosis (tsvetn. fig. 3). The Nekrotizirovanny site is exposed to gradual fusion and rejection. After full sequestration big defect of soft tissues which is gradually carried out by granulations can be formed and begins to live second intention with formation of the rough involved hem.
As a rule, To. happens single and it is localized preferential on a back surface of a neck, in interscapular area, a waist, rumps, the person (tsvetn. fig. 1, 2). The disease begins with emergence of small inflammatory infiltrate, sometimes with a superficial pustule. It quickly increases in sizes, becomes sharply painful at a palpation, intense. For developing To. the sharp, arching, tearing pain is characteristic. Formation of big and painful infiltrate is caused by the forced provision of an affected area of a body, skin in the area K. gains crimson color, it is frequent with a cyanotic shade in the center, it is strained, edematous. The general condition of the patient is frequent, especially at localization To. on a face, heavy, the phenomena of the expressed intoxication develop: nausea, vomiting, loss of appetite, a headache, sleeplessness, temperature increase to 40 °, sometimes unconsciousness. In blood — a high leukocytosis with a deviation to the left, the accelerated ROE, the expressed acidosis. Gradually, in process of formation of the center of a necrosis (3 — 4 days), skin over it becomes thinner, partially melts with formation at first of one, then several openings — «heads» of K. Poverkhnost K. takes a form of a sieve, from openings to-rogo dense yellow or greenish-gray pus is emitted in a small amount. At a further spontaneous current To. separate openings merge and form a serious defect in skin through which necrotic fabrics are gradually torn away. At a favorable current To. from the beginning of sloughing of the phenomenon of intoxication decrease, gradually the wound is carried out by granulations, puffiness of surrounding fabrics disappears. After healing there is a hem with is long the remaining pigmentation and infiltration of skin around. The disease proceeds 4 — 5 weeks. At an adverse current To. hypostasis of fabrics increases, the necrosis and fusion of fabrics progresses, symptoms of a limfangiit and lymphadenitis appear.
the Progressing thrombophlebitis, purulent meningitis, sepsis. On the frequency of dangerous complications wins first place To. persons, at Krom the progressing acute thrombophlebitis of veins of the person can quickly pass through system of an upper eye vein to venous sine of a firm meninx. The purulent sinus thrombosis leads to development of purulent basal meningitis (see. Meningitis ) and an arachnoiditis (see. Arachnoiditis ). A rare complication To. there can be phlegmon or an erysipelatous inflammation (see. Ugly face ).
the Diagnosis is easy. From a furuncle To. differs in existence not of one, but several purulent «heads», more considerable distribution of inflammatory process and more expressed by the general a wedge, manifestations. It is necessary to differentiate To. from an anthracic anthrax (pustula maligna), for to-rogo existence of a small pruritic small knot with a hemorrhagic pustule at top and hypostasis of fabrics in a circle is characteristic. After break of an anthracic pustule the wound becomes covered by the firm scab of black color surrounded with the socket of often merging small bubbles with serous or hemorrhagic contents. For anthracic To. lack of purulent discharges and existence of anthracic sticks in contents of bubbles and wound separated are characteristic also painlessness in a zone of defeat. The general phenomena at an anthracic anthrax are often insignificant. It is necessary to consider contact of the patient with animals in the anamnesis (see. Malignant anthrax ).
Weight of the general state and danger of complications cause the necessity of treatment of patients To., as a rule, in the conditions of a hospital.
In an initial stage of development To. conservative treatment is shown, a basis to-rogo is the directed antibiotic treatment. However at an infiltrative phase of an inflammation it is impossible to allocate the activator and to determine its medicinal stability therefore at this stage of a disease use of semi-synthetic penicillin (ampicillin of 250 — 500 mg of 4 — 6 times a day, Oxacillinum of 250 — 500 mg of 4 — 6 times a day, tseporin 500 mg 2 — 3 times a day, etc.) or antibiotics of a broad spectrum of activity (erythromycin of 0,2 — 0,25 g of 4 — 6 times a day, Ristomycinum only intravenously of 500 000 PIECES 2 times a day, Oleandomycinum of 0,25 g of 4 — 6 times, etc. is shown) in a combination with intramuscular injections of proteolytic enzymes (trypsin, chymotrypsin by 5 mg 2 times a day). Antibiotics apply intramusculary, to an obkalyvaniye To., or by an electrophoresis. Obkalyvaniye K. repeat daily within 2 — 3 days, surely entering solution of antibiotics and novocaine under the center of an inflammation and creating thereby short novocainic blockade. Along with antibiotics it is necessary to use sulfanamide and nitrofuran drugs. Locally appoint dry heat, UVCh, Ural federal district, a roentgenotherapy. On a surface To. apply dry aseptic or salve bandage.
From the general actions rest is necessary. At localization of an anthrax on a face it is necessary to limit informal conversation. At the expressed intoxication transfusions of blood and blood-substituting liquids, purpose of vitamins, increase in immunobiological forces of staphylococcal anatoxin, sick by appointment, anti-staphylococcal gamma-globulin, hyperimmune anti-staphylococcal plasma and other drugs are shown. Are appointed plentiful alkaline drink, soothing and antihistamines. At patients with a diabetes mellitus the correct correction of carbohydrate metabolism is necessary.
At an extensive necrosis of fabrics, the progressing hypostasis, the accruing intoxication needs an urgent operative measure. Operation — a crosswise section To. — make under an intravenous or inhalation anesthesia, cutting To. all the way down to viable fabrics. The formed four angular rags otseparovyvat, nekrotizirovanny fabrics exsect, purulent flow open. The formed wound is washed out solution of hydrogen peroxide and rykhlo tamponed tampons with proteolytic enzymes and hypertensive solution of sodium chloride. Further treatment is carried out according to the general rules of treatment of purulent wounds (see. Wounds, wounds ).
At To. persons resort to conservative treatment more often.
the Forecast at To. in most cases favorable. Are life-threatening To. the faces complicated by thrombophlebitis and a sinus thrombosis and also To. at the exhausted elderly patients and patients with a dekompensirovanny diabetes mellitus.
Prevention consists in personal hygiene, timely treatment of the pustulous diseases, carrying out defined a dignity. - a gigabyte. actions on production.
Bibliography: Voyno-Yasenetsky V. F. Sketches of purulent surgery, L., 1956; V. I Pods. Purulent surgery, M., 1967; it, Modern problems of a surgical infection, Vestn. USSR Academy of Medical Sciences, No. 1, page 46, 1975; V. I. Pods, etc. Antibiotics in surgery, M., 1973, bibliogr.
V. I. Struchkov, I. N. Belov.