(phlebotomus febris; synonym: mosquito fever, fever of a pappatacha, summer fever, three-day fever, a soldier's disease) — the viral disease which is transmitted through stings of mosquitoes of the sort Phlebotomus, characterized by a high-quality current with short-term fever, a severe headache, pains in eyeglobes, gastrocnemius muscles and a waist, an injection of vessels of a sclera, a hyperemia of a conjunctiva, etc.
History. It is considered that for the first time F. l. W. Barnett in 1799 described, having distinguished it from other fevers. He observed a disease on the lake of Malta. In 1804 Pirn observed a similar disease in Gibraltar and described it under the name «bulemsky three-day fever». As independent nosological form F. l. it is described in 1886. A. Pick, to-ry observed a disease on the Balkan peninsula. In 1878 the Russian doctor I. JI. Yavorsky during the travel as a part of the Russian Embassy across Afghanistan quite in detail described this disease. On communication of a disease F. the h.p. by stings of mosquitoes for the first time was specified by E. E. Ivanov in 1904 in Sevastopol. In 1905 S. Taussig on a basis epidemiol. observations in the Austrian troops came to conclusion that the disease is transmitted by mosquitoes of the sort Phlebotomus. In 1909 it was confirmed with the Austrian military commission as a part of R. Dera, Franz (To. Franz), Taussiga; they gave other name to a disease — «mosquito fever». In our country the first cases F. l. described the medical officer W. D. Schröder in 1913 in the Crimea, E. I. Martsinov-sky — in 1917 in Tiflis, I. E. Minka-vich in 1923, N. I. Latyshev and I. N. Moskvin, and also S. V. Viskovsky,
V. P. Petrov, G. A. Akovbyan, I. A. Kassirsky in 1924 — 1925 — in Uzbekistan and Tajikistan. Questions of epidemiology and prevention F. l. in our country E were developed. N. Pavlovsky. Sh. D. Moszkowski (1936), P. A. Petrishchev and A. Ya. Alymov (1939) proved transovarial transfer of a virus F. l. to the first and second generations of mosquitoes.
T. l. it is widespread in Spain, Portugal, France, Italy, Greece, Syria, Egypt, Sudan, Israel, Iran, Iraq, in northwest states of India, the Southern China, etc. Area F. l. matches an area of mosquitoes of the sort Phlebotomus, i.e. it is located in a zone approximately between 20 ° and 45 ° sowing. latitudes. In the USSR F. l. was registered in the Crimea, Transcaucasia, Moldova, Uzbekistan, Tajikistan, Kyrgyzstan; in the 40th 20 century the centers F. l. in the territory of the USSR were liquidated.
Etiology. Virus etiology F. l. it is established at the beginning of 20 century when R. Der and sotr. (1909) reproduced transfer of activators by introduction to volunteers of filtrates of blood of patients F. l. Activators F. l. — arbovirus Sicilian F. l. and Neapolitan F. l. were allocated by Seybin (A. V. to Sabin) from the blood of patients collected in the period of epidemic among an amer. the soldier in 1943 — 1944 in Italy. Viruses are widespread in the countries of Asia, Europe and Africa in an area of a carrier of Phlebotomus papatasii. Mosquitoes are, probably, not only a carrier, but also a tank of viruses in the nature as transovarial transfer of the activator to posterity of mosquitoes of both sexes is proved. Both viruses belong to the sort Phlebovirus this.
Bunyaviridae. They differ on antigenic properties, but are similar on morphology and biol. to properties. Form of virions spherical, to dia. 90 — 110 nanometers, type of symmetry spiral; they have a lipoprotein cover with fibers. Virions are stable at pH 7,0 — 9,0. Are quickly inactivated at t ° 56 °, at influence by UV rays, detergents and proteolytic enzymes. Viruses cultivate on 1 — 2-day newborn white mice at infection in tissue of a brain. In cultures of cells of Hela, VNK-21, VERO form plaques, cytopathic properties are expressed poorly (see. Virologic researches, Cultures of cells and fabrics).
Epidemiology. A source of an infection is the sick person during the last 1 — 2 days of an incubation and the first two days of a disease. Existence of the natural centers F is supposed. l., though sources of an infection among animals in the nature are still unknown. A carrier and a tank of a virus are mosquitoes of the sort Phlebotomus — Ph. papatasii, Ph. sergenti, Ph. perniciosus, Ph. caucasicus, etc. (see Mosquitoes). However Seybin (1952) claimed that experimental proofs of participation of other species of mosquitoes, except Ph. papatasii, to transfer of a virus F. l. does not exist.
The person is attacked only by a female of a mosquito (usually at night or early in the morning), edges after food blood of the patient F. l. through — 8 days become capable to transmit a virus with with lyuny and to keep it for life (up to 1 — 3 month). Optimum ambient temperature for development of a virus in a body of a mosquito is 27 — 31 °. At a temperature below 18 ° the virus does not develop. Females of mosquitoes are capable to transmit a virus transovarialno; from the infected eggs larvae of mosquitoes, also viruliferous develop. The virus in them remains in cold season, and in the spring from larvae the infected females capable at the first krovososaniye take off to transfer the activator. Thus, mosquitoes are not only carriers, but also tanks of a virus F. l.
Incidence F. l. has seasonal nature, matching time of activity of mosquitoes, and proceeds from May to September — October. In Subtropics incidence has two rises — the first at the end of May — the beginning of June, the second — in the second half of July — the beginning of August.
K F. l. all people are susceptible. In places of distribution F. l. are ill preferential again arriving, and from locals — it is preferential children.
Pathogeny. Infection of the person with a virus F. l. occurs through skin at a sting of the infected mosquito. On site a sting the dot reddish speck, as usually appears at a prick a pin. After 3 — 9-day reproduction of a virus in lymphoid cells the virusemia causing all-toxic manifestations, defeat of c develops. N of page, marrow. Inflammatory reaction in the place of a sting of flebotomus is typical. Experimentally it was succeeded to cause a disease in monkeys of macaques Rhesus factors by administration of blood of patients by it F. l., during feverish reaction, and also successfully to brown a virus from a monkey to a monkey. At infection of volunteers Seybin (1952) got the typical
3-day fever proceeding with relative bradycardia and corresponding changes in blood.
The pathological anatomy is not studied.
Immunity. Durable immunity is developed approximately at 80% of the persons who had F. l. once. At the same time the number of persons gets sick 2 — 3 times then immunity also becomes resistant. Recurrent diseases are explained probably by consecutive infections Neapolitan and Sicilian viruses.
Clinical picture. An incubation interval at F. l. fluctuates within 3 — 9 days,
4 — 5 days are more often. The prodromal phenomena are almost always absent. Usually the disease begins suddenly with a fever then during 3 — 5 hours temperature to 39 — 40 ° increases. Patients are disturbed by a severe headache, especially in frontal and temporal areas, weakness, the expressed muscle pain, especially extremities and a back, in joints, an oxycinesia of eyeglobes, edges amplifies in attempt to raise eyelids, and also with a pressure upon eyeballs (a symptom of Taussiga), a photophobia (see).
There can be abdominal pains, nausea and vomiting, loss of appetite. The face of patients is hyperemic, the hyperemia of conjunctivas, an injection of vessels of scleras, more intensive at outside corners of eyes where it has an appearance of the triangle turned by the basis to outside corners of eyes, and top — to a cornea is expressed; these changes received the name of a symptom of Peak, to-ry it is considered pathognomonic for F. l. Also mucous membrane of a pharynx and a uvula is hyperemic, hemorrhages at its basis quite often come to light. Language is covered with a whitish plaque, dry. On lips there are herpetic rashes. On site a sting of a mosquito pruritic papules to dia often appear. 2 — 3 mm of pink or red color sometimes turning into vesicles; in 4 — 5 days of a papule disappear. Pulse corresponds to temperature in the 1st day of a disease, then bradycardia is more often noted; By the ABP it is lowered. Dizzinesses (see), sleeplessness are observed (see), there can be nonsense (see), a loss of consciousness (see), sometimes an excitement and spasms (see).
The feverish period in most cases lasts 2 — 4 days. The period of reconvalescence proceeding to 10 days is followed by astenisation, sometimes a depression, on
5 — the 7th days at patients can appear short-term (1 — 2 day) palindromias.
Complications are absent more often, however emergence of otitis (see), parotitis (see), a polyneuritis (see), pneumonia is possible (see).
The diagnosis is based on data a wedge, pictures. In blood usually the leukopenia with a relative lymphocytosis, to-ry by the end of the feverish period can be replaced by a tendency to a neutrocytosis.
The diagnosis is confirmed by data virusol. and serol. researches (see. Virologic researches, Serological researches). For allocation of a virus infect newborn white mice by introduction with it in a brain of blood of patients. The virus usually manages to be allocated and identified at consecutive infection of several animals (see Identification of viruses). Good results are yielded by allocation of a virus a method of plaque-forming cells on cells of VERO. From serol. reactions the most reliable results are yielded by a neutralization test by method of a reduction of plaques on cells of VERO and reaction of binding complement (see).
Differentiate F. h.p. flu (see), malaria (see), a sapropyra (see the Sapropyra epidemic), a hay fever (see), a dengue (see), a tick-borne typhinia (see).
At flu the catarral phenomena from upper respiratory tracts are expressed, there is no symptom of Peak and pruritic papular rashes.
At malaria alternation of pristupoobrazny rises in temperature through the certain time slices which are followed by oznoba with the subsequent plentiful then, the increased painful spleen in a thick drop is observed (see) and in blood smears plasmodiums come to light. At a dengue dvukhvolnovy rise in temperature, spotty and papular rash, the slow «important» gait caused by sharp joint pains, a polyadenitis is noted. Longer fever, Hypatolum a case of a nya a syndrome, a moderate neutrophylic leukocytosis, etc. are characteristic of a sapropyra, a hay fever, a tick-borne typhinia. Differentiation is helped by positive takes of reactions of binding complement and an indirect gemagglyuta of the nation (see) — at a sapropyra; reactions of microagglutination with live cultures leptospir — at a hay fever; identification of spirochetes in a thick drop of blood and smears — at a tick-borne typhinia.
Treatment. Patients are hospitalized. Appoint a bed rest, good nutrition and means of disintoxication and symptomatic therapy: injection polyion-nykh of solutions. analgetics (pyramidon, analginum), sedative drugs, cardiovascular means (ephedrine, caffeine, according to indications — cardiac glycosides), corticosteroid hormones (a short course in 4 — 5 days), vitamins. Antibiotics are not effective. Write out patients from a hospital on 7 — the 10th day of standard temperature.
The forecast is favorable, lethal outcomes are not registered.
Prevention comes down to destruction of mosquitoes by means of insecticides (see), to protection of people against attack of mosquitoes. For this purpose doors and windows in houses veil close-meshed (cells no more than 0,7 mm) or gauze bed curtains (see. Protecting screens), better impregni-rovanny repellents (see), in particular dietilto luamidy (DETA), impregnation is repeated in
2 — 3 weeks.
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