MALIGNANT ANTHRAX

From Big Medical Encyclopedia

MALIGNANT ANTHRAX (anthrax; synonym: malignant anthrax, anthrax) — the infectious disease from group of zoonoz which is characterized by heavy intoxication, damage of skin and the lymphatic device.

Page I. in the world literature the wedge, forms is usually described in three (skin, pulmonary and intestinal), each of to-rykh can end sepsis (see). V. N. Nikiforov (1980), E. P. Shuvalova (1982), etc. describe two forms C. I.: skin and septic. This classification found reflection in «The instruction and methodical instructions for laboratory, clinical diagnosis, prevention and treatment of a malignant anthrax at people» M3 of the USSR (1980). At a septic form depending on a way of infection it can be observed preferential it is time-yareniye limf, the device of lungs or intestines, causing, according to the scientists who offered this classification, the expressed symptomatology of defeat of these bodies.

History

the Malignant anthrax is known long ago. The description of a disease occurs in Homer's (Homeros) «Illiad», Ovidiya's (Publius Ovidius Naso) «Metamorphoses». K. Galen, A. Tseljs, Publius Vergilius Maro, etc. pointed to a possibility of infection of people from sheep; they called a disease «sacred fire», and the Arab doctors — «the Persian fire». For the first time authentically described S. I. in 1766 S. F. Morand. The Russian doctor S. S. Andreevsky gave the modern name of a disease, to-ry, working at the Urals, studied this disease and described it in the composition «About a malignant anthrax» (1788). In dedicated experience of autoinfection S. S. Andreevsky established S.'s identity I. animals and the person also proved a possibility of transfer it from animals to people. The Russian doctors I. Peterson (1790) and M. Gamaleya (1792) pointed to a possible role of blood-sicking insects in spread of a disease. In 1849 — 1850 F. A. A. Pollender, F. Bra-uell and Daven (Page J. Daveine) almost at the same time described the activator of a malignant anthrax. In 1876 Koch allocated the activator in pure growth. A. Ascoli in 1877 was offered for S.'s diagnosis by me. precipitation test. L. Pasteur developed and in 1881 I offered a vaccine for specific prevention of S. In Russia a vaccine against S. I. L. S. Tsenkovsky prepared. A big contribution to the doctrine about S. I. I. I. Mechnikov, G. N. Minkh, N. F. Gamaley, A. A. Vladimirov, etc. brought. In the 40th 20 century of H. N. Ginsburg and A. L. Tamarin offered live attenuirovanny vaccine STI (Sanitary institute where the vaccine was developed) against S. I., since then inoculations to people carry out to the USSR only by this vaccine.

Geographical distribution and statistics

S. I. it is widespread among animals and people worldwide. In pre-revolutionary Russia animal S.' diseases I. were observed in all territory of the country, from the southern borders to the tundra, and very often had general character. In 1864 in the European part of Russia from S. I. 90 thousand pages fell - x. animals, in 1875 in Siberia — 100 thousand horses, and in 1879 on Yu. the countries — 125 thousand sheep. In 1907 in only one bolynezemelsky tundra in June — July from S. I. 143 866 deer died. According to ofitsa. statistics, for 1901 — 1910 in the territory of Russia fell from S. I. 747 600 animals.

Page I. is not a rarity for many European countries, the countries of Africa, Southeast Asia and South America. According to the international epizootic bureau, S. I. is registered in Great Britain, Spain, Holland, Denmark, France, Switzerland, Belgium, Greece, Yugoslavia, etc. From 1945 to 1948 in the USA death from S. I was registered. 7134 animals, and in 1952 — 3451. High incidence these years is noted also in Portugal (7 thousand animals fell), Spain (4070 animals) and India (7616 animals).

Incidence of people of S. I. is in direct dependence on spread of an epizooty, especially among domestic animals (see). In Russia against the background of the stated above large epizooty (see) S. I. the high level of incidence of this disease of people was observed. H. The N of Mari (1916), proceeding from official reports of Management of the chief inspector of the Ministry of Internal Affairs, provides the following data: in 1896 — 1901 67 240 people, in 1902 — 1907 — 97 569 people, in 1908 — 1913 — 102 696 people got sick; from 267 505 diseased about 10% died. It is necessary to emphasize that registration of diseases was obviously incomplete.

In our country after Great October socialist revolution conditions for decrease inf were created. incidences, including and S.'s incidences I. Reorganization of the industry and agriculture on the socialist principles, creation of state-farm and collective-farm livestock production, holding planned antiepizootic actions, and first of all immunizations of animals, led to considerable reduction of S. I. among animals. Radical improvement veterinary sanitary inspection (see) for animals, slaughter of the cattle and a dignity. supervision of the enterprises for processing of animal raw materials led to sharp reduction of incidence and among people. Stable decrease in incidence of S. I. people in our country occurred against the background of annual increase in a livestock of page - x. animals. Incidence became sporadic and lost strict seasonality. Since 60th 20 century S.'s incidence I. the population of the USSR decreased to several hundred cases a year.

Etiology

Mikropreparata of anthracic bacilli: and — chains of anthracic bacilli with endospores (are specified by shooters); a smear from the culture which is grown up on a beef-extract agar; coloring by methylene blue; x 900; — anthracic bacilli in the capsule (are specified by shooters); mazvk from the culture which is grown up in the atmosphere of carbon dioxide gas; coloring by ink; x 900.

Activator C. I. — anthracic bacillus (you. anthracis Cohn 1872) — belongs to this. Bacillaceae. S.'s bacillus I. — large motionless stick 6 — 10 microns long, 1 — 1,5 micron wide, gram-positive; it is painted by all aniline paints. In uncolored material from the fallen animal of a stick look transparent, with the rounded-off ends, are located in pairs or short chains, are surrounded with the transparent capsule; in the painted smears their ends are represented chopped off. In smears from the culture which grew on a medium, bacilli are located long chains. Distinguish two forms of existence of the activator: vegetative and sporous. The vegetative form develops in a live organism or in young people a lab. cultures. Out of an organism (in the soil) or in cultures 18 hours at access of oxygen are more senior and at an ambient temperature from 15 ° to 43 ° in the center of each stick it is formed a dispute (see. Disputes ), strongly refracting light and not deforming the diameter of a stick (fig., a). Sporogenesis is a patrimonial sign of the activator, however in the nature also asporogenic options meet. Activator C. I. forms the specific belkovopodobny antigenic capsule consisting of polypeptide of D-isomer glutaminic to - you. The capsule is a factor of pathogenicity: it is formed only in susceptible to S. I. an organism of an animal or the person or on artificial blood or serumal atmospheres in the atmosphere of carbon dioxide gas (fig., b).

S.'s bacilli I. well grow on beef-extract environments at optimum t ° 35 — 37 °, at a temperature below 12 ° and higher than 45 ° growth is not noted, optimum pH of the environment 7,2 — 8,6. On a beef-extract agar in one days of growth silver-gray granular colonies of 3 — 5 mm in the diameter, with the fringed edge consisting of interlacings of chains of a microbe (R-form) are formed. Under small increase in edge of rough colonies remind the head of a jellyfish or a lion's mane. In a beef-extract broth growth in a R-form is characterized by formation of the benthonic deposit reminding a lump of cotton wool; broth remains transparent. Kapsuloobrazuyushchy strains at crops on serumal environments in the atmosphere of carbon dioxide gas steadily form smooth or mukoydny colonys. On the Wednesdays containing 0,05 — 0,5 PIECES/ml of penicillin, anthracic bacilli in 3 — 6 hours of growth form spheroplasts (see. Protoplasts bacterial ), located in the form of the chains reminding a pearl necklace (the test of a pearl necklace) in smears. Activators C. I. allocate a zhelatinaza, but have weak hemolitic, letsitinazny and fosfatazny activity. Except capsular, there are a somatic (stenochny) polisakharidny patrimonial antigen and exotoxin, to-ry represents the proteinaceous complex consisting from causing hypostasis, protective and lethal components.

The vegetative form of a microbe perishes at t ° 55 ° in 40 min., at t ° 60 ° — in 15 min., at t ° 75 ° — in 1 min. Perniciously affect it a direct sunlight (perishes in 8 hours) and solutions of corrosive sublimate 1: 1000, 5% of phenol, 3% of chloroamine. Disputes it is incomparable more steadily; under the influence of a hot air at f 120 — 140 ° they perish in 2 — 3 hours, under the influence of fluid steam (in the autoclave) at t ° 110 ° — in 40 min., at boiling, as a rule, in 10 — 15 min., but sometimes remain viable up to 60 min. Sporodidny effect also activated solutions of chloroamine, hot formaldehyde, hydrogen peroxide possess.

Epidemiology

Are susceptible to S. I. cattle, sheep, goats, horses, deer, buffalo s, camels and pigs. Among wildings under natural conditions the disease occurs at herbivorous, and also at boars, foxes, jackals and other carnivorous. The person is also susceptible to S. I., but unlike animals it is not infectious for people around. Possibly, as well as at most of others zoonoz (see), the person is «the biological deadlock» for an anthracic infection.

A source of an infection are sick animals. Exclusive stability of a sporous form of the activator C. I. to influence of environmental factors, its long-term keeping in the soil define a long enzootichnost of territories and preservation of the activator during the interepizootic period.

Infection of the person S. I. perhaps contact, aerogenic, alimentary and transmissible in the ways. Infection with a contact way occurs at patient care by animals, forced slaughter of such animal, removal of a skin, cutting of ink, contact with animal raw materials (skin, a sheepskin, wool, a bristle, etc.), and also in the course of transportation, storages and uses inseminated by the activator C. I. products from leather of sick animals — fur clothes, brushes, shaving-brushes, etc.; constitute danger and the containing S.'s disputes I. soil, manure, in rare instances water. At a contact way of infection the activator gets into an organism through the smallest grazes and skin scratches and I cause a skin form C. In separate years about 99% of the diseased catch a contact way.

Cases of aerogenic infection are practically not registered after elimination of handicraft processing of animal raw materials and disappearance of a profession of the tryapichnik collecting on dumps of rags and junk of animal origin. However there is real a possibility of infection of people through air during the processing of wool on sheepskin and fur-coat productions during the use of the raw materials imported from unsuccessful according to S. I. regions.

The alimentary way of infection is possible at the use of insufficiently thermally processed meat and meat products received from sick animals. A limited role of meat and meat products in S.'s infection I. is explained by small resistance of vegetative forms of the activator to high temperature. However if in meat disputes managed to be formed, cooking can not always secure foodstuff.

The transmissible way of transfer of the activator is possible at a krovoso-saniye insects — gadflies, flies stable-flies, etc.

By data A. I. Korobkova (1946), ud. weight of cases of S. I. people, work-related in the industry on processing of animal raw materials, more than 69%, and the people working in agriculture — 18% make. In 1970 — 1974 in RSFSR among sick S. I. workers of livestock production there were 36,7%, vt. workers — 5,8%, employees of meat-processing plants — 0,7%, suppliers of animal raw materials — 0,7%, owners of the cattle — 52,1%, working skinneries — 0,2%, other groups of the population — 3,8%. In the USA and some other countries the opposite tendency is expressed. E.g., in England importing skin and wool more than 95% of all incidence of S. I are the share of industrial workers in separate years.

Forced slaughter of sick S. I. an animal from public herd seldom involves infection of considerable number of people since processing of hulks is carried out with respect for precaution and meat in these cases is not allowed for consumption. The individual owner in this case, without knowing an actual reason of a disease of an animal, sometimes illegally sells meat or distributes to relatives. As a result a part of these persons who are engaged in preparation of meat dishes and using them has skin and septic (intestinal) forms C. I.

S.'s diseases I., connected with production, are defined by disturbance of sanitary and veterinary rules at preparation, storage, transportation and processing of animal raw materials. On the frequency of infection the first place belongs sheepskin fur-coat to production. During the processing of wool, a hair and a bristle infection is possible at various stages tekhnol. process, as well as through drain waters of the tanning and sheepskin and fur-coat enterprises.

In an epizootology and S.'s epidemiology I. still there are unresolved nek-ry important issues, in particular a role of the soil in an epizootology of a disease. A part of scientists claims that the soil containing sporous forms of the activator C. I., is the place of its natural dwelling, the formed soil centers for vaguely long time remain a source of activators C. I. Other point of view comes down to the fact that in the soil disputes only remain a long time and quantity them over time decreases, i.e. there is a self-cleaning, improvement of the soil; besides specific properties of the activator, feature of its vegetation and sporogenesis do not allow to recognize probability of saprofitichesky existence of such strict parasite what the activator C. I is.

Pathogeny

Entrance gate of the activator C. I. in most cases are the injured skin, mucous membranes of respiratory tracts are much more rare and went. - kish. path. Effect of exotoxin of the activator, separate fractions is the cornerstone of a pathogeny to-rogo cause coagulation of proteins, hypostasis of fabrics, lead to development of toxi-infectious shock (see).

On site implementations of the activator the anthracic anthrax — the center of a gemorragiche-ski-necrotic inflammation of deep layers of a derma on border with hypodermic cellulose which is followed by hypostasis and destruction of fabrics develops in skin; in the center of the center — a necrosis of skin with formation of a brown-black crust. The activator from the place of implementation is brought by mobile macrophages in the next regional limf, nodes, in to-rykh usually develop the phenomena of an inflammation without serious violations of barrier function owing to what generalization of process either does not occur, or comes in rather late terms from the beginning of development of inflammatory process.

At inhalation of the dust particles containing anthracic disputes, mobile macrophages take the activator from a mucous membrane of respiratory tracts and bring on limf, to ways in tracheobronchial (back mediastinal) limf. nodes. Unlike infection through skin in these limf, nodes the inflammation from the outcome develops in the total necrosis promoting hematogenous generalization of an infection.

At consumption infected with activators C. I. animal products the disease results from penetration of the activator through the unimpaired mucous membranes went. - kish. path.

Pathological anatomy

For a skin form C. I. formation on site of implementation of the activator in skin of an anthracic anthrax is characteristic. It represents quite accurate on contours and the cone-shaped inflammatory infiltrate which is slightly towering over the surface of skin from several millimeters to 10 cm in the diameter. At top of an anthrax there is a bubble or group of the bubbles filled with bloody liquid. Skin in a zone of amotio of epidermis early is exposed to a coagulative necrosis with formation of a black scab. Suppuration of an anthrax is not observed. At microscopic examination in a zone of an anthrax and the subject fabrics the picture of a pronounced serous and hemorrhagic inflammation with destructive vasculites, especially in vessels of a micro circulator bed is found. Fabrics are impregnated with the exudate containing fibrin, the breaking-up erythrocytes and a large number of anthracic sticks. It is characteristic that exudate contains few leukocytes and there are no signs of phagocytal reaction that it is connected with biol. properties of the activator. Activator C. I., getting into fabric, causes a negative leukotaxia (see. Taxis ). Occasionally at a skin form C. I. the anthrax is not formed, and in the field of entrance infection atriums the extensive cutaneous dropsy and hypodermic cellulose develops.

At penetration of the activator on limf, to ways in limf, nodes hemorrhagic or gemor-ragicheski-necrotic lymphadenitis (see) with inflammatory infiltration of surrounding cellulose develops in them serous gemorragiche-sky. Limf, nodes are increased in sizes, are full-blooded, cyanotic-red color, with the centers of hemorrhages. The created anthrax and regional lymphadenitis — basic elements of primary anthracic complex.

Initial changes at aerogenic infection are characterized by immediately accruing defeats of a respiratory organs. Macroscopically mucous membrane of a trachea and bronchial tubes of dirty-red color, dim, erozirovana. In lungs focal, segmented or share serous and hemorrhagic pneumonia is found (see) with tendency to a necrosis. In pleural cavities there is a serous and hemorrhagic exudate. Bronchopulmonary peritracheal and tracheobronchial limf, nodes are increased in sizes, on a section of almost black color. In cellulose of a mediastinum the picture of a serous and hemorrhagic inflammation with massive hypostasis and hemorrhages — a media camp it is noted (see). Microscopically in the exudate filling pneumatic ways the hemolyzing erythrocytes, the confused epithelium, leukocytes are visible. In recent years massive therapy by antibiotics of a broad spectrum of activity led to falloff of frequency of pulmonary forms and scales of defeat of a pulmonary parenchyma. The opinion is expressed that damage of lungs in general develops for the second time in the course of generalization of an infection from thoracic limf, nodes (P. N. Burgasov, V. N. Nikiforov) more often.

Fig. 27. Macrodrug of a stomach at a septic (intestinal) form of a malignant anthrax (the stomach is opened): on his mucous membrane multiple hemorrhages in the form of hulls of various size are visible. Fig. 28. The opened abdominal cavity of the dead from a malignant anthrax: sites of a necrosis (dark color) in walls of expanded loops of intestines are visible. Fig. 29. Macrodrug of a brain (a basal surface) at a septic form of the malignant anthrax complicated by a hemorrhagic pia-arachnitis: hemorrhagic treatment of a soft meninx. Fig. 30 — 33. External manifestations of a skin form of the Malignant anthrax. An anthracic anthrax on a hand (fig. 30) and on a face (fig. 31) against the background of a dermahemia and hypostasis of hypodermic cellulose. In the center of an anthrax — the scab (black color) surrounded with a zone of an inflammation (red color). Fig. 32. The expressed hypostasis persons of a neck of the patient with an edematozny kind of a skin form of a malignant anthrax; a necrosis in the field of a century of the right eye. Fig. 33. Secondary necrosis of skin and hypodermic cellulose of a front surface of a thorax and area of a neck; on a side surface of a neck the anthracic anthrax is visible on the right.

At alimentary infection initial manifestations of S. I. are localized, as a rule, in distal department of an ileal gut, it is rare behind the ileocecal valve (the bauginiyevy gate) and in a stomach, in walls to-rykh the single or scattered, accurately outlined nodes — infiltrates are soon formed (tsvetn. fig. 27) with the centers of a necrosis and ulcers on a surface. Loops of intestines have expanded gleams, appear through spotty hemorrhages and sites of a necrosis a serous cover (tsvetn. fig. 28). The mucous membrane of a gut in a zone of defeat dim, is covered with a grayish plaque. In the edematous, impregnated with serous and hemorrhagic exudate mesentery in the form of packages are allocated increased, cyanotic-red color limf. nodes. Damages of intestines at S. I. are complicated by serous and hemorrhagic peritonitis (see), to-ry it is localized in the right ileal area in the beginning, and then accepts character razlitogo3

At microscopic examination in all layers of a wall of intestines the serous and hemorrhagic inflammation with destruction of capillaries, small veins and arteries is found; exudate is poor in leukocytes. In own plate of a mucous membrane of a gut find activators C. I. In limf, nodes of a mesentery of intestines the serous, serous and hemorrhagic inflammation with sharp hypostasis of fabrics, weak cellular reaction and abundance of sticks in regional sine is noted.

At generalization of process develop the expressed hemorrhagic syndrome (multiple hemorrhages in mucous membranes, focal hemorrhages in various bodies), and also characteristic for sepsis (see) and bacterial and toxic shock organ defeats. Often the encephalomeningitis — tension and a plethora of a firm cover of a head and spinal cord, hemorrhagic treatment of a soft cover of a brain, hemorrhage and the centers of a necrosis in the tissues of a brain reminding traumatic damage comes to light (tsvetn. fig. 29). At microscopic examination in bodies dystrophic changes of a parenchyma, destructive vasculites with slight cellular reaction are found.

In addition to local changes, find patol. processes typical for bacterial and toxic shock. The cadaveric spasm is expressed poorly or is absent, in vessels and cardial cavities dark, liquid blood without parcels, internals are full-blooded, on serous covers there are hemorrhages, the spleen is increased, flabby, with the dark and cyanotic pulp giving plentiful scraping, the apoplexy of bark of adrenal glands naturally comes to light.

In case of suspicion on S. I. for gistol. researches take tissue of a brain with covers and a spleen, limf, nodes, skin in the field of an anthrax, pieces of lungs and intestines; for bacterial. confirmations of the diagnosis do smears of skin, a spleen, limf, nodes, a brain and its covers.

Immunity

the Susceptibility of people to S. I. is general. As a result of the postponed disease durable immunity develops, however separate cases of a recurrent disease are described.

Immunity of people to S. I. it is provided with active immunization by their anthracic live vaccine STI. In an injection site of a vaccine the center of an inflammation, but without necrotic component develops. Anthracic microbes of a vaccinal strain get in limf, nodes, a spleen, a liver where there is their reproduction and protective antigen is formed, to-ry promotes transformation of lymphoid cells limf, nodes and a spleen in plasmatic as it is observed during the formation of anti-toxic immunity.

Formation of short oroimmunity in an organism is reached by administration of proti-vosibireyazvenny globulin which effect is connected with gamma and beta globulinovymi fractions.

Clinical picture

Duration of an incubation interval of S. I. from several hours to 12 days, on average 2 — 3 days.

During a skin form distinguish karbunkulezny, edekhmatozny, violent and rozhistopodobny versions. Prevailing a wedge, a version is karbunkulezny, the others meet very seldom (the tenth shares of percent).

Disease at a karbunkulezny kind of S. I. begins with an itch, consolidation of skin and emergence of a bubble in the place of implementation of the activator. During the combing of a bubble on its place the sore with a dark bottom surrounded with an inflammatory rim, with raised edges and serous and hemorrhagic separated is formed, surrounding fabrics become edematous — the anthracic anthrax is formed (tsvetn. fig. 30), develops regional lymphadenitis. The condition of the patient in process of development of an anthrax worsens: temperature increases, the headache, weakness, an indisposition develops. Feature of an anthrax is its painlessness. The anthracic anthrax can be localized on any site of skin, but a thicket on open parts of a body. Damages of visible mucous membranes of a mouth, a throat, a conjunctiva of eyes etc. meet. Usually there is single anthrax, but is frequent 2 — 3 and more. The size of an anthrax and their number do not aggravate disease severity. Localization of a multiple anthrax happens the most various; new appear quite often in quite late terms and are followed by development of all a wedge, the signs observed at a single anthrax. By the end of the 2nd week on site of a necrosis in the center of an anthrax the scab is formed (tsvetn. fig. 31) different from surrounding fabrics in the dark color. Rejection of a scab happens to education or without formation of the granulating ulcer, the sizes and depth a cut depend on the size of a zone of a necrosis of an anthrax. Duration of the period of scarring, and also expressiveness and the nature of cicatricial changes are defined by depth and the place of defeat of the subject fabrics. Hypostasis is one of constant signs of a skin form C. I. Usually it is limited to any one area of a body and localized around an anthrax. Increase of hypostasis happens during increase in the sizes of an anthrax, then 3 — 5 days it remain without changes then its more or less bystry involution is observed. The size of hypostasis does not depend on the size of an anthrax. Also regional is among constant signs lymphadenitis (see). Its feature is painlessness, slow involution, lack of bent to suppuration. Extent of increase limf, nodes depends on size and localization of an anthrax and intensity of hypostasis a little.

Edematozny kind of S. I. it is characterized by a heavy current with the expressed hypostasis developing before emergence of a visible necrosis of skin. In the place of implementation of the activator, usually in cheeks and a century, the itch develops and at the same time the hypostasis extending consistently to all area of the head, neck develops (tsvetn. fig. 32), a thorax, upper extremities, a stomach, it is frequent to inguinal folds. A bit later in a zone of implementation of the activator the necrosis of skin and subjects of fabrics develops; from this point the edematozny version differs in nothing from karbunkulezny any more.

For a violent version development in the space of implementation of the activator not of a bubble, and bubble, for the Crimea is characteristic there is a process of a necrosis of fabrics. Later a nek-swarm time of a wall of a bubble is fallen down, nekrotizirutsya.

At an erysipelatous kind of S. I. on face skin and hands there is a large number of the whitish thin-walled bubbles of various size located on hyperemic swelled up a little, but painless skin. In several days bubbles are opened, and on their place there are sores with dark a bottom and plentiful serous separated. Deep necroses usually are not observed, formation of strup goes rather quickly, and after their falling away of cicatricial changes usually does not happen.

Quite often in the period of the most expressed a wedge, manifestations at a skin form C. I. in places of the developed hypodermic cellulose (eyelids, a front and side surface of a neck, a front surface of a thorax, a scrotum) on nek-rum removal from an anthrax the secondary necrosis of fabrics develops. Usually before development of a necrosis on this place there are bubbles filled with transparent or bloody contents in the beginning to-rye, quickly increasing in sizes, merge with each other or are opened with formation of sores. 5 — 7 days later process of a necrosis comes to an end, devitalized sites of skin and subjects of fabrics accept dark color and have a clear boundary with surrounding fabrics (tsvetn. fig. 33). Sometimes the anthrax also gets to a zone of a necrosis, further its place in uniform necrotic weight cannot be defined. Rejection of a scab on site of an anthrax or a secondary necrosis can be followed by formation of extensive and deep defects of skin and the subjects of the fabrics disfiguring a face, leading to development of an ectropion a century, contractures of large and small joints, to dysfunction of extremities.

Skin form C. I. in 1 — 2% of cases comes to an end with generalization of process with development of anthracic sepsis.

Septic form C. I. meets seldom, its clinic is diverse and depends on preferential defeat of these or those bodies and systems. The heavy current, frequent damage of lungs or intestines depending on a way of transfer of the activator is characteristic of it.

At aerogenic infection the disease begins with a tremendous fever and sharp temperature increase to 39 — 40 °, pains behind a breast, heartbeat, cough, an asthma, the headache expressed to intoxication. The condition of patients quickly worsens, and within several hours pulse becomes threadlike, the ABP decreases to the minimum sizes, a heavy asthma, cyanosis develop. Patients are uneasy, excited. Cardiac sounds are deaf, in lungs a large number of wet rattles is defined. At rentgenol. a research of a thorax in early terms of a disease find increase in the sizes of a shadow of a mediastinum and change of its configuration, shift of a gullet and a prelum of a trachea and large bronchial tubes increased limf, nodes. Language dry, is laid over by a dense dirty plaque. The stomach is blown up, painful at a palpation, the liver and a spleen are not increased. Often the encephalomeningitis develops.

At alimentary infection so rough onset of the illness, as well as at aerogenic, but the phenomena of defeat prevail went. - kish. path: nausea, vomiting and a diarrhea with impurity of blood, paresis of intestines.

At both forms C. I. development of toxi-infectious shock is possible, to-ry is one of the main reasons leading to a lethal outcome. Toxi-infectious shock practically always develops at a septic form and is frequent at skin. The excitement of patients which is observed in the beginning is replaced by block, and motive concern — an adynamia. Body temperature becomes normal or norms, skin cold to the touch are lower, cyanosis amplifies, pupils extend, tachycardia and short wind are expressed very sharply. Quite often the fluid lungs, wet brain develops (see. Swelled also swelling of a brain ), acute renal failure (see).

The diagnosis

the Diagnosis is established on the basis of data epidemiol. the anamnesis (patient care by animals, participation in cutting of ink by force the slaughtered animal, etc.), a wedge, pictures, results of an intracutaneous allergy test with antraksiny and a lab. researches.

The intracutaneous allergy test with antraksiny consists in introduction on an inner surface of a forearm of 0,1 ml of an antraksin — the antigen extracted from you. anthracis. At had and patients since 3 — the 4th day of a disease in 24 — 48 hours from the moment of introduction of an antraksin the hyperemia and infiltrate in the diameter not less than 8 mm appears.

Laboratory diagnosis. For S.'s diagnosis I. at the person make bakte-riol. researches of the contents of vesicles separated an anthrax and ulcers, a phlegm, excrements, urine at sepsis — blood from a vein (1 ml).

Bakteriol. the research of material is begun with a bacterioscopy (see. Bacteriological techniques). From contents of vesicles, an anthrax, a phlegm, blood do thin smears, to-rye paint across Gram, and also on Rebigera (for detection of capsules) and across Peshkov (for identification a dispute). For preparation of paint of Rebiger of 15 — 20 g of a methylrosanilinum chloride dissolve 40% of formalin in 100 ml, maintain several hours at the room temperature and filter. Unstable smear. immerse in paint on 15 — 20 sec., wash out water and dry up; capsules are painted in red-violet color, bacteria — in dark-violet. For detection the dispute a smear is fixed on a flame of a torch, then painted the boiling lefflerovsky blue (over a flame of a torch) 15 — 20 sec. The smear is washed out water and dokrashivat 0,5% water solution of neutral red during 30 sec.; disputes are painted in blue or blue color, vegetative forms of bacilli — in pink. The bacterioscopy can be combined with a luminescent and serological research for what the dried smears fix within 10 — 15 min. in methanol. The fixed drugs place in a moist chamber and apply on them a drop of the luminescing serum in working cultivation and during the time specified on the label maintain in the thermostat at t ° 37 °. Smears carefully wash out 10 min. solution 0,15M of sodium chloride, dry and before viewing put a drop of the solution consisting of 1 p. 0,15M of sodium chloride and 9 h glycerin. Drug is investigated under a luminescent microscope (see. Luminescent microscopy). Disputes and S.'s bacilli I. give the bright luminescence which is most expressed on a contour of cells, other microorganisms — a uniform luminescence of all body of a cell. The bacterioscopy even in positive cases belongs to approximate hmetoda of a research.

For allocation of culture of the activator crops of the studied material on mediums and infection a lab are carried out. animals (biological test). Crops of the studied material is made in a cup with the beef-extract agar prepared on Hottinger's repitch. In 18 — 24 hours characteristic rough colonies appear, from to-rykh find typical chains of bacilli (fig.) in smears. For final identification and differentiation of sticks of S. I. with related bacilli not less than 10 rough typical colonies sift on a slant agar and broth. The received pure growth is investigated in the painted smears across Gram on mobility, put tests with a specific anthracic bacteriophage, carry out the test of «a pearl necklace» (see the Aetiology) and in addition define letsitinazny, fosfatazny and hemolitic activity. For identification of a kapsuloobrazovaniye do crops of pure growth for 1,0% a bicarbonate agar. The incubation of crops is carried out at t ° 37 ° in anaerobic jar at the content of 10 — 50% of CO2. Look through crops in 18 — 24 hours.

Subcutaneously or intraperitoneally infect with the marked-out culture white mice (on 0,2 — 0,5 ml of washout from an agar cup). Rabbits and Guinea pigs are infected subcutaneously, entering it 0,5 — 1,0 ml of material. For animals 10-day observation is established. The fallen animals open: prepare smears from exudates and smears prints from bodies for identification in them the short chains or separate bacilli surrounded with the capsule. During the opening of the animal who died from S. I., find a specific picture: the increased spleen, not turned blood of dark color, as a rule, jellylike hemorrhagic infiltrate in an injection site of material. Then make crops of blood from heart, a spleen, a liver and infiltrate on site of inoculation of material for the subsequent identification of a stick of S. I. A precipitation test across Askoli (see Askoli reaction) with pieces of skin and bodies of animals positive.

Differential diagnosis

Skin form C. I. differentiate with anthrax (see), furuncle (see), plague (see), tularemia (see), ugly face (see), sapy (see). An anthrax and furuncles are sharply painful, hypostasis is expressed poorly, under crusts pus contains. At plague a zone of damage of skin and limf, nodes are sharply painful, it is noted even more expressed, than at S. I., intoxication. Morbidity is inherent to lymphadenites and ulcers of skin at a tularemia. The erysipelatous inflammation is characterized by morbidity, an accurate ocherchennost of affected areas of skin, small hypostasis. At a sapa of change of skin unlike an anthracic anthrax are usually multiple, painful, have no black scab.

Septic form C. I. differentiate with a myocardial infarction (see), pneumonia (see), a pericardis (see), exudative pleurisy (see), impassability of intestines (see), peritonitis (see), an encephalomeningitis, sepsis (see) another etiologies, etc. In establishment of the diagnosis results bacterial are decisive factor. researches.

Treatment

Treatment at a skin form C. I. without the phenomena of toxi-infectious shock does not represent difficulties and consists in use of antibiotics. Once enter intramusculary 30 — 75 ml of antianthracic globulin after preliminary check of individual sensitivity to it by means of an intracutaneous test (see Bezredki methods). The bandage affected areas of skin is not applied, topical treatment is not applied.

At septic and skin forms C. I. with development of toxi-infectious shock the intensive care directed to removal of the patient from shock — administration intravenously of Prednisolonum at the rate of 200 — 800 mg and more in days, 5 — 8 l of polyionic solutions like «Three - salt», Kvartasol, 400 — 800 ml of blood-substituting liquids under control of the ABP and a diuresis, and also antibiotics in the highest doses is required. Pro-tivosibireyazvenny globulin is entered in number of 75 — 100 ml without definition of individual sensitivity to it, but in 30 min. after intravenous administration of Prednisolonum in number of 90 — 120 mg.

The forecast at a skin form C. I. at timely begun treatment quite favorable. At a septic form satisfactory results are yielded by the therapy begun only in early terms of a disease.

Prevention

S.'s Prevention I. is the problem relating hl. obr. to vt. to science and practice, also interests health care only in respect of improvement of methods and remedies for sick people and rescue of their life. It is based on a complex veterinary and sanitary and medical - a dignity. actions.

Veterinary and sanitary actions cover livestock production and process of preparation, storage, transportation and processing of raw materials of animal origin. The measures directed to identification, the account and mapping unsuccessful according to S. I are especially important. settlements, carrying out immunization of page - x. animals in unsuccessful areas, control of a condition of cattle mortuaries, pastures, skotoprogonny routes, improvement of unsuccessful territories by agrotechnical and meliorative actions. Creation of the conditions excluding infection of people through raw materials and livestock products, observance of veterinary health requirements during the carrying out agrohydromeliorative, construction and other excavation is important. Also early detection and isolation of sick animals, neutralization of corpses of the fallen animals and final disinfection in the centers is necessary.

In the Soviet Union there was a harmonious system of identification, the account and mapping of settlements, unsuccessful according to S. I. The veterinarian of the site (economy) focuses all data characterizing the settlement and land grounds in the epizootic relation in the special magazine; many of them are of interest and in a dignity. - epid. relation. So, dates of diseases and quantity of cases on animal species are entered in the magazine, places of cattle mortuaries and separate graves, certain sites of land grounds, bases, the yards and reservoirs, unsuccessful according to S. I are specified., the veterinary and sanitary condition of the meat-processing plants, lethal platforms, disposal plants, warehouses and the enterprises processing animal raw materials, skotopriyemny bases etc. is described. Epizootic data form a basis of planning of safety inoculations and other veterinary and sanitary actions.

The plan of preventive inoculations of animals in unsuccessful settlements and places of possible emergence of S. I. shall consider also the cattle belonging to individuals. As the acquired immunity remains up to 12 months, inoculations carry out annually. Impart animals at the age of over 2 — 3 months. Transfer of animals in other farms and slaughter on meat is allowed in 14 days after an inoculation. Milk of the animals imparted by vaccine STI is used without restrictions.

If necessary collective farms and state farms carry out work on improvement of unsuccessful sites of the territory (drying of boggy pastures and haying grounds, improvement of reservoirs, barrier of cattle mortuaries etc.).

S.'s eradication I. among animals (so, and among people) it is closely connected with neutralization of the soil in places of burial of corpses of the animals who died from S. I. Such work in the Soviet Union is conducted and it is represented very perspective as the strict accounting of cattle mortuaries is adjusted. Economic feasibility of improvement of the soil modern means is undoubted if to consider the huge expenses connected with carrying out a complex of the preventive actions which are carried out at S. I.

During the developing of diseases of S. I. among animals the following events are held: isolation of a sick animal, identification of the reason of infection, thermometry of all livestock of the cattle in this economy, allocation in separate groups of animals, suspicious on a disease, treatment and their passive immunization, disinfection of the room and the contaminated site of the soil, change of a pasture, watering place etc. By the decision of executive committee of local council of People's Deputies it is imposed vt. quarantine for the settlement, site of the area, herd, flock etc. Within a quarantine a number of restrictions is introduced (slaughter of animals on meat, use of milk from sick animals, a regrouping and sale of the cattle, transportation and a run of animals, export of animal raw materials etc. is forbidden). Corpses of animals together with a skin burn on the cattle mortuary or take out on the utilization plant. The remains of a forage, a laying and manure are burned. The soil where the corpse of an animal lay, burn, then fill in 20% with solution of lime chloride or 10% we heat solution of caustic soda and after digging up fill in with one of the called solutions again. Milk from animals, sick and suspicious on a disease, is neutralized by boiling. The quarantine is removed in 15 days after death or recovery of the last sick animal.

At S.', sick or suspicious on a disease, identification I. animals in the party transported by rail all cattle are detained, sick animals are separated from the general party and sent to the isolation center of nearby vt. clinics where carry out their treatment. Other animal enter anthracic serum and leave on a quarantine. Cars, platforms, shelters and other objects disinfect.

At suspicion on S. I. slaughter of animals on meat-processing plants and crushing points is stopped, carcass of the slaughtered animal is left before clarification of the diagnosis. If S.'s diagnosis I. is confirmed, hulk is destroyed. Work of the lethal workshop is resumed after carrying out final disinfection.

At the enterprises animal raw materials are investigated in vt. laboratories. Existence of positive reaction of Asko - whether at a research at least of one skin demands withdrawal of all stack of skins to the special isolation center and its disinfection. Import tanning and fur raw materials, wool, it is allowed to import a bristle, a horsehair in the presence vt. the certificate confirming a negative take of a research on S. I. Such raw materials are processed without research on S. I.

Preventive disinfection in production rooms and on stock rooms is usually carried out time to half a year. At detection of the infected raw materials make disinfecting of the equipment and rooms of an object.

Medical and sanitary actions. Sick S. I. the person is hospitalized surely. For the persons communicating with the patient establish observation within 8 days (see. Isolation of infectious patients ). In the center disinfecting is carried out (see. Disinfection, table. ). The main place in S.'s prevention I. among the population belongs to inoculations live vaccine STI (see. Immunization of table. ). Impart workers of livestock production and owners - the cattle in settlements, unsuccessful according to S. I., the persons occupied with collecting, storage, transportation, processing of raw materials of animal origin and a lab. researches on S. I. According to P. N. Bur-gasova and B. L. Cherkassky (1976), single vaccination protects more than a half imparted — 53,7%. Revaccination considerably 4 reduces risk of a disease of S. I. Immunizirovanny persons can be allowed to work with infectious material in 10 — 14 days after an inoculation. The revaccination repeats annually. To the persons who were taking part in slaughter, cutting or burial of a corpse of the animal who appeared by sick S. I., looking after the sick animal preparing or eating food from meat of the animal who appeared by sick S. I., appoint antianthracic globulin in perhaps earlier terms (see. Immunization, table. ).

An important place in S.'s prevention I. it is taken away medical - a dignity. to control of carrying out a complex of agrotechnical, meliorative and veterinary and sanitary actions., the measures limiting a possibility of infection of people Especially are important (providing with protective clothes, creation of conditions for observance of rules of personal hygiene, control of infectiousness of raw materials of animal origin, veterinary and sanitary examination of meat and meat products, observance of rules of disinfecting of foodstuff and packaging, suspicious on planting by S.'s disputes I., performance dignity. the mode on meat-processing plants etc.).



Bibliography: Burgasov P. N., etc. Malignant anthrax, M., 1970; Burga-with about in P. N., etc. Epidemiological efficiency of anthracic vaccine STI, Zhurn. mikr., epid. and immun., No. 9, page 27,1976; Kolesov S. G., etc. Malignant anthrax, M., 1976; M and hin N. A. Malignant anthrax of the person and farm animals, M., 1942; The Multivolume management to pathological anatomy, under the editorship of A. I. Strukov, t. 9, page 336, M., 1964; Nikiforov V. N. Skin form of a malignant anthrax of the person, M., 1973, bibliogr.; Rudnev G. of II. A malignant anthrax of the person, in book: An anthrax, under the editorship of E. N. Shlyakhov, page 22, Chisinau, 1964; about N e, Antropozoonoza, M., 1970; The Guide to microbiological diagnosis of infectious diseases, under the editorship of K. I. Matveev, page 505, M., 1973; H and l and - with in I. A. and X and z and N about in A. T. Guide to pathoanatomical diagnosis of the major infectious diseases of the person, JI., 1980; Ways E. H. Epidemiology, diagnosis and prevention of a malignant anthrax, Chisinau, 1960; it, Immunology, immunodiagnosis, immunoprevention of infectious diseases, page 315, Chisinau, 1977; E. N. Ways, E. V. Load and. Prisakar V. I. Malignant anthrax, Chisinau, 1975; Jawetz E., M e 1-l i with k J. L. a. A d e 1 b e of g E. And. Review of medical microbiology, p. 208, Los Altos, 1980; P 1 u o t M. o. Anthrax meningitis. Acta neuropath. (BerL), v. 36, p. 339, 1976; S u f f i n S. C., Carnes W. H. a. To an u f-m a n n A. F. Inhalation anthrax in a home craftsman, Hum, Path., v. 9, p. 594, 1978.


P.N. Burgasov; A.S. Zinovyev (stalemate. An.), V. N. Nikiforov (pathogeny, C., treatment, tsvetn. illustrations), E. N. Shlyakhov (etiol., lab. diagnosis).

Яндекс.Метрика