Anthrax - an acute zoonotic infection occurring with severe intoxication, formation of carbuncles on the skin (cutaneous) or in the form of sepsis doxycycline reviews.
Pathogen - facultative anaerobic gram-positive spore-forming stationary encapsulated bacteria of the genus Bacillus anthracis B. Vasillaseae family. Morphologically it appears as a big stick with a chopped off the ends. In smears located singly, in pairs or chains. The presence of oxygen produces spores. It grows well on meat-peptone medium. Pathogen antigenic structure is capsular and somatic antigen antibodies thereto does not have protective properties. Determine the presence of pathogens and synthesis of capsules exotoxin. The anthrax bacillus is able to allocate a strong exotoxin protein nature, providing as inflammatory and lethal effect. It consists of three components, or factors, edematous, protective antigen (non-toxic, exhibit immunogenic properties) and the actual lethal factor. Its combined action on the human body is manifested edema tissue, impaired processes of tissue respiration, inhibition of the activity of phagocytes. Anthrax exotoxin extremely labile: it is completely destroyed after a half-hour of heating at 60 ° C.
The temperature optimum for growth of 35-37 ° C, the optimum pH of 7.2-7.6. Vegetative forms unstable in the environment, die quickly when heated and boiling under the action of conventional disinfectants. The spores are very resistant, can be stored for a long time under the most unfavorable conditions in the water for several years in the soil - for decades. After 5 minutes of boiling controversy retain the ability to vegetate. Under the action of steam flowing through the die only 12-15 minutes at 110 ° C - 5-10 min. Dry heat (140 ° C) kills the spores after 3 h. Under the effect of a 1% formalin solution and 10% NaOH solution are killed after 2 hours. The mold spores of anthrax is not only experiencing a long period of time, but under certain conditions, can germinate and re-form disputes, supporting the existence of the soil chamber.
The pathogen enters the body through damaged skin, at least through the mucous membranes of the respiratory tract or gastrointestinal tract. In place of the entrance gate by the action of bacterial exotoxin arises center serous-hemorrhagic inflammation with microcirculatory disturbances, severe edema, hemorrhagic changes in the surrounding tissue and coagulation necrosis. Against the background of the inflammatory focus carbuncle is formed with areas of necrosis in the center, sometimes other local manifestations of the disease in the form of sudden swelling, blisters or changes resembling pseudoerysipelas. Moving macrophages introduction of the agent in the next few lymph nodes, where a regional lymphadenitis. Bacteremia secondary to the development of sepsis with cutaneous anthrax is very rare. Sepsis occurs more frequently when the penetration of the pathogen through the respiratory tract or gastrointestinal tract, overcoming their protective barriers bronchopulmonary or mesenteric lymph nodes and hematogenous generalization of infection.
Characteristic pathological changes when anthrax develop not only in the field of topically-inflammatory focus. Also watch serous-hemorrhagic inflammation of the regional lymph nodes, changes in the internal organs of their congestion, serous-hemorrhagic edema, development of hemorrhagic syndrome with focal hemorrhages and multiple hemorrhages.
The incubation period. Continuing for several days, but it can be extended up to 8-14 days or reduced to a few hours. There are skin (localized) and generalized form of the disease.
Cutaneous. The most common (95% of cases). It may take the form of several varieties - karbunkulёznoy, edematous and bullosa. Most often develops karbunkulёznaya kind of skin forms. In these cases, the skin at the site of the entrance gate of infection appears painless reddish spot with a diameter up to several millimeters. It quickly turns into a papule copper-red color, sometimes with purple tinge, raised above the skin. Formation of papules spotting accompanied by local itching and slight burning sensation. After a few hours turning into a papule vesicle 2-4 mm in diameter filled with serous contents. The content of the vesicles is fast becoming a bloody, acquiring a dark and sometimes purple-violet (pustula maligna). When combing or (rarely) spontaneous vesicle bursts and forms an ulcer with raised above the skin edges, the bottom of a dark brown color and serous-hemorrhagic discharge. At its edges appear secondary vesicles ( "necklace"), which is considered typical for the disease. In the future, "child" vesicles go through the same stages of development as the primary element. In their opening and merging ulcer size increases.
After a few days, sometimes 1-2 weeks due to necrosis in the center of the ulcer formed black scab, which is rapidly increasing in size, covering the entire bottom of the ulcer, and reminds strongly charred crust. Pain sensitivity in scab lost (local anesthesia), which is an important differential diagnostic sign. Around the scab formed inflammatory crimson cushion, rising above the level of healthy skin. Externally, the scab with roller resembles a fading ember, which determined the old Russian name ( "Ugljevik") and contemporary Latin name of disease (from the Greek anthrax -. Coal). In general, skin changes are called carbuncle. Its dimensions range from a few millimeters to 5.10 cm.
On the periphery carbuncle develops a pronounced swelling of tissues, sometimes spectacular large areas, especially in places with loose subcutaneous tissue (eg, the face). The character of gelatinous edema, impact percussion hammer in his field shake tissue occurs (Stefano symptom). Localization carbuncle and swelling on the face is very dangerous because it can spread to the upper respiratory tract and cause asphyxia and death. Formation carbuncle accompanied by regional lymphadenitis (and in case of severe course of the disease and lymphangitis).
From the very beginning of the disease there is a pronounced intoxication with high fever, headache, weakness, aching lower back. Fever persists for 5-6 days, and then the body temperature is reduced is critical. She was accompanied by normalization of reverse development of general and local symptoms. By the end of 2-3 weeks of scab torn away, the ulcer gradually healed with scar formation.
Most formed one carbuncle, wherein the disease occurs mostly in the form of light or srednetyazhёloy. In rare cases, the number of carbuncles can reach up to 10 or more. With the development of them on the head, the neck, the mucous membranes of the nose and mouth disease it is particularly difficult and can be complicated by the development of anthrax sepsis.
Edematous kind of skin forms. At the beginning of the disease is manifested only pronounced edema, development of necrosis and the formation of large carbuncle observed in the later stages of the disease.
Bullous kind of skin forms. It features the formation of bubbles with hemorrhagic content on the site of infection input gate. After opening the bubbles formed extensive ulcers; subsequent necrosis in their bottom region leads to the development carbuncle.
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