skin anthrax
Introduction
Introduction to skin anthrax Skin anthrax (also known as malignant pustules), the pathogen is Bacillus anthracis. It mainly occurs in herders and workers related to occupations such as fur, meat and livestock. Its clinical features are typical dark red blood blister, obvious soft tissue around the soft tissue, accompanied by severe systemic symptoms, damage to the content of smear and culture can be found in Bacillus anthracis. basic knowledge The proportion of illness: 0.001% - 0.005% Susceptible people: Most of the patients are engaged in meat processing, fur, leather and other occupations related to livestock production. Mode of infection: contact with infection. Complications: sepsis meningitis
Cause
Skin anthrax
Cause:
Mycobacterium Anthrax is a Gram-positive aerobic bacterium with a capsule that can survive for decades in dry environments such as pasture, soil or fur. Common disinfectants are not affected at 100 °C. It can kill spores when wet heat for 10 min or 100 °C dry heat for 3 h. Bacillus anthracis can be seen as long-chain like bamboo in vitro. It is single, double- or short-chain in the body. Endotoxin can not be found in vitro. Exotoxin exists, but it can produce a toxic substance when it grows and reproduces in human or animal body. It has anti-phagocytosis effect. When toxic substances are in the skin, it can cause edema. Inoculation in vein can cause death.
Pathogenesis
When cultured in vitro, Bacillus anthracis can be seen as a long chain, such as bamboo, which is single, double-spherical or short-chain in the body. In vitro culture can not find the presence of endotoxin and exotoxin, but can be grown in human or animal body. Produces a toxic substance that has anti-phagocytic effects, and toxic substances can cause edema when in the skin.
Prevention
Skin anthrax prevention
Strengthen the quarantine of livestock, the sick animals should be strictly disinfected, and the livestock products should be strictly disinfected before processing, and the publicity and education and protective equipment for animal husbandry and meat, fur workers should be strengthened, and the workers can be injected with anthrax vaccine. 0.5ml for the first injection, 1 injection after 6 weeks or 6 months, and once a year thereafter.
Complication
Skin anthrax complications Complications sepsis meningitis
The disease can be complicated with anthrax infections in other parts, as follows:
(1) Pulmonary anthrax: high mortality, rapid onset, and symptoms of poisoning such as chills and high fever. Cough, chest pain, difficulty breathing, hemoptysis, death within 24 hours due to respiratory and circulatory failure, very few cases of anthrax meningitis. People are infected by contact with sick animals and their products or the meat of sick animals. The incubation period is generally 1 to 5 days. Mostly primary, but also secondary to skin anthrax. Initially a mild upper respiratory tract infection, low fever, dry cough, and myalgia. After a few days, the condition suddenly increased, manifested as high fever, chills, shortness of breath, wheezing, cyanosis, hemoptysis, sweating and heart rate, and subcutaneous edema in the neck and chest. Critical, often complicated by sepsis and septic shock, can also be secondary to meningitis, manifested as severe headache, vomiting, convulsions, coma, and obvious meningeal irritation.
(2) Intestinal anthrax: It is mainly caused by eating enteric meat and is characterized by acute intestinal infection. The main symptoms are nausea, anorexia, vomiting and fever, severe abdominal pain, vomiting blood and severe watery stools. Deaths caused by intestinal anthrax account for 25% to 60% of patients. In areas where anthrax is relatively prone and animal vaccination levels are low, people should try to avoid contact with livestock and animal products, as well as meat that is not properly handled or cooked. People can also inoculate human anthrax vaccine, which is said to be effective against 93% of all anthrax infections. Intestinal anthrax has different clinical symptoms and can be expressed as acute gastroenteritis type and acute abdomen type. The former has an incubation period of 12 to 18 hours. The same eater can have severe vomiting, abdominal pain, and watery diarrhea at the same time or in succession, and recover quickly in more than a few days. The latter has a sudden onset of symptoms, severe toxemia, persistent vomiting, diarrhea, bloody stool, abdominal distension, abdominal pain, etc. The abdomen has tenderness or signs of peritonitis. If not treated in time, the emperor is complicated by sepsis and septic shock. He died within 3 to 4 days after the onset of illness.
(C) meningeal anthrax: often secondary to skin, lung and intestinal three types of anthrax, although clinically rare, but the development is extremely rapid and dangerous, and the death is extremely high. At the beginning of the disease, there were mild fever, discomfort, loss of appetite, and varying degrees of headache and vomiting. The condition deteriorated rapidly, sudden high fever, convulsions, frequent vomiting, coma or shock, accompanied by obvious meningeal irritation, cerebrospinal fluid was bloody, and the number of cells increased. There is a significant increase in intracranial pressure, often accompanied by cerebral palsy, and eventually died of respiratory and circulatory failure.
(4) Septicemia anthrax: more secondary to pulmonary anthrax or intestinal anthrax, caused by skin anthrax. May be associated with high fever, headache, bleeding, vomiting, toxemia, septic shock, DIC, etc.
Symptom
Symptoms of skin anthrax common symptoms sepsis rash papules toe skin black veins high fever meningitis edema blood pustules
There is a history of contact with fur or sick animals in the medical history. Most of the patients are engaged in meat processing, fur, leather and other occupations related to livestock production, often occurring in exposed parts, especially the face and neck, hands or forearms, mostly single Hair, incubation period of 2 to 3 days, the first hair is red small papules or blisters, after 1 to 2 days, it becomes a purple red blood blister or pustule, the base is dark red gangrene, the surrounding redness is obvious, but it is not painful, only itchy After 1 to 2 weeks, the sputum is removed, and the scar remains after the healing. It may be accompanied by lymphangitis and lymphadenitis. It may occur in the eyelids, neck and other skin-relaxing parts, only diffuse edema and no blister, which can rapidly form necrosis. With systemic symptoms ranging from mild to severe, severe cases may have high fever, vomiting, general malaise and systemic poisoning symptoms. Severe poisoning symptoms can cause sepsis and meningitis and die within a few days.
Examine
Skin anthrax examination
For patients with central nervous system symptoms, Bacillus anthracis can also be found in cerebrospinal fluid examination.
Histopathology: blister content examination (smear and culture) and blood culture can be found in Gram-positive Bacillus anthracis, with central nervous system symptoms, BCG can also be found in cerebrospinal fluid examination.
Diagnosis
Diagnosis and identification of skin anthrax
According to clinical and histopathology: in the blister content examination (smear and culture) and blood culture can be found Gram-positive Bacillus anthracis, with central nervous system symptoms, cerebrospinal fluid examination can also be found in Bacillus anthracis, can be diagnosed.
TCM pathogenesis and syndrome differentiation:
1. The pathogenesis of traditional Chinese medicine is considered to be infected with the epidemic, which is blocked by the skin and blood stasis and stagnation.
2. Syndrome differentiation
(1) Early stage: toxic heat, qi stagnation and blood stasis, Zheng Xiaoxue rash, itching but not pain, like mosquitoes, freckles, can be slightly hot, tongue and pulse as usual.
(2) Mid-term: toxic heat into the camp, qi and blood stagnation, symptoms of blisters or blood blister on the erythema, quickly become dark red or black carrion, accompanied by fever, dryness, dry mouth, do not want to drink, red tongue and thin Yellow, pulse number.
(3) Late stage: venom heat invagination, stagnation of yang, and the disease is separated from normal skin, fluid, if the swelling gradually disappears as a syndrome; if the swelling continues to spread, the heat is dizzy, the limbs are cold, The pulse is subtle.
