Brucellosis is a disease characterized by damage to the musculoskeletal system, nervous, reproductive, and other systems.
Brucella is stable in the environment. They are stored in water for more than 2 months, in milk - 40 days, in feta cheese - 2 months, in raw meat - 3 months, in salted meat - up to 30 days, in wool - up to 4 months. Brucella die when heated and under the influence of many disinfectants. From a sick person, healthy brucella is not transmitted. The reservoir and source of infection are domestic animals (sheep, goats, cows, pigs, less often dogs).
Brucellosis infection from sick animals occurs by contact, food and airways. Contact infection is especially common when amniotic fluid gets on the skin (help with calving, lambing, caring for newborn calves, lambs). Often infected by veterinarians, calves, shepherds, etc. Infection can occur by contact with the meat of infected animals, with manure.
Brucella penetrate the slightest damage to the skin. Foodborne infections often occur through raw milk, as well as through the use of dairy products (feta cheese, cheese, butter). Airborne infection can occur if dust containing brucella enters the respiratory tract (in grazing areas and in sheep pens), as well as in laboratories in case of safety precautions. This route of infection is relatively rare. Often sick people of working age (18
50 years). In most cases, this is an occupational disease.
What is this disease?
Brucellosis is a disease that is a zoonotic bacterial infection with a high potential for chronicity, characterized by a variety of symptoms, but most often there is a lesion of the musculoskeletal system and peripheral nervous system, and proceeding against the background of general intoxication and fever.
Initially, one of the scientists (Martson in 1856) observed an unknown fever with accompanying symptoms on the island of Malta, and therefore gave it the name "Maltese fever", the same scientist established that the main source of the disease is sheep and goats, and infection occurs when consumed raw milk. In the future, there were those who discovered this same fever later, and called this fever by their name - either because of a thirst for vanity, or because of ignorance (scientist Bruce 1887, etc.). But there were also such scientists who supplemented the data on the "Maltese fever":
Wright and Sample found that serum from patients with brucellosis gives an agglutination reaction, since then this observation has been used for diagnostic purposes as a serological reaction. Other scientists have recorded infectious abortions due to this disease.
The causative agent of brucellosis
The causative agents are aerobic and microaerophilic immobile gram-negative bacteria of the genus Brucella. According to international classification, the genus Brucella consists of 6 independent species, which are divided into a number of biovars.
After penetration into the body of the pathogen that causes brucellosis, the symptoms in a person appear after 5-30 days (on average, 2-3 weeks), with latent carriage it can be extended up to 3 months.
Brucella are highly invasive and can penetrate intact mucous membranes, they are classified as intracellular parasites, but they can also be located outside the cell. Brucella is quite stable in the external environment.
Brucella can survive:
- In water - up to 2 months.
- In raw meat - up to 3 months.
- In animal hair - up to 4 months.
- At a temperature of 60 degrees - up to 30 minutes.
When boiling, these microorganisms die almost instantly, as well as when exposed to various disinfectant solutions (0.2 - 1% solution of bleach, chloramine, and so on).
The disease is caused by specific bacteria that belong to a separate genus Brucella, it has 7 species. In humans, 3 types of disease are caused - B. melitetnsis (also often causes disease in goats), B. suis (can develop in the pigs) and B. abortus (found in cattle). These bacteria are small in size, have polymorphism - there are rod-shaped, spherical (cocci) and convoluted forms. Spore and capsules do not form.
Brucella have a number of features called aggression factors and contribute to the development of the disease in humans and animals, these include:
- Hyaluronidase synthesis is a specific enzyme that breaks down hyaluronic acid of the intercellular substance, which facilitates the penetration of bacteria into the human body and their spread in it.
- Isolation of substances that inhibit (inhibit) the phagocytic activity of macrophage leukocytes - this makes it possible for intracellular parasitization of bacteria inside the cells of the immune system and the long course of the infection process in the human body.
- The ability to allergize the human body due to the release of protein substances, metabolic products of bacterial cells.
- The release of powerful endotoxin during the death and destruction of bacterial cells - it causes severe intoxication of the human body and metabolic disorders in it.
- The formation of special L- and S-forms of bacteria that are resistant to antibiotics and human immunity due to a change in their genetic structure.
These features (aggression factors) of brucella determine the peculiarity of the course of the disease and the mechanism of its development (pathogenesis). The most virulent (the ability to cause a severe course of the disease) is the type of bacteria - B. melitetnsis. All bacteria that cause brucellosis are fairly stable in the environment, in food (meat, milk), skin and animal hair, they can remain viable for a long time (from several months to six months or longer). Boiling in water kills them instantly, they are also sensitive to antiseptic solutions (hydrogen peroxide, alcohol, furatsilin, bleach, chloramine).
How does infection happen?
As already mentioned, the infection enters through the wound surface during the contact of a person with infected objects. Brucella penetrate the body both through damaged skin and through the mucous membranes. Macrophage cells stand up to fight the pathogen, but they only capture the infection and enter it into the lymph nodes. Bacteria actively multiply along the way, and getting into the lymphatic flow lead to local inflammation of the lymph nodes.
The next stage of the spread of infection is associated with its entry into the bloodstream, which contributes to further promotion throughout the body. There are practically no organs and systems where brucellas would not have visited.
The incubation period of brucellosis in humans is 1-2 weeks. The disease develops, as a rule, gradually and does not have specific symptoms. But patients usually present four main complaints:
- intermittent pain in the joints, mainly in the lower extremities, sometimes very strong and painful.
- increase in body temperature in the form of prolonged subfebrile condition (up to 38 ° C) or wave-like type with sharp rises and falls.
- excessive sweating, sweating, sometimes night sweats.
- sharp weakness and breakdown.
Systemic lesions are manifold and affect almost all organs. Meet:
- Musculoskeletal system: septic monoarthritis, asymmetric polyarthritis of the knee, hip, shoulder sacroilial and sternoclavicular joints, spinal osteomyelitis, myalgia.
- Heart: endocarditis, myocarditis, pericarditis, an aortic root abscess, thrombophlebitis, and endocarditis can also develop on previously unchanged valves.
- Respiratory system: bronchitis and pneumonia.
- Digestive system: anicteric hepatitis, anorexia and weight loss.
- Genitourinary system: epididymitis, orchitis, prostatitis, tubo-ovarian abscess, salpingitis, cervicitis, acute pyelonephritis.
- Central nervous system: meningitis, encephalitis, meningoencephalitis, myelitis, cerebral abscesses, Guillain-Barré syndrome, optic atrophy, lesion III, IV and VI pairs.
- Lymph nodes, spleen: lymphadenitis, enlarged spleen
- Eyes: keratitis, corneal ulcers, uveitis, endophthalmitis.
The approximate frequency of the history and some symptoms / complaints in patients with brucellosis (in%)
N. I. Ragosa distinguishes 4 phases: the phase of compensated infection (primary latent), the phase of acute sepsis without local lesions (decompensation), the phase of subacute or chronic recurrent disease with the formation of local lesions (decompensation or subcompensation), and the phase of restoration of compensation with residual effects or without them.
Clinical forms of brucellosis:
- primary latent form,
- acute-septic form,
- primary chronic metastatic form,
- secondary chronic metastatic form,
- secondary latent form.
Primary latent state of practical health. With the weakening of protective forces, it can turn into either an acute-septic or a primary chronic metastatic form. Sometimes microsymptoms: a slight increase in peripheral lymph nodes, sometimes the body temperature rises to subfebrile, increased sweating during physical exertion. They consider themselves healthy and remain healthy.
The acute-septic form is fever (39–40 ° С), the temperature curve is wavy, of an irregular (septic) type with large daily ranges, repeated chills and sweats. She feels good (at a temperature of 39 ° C and above, she can read books, play chess, watch TV). There are no other signs of general intoxication. It does not threaten the patient’s life, even without etiotropic treatment, it ends in recovery. All groups of lymph nodes are moderately enlarged, some are sensitive. By the end of the first week - an increase in the liver and spleen. In the study of blood leukopenia, ESR is not increased. The main difference is the absence of focal changes (metastases). Without antibiotic therapy, the duration of fever is 3-4 weeks or more.
Chronic forms sometimes they develop immediately, bypassing the acute, sometimes after a time after the acute-septic form. According to the clinic, the primary chronic metastatic and secondary chronic metastatic forms do not differ. The difference is the presence or absence of an acute-septic form in the anamnesis. Clinic: prolonged low-grade fever, weakness, increased irritability, poor sleep, impaired appetite, decreased performance. Generalized lymphadenopathy is mild, sensitive, or painful on palpation; small, very dense, painless, sclerosed lymph nodes (0.5-0.7 cm in diameter) are noted. Enlarged liver and spleen. Against this background, organ lesions are detected, most often from the musculoskeletal system, followed by the nervous and reproductive systems. Pain in the muscles and joints, mainly in large ones, polyarthritis, with a new exacerbation, other metastases localize. Periarthritis, paraarthritis, bursitis, exostosis, osteoporosis is not observed. The joints swell, their mobility is limited, the skin above them is normal in color. Mobility impairment and deformation are caused by overgrowth of bone tissue. The spine is affected, more often in the lumbar. Sacroileitis is typical (Eriksen symptom: on the table on the back or on the side and pressurize the crest of the superior ilium when standing on the side or squeeze the front superior iliac crests with the both hands in the supine position. With unilateral pain sacroilitis on the affected side, with bilateral pain in the sacrum from two sides). Symptom Nakhlasa, lay on the table face down and bend the legs at the knee joints. When lifting a limb, pain in the affected sacroiliac joint. Symptom Larrey on the table on his back, the doctor takes with both hands the protrusions of the wings of the ilium and stretches them to the sides, while there is pain in the affected side (with unilateral sacroileitis). Symptom of John — Bera: the patient is in a supine position, with pressure on the pubic joint, pain in the sacroiliac joint is perpendicular downward.
Myositis of pain in the affected muscles. The pains are dull, prolonged, their intensity is associated with changes in the weather. On palpation, more painful areas are determined, and painful seals of various shapes and sizes are felt in the thickness of the muscles. Fibrositis (cellulitis) in the subcutaneous tissue on the legs, forearms, back and lower back. Sizes from 5-10 mm to 3-4 cm are soft oval formations, painful or sensitive. In the future, they decrease, can completely dissolve or sclerosize and remain for a long time in the form of small dense formations, painless.
Damage to the nervous system: neuritis, polyneuritis, radiculitis. Damage to the central nervous system (myelitis, meningitis, encephalitis, meningoencephalitis) is rare, lasts a long time and is difficult.
Changes in the reproductive system in men - orchitis, epididymitis, decreased sexual function. In women, salpingitis, metritis, endometritis. Amenorrhea occurs, infertility may develop. Pregnant women often experience abortions, stillbirths, premature births, and congenital brucellosis in children.
Secondary chronic form proceeds in the same way. The secondary latent form differs from the primary latent in that it more often passes into manifest forms (recurs).
Pathogenesis (development of the disease)
Stage 1 (lymphogenous). After the infection enters the body through microtrauma of the skin or mucous membranes, brucellas enter the lymphatic system and, with the flow of lymph, spread to various lymph nodes. In places of infection, regional lymph nodes do not immediately increase. Lymphadenopathy can form a little later and generalized, i.e. with massive damage to the body by brucella. The duration of the stage depends on the state of reactivity of the human immunity, as well as the type and activity of the bacterium. There are no clinical manifestations of the disease in this period, however, the immune system increases the amount of antibodies to the pathogen in the body.
Stage 2 (hematogenous drift). The infection penetrates the circulatory system, releases toxins, which in turn lead to the appearance of symptoms of intoxication of the body. Disturbances in the functioning of the nervous system appear. During this period, the pathogen can be detected in the patient’s blood.
Stage 3 (acute brucellosis process). Brucellas with blood flow spread throughout the body and form secondary foci of infection in various organs and systems. On the affected organs and tissues, as the disease develops, granulomas appear that are outwardly similar to granulomas in tuberculosis. Some types of brucella contribute to the appearance of abscesses on the organs, for example, Brucella suis.
Stage 4 (exo-focal seeding and an increase in allergic status). It is characterized by the formation of new foci of infection and the development of increased body allergenicity to adverse factors. Hypersensitivity of the body persists for a rather long time, even after stopping the infection, which is one of the leading pathogenetic signs of brucellosis. In fact, this stage is a chronic period of the disease with a long course (up to 3 years or more) and periodic relapses.
Stage 5 (residual effects). It is characterized by the presence of irreversible effects in the body, even after complete relief of the infection. Among these changes can be identified - the destruction and deformation of bones, joints, allergies, disorders of the nervous system.
Brucellosis caused by Brucella melitensis, which is usually transmitted by cattle, is most severe.
After a disease, a person develops a relatively short-lasting immunity - for 3-5 years, after which re-infection is possible.
Brucellosis can lead to damage to almost any part of the patient’s body, including the organs of the reproductive system, liver, heart and central nervous system. Among the possible complications note:
- Endocarditis. This is one of the most serious conditions that can lead to disruption of the heart valves. Endocarditis is the main cause of death for brucellosis patients,
- Arthritis. Infectious inflammation of the joints is characterized by pain, stiffness of movements and swelling in the affected area (usually in the knees, ankles, hip joint, wrists, and spine),
- Infectious inflammation of the testicles (epididymo-orchitis). Brucella can enter the epididymis, the tube connecting the vas deferens and testicles. From there, the infection can spread further into the testicles, causing swelling and pain,
- Infectious inflammation of the liver and spleen. With the development of this complication, the patient has an increase in these organs in size and pain in the epigastric region appears,
- Infections of the central nervous system: meningitis (inflammation of the membranes surrounding the brain) and encephalitis (actually inflammation of the brain).
Brucellosis in pregnant women can cause miscarriage, abnormalities in the development of the fetus.
Brucellosis death is rare. Most of them are the result of a malfunction of the heart after the development of endocarditis.
Symptoms of Brucellosis
The incubation period of brucellosis (from infection to the first signs of the disease) is from 7 to 28 days. If a person becomes a latent carrier, then the incubation period can last up to 3 months.
- A sharp increase in body temperature to 38-39 ° C, pronounced chills,
- Increased sweating
- Weakness, weakness,
- The increase in symptoms of intoxication - lack of appetite, nausea.
In elderly people, the onset of the disease is often less pronounced, but symptoms such as increased body temperature, insomnia, headaches, and weakness gradually increase.
How to diagnose brucellosis? This is a difficult process if the person is not at risk for the disease. In the correct diagnosis, epidemiological data, the combination of symptoms and the person's place of work play a role.
Where does the diagnosis begin?
- To begin with, they collect an anamnesis and find out whether similar outbreaks of brucellosis have occurred before at the enterprise in which the patient works, or at his place of residence.
- Isolation of cell culture from a sick person is an important fundamental diagnostic method. To do this, take blood for brucellosis and other biological fluids. For the growth of cell culture using special media. The difficulty is that cultures sprout for a long time - a column of bacteria has been growing for at least a month.
- What tests to take for brucellosis? Almost any biological fluid is used to determine the presence of bacteria in the blood. But first of all they take blood, especially for serological research methods, of which RSK, RNGA, Coombs reaction are prescribed. These research methods are more sensitive, even L-forms of bacteria can be determined, but these are expensive procedures.
- For the diagnosis of brucellosis in humans, a special serological Wright method is also used. A titer of 1: 200 is considered positive. An obvious plus is a quick diagnosis - no later than 10 days you can get reliable data on the presence of brucellosis.
- A modern method for detecting DNA is PCR diagnostics, which is used in very rare cases due to the high cost.
- Use a Berne skin test or an allergic diagnostic method. It is based on the presence of brucellosis antigen in the blood of a sick person - with the introduction of brucellin, swelling and redness appear at the injection site.
- Fatigue, fatigue, loss of strength,
- Severe, often painful pain in the joints (arthralgia) and muscles (myalgia), as well as tingling sensations in different parts of the body (paresthesia),
- Fever for 5-21 days, characterized by either high or elevated body temperature,
- Periodic chills and excessive sweating
- Neurological disorders - headaches, insomnia, psycho-emotional instability even in the presence of a small irritant factor,
- Lack of appetite, nausea,
- Slightly enlarged lymph nodes in various parts of the body, which may be slightly painful on palpation,
- The formation along the muscle tissues and tendons of fibrositis and cellulite, which are small (5-30 mm in diameter) painful to the touch seals,
- Disorders of the heart - increased heart rate at normal body temperature, bradycardia at high temperature,
- An allergic reaction to the skin - rash, dermatitis.
Also, the patient may have problems with stool (constipation), dry mouth, constant thirst.
Since brucellosis is a multi-organ disease, its development can lead to a number of serious health problems. Consider them:
- Musculoskeletal system - bursitis, synovitis, arthritis, sacroileitis, osteomyelitis, ankylosis, spondylosis, contractures, destruction and deformation of joints, muscle atrophy, John-Behr symptom, Ericksen symptom, Nahlas symptom, Larrey symptom,
- Cardiovascular system - endocarditis, myocarditis, pericarditis, thrombophlebitis, lymphadenitis,
- Nervous system - neuritis, meningitis, encephalitis, sciatica, radiculopathy, myelitis, Guillain-Barré syndrome,
- Gastrointestinal tract - hepatitis (anicteric forms), cholecystitis,
- Urinary system - adnexitis, endometritis, cervicitis, menstrual irregularities, orchitis, epididymitis, pyelonephritis,
- Respiratory system - bronchitis, pneumonia and other acute respiratory infections,
- The organs of vision - optic atrophy, uveitis, keratitis, corneal ulcer, endophthalmitis,
- Other - impotence, infertility, premature termination of pregnancy, anorexia, abscesses, enlarged spleen, infectious toxic shock (ITS).
Treatment of brucellosis in humans
In humans, the treatment of acute and chronic forms of brucellosis varies. In the acute form, the use of antibiotics is in the first place; in the chronic form, vaccines and antiallergic drugs.
|Antibiotics are used in large doses (selected by the attending physician) in a continuous course for 14 days.|
|Glucocorticosteroids - drugs of the adrenal cortex.||Adrenal cortex drugs have a pronounced anti-inflammatory effect. They are used in the presence of a pronounced inflammatory process inside, in injections, or injected into the joint. The dosage is selected by the attending physician.|
|Anti-inflammatory drugs:||Usually used for brucellosis of the joints.|
|Vitamin Complexes||Used to enhance immunity and restore the body's defenses.|
All drug names are for informational purposes only. Self-medication is unacceptable, since it can lead to negative consequences. This information is not a recommendation, the patient himself is responsible for the consequences of the use of drugs without a doctor's prescription.
Causes of Brucellosis
The causative agent of brucellosis - gram-negative immobile bacteria of the genus Brucella (Brucella)that are able to parasitize and inside the cells. For humans, pathogenic, i.e. causing the disease, four of them are:
- Brucella abortus (Banga bacillus) - cause brucellosis in cattle,
- Brucella melitensis - cause disease in small cattle,
- Brucella suis - cause disease in pigs,
- extremely rare Brucella canis - cause disease in dogs.
The most severe course of the disease causes Brucella melitensis (Brucella melitensis).
Bacteria are excreted into the external environment with urine, feces, milk, carrier blood, amniotic fluid. In addition, the usual fly Stomaxys calcitrans (autumn lance) can serve as a vector for infection.
The penetration of bacteria into the body occurs through microtrauma of the skin, mucous membranes, or when eating contaminated food products, especially raw milk or other dairy products made from unpasteurized milk. It is also possible aerogenic penetration of bacteria into the body, which is important in conditions of poor ventilation in large schools.
Brucella can live stably in environmental conditions - in the ground, manure, on livestock wool, even at low temperatures, but they die when exposed to disinfectants or boiling.
At risk of infection are veterinarians, farmers, meat processing workers, as well as enterprises for the preparation of leather and wool.
Treatment of chronic brucellosis
Antibiotics for chronic forms of brucellosis have been found to be ineffective. The main role in these forms is played by the appointment of drugs with a nonspecific and specific desensitizing effect. In chronic forms, vaccine therapy is most effective, which is not only a desensitizing measure, but also stimulates the immune system.
After the illness, a spa treatment is recommended. Balneological clinics and resorts where there are sulfur-radon and radon baths are best suited for such patients.
By clinical manifestations:
Primary latent - characterized by small clinical manifestations (slightly enlarged lymph nodes, elevated body temperature), which increase or move to the next stage of the development of the disease with weakened immunity. The patient's performance is maintained.
Acute septic - characterized by high body temperature with large drops during the day, chills, excessive sweating. At the same time, the patient feels rather well and maintains working capacity. After a week, without help, an increase in the spleen and liver is observed, the lymph nodes are moderately enlarged, some are slightly painful. The absence of antibiotic use can last for more than 30 days.
Primary chronic (with metastases). It can develop bypassing the acute phase of the disease, or as an outcome of the acute-septic period. It is characterized by a sluggish course with all the signs characteristic of brucellosis.
Secondary-chronic (with metastases). According to the symptoms, the primary and secondary chronic form of the disease do not differ. However, changes are observed in various organs and systems - in the first place, the liver and spleen increase, the functioning of the musculoskeletal system is disrupted, after which disorders of the nervous and genitourinary systems develop.
Primary latent. It is characterized by remission of the disease with residual effects.
Secondary latent. It is characterized by periodic relapses.
Diet and nutrition
A special diet specifically for brucellosis has not been developed. At the same time, brucellosis is an infectious disease, the acute course of which leads to a significant expenditure of energy and other resources of the patient's body. That's why the diet for brucellosis should be as high in calories and easily digestible (so that the body expends as little energy as possible on food processing).
During an exacerbation of a fever (that is, at a time when there is a massive influx of brucella and their toxins into the bloodstream), patients are advised to take as much liquid as possible in pure form (up to 2 to 4 liters per day). This helps to dilute the blood and reduce the concentration of toxins in it, and also accelerates the elimination of toxic substances through the kidneys with urine.
After the disappearance of all symptoms in 20-30% of patients, the symptoms of the disease may reappear.
Earlier, the main cause of death in brucellosis was heart damage. Today, with the advent of new effective antibacterial drugs, the prognosis for life is favorable. But the level of health, working capacity and quality of life after a disease is always reduced to one degree or another.
Treatment of a mild form of brucellosis is carried out on an outpatient basis, severe - in a hospital.
There are several points of treatment for this disease:
1. Antibacterial therapy.
2. Symptomatic treatment.
3. Physiotherapeutic treatment.
4. Surgical treatment.
Important! Before using medications, be sure to consult your doctor!
There is no specific effective vaccine for brucellosis in humans. The main recommendations for preventing infection are:
- Avoid eating unpasteurized dairy products,
- Compliance with hygiene rules and wearing gloves by agricultural workers,
- Vaccination of pets. Thanks to the universal vaccination of livestock, the problem of brucellosis in the USA was almost completely eliminated.
Since vaccination is carried out by living attenuated bacteria, getting the vaccine into the human body can cause disease.
After contact with an animal infected with Brucella bacteria, even in the absence of symptoms, careful monitoring of the patient's condition for 6 months is necessary.
1. Antibacterial therapy
The following antibiotics are most effective against brucella - fluoroquinolones, tetracyclines, aminoglycosides. To increase the effectiveness, 2 antibiotics from different groups are used, one of which should act on the pathogen at the cellular level.
Thus, the following combinations of taking antibiotics against brucellosis are distinguished:
- Doxycycline (200 mg per day) + Rifampicin (600 to 900 mg per day) for 6 weeks or more,
- "Doxycycline" (2 x 100 mg per day for 3-6 weeks) + "Streptomycin" (2 x 1 g per day intramuscularly for 2 weeks),
- "Doxycycline" (2 x 100 mg per day for 3-6 weeks) + "Netilmicin" (3 x 100 mg per day, every 8 hours, for 7-14 days),
- Oflaxacin (2 x 200-300 mg per day) + Rifampicin (600 to 900 mg per day) for 6 weeks or more.
- Oflaxacin (2 x 200-300 mg per day) + Netilmicin (3 x 100 mg per day, every 8 hours, for 7-14 days).
- "Rifampicin" (from 600 to 900 mg per day, for 6 weeks or more) + "Biseptol."
In mild forms, fluoroquinolones (Ofloxacin, Ciprofloxacin, Norfloxacin) can be used as monotherapy.
Please note that most antibiotics have contraindications - children under 15 years of age, pregnant women, lactation and others.
2. Symptomatic treatment
To stabilize the patient’s health and accelerate recovery, the following drugs are used:
Detoxification agents - aimed at removing from the body the vital products of pathogenic microflora, which are toxins that poison the body - heavy drinking, Methionine, Atoxil, Polysorb, Enterosgel.
Mild immunostimulants - increase the reactivity of the immune system, which helps the body in the fight against infection - Pentoxyl, Timalin, Dibazol.
Nonsteroidal anti-inflammatory drugs (NSAIDs) - they are used to stop inflammatory processes and normalize body temperature, which often accompanies diseases caused by infection - Indomethacin, Nimesil, Nurofen, Ibuprofen, Paracetamol.
Painkillers - are used to relieve pain in the joints, with various neuralgia, neuritis - novocaine blockade with a 1% solution locally, or intravenous administration of novocaine 0.25%.
Hormonal drugs (glucocorticoids) - used with caution if NSAIDs did not help, with severe inflammatory processes (neuritis, orchitis, and others), or with lesions of the central nervous system (encephalitis, meningitis) - Hydrocortisone, Prednisolone, Dexamethasone.
Antihistamines - are used to lower the allergic status of the body and the corresponding consequences - “Loratadine”, “Claritin”, “Diazolin”, “Suprastin”.
Vitamins - are used to strengthen immunity and maintain the cardiovascular system. Vitamin C (ascorbic acid) and B vitamins are especially useful in this case.
Every year a smaller number of specialists apply the brucellosis vaccine, which is associated with an increased number of adverse effects, of which we can single out - a decrease in the reactivity of the immune system and a large number of autoimmune reactions to serum ingredients.
With the course of the disease can be:
- acute (up to 3 months),
- subacute (up to 6 months),
- primary chronic (the onset of the disease is not exactly established, it takes more than six months),
- secondary chronic (after an acute onset lasts more than 6 months),
- residual brucellosis (disease duration more than 2-3 years).
Chronic brucellosis, in turn, is divided into forms of primary damage to various organ systems.
- visceral form - damage to the cardiovascular system, lungs, liver and kidneys,
- osteoarticular, it is also a locomotor form - a predominant lesion of bones and joints,
- neurobrucellosis: damage to the central and peripheral nervous system, psychotic episodes,
- urogenital form - damage to the genitourinary system,
- combined form.
According to the severity of the course, the disease can be:
Causes of brucellosis
The causative agents of the disease are bacteria from the genus Brucella. Four species are dangerous for humans: B. Melitensis, B. Abortus, B. Suis, B. Canis.
The causative agent is able to penetrate intact mucous membranes. It is highly stable in the external environment: dry heat at a temperature of 90–95 degrees kills it within an hour, in a humid environment at a temperature of 60 degrees it dies in half an hour, when boiled - instantly. At low temperatures, the bacterium remains viable for months. It can survive for quite some time in food: up to 10 days in raw milk (if stored in the refrigerator), up to 2 weeks in fermented milk products and meat, in cheese and butter - more than a month. In sheep's coat, viable bacteria can last up to 4 months.
Most often, cattle, goats and sheep, pigs become the source of infection, but some species can be transmitted by hares, deer, mouse rodents, and even dogs. People usually become infected by direct contact with animals, processing of animal raw materials, or eating infected foods, especially unboiled cow's milk. Cases of the transmission of the disease by an aerogenous route - when cleaning livestock yards and processing wool - are extremely rare. It is also extremely rare that a disease is transmitted from person to person, although cases of infection through blood transfusion and through sexual contact are known.
Bacteria accumulate in the lymph nodes, causing allergic changes in the body. After reaching a certain amount, they enter the bloodstream (this period coincides with the first symptoms of the disease), spreading throughout the body and forming inflammatory foci. Due to allergic adjustment, the immune system, as a rule, is not able to cope with the infection, and the disease acquires a chronic course, either subsiding or exacerbating. An exacerbation can cause any factor that reduces the body's defenses: hypothermia, overwork, stress, viral infections.
3. Physiotherapeutic treatment.
During persistent remission of the chronic form of the disease and the post-brucellosis period, the following methods of physiotherapeutic treatment are prescribed:
- Physiotherapy exercises (LFK),
- Radon baths,
- Paraffin baths,
- UHF therapy
- Ultraviolet irradiation,
It also has a beneficial effect on the spa treatment.
4. Surgical treatment
It is used only in cases where it is necessary to eliminate the defect in the musculoskeletal system, or severe damage to internal organs, the treatment of which conservatively did not bring success.
The mortality rate of the outcome of brucellosis during the observation of the disease was no more than 2%. Moreover, this percentage is due mainly to severe consequences and complications of the disease - endocarditis, infectious toxic shock.
Nevertheless, in some people, especially when not contacting a doctor in a timely manner, it ends in disability.
After recovery, a person who has been ill for 2 years is registered in the dispensary
Forecast and Prevention
After discharge from the infectious diseases hospital, patients should be monitored by an infectious disease specialist for at least two years, regularly examined by a cardiologist, pulmonologist, gynecologist, urologist, etc. The prognosis of the disease varies depending on the severity of the disease, the timeliness and adequacy of therapy. Often the disease leads to disability.
The basis for the prevention of brucellosis is the prophylactic vaccination of people who are in professional contact with animals and animal products.
Brucellosis (clinic, diagnosis, treatment, organization of medical care): a guide for infectious disease doctors and general practitioners. - Stavropol, 2013.