Brucella arthritis
Introduction
Introduction to Brucella arthritis Brucellosis is an acute infectious infectious disease caused by Brucella, and brucellaarthritis is part of Brucellosis. Brucella is a small Gram-positive bacteria that is transmitted to animals through animals. Domestically, cattle and sheep are the main source of infection. The pathogen is present in the tissues of the sick animal, urine, emulsion, fetus, etc. Brucellosis can be an acute, self-limiting disease, joint pain lasts for several days, arthritis subsides after several weeks, no sequelae. It can also be a chronic, infectious disease. Need to be treated with antibiotics. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific people Mode of transmission: insect vector transmission Complications: bacteremia
Cause
Cause of brucellosis arthritis
(1) Causes of the disease
Brucellosis arthritis is caused by Brucella infection. Brucella is mostly digested after entering the body through the digestive tract. A small number of them are propagated in lymph, bone marrow and spleen. Brucella is a tiny polymorphic bacterium, leather. Negative blue staining, divided into sheep, cattle, pigs, rats, sheep, dogs, 6 kinds of biological species, China is mainly sheep, through sheep, cattle, pigs, canine infection, transmission to humans, pathogens mainly exist in sick animals Tissue, urine, milk, fetus, etc., most of them enter the human body through the mouth, and can also invade the body by damaged skin, respiratory mucosa, etc., and eat milk and cheese that have not been sterilized by Pasteurization, and are easily infected with Brucella. Workers who come into contact with animals, meat, veterinarians, etc., are susceptible populations.
(two) pathogenesis
1. Brucella enters the body through the mucosa and skin lesions, and reaches the lymph nodes from the lymphatic vessels. When conditions permit, Brucella begins to proliferate and break through the lymph nodes to enter the bloodstream, causing bacteremia, toxemia, bacteria and endotoxin. Acute symptoms appear after entering the bloodstream from the infected lesions. Repeated episodes and allergic reactions are caused by multiple blood flow, and pathological changes can be formed in the organs. The patient's body temperature rises, and the bacteria circulate through the blood and enter the reticuloendothelial. System, such as liver, spleen, bone marrow, inflammatory cell infiltration and granuloma formation, the macrophage at the lesion phagocytosis of Brucella, the bacillus can proliferate in the cell, after a certain time, it is released into the blood again, forming bacteremia And toxemia, the patient will re-heat, bacteria repeatedly released into the blood, resulting in clinical wavy heat, advanced lesions atrophy, hardening.
2. Pathological basic pathological changes in the reticuloendothelial system, such as liver, bone marrow, lymph nodes, etc., acute phase congestion, edema, cell infiltration, subacute and chronic diffuse hyperplasia, granuloma formation, advanced lesion atrophy, sclerosis, in The same pathological process also occurs in the joints.
Prevention
Brucellosis arthritis prevention
1. Eliminate and reduce or avoid the disease factors, improve the living environment, develop good living habits, prevent infection, pay attention to food hygiene, and rational diet.
2. Pay attention to exercise, increase the body's ability to resist disease, do not fatigue, excessive consumption, quit smoking and alcohol.
3. Early detection and early diagnosis and early treatment, establish confidence in the fight against disease, adhere to treatment.
Complication
Brucellosis arthritis complications Complications bacteremia
It can be complicated or form bacteremia and toxemia.
Symptom
Brucellosis arthritis symptoms Common symptoms Irregular joint surface stiffness irregular joint space irregular...
Brucellosis can be an acute, self-limiting disease, joint pain lasts for several days, arthritis subsides after several weeks, no sequelae, but also chronic, infectious diseases, need to be treated with antibiotics, chronic or recurrent Brinell Bacilli is often caused by Maltese Brucella.
Infections are common in a few joints or asymmetrical few peripheral joints, knees, hips, shoulders are good sites, followed by sputum, wrist, ankle, elbow joints, and can also invade the spine, ankle joints are common on one side, some The patient has both peripheral arthritis and spondyloarthropathy. The patient feels back and limb pain. He has symptoms of fever. Several weeks before the onset of arthritis, the patient has headache, fatigue, sweating and other systemic symptoms. The affected joints are swollen and painful. , fever and erythema, there is exudation in the joint, the heat type is wave heat, sometimes it is relaxation heat or intermittent heat.
Examine
Examination of brucellosis arthritis
Brucella requires complex growth conditions, so the positive rate of synovial fluid culture is only 50% to 65%, and the total number of white blood cells in synovial fluid is 10×109/L to 50×109/L. Monocytes are more common. The most commonly used in the serological test is the agglutination test. The newer enzyme linked immunosorbent assay (ELISA) may be more accurate. The complement fixation test and the 2-mercaptoethanol test are commonly used to diagnose chronic brucellosis, acute. The blood culture of patients with brucellosis is generally positive, and the positive rate of blood culture in chronic cases is less than 10%, while the positive rate of bone marrow culture is higher.
X-ray examination of common shoulder, ankle and spine changes, the shoulders, condyles and other tendon ligaments attached to the bones of the localized superficial small cystic bone destruction and edge sclerosis, tendon, calcification at the bursa The joint cavity is normal, there is no dead bone and sinus, the bone structure of the ankle joint is disordered, the joint space is narrow or blurred, the joint surface is irregularly hardened, the adjacent osteoporosis is loose, the small extent is destroyed, and the fusion is combined with each other. Hardening around the area, when the lumbar vertebra is violated, ligament calcification or ossification can be seen, intervertebral chondritis, the lesion is limited to 1 or 2 intervertebral discs, the intervertebral space is narrowed, the upper and lower margins of the adjacent vertebral body are destroyed, and the bone is obviously Hyperplasia, arthritis, irregular joint space, narrow joint space, etc.
Diagnosis
Diagnosis and identification of brucellosis arthritis
Mainly based on the following aspects of comprehensive analysis and diagnosis:
1. History of contact with pathogens In infected areas, there is a history of contact with sick animals, or drinking dairy products that have not been sterilized by Babangde.
2. History of acute, subacute and chronic Brucella infections.
3. The culture of acute brucellosis has a high positive rate of blood culture. The positive rate of blood culture in patients with chronic infection is only 10%, the positive rate of bone marrow culture is high, and the positive rate of joint fluid culture is 50% to 65%.
4. The total number of white blood cells in the joint fluid is usually between 10×109 and 50×109/L. The classification is more common in monocytes. The complement fixation test and 2-mercaptoethanol test are often used to diagnose chronic brucellosis. The most commonly used serological test is the agglutination test.
5. X-ray examination 1 shoulder joint: humeral large nodules, shoulders, condyles and other tendon ligament attachment, bones are limited superficial small cystic bone destruction and cystic wall hardening, tendon, calcification at the bursa The joint space is normal, 2 ankle joints: the joint space is narrow or blurred, the joint surface is irregularly hardened, adjacent to osteoporosis, small-scale bone destruction, fusion with each other, hardening around the destruction area, 3 lumbar vertebrae: ligament calcification or ossification Or manifested as intervertebral chondritis, that is, the lesion is limited to 1 or 2 intervertebral discs, the intervertebral space is narrowed, the upper and lower margins of adjacent vertebral bodies are destroyed by bone, bone hyperplasia is obvious, or small arthritic changes occur, which is characterized by joint space. Irregularities and narrow joint space.
Brucellosis arthritis is similar to arthritis caused by Salmonella and Yersinia, and attention should be paid to identification.
