Brucellosis - a contagious disease, characterized by a prolonged course, damage to the nervous and cardiovascular systems, as well as osteo-articular apparatus.

Causative agents of brucellosis - bacteria of the genus Brucella - well tolerated in low temperatures and freezing, the water stored up to 5 months in the soil - 3 months. and more, in cow's milk - up to 45 days in cheese - up to 60 days, butter, cream, yogurt and fresh cheeses - during the entire period of their nutritional value, frozen meat - St. 5 months in salted skins - 2 months, in wool - up to 3-4 months. By boiling and pasteurization killed brucellae. Disinfectants kill bacteria within minutes. The most frequently brucellosis sick domestic animals (goats, sheep, cows, pigs), and the animals observed abortion and stillbirth. Brucella released to the environment of milk, the urine of infected animals and detachable uterus (during an abortion). Causative agents of brucellosis are also contained in the meat of sick animals. In the human body brucellae penetrate the mucous membranes of the digestive and respiratory tract, as well as through broken skin (abrasions, scratches). Person is infected with brucellosis in the use of raw milk from sick animals and cooked out of it dairy products (cheese, butter, cottage cheese, feta cheese) and enough cooked and fried meat. Infection can also occur in the workplace, associated with the processing of leather and wool, as well as caring for sick animals, and through objects contaminated by their droppings. The most frequently suffer from a milkmaid, telyatnitsy, shepherds, shepherds, Vet. workers, livestock. The incubation period (latent) can be extended from one week to several months, usually 1-3 weeks. Brucellosis is characterized by a variety of clinical symptoms, for it may be of varying severity. The disease begins slowly: there are malaise, insomnia, and sometimes irritability, headache, aching muscles and joints, decreased appetite, temperature increases up to 37,1-37,3 . Brucellosis often begins acutely: the temperature rises to 39 - 40 , there are chills, weakness, sweating, sharp pain in muscles, joint stiffness and pain in the joints. Characterized by loss of blood vessels, nervous system and kostnosusTavn apparatus, can sometimes be a mental disorder. The disease lasts an average of 3 months, but may be delayed up to 1-2 years or more. Persistent residual symptoms after myocardial brucellosis can lead to disability. In pregnant women with brucellosis possible spontaneous miscarriage. Treatment of brucellosis When ostrosepticheskoy form is the main ztiotropnaya therapy, which lasts up to 3-4 weeks. Antibiotics tetracycline group, streptomycin, chloramphenicol, rifampicin. In chronic forms of conduct complex bracing therapeutic activities in combination with vaccine therapy. Sanatorium treatment may not be earlier than 6 months after the disappearance of clinical symptoms of brucellosis. The prognosis was favorable, but the disease often leads to a partial disability. Prevention. Brucellosis in farm animals. Protivobrutselleznaya vaccination of persons at ris

Brucellosis - zoonotic infectious-allergic disease, prone to chronic, occurring with a primary lesion of the musculoskeletal system, cardiovascular, nervous and reproductive systems. Brief historical information The disease is known since Hippocrates, but its scientific investigation only began in the 60-ies of the XIX century (J. Marston, 1859). At that time it was called the "Mediterranean or Malta fever." Causative agent of brucellosis was first discovered Bruce D. (1886), who gave the name of the bacterium Micrococcus melitensis. Later Bang and B. Stribold identified similar organisms (B. abortus) in infectious abortion in cattle (1897), and J. Traum - pigs (B. suis, 1914). In 1920, the bacteria are combined in one genus, named D. Bruce Brucella, and they cause the disease became known as brucellosis. Were later identified new species of Brucella - V. neotomae (1957), B. ovis and B. canis (1970). Serology for brucellosis begun A. Wright, D. Sample (1897). Agglutination (PA) Wright subsequently assumed great importance in laboratory diagnosis of the disease. Etiology Pathogens - aerobic and microaerophilic Gram-negative bacteria are still kind of Brucella. According to the International Classification of the genus Brucella consists of 6 separate species, which are divided into several biovars. Brucellae differ pronounced polymorphism: in one specimen observed cocci and elongated fingers. B. melitensis presented more coccus forms, B. abortus and B. suis - sticks with rounded ends. Most often lesions in humans causes B. melitensis, biovar submitted by 3 (the main hosts - sheep and goats). Somewhat less - B. abortus, the 9 of biovar (the main host - cattle), and B. suis, on 4 biovar (the main host - a pig, rabbits, reindeer). In rare cases, lesions in humans causes B. canis (the main host - a dog). Determination of species and biovars of Brucella in specific areas and in the foci of infection has important epidemiological and epizootological importance in terms of the classification of lesions, assessment of strength of the epidemic and epizootic processes of establishing the facts of migration of Brucella from one animal species to another, identifying pathways causative agent, the choice of tactics treatment, etc. Brucella are highly invasive and can penetrate intact mucous membranes, they are referred to intracellular parasites, but they can also be found outside the cell. Brucella are sufficiently stable in the environment. The water saved over 2 months, the raw meat - 3 months in saline - up to 30 days in the cheese - 2 months, in wool - to 4 month. Brucellae are killed when heated to 60 C for 30 minutes, while boiling - instantly. Susceptible to many disinfectants - 2% solution of carbolic acid, 3% solution kreolina and Lysol, 0,2-1% solution of bleach and bleach kill them within minutes. Epidemiology The main source and reservoir of infection - sheep, goats, cattle and pigs. Cases of human infection with brucellosis from reindeer. In rare cases, the source of infection may be horses,

camels, yaks and other animals that commit the agent with the milk, urine, feces, amniotic fluid. Most often the person infected with brucellosis of sheep, which the agent (B. melitensis) causes most severe forms of the disease. Also, quite often the person infected B. abortus from cattle, but symptomatic infections are being reported in isolated cases. During pulmonary disease, a sick person is not dangerous to others. The mechanism of transmission varied, most often through fecal-oral, are also possible contact and household (in contact with the pathogen on damaged skin and mucous membranes) and aerogenic transfer mechanisms. Epidemiological importance of food and raw materials of animal origin to determine the massiveness of contamination, type of pathogen, the duration of its preservation. The greatest danger is posed by raw milk products (milk, cheese, cheese, mare's milk, etc.), meat and raw materials (wool, karakul lambskin and leather) from sheep and goats suffering from brucellosis. The meat is much lower epidemiological risk, since it is usually used after heat treatment. However, in some cases when there is insufficient heat treatment (national features cooking - steak, grilled with blood, raw minced meat, etc.), meat and meat products may be the cause of brucellosis. Sick animals brucella pollute the soil, bedding, food, water, becoming, in turn, factors contributing to human infection. Cases of human infection from manure. Aspiration way of infection is possible at ingalirovanii air-dust mixture containing infected fragments of wool, dung, earth. This route of infection is possible shearing, wool sorting, combing down (design, knitting, etc.), as well as janitorial and territories which contain animal or process raw materials from them. In this case, Brucella can also penetrate through the mucous membrane of the conjunctiva. There may be cases of laboratory aerogenic contamination when working with cultures of bacteria. There have been cases of human infection through the water, but the epidemiological importance of this transmission is low. Possible intrauterine infection of the fetus and infection of children in feeding breast milk. The natural susceptibility of people is high. Postinfectious immunity usually lasts 6-9 months. Recurrent disease is observed in 2-7% of cases. The main epidemiological characteristics. Brucellosis - ubikvitarnaya infection, foci of disease identified on all continents. In this case, for it is characterized by distinct professional character of the disease: it is most common in the countryside among livestock workers. The incidence of people closely associated with epizootics in cattle, sheep and goats. Significant place in individual cases is the possibility of migration from the Brucella host biologically adapted to other animals. Migration contribute often sharing the content, or joint grazing of different species. The greatest danger is posed by migration B. melitensis in cattle. Ill mostly people who work with animals: the shepherds, the shepherds, milkmaids, veterinary and livestock workers, bacteriological laboratories, working meat processing plants, slaughterhouses, factories sherstepererabatyvayuschih. Contamination can occur during processing of raw meat, leather, wool, patients with brucellosis. In such cases, the penetration of Brucella in the human body occurs through the skin, mucous membranes, eyes, nose, mouth. At laboratory examination revealed Breeders 1,5-2% of persons with antibodies to the causative agent of brucellosis. The prevalence of brucellosis is not uniform across regions, it registered mainly in livestock areas. Epizootics, and the high incidence of brucellosis is stored in the CIS countries, mainly in

Kazakhstan and Central Asian countries of which may flow in Ukraine infected material. Maximum number of cases of brucellosis goat-sheep type falls on the spring-summer period. Upon infection with brucellosis from cattle seasonality is less pronounced, due to a long period of lactation, and infection is mainly through consumption of milk and dairy products. Pathogenesis Brucella penetrates the body through mucous membranes or damaged skin, leaving no change in the entrance gate. Lymphogenous by agents are recorded in the regional lymph nodes and accumulate in them. This phase of infection is called lymphogenic and corresponds to the incubation period of the disease. Its duration may vary and depends on the ratio of the activity of pathogens (infecting dose) and the body's defenses. With long-term preservation of Brucella in the lymph nodes are immune alteration of an organism to accumulate antibodies detected in serological tests, it becomes a positive allergic skin test with brucellin, but clinical symptoms do not develop (phase primary latentsii). After it comes the hematogenous phase (phase hematogenous drift). Develop bacteremia and endotoxemia, there is clinical symptoms of acute brucellosis. These manifestations are associated with functional disorders of the autonomic nervous system under the influence of endotoxin and toxic-allergic reactions. With blood pathogens are carried on the bodies rich retikuloendoteliem, and recorded them (phase poliochagovyh localizations). Are activated macrophage system, in organs and tissues develop diffuse changes, formed focal accumulations of macrophages with intracellular parasitizing them brucella. These processes are aimed at reducing the intensity of bacteremia, localization, and fixing agents, lead to the formation of secondary multiple organ infection foci in the form of specific granules. In connection with the sensitization of the organism develop allergic reactions - delayed-type hypersensitivity reactions, and sometimes immediate hypersensitivity. The possibility of long-term persistence of pathogens within macrophages due to the incompleteness of phagocytosis and the slow development of the immune response. Easily arise metastatic foci of multiplication of Brucella in the organs with the development of localized infiltrates, in the clinical signs of focal lesions of the musculoskeletal, nervous and other systems. Subsequent episodes out of pathogens into the bloodstream support bacteremia and endotoxemia, give the disease a sinuous pattern. These mechanisms are developed in the subacute phase of brucellosis, but in some cases focal lesions are formed early, even at the stage of acute Brucella process.
The disease is prone to long course and the transition to a chronic condition. Long-term preservation of causative agents in the metastatic foci with episodes of re-dissemination and development of jet-allergic changes underlies chronic brucellosis (phase ekzoochagovyh colonization and allergic reactivity changes). In chronic process weakens pathogenetic significance of bacteremia and endotoxemia, the activity of inflammatory allergic reactions focal organ. The formation of new inflammatory lesions is primarily due to autoimmune mechanisms. In chronic brucellosis in various organs and systems are formed of functional disorders, and sometimes

irreversible organic character to the development of persistent scarring. They persist even after a complete renovation of the body and in these cases the underlying pathogenesis of the so-called residual phase of metamorphosis (phase ratios and residual effects). Functional disorders characterized by the paucity of objective symptoms of an abundance of subjective complaints. The clinical picture The incubation period is 1.4 weeks, but may be extended to 2-3 months in the development of latent infection. According to current clinical classification based on the standard classification, GP Rudnev, are acute (lasting up to 1.5 months), subacute (up to 4 months), chronic (more than 4 months) and residual (clinical implications) of the form. Acute brucellosis. Can be developed gradually (most often the elderly) or overnight. With the gradual onset of illness for different time (from several days to several weeks), patients complain of malaise, fatigue, sleep disturbances, impaired function, joint pain, different groups of muscles and lower back. The examination mark subfebrilitet sometimes - an increase of peripheral lymph nodes by type mikropoliadenopatii. In what is gradually picking up signs of intoxication, the body temperature becomes high, there are chills and heavy sweating, increase in size liver and spleen. With the rapid development of acute brucellosis seen the rise of body temperature to high numbers (39 C and above) within 1-2 first days of illness. Relapsing-remitting fever, fluctuating or intermittent nature accompanies pronounced chills, profuse sweating ending. The febrile reaction usually lasts for several days, but can be extended to 3-4 weeks, taking a sinuous pattern. However, in most cases, being sick as a result of mild intoxication is relatively satisfactory, even against the background of a high body temperature and sufficiently significant objective changes. This clinical feature characteristic of brucellosis, is often caused by difficulties in the differential diagnosis of the disease. Patients complain of headache, emotional instability, irritability, sleep disturbances, pain in muscles and joints. When viewed at the height of rush mark flushing of face and neck, pale skin torso and limbs. Peripheral lymph nodes, especially cervical and axillary, slightly increasing in size, can be somewhat painful on palpation. Mikropoliadenopatiyu, considered an early clinical sign of brucellosis, recently met infrequently (no more than 20-25% of cases). Sometimes in the subcutaneous tissue, but more often in the muscles and tendons can be palpated tight painful nodules or nodes ranging in size from a pea to that of small chicken eggs - fibrositis and cellulite, although their appearance in patients more typical of the following, sub-acute form of brucellosis. Liver and spleen were enlarged, sensitive to palpation. In 10-15% of cases already in the acute stage of the disease develop organ damage musculoskeletal system, reproductive system, peripheral nervous system with an appropriate focal symptoms. The severity of brucellosis depends on the type of agent (its virulence). Typically, the disease caused by B. abortus, milder than the lesions caused by B. melitensis. Subacute form. Characteristic relapsing course. Febrile period with the temperature response of

different severity and duration (usually several days) alternating with periods of apyrexy. During upswings temperature curve becomes invalid character, the level of temperature can fluctuate significantly even during the day. Patients impose many different complaints. Concerned about diffuse pain in muscles, bones and joints, paresthesias, depressed mood. Worsen sleep and appetite, muscle weakness develops, there are dry mouth, thirst, and constipation. On examination patients often reveal fibrositis and cellulite. Cardio-vascular system say the relative bradycardia at the height of fever and tachycardia in a small period of normal body temperature, the muted tones of the heart. In severe cases, can be detected signs of infectious-allergic myocarditis, endocarditis and pericarditis. Pathology of the respiratory system reveal rare (catarrhal tonsillitis, pharyngitis, bronchitis, pneumonia). Changes in digestive organs are functional in nature, which is reflected in the complaints of patients. In severe cases may develop meningism and low-intensity serous meningitis. Much more frequently than in acute brucellosis develop multiple organ damage and allergic reactions (exanthema, dermatitis, reaction from the superficial vessels in the skin, etc.). First of all lesions observed musculoskeletal: arthritis and polyarthritis, synovitis, bursitis, tendovaginitah etc. Typical genital lesions - male orchitis and epididymitis, female disorders of the menstrual cycle, endometritis, spontaneous abortions. Nervous system can manifest as plexites, ishioradikulitov. Chronic brucellosis. Characterized by variability in clinical manifestations and relapsing course. Temperature reaction and other manifestations of intoxication are weak or moderately expressed. Alternate periods of remission, relapse, the duration of which can be up to 1-2 months. Deterioration observed when a fresh source process. The clinical picture of chronic brucellosis is dominated by focal lesions from various organs and systems. Signs of changes in the musculoskeletal system characterized by the development of recurrent, longterm arthritis occurring with frequent involvement of the juxta-articular tissue (periarthritis), bursitis, tendovaginitah, periostitis, perihondritov. Typical fibrositis and cellulite in the lumbar-sacral region and over the elbow joint. Lesions of different parts of the spine manifested by acute pain, limitation of motion, deformities, destructive changes. Damage to the nervous system are expressed in the form of radiculitis, plexitis intercostal neuralgia, neuritis auditory and visual nerves, disorders of sensitivity. In rare cases may develop meningoencephalitis, diencephalic syndrome. Changes in the autonomic nervous system, causing hyperhidrosis, the phenomenon of vegetative-vascular dystonia. Often formed neuroses and reactive states ("difficult character" patients). Urogenital pathology manifests orchitis and epididymitis in men, oophoritis, salpingitis, endometritis

and menstrual disorders in women. Characterized nevynashivaemost pregnancy, dysmenorrhea, infertility. In chronic brucellosis most often develop complex organ damage (mixed form). Chronic active brucellosis can last up to 2-3 years, and when re-infected - and for much longer. Its transition into a chronic inactive form is characterized by lack of education of fresh lesions and toxicity, prevalence of functional disorders, long-term persistence of serum antibodies and positive skin-allergic samples (Burne). The consequences of brucellosis (residual brucellosis). Persist in the absence of the pathogen in the human body. Characterized by residual effects, mainly due to the nature of the functional immunoallergicheskoy adjustment disorders and the autonomic nervous system: sweating, irritability, changes in the neuro-psychic sphere, arthralgia, sometimes subfebrilitet. However, a more severe impact of brucellosis may be associated with the development of irreversible fibrosis, scarring involving the nerve roots, plexus, roots, that provokes the emergence of a variety of neurological symptoms. Organic changes in the musculoskeletal system, sometimes emerging from undergoing brucellosis (strain the joints, ankylosis, contracture, muscle atrophy, spondylosis), in some cases require surgical treatment and the definition of disability. In conclusion, it should be noted that the course of the disease at this stage has a number of features: febrile reaction wrong type often limited subfebrilitet; lesion musculoskeletal appear first pain reaction, less often - focal inflammation; lymphadenopathy and enlargement of the spleen do not develop in more than 25% of cases; focal lesions develop earlier in the 12-15% of cases in the period of acute brucellosisthe organic CNS lesions are rare; lesions of visceral organs in chronic brucellosis usually manifest disorders of the cardiovascular system; residual brucellosis occurs primarily with functional rather than organic disorders. Differential diagnosis Acute brucellosis differentiate from diseases associated with prolonged fever (tifo-paratyphoid diseases, malaria, tuberculosis, nonspecific systemic diseases, HIV infection, sepsis, lymphoma and others). In acute brucellosis note irregularity of the temperature curve, the emergence of mikropoliadenopatii, shivering, sweating, enlarged liver and spleen. In some cases, this period of the disease exhibit fibrositis and cellulite. Typical clinical symptoms (especially a high body temperature) with quite satisfactory state of health. In subacute and chronic brucellosis to exclude rheumatic fever and rheumatoid arthritis, tuberculosis focal lesions, syphilitic and Gonorrheal arthritis. When these forms of brucellosis during

periods of increased body temperature alternate episodes apyrexy, complaints of patients are many and varied (pain in joints, muscles, bones, crawling, etc.) is characterized by focal multiple organ manifestations and allergic reactions, fibrositis and cellulite. Laboratory diagnosis To isolate the causative agent is carried out blood cultures, punctates lymph nodes, spinal fluid, bone marrow. Due to the high contagiousness of Brucella bacteriological diagnosis can be conducted only in specially equipped ("sensitive") laboratories. Isolation of pathogens are rare because of the duration and complexity of cultivating the pathogen, as well as relatively low sowing. In recent years the practice of introducing the reaction agregatgemagglyutinatsii, RSA and RLA, EIA, detecting Brucella antigens in biological fluids (primarily blood). Widely used serological tests (RA Wright, DNC, IHA, IFA), revealing the growth of specific antibodies in paired sera, whose value increases with the presence of clinical signs of brucellosis. In chronic brucellosis detect incomplete antibodies in the Coombs' reaction. The reaction of Wright's most informative in acute brucellosis. In recent years, successfully used the reaction of Brucella lysis under the influence of blood serum of patients. To obtain adequate results recommended by the simultaneous application of 4.3 serological methods (integrated serodiagnosis). Widespread intradermal allergic test with the introduction of Burne brucellin (protein extract of Brucella broth culture). Given the time required for the growth of specific sensitization to the antigens of Brucella, its formulation is not recommended before 20-25 days of illness onset. The sample is considered positive at a diameter of edema more than 3 cm, the development of redness and soreness at the injection site brucellin while optional. Positive samples Burne watch in all forms of brucellosis, including the latent during the infection process, it remains for years after recovery. The sample may be positive also in individuals vaccinated with a live protivobrutselleznoi vaccine, and laboratory staff, long exposed to antigens of Brucella. The introduction of additional brucellin is sensitization, and may be severe local reaction (necrosis). To avoid these phenomena into the practice of introducing the reaction of neutrophil damage and leykotsitoliza. They put the blood of the patient in a test tube without introducing the allergen into the body. Treatment Regime in the outpatient and inpatient lungs in severe cases. Causal therapy is effective in acute brucellosis; smaller effect is observed when the activation in patients with subacute and chronic forms. Optimal believe the appointment of two antibiotics, one of which must pass through the cell membrane.

Apply one of the following combinations, taking into account contraindications (children under 15 years of age, pregnancy, lactation, epilepsy). Rifampicin (at 600-900 mg / day) and doxycycline (200 mg / day) within the continuous course lasting at least 6 weeks. When relapse, repeat the treatment. Doxycycline (100 mg 2 times a day) course for 3-6 weeks and streptomycin (1 g intramuscularly, 2 times a day) for 2 weeks. This combination is more effective the previous one, especially for spondylitis, but used drugs exhibit high toxicity. Oflaksatsin (200-300 mg 2 times a day) orally and rifampicin in the above doses. Duration of use of drugs explains the feasibility of control over their reception of patients. In the treatment of brucellosis detoxification facilities used by the general principles of their applications, ATP, methionine, soft immunostimulants (dibazol, pentoxy, timalin, etc.). Widely used antiinflammatory drugs - NSAIDs (indomethacin, brufen, etc.). When the pain (neuritis, neuralgia, pain, vegetative character) symptomatic therapy in the form of Novocain blocks of 1% novocaine solution, intravenous injection of 0,25% novocaine solution in increasing doses. The use of glucocorticoids should be undertaken with great caution. Their appointments were forced by CNS (meningitis, metal-ningoentsefalit), as well as when expressed inflammatory changes (orchitis, neuritis, etc.) and no effect of other anti-inflammatory drugs. Medical (killed) brucellosis vaccines in recent years for the treatment of patients used less frequently because of its ability to cause immune suppression, increasing the possibility of recurrence and cause autoimmune reactions and reactions to it contains fiber. During the period of stable remission in chronic and residual brucellosis prescribe remedial gymnastics, physiotherapy and spa treatment (UHF, quartz, paraffin baths, radon baths).