Rosacea-like rash

Introduction Non-specific rash occurs in 10% of cases of brucellosis, and the more common are measles-like, scarlet-like and rash-like rashes. Caused by Brucella, the source of infection is mainly livestock, and contact infection is the main route. They have the ability to reproduce and infect the mites. Brucella is an inactive, tiny polymorphic bacterium, which is negative for Gram stain and has no spore formation. The bacteria are sensitive to light, heat, and common chemical disinfectants; they can be killed by sunlight for 10 to 20 minutes, moist heat at 60 ° C for 10 to 20 minutes, and 3% bleaching powder clear solution for several minutes. Brucella has a strong viability in the external environment and can survive for several weeks to several months in dry soil, fur and dairy products, and can survive for 5 to 4 months in water.

Cause

Brucella is an inactive, tiny polymorphic bacterium, which is negative for Gram stain and has no spore formation. The bacteria are sensitive to light, heat, and common chemical disinfectants; they can be killed by sunlight for 10 to 20 minutes, moist heat at 60 ° C for 10 to 20 minutes, and 3% bleaching powder clear solution for several minutes. Brucella has a strong viability in the external environment and can survive for several weeks to several months in dry soil, fur and dairy products, and can survive for 5 to 4 months in water.

Brucella produces only endomycin and is somewhat toxic to experimental animals. After the Brucella enters the human body from the skin or mucous membrane, the neutral polynuclear cells appear first, and the swallowed bovine bacteria can be partially killed, but the sheep type bacteria are not easily killed. The viable Brucella goes with the lymph to reach the local lymph nodes. According to the disease resistance of the human body and the number and virulence of the invading bacteria, the bacteria are either eliminated locally or grown in the lymph nodes to form an infection. When the proliferation of the bacteria reaches a considerable amount, it breaks through the lymph node barrier and invades the blood circulation. At this time, a series of symptoms such as bacteremia and toxemia may occur. After entering the blood circulation, the pathogen can form a new infection in the reticuloendothelial system such as liver, spleen, bone marrow and lymph nodes. After that, the pathogen can enter the blood circulation several times and cause recurrence. The fever is wavy (so the disease is also called wavy heat).

Brucella is mainly parasitic in macrophages. Like the chronic infectious diseases caused by bacteria in other parasitic cells, the pathogenesis is mainly delayed type allergic reaction. The occurrence and development of brucellosis is very recurrent, one is related to bacteremia, toxemia, allergic reaction, and the other is that the bacteria invade multiple organs. The three antibacterial drugs and antibodies are not easy to enter the cells, so the clinical manifestations of this disease are complicated. It is difficult to cure.

an examination

Related inspection

Blood and bone marrow bacterial culture agglutination experiment

Epidemiological data and occupations are of great value in assisting in the diagnosis of this disease. If there are some special clinical manifestations of this disease, such as wavy heat, orchitis, the diagnosis can be basically established. The positive results of blood, bone marrow, pus and other cultures are the basis for diagnosis.

Agglutination test (or ELISA, supplementation test, etc.) should be measured on a weekly basis, and the high titer or titer should be diagnosed. Chronic patients with agglutination test should be used as an ELISA or anti-human globulin test. To identify natural infections and artificial immunity, or to determine whether the disease is active, a 2-ME test can be performed.

Differential diagnosis

Differential diagnosis of rash-like rash:

1. Systemic lupus erythematosus: Lupus erythematosus is an autoimmune disease with slow onset, insidious attack, diverse clinical manifestations, and a variety of autoimmune diseases involving many systems and organs, due to cellular and humoral immune functions. Barriers produce a variety of autoantibodies. It can affect the skin, serosa, joints, kidneys and central nervous system, and is characterized by autoimmunity. There are many autoantibodies in patients, which not only affects humoral immunity, but also affects cellular immunity, and the complement system also changes. The pathogenesis is mainly due to the formation of immune complexes. The exact cause is unknown. The condition is an alternating process of recurrent and remission. The disease is more common in young women. The prevalence rate in China is higher than in Western countries and may be related to genetic factors.

2. Measles: Measles is one of the most common acute respiratory infections in children. It is highly contagious. It is prone to epidemic in a densely populated area where there is no vaccine, and a pandemic occurs about 2 to 3 years. Clinically, fever, upper respiratory tract inflammation, conjunctivitis, etc. are characterized by red maculopapular rash on the skin and measles mucosal plaque on the buccal mucosa and residual pigmentation after retraction with bran-like desquamation. Since 1965, China has controlled a pandemic since the introduction of a live attenuated measles vaccine.

3, scarlet fever: Scarlet Fever (Scarlet Fever) is a group of hemolytic streptococcal infection caused by acute respiratory infections. Its clinical features are fever, angina, diffuse red rash of the whole body and obvious desquamation after rash. A small number of patients develop heart, kidney and joint damage due to allergies after illness. The disease occurs all year round, especially in the winter and spring seasons. More common in children, especially 5-15 years old.

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