Brucellosis of the eye

Brucellosis (Bang's disease, Maltese fever, melikovoksiya) - a common infectious allergic disease, belonging to a group of zoonoses.

[1], [2], [3], [4], [5], [6], [7], [8]

The causes and epidemiology of eye brucellosis

The causative agent of brucellosis is bacteria of the Brucella type. For humans, the most pathogenic Br. Melitensis. Infection occurs when contact with sick animals (goats, sheep, cows, pigs), with the use of contaminated dairy and contaminated meat products. The danger of hair, skin, astrakhan, contaminated discharge of sick animals is dangerous. Patients with brucellosis do not carry the infection. The entrance gates for brucella can be skin with abrasions, small wounds, mucous membranes of the digestive tract and respiratory tract, i.e., the infection is transmitted by alimentary, contact and aerogenic routes.

Pathogenesis of eye brucellosis

Brucella, penetrating the body, first enter the regional lymph nodes, and from them into the blood. From the blood stream settle in the organs of the reticuloendothelial system (liver, spleen, bone marrow, lymph nodes), where they can persist intracellularly for a long time. At exacerbations of the process brucella again multiply intensively, enter the bloodstream, causing repeated "waves of generalization. In the pathogenesis of brucellosis, a significant role is played by allergic reactions, which can be observed from the 2-3 rd week of the disease. Changes in the organ of vision in brucellosis occur with the dissemination of brucella from the primary focus to the already sensitized tissues of the eye, either during super-or reinfection, as well as when the vaccinated are infected.

Symptoms of eye brucellosis

The duration of the incubation period is 1-3 weeks, sometimes several months. There is a significant polymorphism of clinical manifestations of brucellosis. The disease can occur in the form of acute, chronic brucellosis and latent? Form.

Acute brucellosis is characterized by a lack of focal lesions. For acute brucellosis typical increase in body temperature, chills, pouring sweat with a satisfactory general condition. Only from the 2nd week of the disease does hepatolyenal syndrome develop.

Chronic brucellosis is characterized by a variety of clinical manifestations, caused by the defeat of various organs and systems, a recurring course for many years. Typical defeat of the musculoskeletal system (arthralgia, arthritis, bursitis, spondylitis, etc.), central nervous system (functional disorders, meningomyelitis, meningitis, encephalitis, meningoencephalitis), liver, spleen and other organs. Eye disease mainly occurs in chronic and latent forms of brucellosis. Thus patients can feel clinically healthy, remaining carriers of infection, which under the influence of adverse factors (hypothermia, overfatigue, catarrhal diseases) can cause damage to the uveal tract, optic nerve, cornea. Often with brucellosis, uveitis is observed, which are metastatic or toxic-allergic in nature. The clinical picture of brucellosis uveitis does not have any specific features: Fig.

There are following forms of brucellosis uveitis:

1. exudative iritis;
2. anterior exudative choroiditis;
3. metastatic ophthalmia;
4. nodular iritis;
5. disseminated chorioretinitis;
6. central chorioretinitis;
7. total uveitis.

The most common form of brucellosis uveitis is exudative iridocyclitis. It can occur acutely or chronically, with relapses, sometimes over many years. The process is often one-sided. In the clinical picture, along with the typical signs of iridocyclitis, folds of Descemet's membrane are often observed. On the posterior surface of the cornea, in addition to the usual precipitates, coarser deposits of exudate in the form of lumps may appear, sometimes hypopion. With chronic course of iridocyclitis or relapses in the iris, newly formed vessels, coarse posterior synechia and even fusion and infection of the pupil develop. In the future, in such cases, there is a secondary glaucoma and cataract. In severe cases, the development of the panoveitis, ending with atrophy of the eyeball, is possible.

For anterior exudative choroiditis is characterized by turbidity of the vitreous of various intensity without visible changes from the anterior part of the eye and the fundus. Choroiditis can be focal or diffuse. Brucellosis choroiditis is characterized by the presence of foci with weak perifocal edema. Ophthalmic forms of brucellosis uveitis are much less common. Separate cases of brucellosis keratitis in the form of a surface coin-like, deep or flakenoid-like are described.

Coin-like keratitis is characterized by the appearance of yellowish infiltrates located along the entire surface of the cornea. Infiltrates with timely treatment can completely dissolve or undergo disintegration and ulceration due to secondary infection. Deep brucellosis keratitis is more often unilateral, has a recurrent course with localization of the main focus in the center, presence of folds descemet coat, precipitates. Initially, the process is avascular, then there is an insignificant vascularization. Changing the cornea in brucellosis does not have any specific pattern, and the diagnosis can be established with the help of serological reactions.

In chronic brucellosis against the background of meningitis, meningoencephalitis can develop acute bilateral retrobulbar neuritis. The clinical picture of brucellosis of retrobulbar neuritis does not differ from neuritis of other etiology and is characterized by impaired visual functions. In brucellosis, changes in the optic nerve and in the form of papillitis are described in the absence of changes from the side of the central nervous system. Sometimes papillitis is combined with uveitis.

Diagnosis of brucellosis lesions of the organ of vision

Polymorphism of the clinical picture and stereotyping of a number of infectious diseases make it difficult to diagnose brucellosis. Changes in the eyes with brucellosis are also nonspecific. Each patient with uveitis, neuritis, keratitis of the waist etiology, turned to the oculist, must be examined for brucellosis in the department of especially dangerous infections at the republican, regional, regional sanitary-epidemiological stations. Establishing the fact of infection with brucellosis does not yet mean recognition of the brucellosis of the eye process. It requires a comprehensive examination of the patient and the exclusion of any other etiology of eye disease (tuberculosis, leptospirosis, toxoplasmosis, syphilis, etc.).

In the diagnosis of brucellosis and ocular manifestations, bacteriological and serological methods of investigation are crucial: the Wright and Haddleson agglutination reaction, the passive hemagglutination reaction (RPGA), and the skin-allergic Burne test. In brucellosis, the bacteriological method of diagnosis is reliable-brucella isolation from blood, urine, cerebrospinal fluid, moisture in the anterior chamber of the eye, and so on.

Reaction of Wright agglutination is one of the main diagnostic methods of acute forms of brucellosis. It becomes positive in the early period after infection. The titer of agglutinins in the tested serum is not less than 1: 200.

A common method of accelerated diagnosis of brucellosis is the platelet reaction of Haddleson agglutination. The reaction is specific, positive in the early period and persists for a long time.

RPHA is highly sensitive and specific for brucellosis infection. It allows to detect antibodies not only in patients, but also in the serum of people who had contact with the source of infection. It is considered positive starting with a dilution of 1: 100. To diagnose chronic forms of brucellosis, the Coombs reaction is widely used - the determination of incomplete antibodies.

Skin and allergic test is based on the ability of the organism to be sensitized by the brucellosis allergen, to respond with a local reaction to intradermal administration of brucellin. The sample becomes positive in 70-85% of cases by the end of the first month of the disease (there are cases of an earlier appearance) and remains so for a very long time. It is positive in the latent period of the disease and in vaccinated people. When examining patients for brucellosis, it is necessary to take into account that an allergen is injected into the skin-allergic test, therefore, to carry out the agglutination reaction, the blood must be taken before the skin-allergic test is set. Serological reactions and skin-allergic test in their diagnostic value at different periods of the disease are unequal, which causes the use of a complex of the seroallergic method for the diagnosis of brucellosis.

[9], [10], [11], [12], [13], [14]

Treatment of eye brucellosis

Treatment of patients with eye brucellosis in the presence of signs of activity of the process is carried out in the conditions of an infectious hospital under the supervision of the oculist. Patients with chronic brucellosis can be hospitalized in any department, depending on the clinical manifestations. In the acute period, long-term (up to 1 month) use of various antibiotics (except penicillin) in therapeutic doses is indicated. However, antibiotics do not act on brucella located intracellularly, and do not prevent relapses, so they can be prescribed only if there is bacteremia. In the treatment of brucellosis, haemodesis, brucellosis gamma globulin, polyglucin, rheopolyglucin, vitamins (especially C and group B) are widely used. In chronic forms, when eye disease is more common, the main method of treatment is vaccine therapy. Brucellosis vaccine is used intradermally, subcutaneously, intramuscularly or intravenously, strictly individually. The first dose of the vaccine is administered depending on the results of the skin-allergic test. The interval between the administration depends on the post-vaccination reaction: for a strong reaction, the dose is repeated or even decreased, while on the contrary, the dose is increased and the interval is decreased. On the course of treatment 8-12 injections of the vaccine. Contraindications for the treatment of the vaccine are chronic diseases of the central nervous system, heart, etc. In the phase of recurrences of the chronic form of brucellosis, the use of corticosteroids is pathogenetically grounded. Local treatment with uveitis is reduced to the appointment of mydriatic, corticosteroids, enzymes, desensitizing agents. With neuritis of the optic nerve of brucellosis, in addition to specific therapy, it is advisable to use dehydration, vasodilators, corticosteroids according to indications.

Prevention of brucellosis

Prevention of brucellosis is the elimination of sources of infection (cure brucellosis in animals, disinfection of animal care products, products and raw materials of animal origin), vaccination of persons at risk of infection.

Prevention of eye brucellosis is in the early diagnosis of brucellosis and timely treatment.

The ability to work with brucellosis of the organ of vision is determined by the clinical form of the disease, the state of vision, the damage to other organs and systems. With uveitis, neuritis and keratitis of brucellosis, due to the tendency to recurrent course, the prognosis regarding vision remains serious.