Laryngitis with glanders: causes, symptoms, diagnosis, treatment

Sap - an infectious disease of animals and humans, characterized by the development of septicopyemia with damage to the skin, mucous membrane and other organs and tissues. Pathogen - Ps. Mallei - Gram-negative bacillus, not forming spores and capsules, in water in the soil is kept up to 1-1,1 / 2 months. The causative agent of fat was first discovered in 1881 by the Romanian researcher V. Babesh in tissue sections and pus, taken from the sap of the sick person. Regardless of it, the causative agent of the sapa was discovered by Loffler and Schiitz in 1882. The main source of the disease is mainly sick domestic animals - horses, camels, mules, donkeys, in which the disease proceeds with the formation of festering ulcers on the nasal mucosa. Infection of a person occurs when the discharge from the nose of diseased animals gets on the damaged skin or mucous membrane of the mouth, nose, larynx. Infection from a sick person is unlikely. Mostly people whose occupations are related to animals (cattle breeders, shepherds, veterinarians, groomsmen, jockeys, trainers) are ill. Sap, probably, was also known to Hippocrates and Greek veterinarians. Sap in the past centuries has been prevalent all over the world and especially in those countries where horse-drawn transport predominated. The epidemics among these animals were of a massive nature, because of which the same nature was borne by their "sanitary" extermination. Thus, according to A. Ter-Karapetyan (1963), one of the first decrees of the Petrograd health commissariat was the decree of 31.01.1919 "On measures to stop sap on horses", according to which only in 1920, 12 819 horse horses. Along with the elimination of sapa among animals in Russia, the incidence of sap among people began to decrease: in 1926, 106 patients were registered in the USSR, and in 417 41 patients. Currently, sap among people is found in the form of rare individual diseases.

Pathogenesis and pathological anatomy. The causative agent of sap penetrates into the human body through damaged skin, mucous membrane, conjunctiva, respiratory tract, less often through the gastrointestinal tract; blood and lymph is spread all over the body. Septicopyemia develops with the formation of purulent inflammatory foci on the skin, mucous membrane, in muscles, bones, joints and internal organs (more often in the lungs, kidneys, spleen). In the place of introduction of the pathogen initially appears red-purple papule, surrounded by a bright red border, then a pustule with bloody contents is formed, which ulcerates. The ulcer has a sebaceous bottom covered with mucus-purulent secretions of greenish color. In the future, necrosis of affected tissues occurs with their destruction.

After 5-7 days, multiple secondary nodules and papular eruptions appear on the skin, passing into pustules and ulcers scattered throughout the body, but with predominant localization on the face. In the muscles, deep abscesses are formed, and then fistulas, through which dense green pus is prominent. When lesions of the lungs clinically and radiologically, small focal pneumonia is detected. As a rule, an enlarged spleen is palpated, and rarely a liver. In the blood - pronounced inflammatory changes.

Symptoms of laryngitis with sapa. The disease occurs in acute or chronic form. In acute form, the incubation period lasts 4-5 days. The disease begins sharply with chills, raising the temperature to 38.5-40 ° C. The body temperature fluctuates significantly during the day, accompanied by a chill and lasts for a long time at a high level. Patients are concerned about headache and muscle pain, weakness, sweating, sometimes nausea and vomiting of toxic origin.

When the upper respiratory tract, and in particular the larynx, is affected, profound painful ulcers appear on the mucous membrane, completely disrupting swallowing and phonation. In the acute course of the disease, these ulcers are accompanied by a pronounced toxemia, rapidly ending with the death of the patient.

The chronic form of glanders occurs in the form of chroniosepsis with the predominant lesion of the skin, lungs and nose. Often, nose damage is only the initial phase of a descending infection that affects the larynx, and further - the trachea, bronchi and lung tissue. The chronic form can last several years with periodic remissions and exacerbations.

The diagnosis is based on a characteristic clinical picture, pathoanatomical changes, epidemiological history (contact with sick animals) and laboratory and, in particular, bacteriological studies - bacterioscopy and culture of microorganisms. For this use nasal discharge, the contents of abscesses, pustules, ulcers, blood. Serological diagnosis, complement fixation, agglutination, indirect haemagglutination and skin-allergic tests with mallein - the filtrate of the killed 4-8-month culture of the sapa pathogen on broth with 4% glycerin are also applied, which is also applied to suspicious sap animals, in particular horses. Most often the animal is injected with mallein into the conjunctival sac: with a positive sample 3-4 hours after the administration, purulent conjunctivitis of different severity develops.

The prognosis for acute sap is practically hopeless; at early treatment with the use of broad-spectrum antibiotics, immunoprotectors, multivitamins, antihistamines, effective detoxification products (infusion of saline solutions, haemodesis, rheopolyglucin), recovery may occur. However, all these measures are mainly aimed at the prevention of secondary infection and the fight against intoxication, while antibiotics and sulfonamides effective against the pathogen are not yet available.

Treatment of laryngitis with sapa. It is strictly necessary to hospitalize patients who are kept in separate boxes. Assign sulfonamide drugs in combination with antibiotics. To detoxify prescribe infusions of solutions of hemodeza, rheopolyglucin. Locally - inhalation solutions of antibiotics in a mixture with hydrocortisone and anesthetic drugs (novocaine, lidocaine, dicaine).

Prophylaxis of laryngitis in sapa includes veterinary and sanitary supervision of animals for the detection of sap patients among them (they are destroyed), careful observance of the rules of individual protection when caring for suspected sap animals (wearing overalls, aprons, boots, gloves, gauze masks, glasses-canned food, the prohibition of smoking and eating during work, the storage of work clothes at the place of work in special cabinets, etc.).

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