Glanders and Melioidosis
Signs and symptoms:
The incubation period of 10-14 days after inhalation. And the onset of symptoms may be a surprise or appear or may appear gradually. When a person is infected by inhalation haunted by high fever (usually above 102 F) and trembling, race and malaise and headache and pain in the chest, lung and at the same time appears a swollen neck glands and swelling of the liver and spleen and inflammatory papillary and in the form of blisters. And there may be a severe pneumonia, and other complications may appear such as the spread of bacteria in the blood and blood acute poisoning.
Diagnosis:
When you make a microscopic examination of pus on the use of blue dye Mithleen Methylene blue dye Wright or Wright stain, and it shows a few vertical spread bacteria on the slide and form of the bacteria, such as a pin with two poles and can be used as the core media (regular) for the cultivation of the causal factors of this disease and is B. mallei and B. pseudomallei. and may appear in the scattered rays chest injuries and multiple or intoxicate a small complex in the upper part of the lung with the hoarding and scaly. And often the number of white blood cells normal or slightly higher and can be performed on the serum tests to help confirm the diagnosis and the antibodies do not appear or appear with a live low does not mean that the disease does not exist.
Treatment:
Treatment depends on the type and severity of clinical symptoms of the disease. In cases of topical treatment is the use of oral antibiotics for 60 to 150 days. In the event of severe patient may need to prolong the duration of treatment and to give antibiotics by injection.
Prevention:
There is no preventative treatment for cases of pre-or post-exposure at this time.
Isolation and sterilization:
Can be used as the basic preventive measures for health personnel and rare infection from person to person through the air, but the person may become infected when handling materials contaminated with secretions the patient must be careful of care for patients infected with skin because the infection may occur during the touch-in this case. And for environmental sterilization, it can be used to focus Alhipklorat solution of 0.5%.
Overview
The causative agent of glanders disease and pseudo-disease glanders is the bacterium Burkholderia mallei and Burkholderia pseudomallei, respectively, and each of these bacteria is confined to vertical negative and appears as a pin when microscopic examination. And the two types of bacteria infect pets and wild animals that become (such as rights) through inhalation or contamination of wounds.
And the mallei bacteria cause disease in horses and donkeys and mules. And they were very rare incidence of this disease in humans despite the repeated handling and adjacent to the infected animals. And it may cause the disease as a result of exposure to low concentration of microbes from injuries on the spot animals. It is worth mentioning that the malignant types of the bacteria to animals is not malicious for humans. And spread among humans and horses are four types of the disease. And species are more common in the acute mules and donkeys, and death occurs usually after a period ranging from 3 to 4 weeks from the beginning of infection. The other type of this disease is more common in horses and causes swelling in the lymph nodes, and many of the contract turn into skin ulceration and start of attrition. And other symptoms Frost and inflation and the complexity of the lymph nodes and localized in other regions. And intensify the so-called lymph nodes, and to freeze Glanders farcy and human infections usually occur among veterinarians, horses and donkeys, shepherds and slaughterhouse workers.
Spread and B. pseudomallei in abundance in tropical and subtropical regions, dengue is endemic in Southeast Asia and northern Australia and in north-east Thailand.
B. pseudomallei is one of the common risk factors for blood poisoning in the community. And this semi-glanders disease in humans appears in various forms in the degree of severity is the range of mild clinical symptoms of disease do not lead to satisfactory up to severe blood poisoning, where the percentage of death to 90% and occurs within 24-48 hours of onset of the disease. And also can be infected with glanders semi-ill patient and the patient can remain a carrier of the disease for a long time after the first infection and may lead to chronic disease and life-threatening.
These microbes spread through the invasion of the mucous membranes in the eye and the mouth, nose, and also by inhalation, which reaches the lungs or through cuts or scratches on the skin. Have been observed the spread of disease among factory workers through the spray causes of laboratory cultures and this spray is very contagious.
There is no vaccine or cure and is supported by the spreading infection by aerosols, a very effective way.
History and importance:
Despite this potential for large deployment in the laboratory, the spread between humans is rare in nature and did not record a case of a pandemic of the disease in humans, where there are only sporadic cases rather than epidemics, and during the sixty-one years did not record a single case a natural proliferation in the United States, but sometimes appear sporadic cases in Asia, Africa and the Middle East and South America. It is believed that during the First World War spread a disease glanders by the central forces and caused injury to large numbers of Russian horses and mules in the eastern facade and this had an impact on the convoys of troops to rely on horses and mules. Has increased the incidence in humans during the First World War and beyond and it is known that the Japanese deliberately infected horses and civilians and prisoners of war by B. mallei at the Institute of Pinfan in China during World War II. And the United States had considered this factor as a weapon of war, a possible common 1942 -44, but not Islhoh (ie Iteke for use as a weapon) and believed that the former Soviet Union was interested in. B. mallei as a biological weapon possible after World War II. And which represents a difficult-to-human transmission, during the Second World War there were 30% of animals showing positive results in tests that indicate the disease, but the incidence in humans is rare. In Mongolia and the proportion of infected animals, ranging from 5-25%, but there were no casualties. And in nature (in these areas) are the bacteria in infected animals but not found in water, soil or plants.
And on the contrary, in tropical regions, the spread of these bacteria in the soil and water and the disease remains endemic in some of those areas for a long time. And disease glanders is one of the origin of tropical diseases in Southeast Asia and northern Australia and can be spread easily and unintentionally because of ignorance of its existence because the incubation period is too long.
And studies have been done in the United States about the possibility of using this disease as a biological weapon, but did not arm and had also stated that the former Soviet Union was seriously considering this factor in the arm.
Clinical symptoms:
The patients and semi-glanders glanders may appear in the form of localized disease or severe pneumonia or blood poisoning, explosive (fulminant) a sharp and deadly. And may show some or all of these symptoms in human cases. It may remain semi-glanders disease without symptoms after infection dormant for decades, but in the case of vulnerability to show symptoms of the disease after several years. And incidence of the disease after exposure to the spray prepared as a biological weapon shows this syndrome as well. And the incubation period ranging from 10 to 14 days and this period depends on the dose received by the injured and the power of bacteria.
It seems that one form of the disease may appear suddenly Kedzmm blood associated with fever, stiff and sweat and muscle pain and chest pain pneumonia and ulcers or granulomatous vital Mcnrzp necrotizing lesions and Zmat Ihmrrarip generalized erythroderma and appears yellow and sensitivity to light and Altadma and diarrhea. In the clinical examination are fever and rapid pulse and swelling in the cervical lymph nodes and slight enlargement of the liver or spleen. And the results of blood culture is usually negative, and there may be a simple shortage of white blood cells with an offset to the left (in the development of white blood cells) shift to the left, or may appear to acute shortage of white blood cells.
In case form of the disease that appears sore pneumonia following inhalation or natural outbreaks, the symptoms of poisoning appear in systemic as described previously. And appear in the chest X-rays scattered from a 0.5 to 1.0, or inflammation of the alveoli in the lungs symmetrically bilateral and appear as pneumonia may experience partial or one-lobed or there is condensation or hollowing-out of the lungs. May appear in the case of acute inflammation of the mucous membranes and / or mucous membranes kind pus which blood from the nose accompanied by a contract and sores on the wall of the nose bone Qarni contract or in the nose. If there were infected in all organs of the body caused the spread of infections or injuries, mucous membrane skin rash may appear or Garihat on the skin and these symptoms may resemble symptoms of smallpox (and is a factor used as a biological weapon) and evidence suggesting the existence of such situation is Algarihat a damn on the skin and internal organs like the liver or spleen and lung injuries, and many of the disease when it appears on this picture, the very high risk of death, and in most cases the patient suffers the shock of the situation of severe bacterial poisoning.
As for the chronic state, it is not unusual to show any symptoms within 14 days after the attack Diversity droplet. Specifications and form of the disease and a damn on the skin and within the muscle on both arms and legs and these ulcers related to inflation and the complexity of the lymph glands and channels localized, and may not show symptoms of the chronic form of the disease, and particularly in the event of illness semi-glanders. And have been found in some cases, bone infections and Waldman in the brain and inflammation of the brain.
Diagnosis:
These bacteria appear when a microscopic examination of pus using Gram staining bacteria in the form of bipolar negative coloring. And does not have a specific character when using two instances dye blue or Wright. And these organisms are grown in the center of a basic agricultural. And add 1-5% glucose or 5% glycerin agar or record the use of foodstuffs, including meat, meat infusion maceration could speed up growth. Insulation needs to be the initial 48 hours at a temperature of 37.5 o. With regard to B. mallei, the Alilzan agglutination tests may not show positive only after 7-10 days and usually no standard in the background of high-titer serum affect the result (1:32 - 1:640) and the presence of this background, cause difficulty in reading and interpreting test results. It is therefore advisable to install the use of complementary tests complement fixation because they are more specialized. And the result is considered positive if the criterion is equal to or greater than 1:20 for him and for B pseudomallei increase in the standard by 4-fold supports a diagnosis of disease almost glanders. And therefore the presence of a single standard 1:160 with an appropriate clinical picture indicates the presence of inflammation effectively. These cases that appear with no presence of any contact with animals or non-presence in the area of the settlement of the disease refers to an attack with biological weapons. And the mortality rate seems high, even after the use of antibiotics. Has been found in research conducted on mice exposed to RnB to a number from 1 to 10 objects by the spray was a killer too.
Medical treatment:
Should take the usual precautions (core) to prevent infection from one person to another in the event that the presence of the disease. The proposed treatment varies according to different quality and the power of the medical situation and had proposed a program of oral treatment (given by mouth) follows in the case of residual disease and this program is as follows:
Alomuksyschaelin / Kfayyolanat 60 mg / kg / day in three divided doses per day.
Tetracycline / sulfa 40 mg / kg / day in three doses fragmented
Or Altramthoprem (TMP) 4 mg / kg / day and sulfa 20 mg / kg / day in divided doses and continue treatment for a period of 60-150 days.
And if it is found that the situation has led to localized disease with a simple poisoning should be given two of the programs listed above for 30 days and follow the program component of treatment and one either: for Omuksyschaelin / Kfayyolanat or tetracycline / sulfa for a period of 60-150 days. And if there is spread of the disease outside the lungs, inflammation of explosive must continue treatment for 6-12 months. Accordingly, the patient requires surgery to dump Waldman.
In difficult cases of the disease must be given injections consisting of Ambasstmzdaem (ceftazudime) 20 mg / kg / day in three doses with the TMP / sulfa (TMP 8 mg / kg / day and sulfa 40 mg / kg / day) in four divided doses for two weeks and then followed by oral treatment for six months.
And have been found that some of the other antibiotics effective in tests conducted outside the body or on rats and rabbits, these include: Aldotxoschaelin and Alrvambyn and Alcyprovluxin and should be taken into account it is not evaluating the effectiveness of these therapies are a small percentage of human cases, the more information known come from experiments conducted on animals or experiments conducted in vitro outside the body, and many species have been isolated in very different sensitivities, so tests must be conducted on each type are isolated from bacteria.
Prevention before exposure:
Vaccination: There is no vaccine suitable for use in human cases
Antibiotics: may experiment with the use of post-exposure prophylaxis TMX / SMX
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