Symptoms of brucellosis in adults

The incubation period with acute onset of brucellosis lasts about 3 weeks, but if the disease begins as a primary latency, after which the symptoms of brucellosis then appear, the incubation can last several months. Symptoms of brucellosis caused the need to develop a classification of clinical forms. Brucellosis does not have a single classification.

The classification of clinical forms of brucellosis, proposed by N.I. Ragoza (1952) and built on the clinical and pathogenetic principle. N.I. Ragosa showed the phasic dynamics of the brucellosis process. He identified four phases:

• compensated infection (primary-latent):
• acute sepsis without local lesions (decompensation),
• subacute or chronic recurrent disease with the formation of local lesions (decompensation or subcompensation);
• restoration of compensation with or without residual phenomena.

Five clinical forms of brucellosis are closely connected with these phases:

• primary-latent;
• an acute-septic;
• primary-chronic metastatic;
• secondary-chronic metastatic;
• secondarily latent.

As a separate option septic-metastatic form is distinguished, to which those cases are attributed when separate focal changes (metastases) are detected against the background of an acute-septic form. The classification shows the dynamics of the further development of each selected form.

Brucellosis of the primary latent form is characterized by a state of practical health. Inclusion of it in the classification of clinical forms is due to the fact that with a weakening of the protective forces of the organism, it can go either to an acute or a primary chronic metastatic form. With a careful examination of individuals with this form of brucellosis infection, one can sometimes find symptoms of brucellosis in the form of a small increase in peripheral lymph nodes, a subfebrile condition, increased sweating at physical stress. However, these people consider themselves to be healthy and fully maintain their efficiency.

The high-grade fever is characterized by high fever (39-40 ° C and higher), the temperature curve in some cases has a tendency to wave-like flow, often incorrect (septic) type with a large daily amplitude, repeated attacks of chills and sweat. Despite the high and very high body temperature, the patient's state of health remains satisfactory (at a temperature of 39 ° C and above the patient can read, watch TV, etc.). There are no other signs of general intoxication.

Typically, a moderate increase in all groups of lymph nodes, some of them are sensitive to palpation. By the end of the first week of illness, the liver and spleen often increase. In the study of peripheral blood, leukopenia is noted, ESR is not increased. The main difference of this form is the absence of focal changes (metastases). Without antibiotic therapy, fever can last 3-4 weeks or more. This form does not threaten the life of the patient and even without etiotropic treatment results in recovery. In connection with this, the acute-cut form of brucellosis can not be considered a sepsis, but it should be considered as one of the variants of brucellosis.

Chronic forms of brucellosis in some cases develop immediately, bypassing the acute phase, in other cases, signs of chronic brucellosis appear some time after the acute-brucellosis form. Symptoms of brucellosis of primary and secondary chronic metastatic form do not differ in any way. The only difference is the presence or absence of an oasseptic form in the anamnesis.

Symptoms of brucellosis of chronic forms are characterized by a syndrome of general intoxication, against which a number of organ lesions are observed. They note a long subfebrile condition, weakness, increased irritability, poor sleep, a violation of appetite, a decrease in working capacity. Almost all patients have generalized lymphadenopathy, and along with relatively newly appeared enlarged nodes (soft, sensitive or painful on palpation), small, very dense, painless sclerotic lymph nodes (0.5-0.7 cm in diameter) are noted. Often find an increase in the liver and spleen. Against this background, organ lesions are revealed.

The most common defeat of the musculoskeletal system. Patients complain of pain in the muscles and joints, mostly in large ones. Brucellosis is characterized by polyarthritis, with each exacerbation, new joints are involved in the process. The knee, elbow, shoulder, hip joints are more often affected, rarely - small joints of the hand and foot. Characteristic of periarthritis, pararthritis, bursitis, exostosis. Joints swell, mobility in them is limited, the skin above them, as a rule, normal color. Disturbance of mobility and deformation of the joints are caused by the proliferation of bone tissue. The spine is affected, more often in the lumbar spine.

For brucellosis, sakroileitis is typical, its diagnostic significance is extremely high, since other etiologic agents cause it very rarely. To identify sarcoiliitis, there are a number of diagnostic techniques. Ericksen's symptom is informative: the patient is placed on the dressing table and pressure is applied to the iliac crest when positioned on the side or squeezed with both hands the anterior superior crests of the iliac bones in the position on the back. With unilateral sakroileitis, there are pains on the affected side, with bilateral marked pain in the sacrum from both sides.

To diagnose sakroileitis, the presence of other symptoms is also checked: Nahlussa, Larray, John-Beer, Hanslen, Ferghanson, and others.

Symptom Nahlassa: when the patient is sitting on the table face down, his legs are bent in the knee joints. When the limb is raised, pain appears in the affected sacroiliac joint. Larry's symptom: the patient is laid on the table in a position on the back. The doctor stretches the protuberances of the wings of the iliac bones in both directions with both hands, and pain occurs on the affected side (with unilateral sakroileitis). The symptom of John-Bera: the patient is in the position on the back, at a pressure on the articular joint perpendicular down he feels pain in the sacroiliac joint.

When chronic forms of brucellosis are often affected not only the joints, but also the muscles. Myositis is manifested blunt, prolonged pain in the affected muscles, their intensity is often associated with changes in the weather. With palpation, more often in the muscles of the limbs and lower back, more painful areas are identified, and in the thickness of the muscles, painful seals of various sizes and shapes are palpated. More often they are palpated in the form of cords, rollers, rarely have a round or oval shape. Over time, in one area, muscle changes pass, but inflammatory foci appear in other muscle groups. After the introduction of a specific antigen (for example, when setting a Burne test), painful sensations in the area of the affected muscles are markedly enhanced, and sometimes an increase in the size of the inflammatory infiltrate can be determined.

In addition to myositis, fibrositis (cellulitis) is often found in patients with brucellosis (up to 50-60%), which can be localized in the subcutaneous tissue on the lower legs, forearms and especially often on the back and back. The dimensions of the area of fibrosites (cellulites) range from 5-10 mm to 3-4 cm. Initially, they are probed as soft oval formations, painful or sensitive on palpation (sometimes patients themselves pay attention to their appearance). In the future, they decrease in size, can completely dissolve or sclerose and remain for a long time in the form of small dense formations, painless during palpation. With exacerbations, new fibrositis may appear.

The defeat of the nervous system in chronic brucellosis is manifested most often neuritis, polyneuritis, radiculitis. CNS lesions (myelitis, meningitis, encephalitis, meningoencephalitis) are rarely seen, but these complications are long and rather difficult.

Changes in the reproductive system in men are expressed by orchitis, epididymitis, decreased sexual function. In women, salpingitis, metritis, endometritis are observed. There is amenorrhea, infertility may develop. Pregnant women often have abortions, stillbirths, premature births. Described congenital brucellosis in children.

Sometimes eye lesions are observed (iritis, chorioretinitis, uveitis, keratitis, optic nerve atrophy, etc.).

When aerogenic infection often develop sluggish brucellosis pneumonia, which are unsuccessfully treated with antibiotics.

Possible myocarditis, endocarditis, aortitis and other lesions of the cardiovascular system.

The secondary chronic form proceeds in the same way as the primary chronic disease. Both of them end in a transition to a second-latent form, can repeatedly recur.

The secondary-latent form differs from the primary-latent form in that it more often passes into manifest forms (recurs); In addition, against the background of secondary latency, it is possible to develop various residual phenomena after chronic forms (limitation of joint mobility, infertility, visual impairment, etc.).

The symptoms of brucellosis and its course depend on the type of pathogen. In sheep brucellosis (Brucella melitensis), the disease often begins with an acute-septic form and is more severe, with infection from cows (Brucella abortus) often occurs as a primary chronic metastatic or even as a primary latent form. However, it should be borne in mind that when cattle (sheep and cows) are kept together, the infection of cows with sheep is sometimes noted, and then the person becomes infected from cows of Brucella melitensis.

Complications caused by secondary flora are rare.

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