Relapsing fever

Relapsing fever is spirochetesoccurring in the form of febrile seizures, alternating with periods of normal temperature (pyrexia). Relapsing fever is a collective term that includes louse and tick-borne relapsing fever.
Lousy relapsing fever (synonym: epidemic relapsing fever, relapsing fever, relapsing fever).
Etiology. The disease is caused by the spirochete of Obermeier detected in blood of patients during the attack, has the form of a spiral with a small number of turns in length on average 15 - 20 MK, mobile, easily painted aniline paints.
Epidemiology. The source of infection is a sick man. Vector are lice - plus, rarely head and pubic. Infection occurs when damage to the body lice and contact with damaged skin (scratches, bites) haemolymph infected lice, which contains spirochetes. Susceptibility to disease is 100%. Epidemiological significance only febrile patients; in the period of apyrexia patients are practically safe. The disease is widespread in countries with low sanitary standards. In the USSR relapsing fever eradicated.
Pathogenesis and pathological anatomy. The causative agent, once in the blood through the damaged skin, is posted on the body. In the bodies of the rich reticuloendothelial, is the multiplication of the pathogen, and then re-entering the blood in large quantities and death with the release of endotoxin. In the result of exposure to the pathogen and its endotoxin develop degenerative, inflammatory and necrobiotic processes in organs, especially pronounced in the liver and spleen, evolving phenomenon of hemolysis. The emergence of progressing from attack to attack anemia, urobilinemia and jeltushnosti the skin associated with symptoms of hemolysis. In severe cases, hemolysis expressed sharply and is accompanied by a significant jaundice and hemorrhagic phenomena. At postmortem examination are significant (5-6 times) enlargement of the spleen. In the liver, kidney, myocardium observed dystrophic changes. Sometimes there hemorrhages in the kidneys, brain, skin.
Immunity after the disease unstable, often recurring disease.
Clinical presentation and course. The incubation period is often 5-8 days. Onset is sudden, with stunning fever, elevation of temperature to 39-409. They have a severe headache, muscle pain (mainly calf), along nerves and joints. Appetite disappears, a bad dream, a strong thirst. The skin is dry. Language white furred ("milky"or "chalk", language). Pulse Ochsen. From the first days of the disease there is a feeling of pressure in the left hypochondrium due to enlarged spleen, with 3-4-day - light yellowness of the skin and eyes. Spleen tight and painful to palpation. The liver also increased. Sometimes diarrhea. In the period of fever noted oliguria, changing after the crisis abundant selection (up to 5 l) of the urine with a low specific gravity.
In blood there is a slight hypochromic anemia, more expressed in severe cases. During the attack in moderate peripheral blood neutrophilic leucocytosis with a shift to the left, limfopenia, monocytosis, and aneosinophilia. The number of platelets decreased. In the period of apyrexia - lakopenia, monocytopenia, lymphocytosis (relative)appear plasma cells, eosinophilia (5-6%). Accelerated ROHE appears from the end of the first attack and last for several weeks. Sometimes there phenomena of meningism.
The disease occurs in the form of attacks. The duration of the first febrile seizure 5-7 days, sometimes shorter. The temperature falls critically at strong perspiration to normal or subnormal. During apyrexia lasting 1-2 weeks, the patient feels healthy. Then begins the second attack, occurring as the first. The duration of each subsequent attack less than the previous one. Usually 2-3 attack (at least 4-6), followed by recovery.
Complications. The most threatening is the heart of the spleen, which in some cases may result in rupture of the spleen with subsequent fatal bleeding. The second is the gall typhoid - the result of the merger, Salmonella infection (protivorechiia). Most often this complication occurs in the second attack and is characterized by the acute jaundice, hemorrhagic manifestations, numerous small abscesses in various organs. There are catarrhal and hemorrhagic pneumonia, abscesses of nadgraditi rib cartilage, osteomyelitis, interstitial myocarditis. Mortality in the development of biliary tifoide to 50%. Pregnant arise abortion, premature birth with uterine bleeding. Often marked otitis, neuritis of the auditory nerve, irity, iridotsiklity, opacity of vitreous body, swelling of the eyelids.
The diagnosis. In addition to the typical clinical presentation and course of the disease, certain value for the diagnosis has an epidemiological anamnesis (lice, contact with sick recurrent fever, stay in areas where the disease). Laboratory methods during the attack are reduced to repeated smear of blood or thick dark-field and painted. In the interictal period when the spirochaetes in the blood of little use by concentrating on Bernhoff: take from Vienna 2-3 ml of blood in a test tube, centrifuged and in the sediment are looking for a spirochete. Of serological methods matters reaction B Rusina - Rickenberg (phenomenon load), which is placed with the blood serum of a patient, platelet-Guinea-pig and culture of the spirochete.
In the presence in the blood of antibodies spirochaete obsalyutno (loaded) platelets.
The differential diagnosis spend with malaria, tick-borne recurrent fever, leptospirosis, influenza, lobar pneumonia (see articles about the diseases).
Treatment. Noversana during the attack injected of 0.45-0.6 g in 10 ml bidistilled water 2-3 times at intervals of 4-5 days, during apyrexia (4-5 day) 0.45 g of the preparation with the re-introduction of the same dose after 6 days. If it is impossible to enter the drug intravenous use of miasena intramuscularly of 0.45 - 0.6, However, this drug on effective than orally as tablets. In recent years, the proposed maarsen, mahfarid, coarsen, differ less toxicity. Good results in early treatment of recurrent fever gives penicillin, which assigned to 200 000-300 000 IU 5-6 times a day within 5-7 days. You can apply tetracycline, chloramphenicol. The latter is particularly indicated when complications return typhoid gall Tebaida, recommended cardio-vascular equipment.
Prevention. The fight against lice (see). When the disease should probably early detection and isolation of patients in the infectious diseases hospital, disinsection things patient and sanitary treatment of others. Behind the fireplace establish surveillance for 3 weeks. The patients are discharged from hospital after 3 weeks after the normalization of temperature.