YuKSOVSKO-SARTLANSKAYa DISEASE (synonym: a gaffsky disease,
the Sartlan disease, an acute alimentary miositis, an alimentarnotoksichesky paroxysmal myoglobinuria) — an acute disease presumably alimentary current - sicheskoy the nature, arising in the form of epidemic flashes separate as if among the population of fishing settlements and shown damage of skeletal muscles and kidneys in the form of a so-called miorenalny syndrome.
For the first time the disease was observed among fishermen of the Gaffsky gulf
of the Baltic Sea in 1924 — 1925; in the subsequent it was noted in 1927—1928, 1932—1933 in the same place and in 1939 — 1940 (from 1100 cases 18 ended letalno). In 1942 the similar disease is noted in Sweden on the lake Imsen (11 cases, from them 2 lethal). In the USSR, obviously, the same disease was observed in 1934 — 1935 among the population living near the lake Yuksovsky of the Leningrad Region in 1946 — 1948 — near the Lake Sartlan in Western Siberia, in 1960 — in Zolochevsky district of the Kharkiv Region.
Etiology. The disease is considered as the alimentary toxicosis connected with consumption even of thermally well processed fish who is temporarily gaining toxic properties (pikes, a pike perch, a burbot, a perch, eels, etc.)*. Also the animals eating fish are ill (cats, gagara, mergansers).
Assumptions of an infektsionnobakterialny, virus and parasitic etiology of Yu.-S. were not confirmed. Assume that fish gains toxic properties, eating plankton infected with the toxic agents which are washed away from soil. The possibility of poisoning of fish through drain waters of productions is disproved since Yu.-S. it was noted in districts where in reservoirs drain waters of productions did not go down. The possibility of swallowing by fish of nek-ry types of the ergot getting to water from coastal reeds at increase in the water line in reservoirs and also the blue-green seaweed which gained toxic properties is not excluded.
Separate disease outbreaks, Yu.-S. proceeding similarly., tried to connect with consumption of bread from wheat, and also the lard infected with seeds of a weed of a hemp nettle (common hemp-nettle).
The pathogeny is almost not studied. Consider that the thermostable toxicant which is contained hl. obr. in fatty tissue of fish, getting into a human body, selectively breaks a metabolism in skeletal muscles that is expressed in loss of a glycogen by them and accumulation milk to - you. The myoglobin (see) which, passing through renal balls, damages a canalicular epithelium is as a result released (see the Myoglobinuria). In hard cases it leads to development of uraemia (see). The damage of a muscle of heart revealed generally by means of an ECG is connected probably with a renal failure, but also its direct damage by exogenous toxin is not excluded. Since the repeated uses of fish can cause new attacks of Yu.-S., there was an assumption of participation in a pathogeny of a disease of a sensitization of an organism that did not receive confirmation yet and it is represented doubtful.
Pathological anatomy. The greatest patomorfo l. changes are found in a nervous system, skeletal muscles, kidneys. Dystrophic changes of ganglionic cells of bark of big hemispheres, side horns of a spinal cord (swelling, vacuolation, a necrosis), dystrophy of muscle fibers and their necrosis as tsenkerovsky are observed (see. Muscular tissue); Dystrophy is most expressed in gastrocnemius, lumbar and respiratory muscles. In kidneys dim swelling of an epithelium of gyrose tubules, abundance in tubules of fine-grained cylinders, accumulation in a cavity of capsules of granular proteinaceous masses is noted.
Clinical picture. The disease arises usually during the spring and summer period. Begins sharply, without prodromal stage, during physical tension or during the cooling of a body, in 10 — 68 hours after consumption of fish. Suddenly there are sharp pains and weakness in muscles of legs («legs are taken away»), hands, a waist, a thorax. Pains amplify at the slightest movement, in hard cases they in a short space of time extend almost to all skeletal muscles, except face muscles and the head. Difficulty of breath because of sharp morbidity of respiratory muscles is noted. Cyanosis of skin, dryness in a mouth, a hyperhidrosis, sometimes vomiting are observed. Consciousness is kept, but during the first hours diseases patients are sluggish, suppressed. Deep sensitivity does not suffer. At a palpation of a muscle and nervous trunks are painful. Standard temperature or increases to 38 °. In the first days of a disease the ABP — to 150/105 mm of mercury moderately raises.; borders of heart extend a little to the left, the systolic apex murmur is listened, sometimes there is premature ventricular contraction. At repeated emergence of the described symptoms increase in a liver is possible. In an onset of the illness the short-term polyuria is observed, then there comes the oliguria. Urine of red-brown color, in hard cases almost black, supports squirrels (0,5 — 12 °/00), granular and hyaline cylinders, single leukocytes, erythrocytes, a myoglobin, in a large number creatine. In blood already in an onset of the illness the moderate neutrophylic leukocytosis (to 9000 — 20 000), sometimes an aneosinophilia comes to light; ROE within norm or is a little accelerated. At uraemia concentration sharply increases in blood of creatinine.
Painful attack of Yu.-S. lasts of 3 hours to 4 days, then pains gradually abate, urine accepts normal coloring, but the proteinuria remains during 1 — 3 week. After an attack of a disease patients a nek-swarm time feel weakness, weakness. In hard cases on 2 —
the 3rd day of a disease develops an acute anury, and on 5 — the 11th day of a disease patients perish from uraemia. During the first hours diseases death from asphyxia as a result of damage of respiratory muscles is possible. About 18 repeated attacks of Yu.-S. would be observed.
The diagnosis is difficult, especially in the presence of the first cases.
The differential diagnosis is carried out with an acute glomerulonephritis (see), a nephrolithiasis (see), an acute porphyria (see Porphyrias), acute front poliomyelitis (see).
Treatment. Recommend a bed rest, heat, plentiful drink, vitamin therapy; apply glycine (in connection with damage of muscles), bloodlettings. In hard cases carry out decapsulation of a kidney, carry out a hemodialysis.
Profilakt and to and — an exception of food of fish, suspicious on toxicity, to-ruyu establish by biocontrol: fish
is fed to cats and watched their behavior within several days.
The forecast depends on weight of disease. Chronic damage of kidneys and muscles does not occur. The lethality makes 1-2%.
Bibliogrberman Yu. 3. both Stru-s e in and the p A. B. Sartlan disease. (Alimentary and toxic paroxysmal myoglobinuria), Novosibirsk, 1957; Kozlov I. N. and Konovalova of G. A. Gaffsko-yuksovskoye a disease near the Lake Sartlan, the Gigabyte. and dignity.,& JS 7, page 43, 1951; To about l about m and -
e L. M. O c of a myoglobinuria like the Yuksov-sky disease, the Doctor, business, No. 2, page 143, 1963; Laskin V. E. To history of emergence and studying of a yuksovsky (gaff-sky) disease, Gigabyte. and dignity., No. 10, page 44, 1948; M. M. K Nightingales to a question of the reasons of a gaffsky disease, Izv. Academy of Sciences of the USSR, it is gray. biol., No. 2-3, page 605, 1936; Tareev E. M. Nephrites, page 131, M., 1958; Berlin K. Haff disease in Sweden, Acta med. scand., v. 129, p. 560, 1948; Vogt H. Die Haffkrankheit, Dtsch. Arch. klin. Med., Bd 188, S. 1, 1941.
E. M. Tareev.