Laryngitis in sap: causes, symptoms, diagnosis, treatment

Glanders is 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. The causative agent is Ps. mallei, a gram-negative rod that does not form spores or capsules; it survives in water and soil for up to 1-1.5 months. The causative agent of glanders was first discovered in 1881 by the Romanian researcher V. Babesh in tissue sections and pus taken from a glanders ulcer of a sick person. Independently of him, the causative agent of glanders was discovered by Loffler and Schuetz 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 purulent ulcers on the mucous membrane of the nose. Humans become infected when nasal discharge from sick animals comes into contact with damaged skin or the mucous membrane of the mouth, nose, or larynx. Infection from a sick person is unlikely. People whose professions involve animals (livestock breeders, shepherds, veterinarians, grooms, jockeys, horse riders) are the main victims. Glanders was probably known to Hippocrates and ancient Greek veterinarians. In past centuries, glanders were widespread throughout the world, especially in countries where horse-drawn transport was dominant. Epidemics among these animals were widespread, which is why their "sanitary" extermination was of the same nature. 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 glanders in horses", according to which 12,819 glanders horses were killed in Russia in 1920 alone. Along with the elimination of glanders among animals in Russia, the incidence of glanders among people also began to decrease: in 1926, 106 patients were registered in the USSR, in 1927 - 41 patients. Currently, glanders among people are found in the form of rare individual diseases.

Pathogenesis and pathological anatomy. The glanders pathogen enters the human body through damaged skin, mucous membrane, conjunctiva, respiratory tract, less often through the gastrointestinal tract; it is carried throughout the body by blood and lymph. Septicopyemia develops with the formation of purulent inflammatory foci on the skin, mucous membrane, in muscles, bones, joints and internal organs (usually in the lungs, kidneys, spleen). At the site of pathogen penetration, a red-purple papule initially appears, surrounded by a bright red border, then a pustule with bloody contents forms, which ulcerates. The ulcer has a greasy bottom covered with greenish mucopurulent discharge. Subsequently, necrosis of the affected tissues with their destruction occurs.

After 5-7 days, multiple secondary nodules and papular rashes appear on the skin, turning into pustules and ulcers, scattered throughout the body, but with predominant localization on the face. Deep abscesses form in the muscles, and then fistulas, through which thick greenish pus is released for a long time. When the lungs are affected, small-focal pneumonia is detected clinically and radiologically. As a rule, an enlarged spleen is palpated, less often the liver. In the blood - pronounced inflammatory changes.

Symptoms of laryngitis in glanders. The disease occurs in acute or chronic form. In the acute form, the incubation period lasts 4-5 days. The disease begins acutely with chills, an increase in temperature to 38.5-40 ° C. Body temperature fluctuates significantly during the day, is accompanied by chills and remains high for a long time. Patients are bothered by headaches and muscle pain, weakness, sweating, sometimes nausea and vomiting of toxic genesis.

When the upper respiratory tract and, in particular, the larynx are affected, deep painful ulcers appear on the mucous membrane, completely disrupting swallowing and phonation. In the acute course of the disease, these ulcers are accompanied by severe toxemia, quickly ending in the death of the patient.

The chronic form of glanders occurs as chronic sepsis with predominant damage to the skin, lungs and nose. Often, damage to the nose is only the initial phase of a descending infection that affects the larynx, and then the trachea, bronchi and lung tissue. The chronic form can last for several years with periodic remissions and exacerbations.

The diagnosis is based on the characteristic clinical picture, pathological changes, epidemiological history data (contact with sick animals) and the results of laboratory and, in particular, bacteriological studies - bacterioscopy and isolation of a culture of microorganisms. For this, nasal discharge, the contents of abscesses, pustules, ulcers, and blood are used. Serological diagnostics, complement fixation reaction, agglutination, indirect hemagglutination and skin-allergic tests with mallein - a filtrate of a killed 4-8-month culture of the glanders pathogen in broth with 4% glycerin, which is also used for animals suspected of having glanders, in particular horses - are also used. Most often, mallein is injected into the animal's conjunctival sac: with a positive test, purulent conjunctivitis of varying severity develops 3-4 hours after the injection.

The prognosis for acute glanders is almost hopeless; with early treatment using broad-spectrum antibiotics, immunoprotectors, multivitamins, antihistamines, effective detoxification agents (infusion of saline solutions, hemodesis, rheopolyglucin) recovery may occur. However, all these measures are aimed primarily at preventing secondary infection and combating intoxication, while antibiotics and sulfonamides that effectively act against the glanders pathogen have not yet been obtained.

Treatment of laryngitis in glanders. Hospitalization of patients is strictly mandatory and they are kept in separate boxes. Sulfanilamide preparations are prescribed in combination with antibiotics. For detoxification, infusions of hemodez and rheopolyglucin solutions are prescribed. Locally - inhalations of antibiotic solutions mixed with hydrocortisone and anesthetic preparations (novocaine, lidocaine, dicaine).

Prevention of laryngitis in glanders includes veterinary and sanitary supervision of animals to identify those sick with glanders (they are destroyed), careful observance of personal protective equipment when caring for animals suspected of having glanders (wearing overalls, aprons, boots, gloves, gauze masks, goggles, prohibition of smoking and eating during work, storing special clothing at the workplace in special cabinets, etc.).

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