CARRIAGE OF CONTAGIUMS (INVASION)

From Big Medical Encyclopedia

CARRIAGE OF CONTAGIUMS (INVASION) — one of forms of infectious (invasive) process, at a cut parasitizing of activators in an organism of the owner proceeds without externally expressed clinical manifestations.

The terms «bacteriocarrier», «carriage of bacilli», «carriage of virus», «parasitosis», etc. apply to designation of a carriage of various causative agents of infectious diseases.

History

In 1884 F. Leffler reported about allocation of the causative agent of diphtheria from healthy people. The beginning to scientific studying of a problem of a carriage polosheno by D. K. Zabolotny and I. G. Savchenko, to-rye in 1893 experimentally established a possibility of a carriage of a cholera vibrio by clinically healthy people. During the same period of G. Sanarelli, etc. showed that causative agents of a typhoid can be allocated from excrements of healthy people, and also be found at had a typhoid in 15 — 30 and more days after recovery. In on the chal of 20 century. I. I. Mechnikov already wrote that penetration of pathogenic microbes into a sensitive organism at all not necessarily causes the corresponding disease.

For development of the doctrine about a carriage 50 — 70 20 century when the long carriage of causative agents of various infections as had a disease, and persons was established were especially fruitful, at to-rykh a disease it was not noted. Establishment of the persistent infection which is characterized by long stay of a virus in an organism at so-called slow infections is of great importance. Further researches in this area can make additions to classification of a carriage. As it is possible to establish a carriage only by laboratory methods of a research, further studying of this problem is closely connected with development of new techniques, improvement a lab. technicians.

Classification

Distinguish a carriage: convalescents (rekonvalestsentny carriage); immune people (immune carriage); healthy faces (healthy carriage). Nek-ry researchers allow a carriage the persons which are in an incubation interval of a disease (an incubatory carriage) and the short-term carriage found accidentally — a tranzitorny carriage.

Practically the carriage is divided on the allocated activators into a bacteriocarrier (a carriage of bacilli, a vibriononositelstvo, etc.), a carriage of virus, a rik-ketsionositelstvo, etc. On duration of allocation of activators distinguish acute and hron, a carriage; on virulence (toxigenicity) of the allocated activators — a carriage of virulent (toxicogenic) activators and a carriage of avirulent (not toxicogenic) activators.

Carriage convalescents perhaps after transferring of many infectious diseases — belly a ti-phage, paratyphus, salmonellosises, dysentery, cholera, a meningococcal infection, diphtheria, malaria, etc. It, apparently, is connected with defective immunity at individuals and depends on specific features, the wrong treatment, etc. Nositelyam-rekonvales-tsentam possess the main epidemiol. a role — a source of activators. The carriage convalescents under the influence of pathogenetic treatment and protective forces of an organism often quickly stops. Only the carriage of causative agents of a typhoid convalescents can proceed several weeks, and 3 — 5% which had a disease remain carriers for life, i.e. turn into category hron, carriers; many years the carriage of plasmodiums at transferred a quartan malaria can also proceed.

The carriage the immune persons i.e. who earlier had or imparted usually happens short-term and has no great practical value in spread of an infection.

The carriage the healthy faces which were earlier not hurting and are not imparted, as a rule, short-term quantity of the allocated microbes is small, it is more often observed at a carriage of causative agents of the infections differing in big variability a wedge, manifestations (diphtheria, scarlet fever, dysentery, a meningococcal infection, cholera, poliomyelitis, etc.). In the same cases when in a wedge, a picture of a disease typiforms (e.g. prevail, at natural smallpox, sypny and a typhinia), the carriage is not observed by healthy people.

Between a carriage and the explicit, clinically expressed form of a disease there is a number of intermediate lungs and the easiest forms and to establish border between them very difficult.

The incubatory carriage is observed at all infectious diseases. However allocation of the activator to the environment is noted only at nek-ry diseases (measles, chicken pox, etc.).

The Tranzitorny carriage is caused by impossibility of preservation of the activator in an organism (e.g., decrease in aggression) or specific features of a macroorganism (a condition of resistance, a hyperoxemia of a gastric juice for intestinal infections, etc.).

The carriage is considered to be acute if allocation of activators continues days or weeks after transferring of a disease. As for a chronic carriage, among researchers there is no consensus in a question of the one who should be carried to hron, to carriers. This question in relation to a typhoid and parati-fa is most developed. So, according to the existing instruction, to hron, to carriers of typroid microbes the faces excreting the activator more than 3 months after the postponed disease belong (their number fluctuates from 3 to 5% to number of had).

As carriers most often do not know epidemic value of a carriage about allocation of disease-producing microbes by them to the environment and owing to this fact do not observe necessary a dignity. the mode, their danger to people around exceeds danger of obviously sick people. Value of a carriage is defined also by intensity of allocation of activators to the environment, properties of activators (virulence, aggression), a dignity. - gigabyte. skills of the carrier, nature of his communication with people around, condition of immunity of collective.

A working condition and life of people have significant effect on a role of a carriage. Danger of a carriage at working at certain productions (public catering, the milk and food industry, etc.) is in direct dependence from a dignity. - a gigabyte. level of these productions and culture of the carrier.

Epidemic, assessment of carriers as sources of activators, their place in epid, process are not identical at various nosological forms. At nek-ry diseases the carriage is the main form supporting epid, process (diphtheria, scarlet fever, a meningococcal infection, poliomyelitis, etc.).

The pathogeny

Formation of a carriage at had connects most of researchers with defective immunity (see), arising at individuals as a result of their specific features, the wrong treatment, etc. It is known what, as a rule, is found in carriers convalescents it is more or less long the remaining inflammatory process of mucous membranes of intestines, upper respiratory tracts, nasopharynxes etc. This inflammatory center promotes preservation of microbes at the carrier convalescent. At nek-ry diseases (e.g., a typhoid or paratyphus) the inflammatory phenomena in a gall bladder, bilious channels, an urinary system remain many years, sometimes for life. Hron, carriers often have hypovitaminosis, disturbance fiziol, functions of digestive organs etc.

As for a gshmunny carriage, it is noted that the faces imparted against a typhoid, dysentery or diphtheria become more rare long carriers. It gives the grounds to consider that preventive inoculations not only reduce incidence of this or that infection, but also interfere with formation of a carriage.

Healthy and tranzitorny carriers, i.e. not transferred diseases, have no patol, the center supporting existence of microbes in an organism of the carrier and therefore the carriage at them usually happens short-term, and the quantity of the microbes which are allocated in one step is small. L. V. Groma-shevsky (1947) claims that preservation of causative agents of infectious diseases in a healthy organism is possible only with immunity, to-ry can be caused by the natural, inborn or acquired immunity.

Diagnosis. Carriers reveal only in the laboratory way. For this purpose use bacteriological, virologic, microscopic and other methods. In some cases apply immunol. method, napr, immunofluorescence or Vi-hemagglutination.

Treatment

Sanitation of carriers is carried out taking into account genesis of a carriage, epid, by dangers of the carrier and the available arsenal of levers on this process, from to-rykh the most widespread antibiotics, chemotherapeutic drugs, bacteriophages, vaccines are. Use not only the means and methods influencing directly on the activator in an organism of the carrier but also the means increasing the general body resistance, its tone.

In spite of the fact that a problem of treatment of carriers it is already long it is studied in many countries, nevertheless there are no means and a method guaranteeing release of an organism of the carrier from pathogenic activators in short terms.

The most frequent outcome of a carriage is total disappearance from an organism of pathogenic activators. Come to an end with it in short terms an acute, healthy and tranzitorny carriage. Under unfavorable conditions (the wrong treatment, weakening of an organism of the carrier, accession of other diseases) the listed forms of a carriage can pass in hron, a form, duration the cut can be various, but is frequent also lifelong.

Prevention

Actions for fight against a carriage are conducted in two directions. Early and rational specific and fortifying treatment of patients with infectious diseases, their extract concerns to the first group of actions from to lay down. institutions only after full a wedge, recovery and establishment a lab. by methods of the termination of allocation of activators, timely isolation inf. patients, preventing emergence of a carriage in collective (e.g., at a meningococcal infection, diphtheria).

Early detection of carriers, especially in collectives where they constitute the greatest danger concerns to the second group of measures first of all (institutions of public catering, the food industry, child care facilities, etc.). Important measures are the accounting of carriers, their sanitation, dispensary observation for shsh and training of carriers in observance a dignity. - a gigabyte. rules and skills. In some cases are necessary isolation of carriers (e.g., at cholera) and other restrictive measures (e.g., discharge from work, etc.).

Features of a carriage at separate infectious diseases — see in articles devoted to the corresponding diseases, e.g. Amebiasis , Typhoid , viral hepatitis , Dysentery , Diphtheria , Lambliasis , Malaria , Meningococcal infection , Paratify , Salmonelloses , Cholera etc.



Bibliography: Bacteriocarrier and chronic forms of infectious diseases, under the editorship of K. V. Bunin, etc., M., 1975; Bilibin A. F. A problem of a bacteriocarrier at a typhoid and perspectives of fight against it, Vestn. USSR Academy of Medical Sciences, No. 12, page 3, 1969; B and l and-bina.f.i other. Quantitative definition of specific immunoglobulins in serums of bacillicarriers at a typhoid, Zhurn, mikr., epid, and immun., No. 2, page 42, 1976; In about r and - l and to G. F. The doctrine about epidemic diseases, the p. 2, page 185, etc., Tomsk, 1935; D r about and N with to and y I. R. Batsillonositelstvo and fight against it, M., 1953; M. N. Nositelstvo's Nightingales of pathogenic microbes and his form, Doctor, business, No. 1, page 17, 1950; Shura - Bu - r and B. of JT. Identification of bacilli carriers of dysentery and typhoid, Works Uchen, medical council at the head Medical - a dignity. ex. Soldier. - the Pestilence. Fleet, t. 2, No. 3-4, page 28, M., 1943.


V. N. Dodonov, A. V. Malygin.

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