Courage

Introduction to heat Qfever is a natural epidemic infection caused by systemic infection of coxiellaburnetii, also known as cox's disease. Livestock such as cattle, sheep, dogs, horses, donkeys and pigs are the main source of infection. The clinical features are fever, headache, and muscle pain. But there is no rash, sometimes with interstitial pneumonia. A few patients have chronic hepatitis or fatal heart. Endometritis. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: fecal-mouth transmission Complications: chronic pneumonia endocarditis

Cause of fever

Dietary factors (55%):

Bena Keke body has strong resistance to the outside world, can live for 6 months in dry blood, can survive for 2 years in dry manure; needs to be boiled for more than 10 minutes in milk to be killed, contagious, without going through the limbs Animals can infect humans as a medium of communication.

Environmental factors (35%):

It can be transmitted by aerosol. It is a highly contagious pathogen that can cause laboratory infection. There is no cross-immunization between the hot cox and the Proteus, and the infected patient is negative.

Pathogenesis

After being infected into the human body by different routes of transmission, the hot Cox body first propagates in the local reticuloendothelial cells, and then invades the blood circulation to form rickettsialosis, which spreads to various organs and tissues throughout the body, mainly causing small blood vessels throughout the body. , lung, liver and kidney and other organ diseases, , , , , , Alveoli are filled with lymphocytes, monocytes, tissue cells and fibrin exudate, alveolar septal thickening, pulmonary interstitial edema, severe cases resembling lobar pneumonia, liver with necrotic granuloma with fat, heart can develop myocarditis, Endocarditis or pericarditis, heart valves can be formed by neoplasms, and even lead to rupture of the aortic sinus or perforation of the heart valve. In addition, the kidneys, spleen and testicles can also develop lesions, and the diseased organs contain a large number of hot rickettsia.

Hot prevention

1. Manage the source of infection

(1) The patient should be strictly isolated and disinfected for sputum and excretion.

(2) Pay attention to the management of livestock and poultry, and thoroughly disinfect the excrement, placenta and its polluted environment during the delivery period.

2. Cut off the route of transmission

(1) Staff members who are in close contact with livestock in slaughterhouses, fur tanneries and meat processing plants must work in accordance with the protection regulations.

(2) Vaccination of exposed areas in contact with livestock and slaughterhouses, raw milk processing, laboratory operators, and preventive medication if necessary.

(3) Destroy the rodent.

(4) Although the spread of heat between people is not dominant, blood, urine, sputum, clothing, autopsy specimens, etc. of contaminated patients should be worn with gloves and masks without direct contact with hands.

(5) Suspected contaminated cattle and goat milk should be boiled for more than 10 minutes before drinking.

3. Protect susceptible populations

(1) Attenuated live vaccine is used for skin scratches or sugar pills, no adverse reactions, and the effect is better.

(2) Workers who have more exposure to livestock can be vaccinated to prevent infection.

(3) Livestock can also be vaccinated to reduce the incidence rate.

Thermal complications Complications chronic pneumonia endocarditis

Interstitial pneumonia, chronic pneumonia or fatal endocarditis.

Symptoms of fever, common symptoms, fever, loss of appetite, loss of appetite, relaxation, heat, dryness, cough, difficulty in breathing, weight loss, granuloma, jaundice

Acute heat

The incubation period is 14 to 39 days, with an average of 20 days.

Most patients have acute onset, fever, body temperature often rises to 39 ~ 40 ° C within 2 to 3 days, is a relaxation heat, heat cycle 10 ~ 14 days, after which can quickly decline or fall to normal within 2 to 3 days, fever The degree is directly proportional to the severity of the disease, accompanied by fatigue, lack of appetite, body aches and a lot of sweating, headache, severe in the forehead and eyelids, but also lumbar muscle, gastrocnemius and joint pain, etc., the course begins 5 to 6 days There is dry cough, chest pain, a few have mucus or sputum with blood, but the lung signs are not common, most patients have liver enlargement and tenderness, jaundice is rare, no rash, the disease is obvious to the body, the severe patients after fever Weak, it takes weeks to recover.

2. Chronic heat

Chronic sputum fever is a small number of acute type of sputum fever that lasts more than 1 year. It is mainly manifested as endocarditis or chronic granulomatous hepatitis. It can be infected with rickettsial to the endocardial inflammation. From 1 to 20 years, manifested as long-term irregular fever, anemia, clubbing, heart murmur and difficulty breathing, chronic granulomatous hepatitis may have fatigue, loss of appetite and hepatosplenomegaly, in addition, there may be Interstitial nephritis, aneurysm, pericarditis, myocarditis, cardiopulmonary infarction, meningoencephalitis and myelitis are rare.

Hot check

1. Blood routine and biochemical examination

Peripheral blood leukocyte counts are mostly in the normal range, neutrophils may be slightly elevated, erythrocyte sedimentation rate is moderately increased, and acute or chronic sputum fever may increase alanine aminotransferase and aspartate aminotransferase, serum Elevated bilirubin is rare, and chronic sputum fever may cause abnormalities in myocardial zymogram.

2. Serum immunology and pathogen examination

(1) Proteus OXk, OX19 and OX2 agglutination test: negative reactions were observed.

(2) Complement binding test: antibody titer 1:81:10 is the positive minimum titer, and repeated detection once after 1 week, if the titer is increased by more than 4 times, it may have diagnostic significance.

(3) Anthrax Cox agglutination test: The antibody titer has a diagnostic significance from 1:16 to 1:512.

(4) Indirect immunofluorescence assay: An increase in the antibody to the Rickettsia phase II phase indicates the recent exposure or acute type of hot, hot-spotted Kirk-body I phase antibody titration, IgG>1:800 and:IgA>1:50 Or the level of I phase antibody is higher than that of phase II, suggesting chronic type of fever.

(5) Animal inoculation: 2 to 3 ml of blood of a fever patient is inoculated into the abdominal cavity of a guinea pig. After the guinea pig is heated, the spleen cell suspension is inoculated into the testicle of a normal guinea pig. The guinea pig is anatomized after 7 to 10 days of fever, and the testicular parenchyma is visible. Hot Cox body, has a diagnosis.

Other auxiliary inspections:

1. Imaging examination

X-ray examination can detect inflammation in the lungs, and there are segmental or large-leaf blurred shadows around the lower lobe of the lungs. It can also be thickened and infiltrated around the hilum or bronchi.

2.B type ultrasonic inspection

Chronic heat can be found in the liver and spleen.

Diagnostic diagnosis

Diagnose based on

Epidemiological basis

The local area is hot and popular, with close contact with cattle, sheep and other livestock. It has drinking contaminated water or infected animal dairy products, and has direct contact with sick animal manure, urine, amniotic fluid, placenta and fur. The significance of auxiliary diagnosis, slaughterhouses, meat processing plants, milk factories, various animal husbandry and tanneries are high-risk groups.

2. Clinical manifestations

Fever, headache, muscle pain, chest pain, cough, no rash is a common manifestation of acute sputum fever, long-term fever, fatigue, weight loss, joint pain, hepatosplenomegaly and heart murmur are common manifestations of chronic fever.

3. Laboratory and special examination of peripheral blood leukocytes are normal, neutrophils are high, erythrocyte sedimentation rate increases, liver function and cardiac function are abnormal, external-fibe reaction is negative, X-ray lung has inflammation changes, B-mode ultrasound has liver and spleen Swelling has the value of auxiliary diagnosis. Serological examination titer can reach the diagnostic criteria or the animal is positive for the separation of the rickettsia culture.

Differential diagnosis

Acute type of fever should be differentiated from diseases such as influenza, typhoid, leptospirosis and mycoplasmal pneumonia. Chronic heat should be differentiated from diseases such as brucellosis, chronic viral hepatitis and rheumatic heart disease.

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