Bartonellosis
Introduction
Introduction to Barton's disease Infection of Bartonella disease caused by Bacterium Bartonella is generally referred to as Human Bartonella. Because Daniel Carrion of Peru first reported the symptoms and signs of the disease in 1855, it is also known as Carriondisease. The white peony is the medium of transmission. There are two distinct stages in clinical manifestation, namely acute fever and hemolysis. Oroyafever, which is mainly anemia, and verrugaperuana, which is mainly skin lesions. basic knowledge The proportion of illness: the incidence rate is about 0.001% - 0.005% Susceptible people: no specific population Mode of transmission: bacterial transmission Complications: malaria amoebic dysentery brucellosis bacterial pneumonia
Cause
Cause of Bartonosis
(1) Causes of the disease
In 1905, Peruvian doctor Alberto Barton first discovered the bacillus microorganisms that survived the red blood cells of patients with Oroya fever. Later, it was confirmed by most scholars. Therefore, the pathogen was called bartonella bacilliformis, and the pathogen was cultured in 1920. And successfully infected with monkeys, Bacillus brevis is a small Gram-negative coccus, the size is (0.2m ~ 0.5m) × (1m ~ 2m), can move, polymorphism, can be expressed as a sphere, ring, Oval or granules, 1 to 10 single-ended flagella, 3 to 10 m long, pathogens in acute early patients, more globular, often in the cytoplasm of red blood cells and endothelial cells, Giemsa staining purple Red, the bacteria are required to grow in a high-nutrient medium (agar containing animal or human blood), the optimum temperature is 28 ° C, 5% carbon dioxide environment, slow growth, 42 ° C does not grow, the biochemical reaction is extremely inactive, does not produce Hemolysin, sensitive to a variety of antibiotics, the fatty acid composition of Bacterial Barton has more C16:17c (18%) than other Barton, and C12:O and C14:O are detected, and OConnor is gelled. The 16S rRNA sequence of the pathogen showed that the fragment was 1431 bases, and the homology with the five-day heat Baton was 91.7%. The two genes of ialA and ialB were related to invasiveness and had been cloned and expressed. The flagella was bacillus. An important virulence factor of Baton body invading host cells. It has been observed that the moving Baton body, such as a drill, combines other factors to change the erythrocyte membrane, causing the Baton body to invade the red blood cells.
(two) pathogenesis
When the bacilli-like Baton body enters the human blood flow, it first proliferates in the vascular epithelium, and then invades the red blood cells to reproduce. In severe cases, almost all the red blood cells in the peripheral blood are infected, and one red blood cell can have up to 20 pathogens, causing a large number of red blood cells to be destroyed. Lead to severe hemolytic anemia, due to the proliferation of red blood cell lines, to the appearance of nucleated red blood cells, giant red blood cells and a large number of reticulocytes (up to 50%) in peripheral blood, white blood cells change little, and platelets are often reduced, and the liver is visible. Reticuloendothelial cells of the spleen and lymph nodes phagocytose pathogens, red blood cells and hemosiderin, liver, sometimes visible central necrosis of the lobules; splenomegaly with infection, due to damage and swelling of capillary endothelial cells, can lead to tube Cavity obstruction and tissue ischemic necrosis, cerebrospinal fluid examination can increase the number of cells and find the pathogen, clinical manifestations are closely related to the host's immune status, and no immunity can occur in the Aroya fever.
Prevention
Bartonosis prevention
The precautionary measures are mainly to kill the white peony, spray insecticides indoors and outdoors, and control the white bite at night to be very effective. Personal protection can be used as an insect repellent or a mosquito net.
Complication
Bartonosis complications Complications malaria amoebic dysentery brucellosis bacterial pneumonia
Prone to complications, the most common Salmonella infection, followed by malaria, brucellosis, bacterial pneumonia, amoebic dysentery and other complications, can also be complicated by encephalopathy, chronic serious organ damage (hepatic granuloma, bone marrow Inflammation, etc., joint disease (joint pain, arthritis, etc.), nodular erythema, etc., other temporary porcine rash, polymorphous erythema, thrombocytopenic purpura, parotid swelling, multiple hemangioma and visceral purpura ( More common in people infected with hiv), etc., are occasional.
Symptom
Barton's disease symptoms common symptoms fatigue coma joint pain high fever muscle soreness chills low fever
The incubation period is about 3 weeks or longer. There are often prodromal symptoms before the onset, such as low fever, bones and joints and muscle soreness. After that, the disease can develop one of two types of diseases.
1. Oroya fever is a stage of acute blood disease. The patient suddenly has chills, high fever, sweating, extreme fatigue, pale face, severe muscle, joint pain and headache. In severe cases, paralysis, coma and peripheral circulatory failure may occur. Performance, at this stage can be the main cause of death of the disease, this type of untreated mortality rate often exceeds 50%, mostly occurred within 10 days to 4 weeks after onset, after antibiotic treatment, fever subsided, The bacteria in the blood are reduced or even eliminated, and the physical strength is gradually restored. Some lighter cases can recover on their own, but they are slower, with a constant monthly to half a year.
2. Peruvian scorpion type is the stage of skin damage, characterized by anemia or no prodromal symptoms, many spasm rashes on the skin, which can be miliary, nodular or large carrion, ranging from 2 to 10 mm to 3 ~4cm, the above three kinds of sickle lesions can be seen in the same patient, with more limbs and face on the limbs, followed by genitals, scalp and mouth, pharyngeal mucosa, sputum rashes of different colors, from red to Purple, which can persist for 1 month to 2 years, pathogens can be detected from the lesion.
Patients in the epidemic area have a history of white bite, and typical clinical manifestations such as fever, progressive hemolytic anemia, swollen lymph nodes, verrucous rash, etc. should be suspected and the disease can be diagnosed by finding a pathogen or culture positive in the blood smear. Asymptomatic carriers should be blood culture to be clear, the medium should be added 5% defibrinated human blood or 10% fresh rabbit serum and 0.5% rabbit hemoglobin, the optimum temperature is 28 ° C, after 7 to 10 days of culture, small colonies can be seen Identification, the Gibson staining of the specimens of Peruvian cockroaches can be diagnosed, and the pathogens can be diagnosed. Recently, serum immunological tests, such as fluorescent antibodies, indirect hemagglutination and enzyme-linked immunoassay, are also helpful for epidemiological investigation and diagnosis.
Examine
Barton's disease check
Blood tests showed a sharp drop in red blood cells, which usually decreased from normal to 1.0×1012/L within 4 to 5 days. It is a normal pigment macrophage anemia, with nucleated red blood cells, Howell-Jolly bodies, Cabot rings and basophilic points. Color, white blood cells can be slightly increased with nuclear left shift, blood contains a large number of pathogens, smear staining can show that 90% of red blood cells are invaded, carriers should be blood culture to be clear, the medium should be added 5% defibrin Blood or 10% fresh rabbit serum and 0.5% rabbit hemoglobin, the optimum temperature is 28 ° C, after 7 to 10 days of culture, small colonies can be identified for identification, and the tissue specimens of Peruvian cockroaches can be stained with Giemsa, and the pathogens can be diagnosed. Recently adopted Serological immunological tests, such as fluorescent antibodies, indirect hemagglutination and enzyme-linked immunoassays, are also helpful for epidemiological investigations and diagnosis.
Diagnosis
Diagnosis and diagnosis of Bartonella disease
Differential diagnosis
1. Infectious diseases:
(1) bacterial lung abscess (Streptococcus, Staphylococcus, Haemophilus influenzae, anaerobic bacteria)
(2) Fungal infections (histoplasmosis, blastomycosis, coccidioidomycosis and aspergillosis)
(3) Other bacterial infections (toxoplasmosis, cat scratching)
2, tuberculosis
3, neoplastic disease: bronchial lung cancer, lymphoma, metastatic cancer
4, vascular disease: pulmonary embolism and infarction, Wegeners granuloma
5, during fever should be identified with other febrile diseases and hemolytic anemia, skin lesions must be identified with common warts, pyogenic granuloma.
6, other: sarcoidosis
