Epstein-Barr virus (EBV). Symptoms, diagnosis, treatment in children and adults

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Possible deviations from the norm in functional liver tests with infectious mononucleosis:

1. 
   Increased transaminase levels several times:
   • alt rate 10-40 U / l,
   
   
   • aST norm 20-40 U / l.
   
   
2. Increased thymol test - the norm is up to 5 units.


3. Moderate increase in total bilirubin levels due to unbound or direct: the rate of total bilirubin is up to 20 mmol / l.


4. Increased alkaline phosphatase levels - the norm is 30-90 U / l.

A progressive increase in indicators and an increase in jaundice may indicate the development of toxic hepatitis, in the form of a complication of infectious mononucleosis. This condition requires intensive care.

Epstein-Barr virus treatment

There is still no consensus among physicians and scientists about the methods of treatment, and a large amount of research is currently being carried out regarding antiviral treatment. At the moment, there are no specific drugs effective against the Epstein-Barr virus.

Infectious mononucleosis is an indication for inpatient treatment, with further recovery at home. Although with a mild course, hospitalization in the hospital can be avoided.

In the acute period of infectious mononucleosis, it is important to observe sparing regimen and diet:

• semi-bed rest, limitation of physical activity,


• an abundant drink is necessary,


• meals should be frequent, balanced, in small portions,


• exclude fried, spicy, smoked, salty, sweet foods,


• fermented milk products have a good effect on the course of the disease,


• the diet should contain a sufficient amount of proteins and vitamins, especially C, group B,


• refuse products containing chemical preservatives, dyes, flavor enhancers,


• it is important to exclude foods that are allergens: chocolate, citrus fruits, legumes, honey, some berries, fresh fruits out of season, and others.

With chronic fatigue syndrome useful will be:

• normalization of work, sleep and rest,


• positive emotions, doing what you love,


• good nutrition,


• complex of multivitamins.

Epstein-Barr virus drug treatment

The principles of EBV infection treatment in children and adults are the same, the difference is only in the recommended age-specific dosages.

Treatment of the Epstein-Barr virus is selected individually, depending on the severity of the course, manifestations of the disease, the patient's immunity and the presence of concomitant pathologies.

Principles of drug treatment for chronic fatigue syndrome

• Antiviral drugs: Acyclovir, Gerpevir, Interferons,


• vascular drugs: Actovegin, Cerebrolysin,


• drugs that protect nerve cells from the effects of the virus: Glycine, Encephabol, Instenon,



• sedatives,


• multivitamins.

Treatment of the Epstein-Barr virus with folk remedies

1. Echinacea tincture - 3-5 drops (for children over 12 years old) and 20-30 drops for adults 2-3 times a day before meals.


2. Ginseng tincture - 5-10 drops 2 times a day.


3. Herbal collection (not recommended for pregnant women and children under 12 years old):
   
   
   • Chamomile flowers,
   
   
   • Peppermint,
   
   
   • Ginseng,
   
   
   
   • Calendula flowers.
   Take herbs in equal proportions, stir. To brew tea, 200.0 ml of boiling water is poured over 1 tablespoon and brewed for 10-15 minutes. Take 3 times a day.


4. Green tea with lemon, honey and ginger - increases the body's defenses.


5. Fir oil - used externally, lubricate the skin over the enlarged lymph nodes.


6. Raw egg yolk: every morning on an empty stomach for 2-3 weeks, improves liver function and contains a large amount of nutrients.


7. Magonia Root or Oregon Grape Berry - add to tea, drink 3 times a day.

Which doctor should i go to for Epstein-Barr virus?

If infectious mononucleosis becomes a generalized infection, you should immediately call an ambulance and be hospitalized in the intensive care unit (intensive care unit).

Frequently asked Questions

How does the Epstein-Barr virus affect pregnancy?

• Detected class immunoglobulins G ( VCA and EBNA) - you can safely plan a pregnancy, with good immunity, the reactivation of the virus is not terrible.


• Class M positive immunoglobulins - with the conception of the baby, you will have to wait until complete recovery, confirmed by an analysis for antibodies to EBV.


• There are no antibodies to the Epstein-Barr virus in the blood - you can and should become pregnant, but you will have to be observed, periodically passing tests. You also need to protect yourself from possible EBV infection during the gestation period, to strengthen your immunity.

If antibodies of class M were detected during pregnancy to the Epstein-Barr virus, then the woman is necessarily hospitalized in a hospital until complete recovery, the necessary symptomatic treatment is carried out, antiviral drugs are prescribed, immunoglobulins are administered.

How exactly the Epstein-Barr virus affects pregnancy and fetus is not fully understood. But many studies have proven that pregnant women with active EBV infection are much more likely to have pathologies in a pregnant baby. But this does not mean at all that if a woman had an active Epstein-Barr virus during pregnancy, then the child should be born unhealthy.

Possible complications of the Epstein-Barr virus in pregnancy and fetus:

• premature pregnancy (miscarriages),


• stillbirth,


• intrauterine growth retardation (IUGR), fetal malnutrition,


• prematurity,


• postpartum complications: uterine bleeding, disseminated intravascular coagulation, sepsis,


• possible malformations of the child's central nervous system (hydrocephalus, brain underdevelopment, etc.) associated with the action of the virus on the nerve cells of the fetus.

Can the Epstein-Barr virus be chronic?

1. Infection followed by an active period of the virus (acute viral EBV infection or infectious mononucleosis);


2. Convalescence, in which the virus goes into an inactive state , in this form, the infection can exist in the body all life;


3. Chronic course of viral infection Epstein-Barr - characterized by reactivation of the virus, which occurs during periods of decreased immunity, manifests itself in the form of various diseases (chronic fatigue syndrome, changes in immunity, cancer, and so on).

What are the symptoms of the Epstein-Barr igg virus?

Thus, the entire record "Epstein-Barr virus igg" means that we are talking about the presence in the human body of antibodies of the IgG type to the virus. Currently, the human body can produce several types of IgG antibodies to different parts epstein-Barr virus, such as:

• IgG to capsid antigen (VCA) - anti-IgG-VCA;
• IgG to early antigens (EA) - anti-IgG-EA;
• IgG to nuclear antigens (EBNA) - anti-IgG-NA.

But the detection of antibodies such as anti-IgG-EA may indicate an active course of chronic infection, which is accompanied by clinical symptoms. Thus, under the entry "Epstein-Barr igg virus" in relation to symptoms, doctors understand precisely the presence of antibodies of the anti-IgG-EA type in the body. That is, we can say that the concept of "Epstein-Barr virus igg" in short form indicates the presence of symptoms of a chronic infection caused by a microorganism in a person.

The symptoms of chronic Epstein-Barr virus infection (EBBI, or chronic fatigue syndrome) are as follows:

• Prolonged low-grade fever;
• Low efficiency;
• Unreasonable and unexplained weakness;
• Swollen lymph nodes located in various parts of the body;
• Sleep disturbances;
• Recurrent sore throats.

In addition, chronic EBBI can lead to the formation of certain tumors, such as:

• Nasopharyngeal carcinoma;
• Burkitt's lymphoma;
• Neoplasms of the stomach and intestines;
• Hairy leukoplakia of the mouth;
• Thymoma (tumor of the thymus), etc.

Monoinfection - an infectious disease caused by one type of pathogen.

Mixed infection (mixed) - two or more types of pathogens cause an infectious disease.

Secondary infection - another infection caused by a opportunistic pathogen joins the initial (main) infection.

Reinfection - Re-infection with the same pathogen after recovery against the background of immature immunity.

Superinfection- Re-infection with the same pathogen against the background of the current disease.

Relapse - Re-disease due to endogenous infection.

When exogenous infection the pathogen enters the body from the environment (from the outside), when endogenous― is in the body itself.

Autoinfection - endogenous infection caused by the body's own opportunistic microflora.

Persistence- long-term presence of microorganisms in the body in an inactive state.

Microcarrier (carrier of bacteria, carrier of viruses) - the presence (carrier) of a microorganism in a macroorganism without clinical manifestations of infection. Maybe: healthy microcarrier - develops in healthy individuals who have been in contact with patients or carriers of the corresponding pathogenic species; convalescent microbearer - a condition in which the release of the pathogen continues after the patient's clinical recovery; most often formed with a weak tension of post-infectious immunity.

Focal infection - an infection in which the process is localized in a specific organ or tissue (body) and does not spread throughout the body. However, focal infection with the slightest imbalance between macro and microorganisms can turn into a generalized form.

Generalized infection - an infection in which pathogens are spread mainly by the lymphatic-hematogenous route throughout the entire macroorganism.

In this case, it develops:

Bacteremia is a condition in the body in which microorganisms circulate in the blood but do not multiply.

Viremia is a condition of the body in which viruses circulate in its blood (generalized viral infection).

Sepsis is the finding of microorganisms in the blood and their reproduction.

Septicemia is a form of sepsis in which microorganisms circulate and multiply in the blood without the formation of secondary foci of infection.

Septicopyemia is a form of sepsis in which microorganisms not only circulate and multiply in the blood, but also purulent metastatic foci are formed in various organs.

Toxemia is a condition of the body in which bacterial endotoxins circulate to the blood.

Toxinemia is a condition of the body in which a bacterial exotoxin or other toxin circulates in the blood (with botulism, tetanus and other diseases).

When bacteria and their toxins enter the bloodstream, bacterial or toxic-septic shock.

Epidemiology- the science of the epidemic process. Studies the emergence and spread of infectious diseases among the population. Links of the epidemic chain:

1. Source and reservoir of infection.

2. Mechanisms and factors of transmission of pathogens (the transmission factor can be water, food, air, etc.).

3. A susceptible organism.

By influencing these links, it is possible to prevent or even eliminate an already existing epidemic process.

1. Herpetic encephalitis - caused more often by HSV-I, less often by HSV-II:

Acute onset of the disease with severe fever, chills, myalgia, and other symptoms of general intoxication preceding damage to the central nervous system

A few days later, consciousness disorders suddenly appear (confusion, disorientation, psychomotor agitation, stupor, coma), repeated generalized seizures are often observed, focal symptoms develop (paresis and paralysis of the limbs, cranial nerves, impaired stem functions)

The lesion can proceed as a slow, progressive infection with a fatal outcome

In the recovered, organic damage to the central nervous system remains in the form of a sharp decrease in intelligence, paresis and paralysis of the limbs, leading to persistent disability

CSF study: low lymphocytic or mixed pleocytosis, often an admixture of erythrocytes, xanthochromia, moderately high protein and glucose

CT or MRI of the brain: foci of brain tissue rarefaction in the temporo-frontal and temporo-parietal regions of the brain

Treatment: acyclovir 10 mg / kg 3 times / day i / v for a day + appropriate pathogenetic and symptomatic therapy as in other viral encephalitis.

2. Chickenpox is an acute anthroponous infectious disease with an aspiration mechanism of transmission of the pathogen - varicella-zoster virus (VZV), characterized by vesicular rash, fever and benign course.

Epidemiology: source - patients with chickenpox (infectious a day before the appearance of the first elements of the rash and up to 5 days after the appearance of the last elements, the virus is released when coughing, sneezing, talking, has great volatility) and shingles, the transmission mechanism is aspiration (airborne by way); the highest incidence is under the age of 7, the peak incidence occurs in the autumn-winter period

Pathogenesis: introduction of the virus into the epithelial cells of the upper respiratory tract -\u003e primary replication -\u003e viremia -\u003e fixation of the virus in the epithelial cells of the skin and mucous membranes -\u003e replication, cytopathic effect in the form of ballooning dystrophy and cell necrosis, fluid exudation into the necrotic zone with the formation of vesicles -\u003e gradual resorption of exudate, vesicle collapse and crusting; lesions of the central nervous system and internal organs are possible, but rare; after a disease, immunity is stable, but the virus is latent in the spinal ganglia and with IDS it can be reactivated with the development of shingles.

The clinical picture of chickenpox:

Incubation period average day

The disease begins with the appearance of a rash, an increase in body temperature and general symptoms of intoxication, the severity of which corresponds to the abundance of rashes; in adults, the body temperature is higher, the duration of fever and the severity of intoxication are greater than in children

The rash is profuse, appears in waves on the body, limbs, face, scalp, each pouring is accompanied by a rise in body temperature; the elements of the rash first look like red spots, which turn into a papule within a few hours, and then into a vesicle filled with transparent contents; small vesicles are single-chambered, they collapse when punctured, may be surrounded by a thin corolla of hyperemia, large vesicles may have an umbilical depression; after 1-2 days, the vesicles dry out, become covered with a brown crust, after which, after falling off, pigmented spots remain, in some cases - scars

The rash is accompanied by severe itching, polyadenopathy, in adults, there may be pustular rash (due to the addition of bacterial flora)

Characterized by polymorphism of the rash: in one area of \u200b\u200bthe skin, you can find elements at different stages of development (from spots to crust) and different sizes (from 1-2 to 5-8 mm)

Elements of a rash can also appear on the conjunctiva of the eyes, oral mucosa, larynx, genitals; in debilitated patients, severe forms of the disease (bullous, hemorrhagic, gangrenous) are possible

In the KLA in adults - leukocytosis with a shift to the left, a moderate increase in ESR

Diagnosis of chickenpox:

1) clinical based on the characteristic type of rash

2) detection of elementary virus bodies (Aragao bodies) in the content of vesicles during treatment by silver plating or virus by immunofluorescence

3) serological reactions: RSK, RTGA (used for retrospective diagnosis)

Treatment for chickenpox:

1. Hospitalization for clinical and epidemiological indications, in other cases, home treatment

2. There is no etiotropic therapy, with severe intoxication with abundant pustular rashes, antibacterial therapy is indicated, in persons with chickenpox against the background of IDS, it is possible to use antiviral drugs (acyclovir, vidarabine - only reduce the severity of clinical manifestations), in severe cases in weakened and elderly people - specific immunoglobulin

3. Skin and mucous membrane care: lubrication of bubbles with 1% aqueous solutions of methylene blue or brilliant green, concentrated solution of potassium permanganate

4. With severe itching: baths with a weak solution of potassium permanganate, rubbing the skin with water with vinegar or alcohol, lubricating the skin with glycerin, antihistamines

3. Cytomegalovirus infection (CMVI) is a chronic anthroponous infectious disease with multiple transmission mechanisms of the pathogen - Cytomegalovirus hominis, characterized by lifelong persistence of the pathogen in the body, the formation of specific giant cells (cytomegalovs) in the affected organs, and a variety of clinical manifestations.

Epidemiology: source - sick people and virus carriers (the virus is found in saliva, urine, semen, vaginal contents, breast milk, lacrimal fluid, with an active infection - in the blood), the route of infection is transplacental, intranatal, during breastfeeding, contact (through objects, contaminated with saliva), genital, airborne, organ transplant; susceptibility is high, however, the clinic manifests itself only in persons with HIV infection (opportunistic infection)

Pathogenesis: entry of the virus into the body through numerous gates (mucous membranes of the oropharynx, respiratory tract and genital organs, directly blood, etc.) -\u003e replication in epithelial cells -\u003e primary viremia with fixation in mononuclear phagocytes, T-helpers and lifelong persistence in them in the future without clinically pronounced manifestations -\u003e virus reactivation on the background of cellular IDS -\u003e clinically pronounced forms of infection

Clinical picture of CMVI:

A) congenital CMVI - most often develops when the mother is infected during pregnancy, rarely with an exacerbation of a latent infection; the nature of fetal damage depends on the timing of infection, when infected in the early stages, the fetus dies, when infected at a later date, the child is born with signs of CMVI (fever, hemorrhages on the skin, jaundice, hepatosplenomegaly)

B) acquired CMVI:

Incubation period days

When a child is infected during childbirth or immediately after birth, the infection can proceed latently or in the form of a localized form with damage to the parotid, less often other salivary glands

With primary infection, mononucleosis-like syndrome with fever, an increase in l is more often characteristic. at. (mainly cervical groups), hyperemia and swelling of the tonsils, hepatosplenomegaly, the appearance of atypical mononuclear cells in the blood, usually against a background of leukopenia; there may also be interstitial pneumonia, cholestatic hepatitis, enterocolitis, etc.

With IDS (HIV infection), it manifests itself as generalized forms of CMVI with multiple organ lesions (most often chorioretinitis, meningoencephalitis, ulcerative lesions of the intestine and esophagus) with a severe progressive course

1) detection of cytomegalic cells ("owl's eye") during cytoscopy of urine sediment, saliva, cerebrospinal fluid and other biological fluids

2) detection of viral DNA fragments by PCR methods (also allows you to determine the viral load)

3) virological research (isolation of the virus culture from biological body fluids)

4) serological reactions: ELISA for detecting antibodies to the virus (the presence of IgM-AT is a sign of primary infection, IgM and IgG-AT - reactivation of a latent infection, IgG-AT - the presence of a latent infection).

CMVI treatment: etiotropic therapy - ganciclovir (most effective) 500 mg 3 times / day by mouth or 5-15 mg / kg / day IV for a day or more; also use human hyperimmune immunoglobulin, immunomodulators (T-activin, decaris, etc.) and other means to reduce the immunodeficiency state + concomitant pathogenetic and symptomatic therapy.

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C epsis (generalized purulent infection)

Sepsis (sepsis; Greek sepsis putrefaction; synonym - generalized purulent infection) is a common severe infectious disease resulting from the spread of infection from the primary focus due to a violation of local and general immunological mechanisms.

Any suppurative process of soft tissues, bones, joints and internal organs can be the primary septic focus. The prolonged existence of a local purulent focus (due to prolonged self-medication of the patient, his refusal from medical care, ineffective long-term polyclinic stage of treatment), as well as non-radical surgery for a purulent process may be accompanied by the development of sepsis. Sometimes the primary septic focus cannot be identified. In such cases, they speak of cryptogenic, or primary, sepsis.

Distinguish between surgical, odontogenic, otogenic, rhinogenic, obstetric-gynecological sepsis, urosepsis.

Surgical sepsis, which occurs most often, can be a complication of various surgical diseases, especially purulent (peritonitis, lung abscess, etc.), and damage (for example, in case of burns - burn sepsis).

The primary septic focus in odontogenic sepsis is dental granulomas, purulent processes in the gums or jaws; the latter can be complicated by suppuration of the submandibular lymph nodes and phlegmon of the oral cavity. It can also be a consequence of tonsillitis (tonsillogenic sepsis).

Otogenic sepsis occurs as a complication of purulent otitis media and can quickly lead to the contact spread of pathogens to the membranes of the brain with the development of meningitis.

Rhinogenic sepsis can occur as a complication of purulent diseases of the nose and its paranasal sinuses. Local spread of the process leads to regional thrombophlebitis or osteomyelitis of bone structures that form the walls of the sinuses, phlegmon of the orbit, accompanied by conjunctivitis, exophthalmos. Thrombosis of the sagittal sinus and meningitis are possible.

Obstetric and gynecological sepsis can be a consequence of complicated labor, surgical interventions on the genitals, or their purulent-inflammatory diseases. Sepsis, which occurs as a result of a criminal abortion, is extremely difficult (often in the form of septic shock).

The primary septic focus in urosepsis is localized in the genitourinary system (ascending urethritis, cystitis, pyelitis, nephritis, bartholinitis in women, prostatitis in men).

By the type of pathogen, staphylococcal, streptococcal, pneumococcal, gonococcal, colibacillary, anaerobic, mixed sepsis, etc. are distinguished.

Anaerobic sepsis can occur with anaerobic gangrene (see table Anaerobic Infection). The leading mechanisms in the pathogenesis of sepsis are bacteremia and intoxication. Septicemia (sepsis with bacteremia but no suppurative metastases) is the most commonly observed form of sepsis. More often it proceeds acutely and is accompanied by symptoms of intoxication, dystrophic changes in internal organs. The causative agents are staphylococci, streptococci, often gram-negative microbes (Pseudomonas aeruginosa and Escherichia coli), as well as non-spore-forming (non-clostridial) anaerobes (bacteroids, fusobacteria, peptostreptococci, etc.). Septicopyemia (pyemia) - sepsis with the formation of purulent metastases in the internal organs. The causative agents can be any microorganisms located in the primary purulent focus, which with the blood flow enter the vascular system, more often the lungs and kidneys.

Common symptoms of sepsis are high body temperature (up to 39-40 °), severe tachycardia, often chills, leukocytosis (less often leukopenia) with a shift of the leukocyte count to the left, sharply increased ESR, lymphopenia, hypoproteinemia, as well as signs of damage to internal organs (toxic nephritis, hepatitis, myocarditis). According to the clinical course, fulminant, acute, subacute, recurrent and chronic sepsis are distinguished. With fulminant sepsis, clinical symptoms are rapidly increasing, and within 1-3 days the disease ends in death.

With the most common acute sepsis, symptoms develop rapidly; the duration of the course depends on the nature and effectiveness of treatment - usually 1 0.5-2 months after which a period of recovery begins or the disease becomes subacute. With subacute sepsis, acute phenomena (fever, intoxication, etc.) gradually subside.

Chronic sepsis is spoken about when its manifestations persist for more than 6 months, which, as a rule, is explained by the presence of purulent foci that are difficult to treat surgically (in bones, joints, but more often in internal organs - endocarditis, chronic lung abscess, pleural empyema). Recurrent sepsis is characterized by a change in periods of exacerbation with bright symptoms and periods of remission, when it is not possible to identify any noticeable clinical symptoms.

One of the complications of sepsis is bacterial-toxic shock - the body's reaction to the breakthrough of pyogenic microorganisms or their toxins into the blood, which can occur at any time during the course of sepsis. The initial signs of shock are high fever (up to 40-41 °) with tremendous chills, which are replaced by severe sweating (torrential sweats) with a drop in body temperature to normal or subfebrile. The main symptom of bacterial toxic shock, like any shock, is acute vascular insufficiency: frequent pulse (beats per minute) of weak filling, falling blood pressure. Motor excitement, pallor of the skin, acrocyanosis, increased respiration (up to 1 minute) are noted. Severe changes in hemodynamics and a violation of the blood coagulation system (disseminated intravascular coagulation - DIC syndrome) lead to a sharp sudden decompensation of the functions of vital organs and systems.

Treatment of sepsis is complex, it should be carried out in an intensive care unit for patients with purulent infection. Includes active surgical treatment of purulent foci (available for surgery) and general intensive multicomponent therapy. Surgical treatment consists in excision of all affected tissues, prolonged active drainage of the surgical wound and the fastest closure of wound surfaces by suturing or using skin grafting. After surgical treatment of a purulent focus, for its fastest cleansing and preparation for closure, osmotically active ointments on a water-soluble basis (levosin, levomekol, dioxidine ointment) are used, which have pronounced antiseptic and sorption properties. The appointment of proteolytic enzymes is also advisable. For large flat wounds, treatment in a controlled abacterial environment is successfully used: the affected area of \u200b\u200bthe body is placed in a plastic insulator through which sterile air is blown.

Intensive therapy for sepsis includes the introduction of antibiotics and antiseptics, taking into account the sensitivity of the isolated microflora to them, detoxification therapy - forced diuresis (see Poisoning), hemosorption, plasmapheresis (Cytapheresis), targeted immunocorrection with the introduction of cellular (leukemia suspension) or serum (antistaphylococcal gamma antistaphylococcal hyperimmune plasma) drugs, immunostimulants and immunomodulators (thymalin, interferon, decaris), correction of protein-energy losses (high-calorie nutrition, tube and parenteral nutrition), infusion-transfusion therapy (transfusion of fresh citrate and rheopolytic blood, electrolytes, polylution , protein preparations, the introduction of cardiac glycosides), correction of impaired functions of various organs and systems.

Treatment of anaerobic sepsis should include intramuscular and intravenous drip of large doses of antigangrenous serum (from 10 to 20 prophylactic doses per day), intravenous drip and intramuscular administration of a mixture of antigangrenous phages.

Prevention is based on the correct and timely treatment of local purulent processes. If outpatient treatment is ineffective, patients should be hospitalized in the surgical department. It is necessary to carry out sanitary and educational work directed against self-medication of patients with purulent diseases of any localization.

Sepsis in children. The most susceptible to sepsis are newborns and children in the first years of life, which is explained by their age-related anatomical and physiological characteristics (imperfection of the immune system, a tendency to generalize pathological processes, immaturity of the central nervous system). The main role in its occurrence belongs to staphylococcus, gram-negative flora. Their association is often revealed, as well as the viral-bacterial association. Infection occurs in various ways: intrauterine - transplacental or through the birth canal; in the postpartum period - by drip and contact (through the hands of the medical staff and mother, through linen and care items) transmission of infectious agents. Entrance gates of infectious agents: umbilical vessels and umbilical wound, respiratory tract, gastrointestinal tract, skin, ears, eyes. At the site of the introduction of pathogens, purulent inflammation develops - pyoderma, otitis media, pneumonia. Depending on the entrance gate, sepsis is distinguished: umbilical, otogenic, cutaneous, intestinal, etc. With a decrease in immunological security, maternal infection, defects in care and nutrition, the local purulent process can turn into general sepsis with metastasis to various organs.

The harbingers of sepsis are a delay in the growth of the child's body weight, bleeding from the umbilical wound, omphalitis, vesiculopustulosis (see pyoderma). Such children are allocated to the risk group for the development of sepsis.

Early symptoms of sepsis: sleep impairment, restlessness or lethargy, breast refusal, erratic body temperature, regurgitation, vomiting, loose stools, tachycardia, pale gray skin. Septicemia is characterized by intoxication, an increase in body temperature, a sharp deterioration in the general condition, cyanosis of the nasolabial triangle, tachycardia, a decrease in tissue turgor, and depression of consciousness. Subacute, undulating septicemia with less pronounced clinical symptoms is more common. With septicopyemia against the background of a severe course, metastatic purulent foci are formed: purulent otitis media, abscess pneumonia, phlegmon, arthritis, purulent meningitis, osteomyelitis, myocarditis, pleurisy. In the blood, leukocytosis with a shift of the leukocyte formula to the left, increased ESR, anemia, a decrease in the content of total protein and protein fractions, a positive reaction to C-reactive protein, etc. are noted.

Treatment should be prescribed as early as possible, always in a hospital setting. It should be sufficiently long and complex. Antibiotics are prescribed in high doses, taking into account the sensitivity of the flora to them. In the absence of an antibioticogram, one or two antibiotics must be prescribed intravenously or intramuscularly. The best effect is given by semi-synthetic penicillins (ampicillin, oxacillin, ampiox, methicillin), cephalosporins, gentamicin, ristomycin, carbenicillin. Antibiotics should be changed every other day. The complex of therapy usually includes corticosteroids, desensitizing drugs, cardiac glycosides for symptoms of heart failure, vitamins. To increase the reactivity of the child's body, plasma is transfused, gamma globulin is injected. For the purpose of detoxification, hemodez is used, reopolyglukin intravenously drip.

With sepsis caused by staphylococci or Pseudomonas aeruginosa, specific therapy with antistaphylococcal gamma globulin and plasma is performed. Children over 3 months are prescribed staphylococcal toxoid. Heparin is indicated for disseminated intravascular coagulation. With the development of intestinal dysbiosis (more often as a result of antibiotic treatment) and for the purpose of its prevention, lactobacilli, bifidumbacterin are prescribed. Treatment should continue until the complete disappearance of all symptoms of infection, the normalization of the hemogram, proteinogram, and a stable increase in body weight. Children who have had sepsis are under the dispensary supervision of a local pediatrician for 2-3 years.

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Meningococcal infection

Outbreaks of many infections and even isolated episodes of their occurrence are not accidental - this is a natural phenomenon. Each ailment is characterized by a seasonality of manifestation, therefore, in our time it is possible to predict the development of many of them. But there are diseases with numerous variants of the course, with an erased clinical picture, which often end in carriage. Meningococcal disease is one of those.

What is the danger of a disease other than brain damage? What is meningococcal infection and what are the variants of the disease caused by this microorganism? What measures of prevention and treatment exist today?

What is meningococcus

Until the end of the 19th century, scientists mistakenly believed that meningococcus caused only damage to the lining of the brain. Only in the last century have biologists and doctors fully studied the microorganism and its effect on humans.

The causative agent of meningococcal infection - neisseria meningitidis from the genus Neisseria, when viewed through a microscope, looks like a coffee bean. The microorganism is unstable in the external environment. Under the influence of sunlight, it dies in a few hours. A high temperature of 50 ºC kills a microorganism in 5 minutes, 100 ºC almost instantly. He does not like Neisseria and freezing, so 2 hours at minus 10 ºC is enough and meningococcus dies. In addition, the causative agent of meningococcal infection is extremely sensitive to all disinfectants.

Why is such a "weak" microorganism still not defeated?

1. Two-thirds of the cases of meningococcus in the human body are carriers, and as you know, this form of habitation does not manifest itself in any way, there are not even slight signs of meningococcal infection.
2. From 10 to 30% of all variants of the disease are meningococcal nasopharyngitis, the main symptoms of which are runny nose and sore throat. It is difficult to suspect a severe infection in the body with such manifestations.
3. About 80% of patients with meningococcal infection are children, half of whom are sick before the age of 5 years. How to protect your child from meningococcal infection? You need to know everything about the characteristics of this microorganism.
4. Adults get sick more often under the age of 30, more living in a hostel, students of educational institutions.
5. Epidemics are observed every 10-15 years and are seasonal in nature, more often in winter and spring, which coincides with the spread of influenza and other viral diseases. Mild forms of meningococcal infection are hidden behind viral diseases and often become carriers.

The microorganism Neisseria in various variants of diseases lingers for a long time in the human body, which infects others. Meningococcal disease is all possible form of the disease caused by meningococcus. There are many types of infections, and each one has a special course and manifestations.

Causes and methods of infection

The peak incidence occurs from February to April, but isolated cases of meningococcal infection can also occur throughout the year. This is a strict anthroponosis, which means that only a person is a reservoir for the reproduction of bacteria, this excludes the possibility of infection from pets. The source of infection is a sick person and a carrier of bacteria. The disease is widespread everywhere and does not depend on race and place of residence.

How is meningococcal disease transmitted from person to person? The cause and method of infection is airborne droplets, which happens during:

Long-term close contact is necessary for transmission of meningococcus from an infected person to others. This explains why infections often occur in families, barracks and educational institutions. The incidence in large cities is much higher than in rural areas.

The route of transmission of meningococcal infection is airborne, susceptibility to the microorganism is universal, the transmission mechanism is aerogenic. Despite the fact that there are more carriers of bacteria than sick people, the latter in the same period of time infect 6 times more people around them. Therefore, any variants of the manifestation of infection are dangerous.

Clinical forms of meningococcal infection

Once a bacterium enters the human body, it can affect every organ system, so there are many clinical manifestations.

Forms of meningococcal infection are localized and generalized (common throughout the body). The localized form includes bacterial carriers and acute nasopharyngitis.

A more serious danger is the generalized form of meningococcal infection. In this case, the following diseases caused by meningococcus are possible:

• purulent meningitis or inflammation of the lining of the brain;
• pneumonia;
• meningoencephalitis, when the brain is also involved in the inflammatory process;
• meningococcemia - bacterial infection of the blood, can be either an independent disease or a complication of another meningococcal infection;
• mixed forms are often observed.

Rare forms of meningococcal infection include:

• arthritis or joint damage;
• osteomyelitis or purulent fusion of bone tissue;
• myocarditis (inflammation of the heart muscle);
• iridocyclitis - damage to the organ of vision.

Meningococcal disease can be mild, moderate, or severe. Each disease has three periods:

• incubation;
• period of clinical manifestations;
• resolution period.

The incubation period for meningococcal infection lasts a maximum of 10 days. More often it is 5 to 7 days. The duration of clinical manifestations depends on the form and severity of the disease.

Localized infections

As already mentioned, the localized form of manifestation of meningococcal infection includes bacterial carriers and acute nasopharyngitis. Let's consider them in more detail.

Meningococcal nasopharyngitis

This is about 30% of cases of infection. It proceeds easily and more often resembles ARVI.

Meningococcal nasopharyngitis is characterized by the following symptoms:

• acute onset with an increase in temperature not exceeding 38 ºC for a maximum of three days;
• severe headaches, which are more localized in the frontal and parietal regions;
• nasal congestion;
• pain and sore throat, persistent dry cough;
• in addition, the disease proceeds with severe acute symptoms: weakness, sleep disturbance, decreased or loss of appetite, lethargy.

This is a relatively favorable course of meningococcal infection, but in the case of the addition of other infections or when the immune system is weakened, nasopharyngitis is complicated by more severe forms, which happens in 30-50% of cases.

Carrier bacteria

The most common form of meningococcal infection is the carrier of bacteria. According to some authors, it occurs in 70–80% of cases. Its danger is that the carrier of bacteria does not manifest itself in any way. There are not even minor signs of the presence of the bacteria Neisseria in the human body. In rare cases, with a sharp and strong decrease in immunity, meningococcal bacterial carriers can change into another form.

Most carriers are among adults, and in children it is much less common. Often, newborn babies are infected with meningococcal infection of their grandparents, because there are no age-related barriers to infection.

Generalized infections

Almost everyone is familiar with such a dangerous disease as meningococcal meningitis. Everyone knows this condition and how it ends. But this is not the only severe manifestation of meningococcal infection. There are other generalized forms.

These include blood diseases caused by meningococcus and all kinds of damage to the nervous tissue, and, first of all, various variants of the course of brain diseases. The worst is when there are combinations of both.

Meningococcemia

Meningococcemia is a special type of sepsis or bacterial infection in the blood. It is characterized by a stormy and difficult course, the development of metastases.

rash with meningococcemia

• acute onset;
• an increase in body temperature up to 40–41 ºC, but with different manifestations: a wave-like increase, with an increase;
• general symptoms: lack of appetite, weakness, headaches and in the area of \u200b\u200bthe joints, dry mouth and pale skin;
• heartbeat increases, shortness of breath appears, blood pressure decreases;
• a typical sign of meningococcemia in the development of meningococcal infection is a rash: it is of an irregular stellate shape, rises above the surface of the skin, is different in localization (often on the buttocks, limbs and trunk), and in nature, occurs after a few hours, less often on the second day of the disease;
• after some time, secondary purulent foci of meningococcal infection form in the joints, on the skin, in the membranes of the eye, in the lungs and on the heart.

Serous meningitis

Purulent or serous meningitis is another manifestation of meningococcal infection in the human body.

It has a number of distinctive features:

• arises suddenly, against the background of complete well-being;
• meningococcal nasopharyngitis is its precursor;
• a typical symptom of meningococcal infection is a pronounced increase in body temperature up to 42 ºC;
• in addition to fever, a person is worried about a severe headache, without clear localization, which does not go away after taking potent drugs, intensifies at night and after a change in body position, sounds and bright light provoke pain;
• vomiting is another important symptom, meningococcal meningitis is characterized by the absence of nausea before vomiting, and it does not bring relief;
• almost from the first symptoms a person has convulsions;
• the hallmarks of meningococcal meningitis are meningeal symptoms, when, lying on the back, the patient cannot touch the chest with his chin, these are specific manifestations that only a specialist can detect.

A rare form of meningococcal infection is inflammation of the brain and its lining (meningoencephalitis). It is characterized by an acute onset, an almost lightning-fast course, the appearance of seizures, mental disorders and the development of paralysis.

Features of the course of diseases in children

Symptoms of any meningococcal infection in children in most cases correspond to the classic clinical picture of the disease. But there are some distinctive features to keep in mind.

1. Children get sick more often than adults, but there are practically no bacteria carriers among babies.
2. Meningococcal sepsis or meningococcemia in children occurs with nausea, repeated vomiting, and seizures.
3. With this variant of the disease in children, at first, there is a pronounced excitement of the nervous system, then meningococcal infection or sepsis in children is complicated by shock and depression of consciousness to a coma.
4. The development of meningitis also has its own characteristics, the nervous system reacts to the presence of meningococcus more sharply, during the course of the disease, the child takes the pose of a "cop dog": lying on his side with his head thrown back, bent legs, arms crossed on his chest, in children this body position observed more often.
5. Rare forms of meningococcal infection are recorded in children, for example, they have meningitis with cerebral hypotension syndrome, which proceeds violently, and its characteristic feature is the retraction of the fontanelle in an infant.
6. One of the stages in the development of meningitis for blood vessels and heart in children is a decrease in blood pressure, in contrast to adults, in whom the pressure rises.

Signs of meningococcal infection in children are an abrupt onset, rapid development, fulminant forms of disease and the onset of severe symptoms.

How do diseases caused by meningococcus progress in adults?

The bulk of the adult population, who most often suffers from meningococcal infection, are people under the age of 30. This is more often influenced by the characteristics of the environment, namely the place of residence of young people. Life in the barracks, the student period and stay in the hostel are often to blame.

Meningococcal disease in adults also has a number of minor features.

1. More often men are sick, which is also in most cases associated with time periods in their lives (military service).
2. Older and older adults are less susceptible to meningococcal infection, but compared to children, they are more likely to become carriers.
3. Symptoms of meningococcal infection in adults depend on the person's age and the state of their immune system. Basically, the disease progresses more favorably, but if there are concomitant diseases, the course of infections is severe in the elderly and bedridden patients.

Diagnosis of meningococcal infection

At the first stage, the examination of the person and the collected anamnesis help to make the correct diagnosis. It is difficult to suspect a disease caused by meningococcus. Nasopharyngitis is hidden behind a simple ARVI, sepsis before the appearance of the rash has no peculiarities, and meningitis sometimes proceeds only with severe headaches.

What tests for meningococcal infection help clarify the situation?

1. The bacteriological method of research is one of the main, the material for making a diagnosis is the discharge of the nose, blood or cerebrospinal fluid, the discharge of the respiratory tract when carrying bacteria. But it is difficult to grow Neisseria in artificial conditions; for its growth, special nutrient media are needed, similar in composition to human proteins.
2. The most valuable serological methods for diagnosing meningococcal infection are RNGA, ELISA.
3. General analyzes carry less information, although there is an increase in ESR and an increase in the number of young cells in the blood.

Complications

The prognosis of rare and mild forms of the disease with timely diagnosis and proper treatment is generally favorable. But meningitis is included in the group of dangerous ailments both in its clinical course and in the presence of complications. If a person has suffered without consequences any disease caused by meningococcus - he is lucky.

paresis of the facial nerve

What happens after an illness:

• carriage of bacteria is the most successful outcome for a person, but not for the people around him;
• meningococcal nasopharyngitis often turns into more severe generalized forms;
• a complication of meningococcal infection, namely meningitis, is subdural hematoma - hemorrhage between the membranes of the brain;
• all kinds of disturbances in the work of the nervous system - paresis and paralysis - these are long-term consequences of meningoencephalitis;
• possibly the development of acute renal failure;
• fulminant forms of diseases in most cases end in death.

Treatment of meningococcal diseases

The basis of treatment is the appointment of antibiotics. For any moderate and generalized forms of disease, antibacterial drugs are used.

Only in the treatment of nasopharyngeal meningococcal infection is it not necessary to use antibiotics. It is quite often to rinse the throat with antiseptic solutions, use immuno-strengthening drugs, a plentiful warm drink will remove the symptoms of intoxication, and drugs for the common cold, sometimes containing antibiotics, are dripping into the nasal cavity.

1. Before the appointment of antibiotics, the patient's biological fluids are cultured and the sensitivity of the microorganism to the drugs is determined. There are many types of antibiotics that can be given to someone with meningococcal disease.
2. Generalized forms of diseases and all serious ones are treated only in a hospital under the supervision of doctors.
3. The fight against symptoms consists in prescribing drugs that alleviate the patient's condition: use hormones, diuretics for cerebral edema.
4. Emergency care for meningococcal infection is provided for fulminant and complicated forms: antibiotics, special solutions, plasma are prescribed intravenously.
5. Physiotherapeutic methods of exposure are used: oxygen therapy and ultraviolet irradiation of the blood of a sick person.
6. In acute renal failure, hemodialysis is used.

Prevention of meningococcal infection

Quarantine for meningococcal infection is carried out before examining contact persons for a short time. At the place of detection of the microorganism, relatives, colleagues or children are observed for 10 days.

Anti-epidemic measures for meningococcal infection include washing the room, airing, routine cleaning with the use of detergents. If there is special equipment, you can carry out ultraviolet irradiation of the room where the patient was (apartment, work room).

Today, one of the most effective methods of prevention is vaccination against meningococcal infection. Who should be referred for vaccination:

• all contact persons;
• during epidemics, children under 8 years old;
• arrived from abroad with an unfavorable epidemic situation.

Vaccinations begin to be given to children over a year old, revaccination is carried out no earlier than three years later.

What vaccines are available for meningococcal infection today:

Vaccines differ in composition. The list contains drugs that protect against three serotypes of meningococcus (A, B, C) or just one. Free of charge can be vaccinated for epidemic indications. In other cases, prevention is carried out at the request of people.

Today, the prevention of meningococcal infection almost always falls on the shoulders of people who monitor their health and the health of loved ones. It is not difficult. To combat the microorganism, you need to regularly clean the apartment in which you are, be examined for the presence of meningococcus in the body and get vaccinated in a timely manner.

The generalized forms of purulent-septic diseases include neonatal sepsis - a common severe infectious disease that results from the activation of the focus of infection in the body and is not a nosological form, but a phase or stage of the infectious process. Newborns are prone to sepsis, which is associated with the immaturity of a number of organs and systems, weakness of immunobiological and enzymatic reactions, increased vascular permeability, and a tendency to generalize pathological processes.

Sepsis is more often caused by staphylococci and streptococci, Escherichia coli, Klebsiella, less often - pneumococci, meningococci, Pfeiffer's bacillus, Pseudomonas aeruginosa, salmonella, mold fungi. Infection can occur both in utero (infectious purulent diseases of the mother, aspiration of infected amniotic fluid), and after the birth of a child (sick mother, staff, contaminated care items and food). Most often, the umbilical wound becomes the entrance gate of infection in newborns. Depending on the entrance gate, infections speak of umbilical, otogenic, cutaneous sepsis, etc.

Umbilical sepsis is most common. Among the pathogens, staphylococci and Escherichia coli are of the greatest importance. The primary septic focus is rarely solitary - more often the lesions are found in different combinations: in the umbilical arteries and fossa or in the umbilical vein and arteries. On palpation, thickened umbilical arteries and / or veins are sometimes identified. With thrombophlebitis, a swollen and tense abdomen with dilated venous vessels extending upward from the navel, a pasty and shiny skin surface, an enlarged liver and spleen are observed.

Septic shock.

Septic shock is the most severe manifestation of a septic infection. Most often, septic shock complicates infected criminal abortions, septic late miscarriages, less often - infected childbirth in the presence of placentitis, chorionamnionitis, a long anhydrous gap, chronic infectious diseases. The factors contributing to the occurrence of septic shock are late gestosis, subcompensated and decompensated somatic diseases, moderate and severe anemia, and immunodeficiencies. Most often, shock occurs when infected with staphylococcus, gram-negative microorganisms (aerobic and anaerobic). With the massive death of gram-negative pathogens under the action of antibacterial therapy, microbes release a large amount of lipopolysaccharide endotoxin, which is tropic to the endothelium of the vascular wall (if the causative agent of the infection is staphylococcus, then the components of the bacterial cell wall have a toxic effect on the vessels). These toxins have both direct and indirect (through various biologically active substances: histamine, serotonin, bradykinin) a damaging effect on the vascular wall. As a result, the permeability of the vascular wall changes, vasospasm occurs with their subsequent paretic expansion, fluid exudates into the surrounding tissues, blood thickens, a decrease in the mass of circulating blood, platelet hyperaggregation, erythrocyte hemolysis, and DIC syndrome develops.

All these disorders lead to the occurrence of hypotension, acidosis, tissue hypoxia, oliguria with the subsequent occurrence of renal, hepatic, respiratory failure, damage to the nervous system.

Stages of septic shock

1. Vasospasm - occurs under the influence of toxic substances. There is no vasospasm in vital organs. Blood pressure is kept at normal numbers, there is a high body temperature, chills, frequent pulse.
2. Vasoplegia of the vascular bed, leading to a slowdown in blood flow, increasing the release of the liquid part of the blood from the vascular bed into the surrounding tissues, leading to a mismatch between the vascular bed and the BCC. It is characterized by hypotension, not associated with blood loss, a decrease in body temperature to subfebrile values.
3. Activation of the hemostasis system - the development of DIC syndrome.
4. Irreversible changes: multiple organ failure develops, blood pressure is 60/20 and below, irreversible processes develop in internal organs, fibrinolysis is activated. The body temperature is subfebrile, the skin is pale, cold, anuria, hemorrhagic rash, nasal, gastric, uterine bleeding, hemorrhages in internal organs. Death.

Diagnostics

1. Coagulogram - the level of fibrinogen, prothrombin index are determined.
2. Every 2-3 hours, a KLA is performed (monitoring the level of platelets, erythrocytes, hematocrit). Thrombocytopenia is characteristic of septic shock.
3. According to the biochemical blood test, an increase in the level of residual nitrogen, urea, creatinine, uric acid is noted.
4. OAM - hematuria, proteinuria, bacteriuria.

Urine culture and blood culture should be performed. Blood is sown after each chill (since at this time the maximum concentration of the pathogen is observed in the blood).

Constant monitoring of CVP, blood pressure, diuresis is carried out.

Treatment. Removal of the focus of infection (extirpation of the uterus), at the same time massive antibacterial and infusion therapy is carried out, aimed at restoring the BCC and combating intoxication, spasmolytic (in stage I shock), hormonal (glucocorticoids), desensitizing drugs are administered, therapy of DIC syndrome (depending on from its stage). At stage I of shock, treatment, as a rule, gives a positive result. At subsequent stages, treatment is ineffective.

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infection, nail infection
Infection - the danger of infection of living organisms with microorganisms (bacteria, fungi, protozoa), as well as viruses, prions. The term means various types of interaction of foreign microorganisms with the human body (in medicine), animals (in zootechnics, veterinary medicine), plants (in agronomy). In total, approx. 1420 microorganisms.

• 1 Types of infections
• 2 Stages of infectious diseases
• 3 See also
• 4 Literature
• 5 References

Types of infections

The infection can develop in different directions and take different forms. The form of development of infection depends on the ratio of the pathogenicity of the microorganism, factors of protection of the macroorganism from infection and environmental factors.

Generalized infection - an infection in which the pathogens have spread mainly by the lymphatic hematogenous route throughout the entire macroorganism.

Local infection - local damage to body tissues under the influence of pathogenic factors of the microorganism. The local process, as a rule, occurs at the site of penetration of the microbe into the tissues and is usually characterized by the development of a local inflammatory reaction. Local infections are represented by tonsillitis, boils, diphtheria, erysipelas, etc. in some cases, a local infection can turn into a general one.

General infection - the penetration of microorganisms into the blood and their spread throughout the body. Having penetrated into the tissues of the body, the microbe multiplies at the site of penetration, and then enters the bloodstream. This mechanism of development is characteristic of influenza, salmonellosis, typhus, syphilis, some forms of tuberculosis, viral hepatitis, etc.

Latent infection - a condition in which a microorganism living and multiplying in the tissues of the body does not cause any symptoms (chronic form of gonorrhea, chronic salmonellosis, etc.)

Stages of infectious diseases

Incubation period -. Usually, between the penetration of an infectious agent into the body and the manifestation of clinical signs, there is a time interval specific for each disease - an incubation period characteristic only for exogenous infections. During this period, the pathogen multiplies, there is an accumulation of both the pathogen and the toxins secreted by it to a certain threshold value, beyond which the body begins to respond with clinically expressed reactions. The incubation period can vary from hours and days to several years.

Prodromal period -. As a rule, the initial clinical manifestations do not carry any pathognomonic signs for a specific infection. Weakness, headache, feeling of weakness are common. This stage of an infectious disease is called the prodromal period, or the "precursor stage". Its duration does not exceed 24-48 hours.

The period of development of the disease - At this phase, the personality traits of the disease or signs common to many infectious processes are manifested - fever, inflammatory changes, and other clinically pronounced phase, the stages of increasing symptoms (stadium incrementum), flourishing of the disease (stadium acme) and extinction of manifestations (stadium decrementum) can be distinguished ...

Reconvalescence -. The period of recovery, or convalescence, as the final period of an infectious disease, can be fast (crisis) or slow (lysis), and also be characterized by a transition to a chronic state. in favorable cases, clinical manifestations usually disappear faster than normalization of morphological disorders of organs and tissues and complete removal of the pathogen from the body. Recovery may be complete or be accompanied by the development of complications (for example, from the central nervous system, musculoskeletal system, or cardiovascular system). The period of final removal of the infectious agent can be delayed and for some infections (for example, typhus) it can be decades.

see also

Literature

• Hertsenstein G. M., Sokolov A. m.,. Infectious diseases // Brockhaus and Efron Encyclopedic Dictionary: 86 volumes (82 volumes and 4 additional volumes). - SPb., 1890-1907.
• Borinskaya S.A. Infections as a factor of selection // antropogenez.ru.

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