Tick

Tick's disease overview

What is

What is the fever?

Cell fever is an acute infectious disease caused by Orientia Tsutsugamushi (a pathogenic bacteria of the Rickettsia family and is a natural and compulsory intracellular parasite of The species belongs to the Trombiculidae family), there is a outbreak in nature, randomly transmitted to humans when the larvae are burned. The larvae with intermediaries are rodents, especially mice.

Diseases are mainly distributed in Asia (Central Asia, East Asia, Southeast Asia and Western Pacific), from Japan to Pakistan, from North Korea to North Australia. The disease produces small outbreaks, scattered on the edge of the forest, newly destroyed or newly planted forests, border areas, where there are many bushes, lawns along rivers and streams, on upland fields, points with points Shade and moist soil, even new deserts and Hymalaya high mountains.

All ages may have the disease but mainly distribute at working age. Diseases distributed with occupational nature: forestry, agriculture, soldiers. The disease is mainly in rural areas of mountain forests (80.5%), rarely seen in urban areas. In temperate and tropical regions, the disease develops in the summer and the rainy months with high humidity is the high fever time.

In Vietnam, cicadas are present in almost 24 northern provinces (not to mention the south), accounting for 38.51% of patients hospitalized for unexplained fever. The disease appears all year round but mainly in the rainy season from 4-5 to September to October, the peak in June July. The object is susceptible to the disease is reclaimed people, the army, the picnic.

People who have had a long -term immune and immune immunity with pathogenic bacteria but only have temporary immunity with other strains (strains of other antigen structures or in other structures or in other structures. other areas). So if re -infected with other bacteria within a few months after recovering, the disease will have a mild disease. People living in an outbreak may be infected 2-3 times, but often suffer from mild or potential (asymptomatic). Local people are often rarely stuck and have mild forms while people from elsewhere are susceptible to heavy body.

If not treated, the disease may experience serious complications and are often a cause of death such as: cardiovascular (myocarditis, cardiovascular collapse, bacterial shock), respiration (pneumonia, waste inflammation Heavy management caused by superinfection or Orientia Tsutsugamushi bacteria itself), meningitis, glomerulonephritis. The mortality rate varies depending on the region and toxicity of the bacteria in each place: Vietnam (about 1%), Indonesia and Taiwan (5% - 20%), Malaysia (15% - 20%), Japan (20% - 60%).

Causes of Tick's disease

The cause of fever is Orientia Tsutsugamushi:

Orientia Tsutsugamushi (also known as Rickettsia Orientalis, or Rickettsia Tsutsugamushi), when dyed Giemsa catch purple blue, spherical, short or fiber -shaped, separate arrangement, Each pair or into the cells of the host cell.

Orientia Tsutsugamushi has an independent respiratory system but has a non -complete enamel system forced to live parasites in the living body (Trombiculidae of the Ve Acarformes). The structure of the antigen is diverse, depending on the species, rodents and geographical areas. There may be many strains of bacteria with different antigen structures so it is easy to re -infection and difficult to produce vaccines. The poison is very different depending on the strain: in Japan and China, the disease is often worse than Malaysia and Vietnam.

Orientia Tsutsugamushi has weak resistance, easy to kill by high temperatures and conventional antiseptic, long -lasting in freezing in cold storage -700C.

Intermediate transmission is Orientia Tsutsugamushi infected larvae.

Trombiculidae belongs to the Bét family (Acarormes), the spider layer (Arachnida), the foot of the burning leg (Arthropoda) has a small size of less than 1mm, the color from yellow to orange, also known as red so.

Developed in 4 stages: eggs, larvae, pupae and mature. Larvae are the only stage of development of parasites in vertebrates (mice and small animals)

The growth cycle of 2-3 months long (warm areas) and over 8 months (cold areas), adult groping on average 15 months, larvae that have not burned animals can live for 30 days. P>The host is wildlife like rodents (mainly rats), birds or cattle (dogs, pigs, chickens).

The larvae are infected with Orientia Tsutsugamushi when the host has a host blood, then the larvae grow into an adult and lay eggs. Eggs hatched into larvae that have germs and are ready to suck blood (groping can transmit pathogens through eggs to the 3rd generation). Later larvae will infect other animals and people when burning and sucking blood, thus groping both the host and intermediaries. The process of infection is maintained in the wild between groping and hosts. The burning and sucking human blood, transmitting Orientia Tsutsugamushi to humans is just a coincidence.

Symptoms of Tick's disease

From the ulcer, Orientia Tsutsugamushi penetrates into the lymphatic system that causes lymphadenitis and then proceeds to cause systemic lymphadenitis and enters the blood of the endocarditis, leading to the end of the body, leading to infection damage in Organs.

Severe or mild clinical scenery depends on many conditions such as the place of residence, the toxicity of each strain and the patient's resistance to bacteria.

Clinical symptoms have the following diseases:

Typical form:

Incubation period: Average from 8 to 12 days, early 6 days, 21 days long.

The onset period: Within a day from the when burning, at the place where the burning is the size of the bean, the patient does not know because of no Feeling pain, burning or itching. The patient only goes to treatment when he has high fever and the disease has entered the stage of fullness. This burn will then become an ulcer.

During the whole period of infection: Often severe and early symptoms of the disease with the following manifestations:

Mild fever 1 to 2 days, then continuous high fever, there are many cases of sudden high fever 39 - 40 ° C on the first day like malaria.

High fever 40 ° C is persistent or pervasive, lasting from 15 to 20 days. If left untreated, the temperature and circuits are often dissociated like typhoid.

Heavy nerve poisoning, headache is a sign of starting, pain throughout the head, can ache both eye holes.

tired, uncomfortable, dizzy, dizzy, staggering, tinnitus, trembling tongue, sweating, muscle pain as much as in Leptospirosis The case is also packaging, gloomy perception as in typhoid.

Syndrome of ulcer - lymphadenopathy - Ban:

The typical ulcer of the fever is found in many places all over the body, often seen in the young and moist skin such as the genitals, armpits, groin and the anus, waist and waist. limbs, back, chest, abdomen, neck, sometimes ulcers in a sudden position such as ears, navel, eyelids.

ulceration is usually round or oval, from 1mm to 2cm in diameter. If there is a scales, it is black, hard on a tough nodules. If the scales have peeled off, leave a concave ulcer, bright red, clean without discharge, no pus. The patient does not know if there is an ulcer because it is completely painless, no itchy or burning. In the third week of the disease, the ulcer heals, the skin returns to normal.

Tige lymphadenopathy: There are 2 types: lymphadenitis in the primary area and secondary systemic lymphadenopathy. Lymph nodes in the primary area: near where the ulcer, the swollen lymph nodes are as big as the apple seeds, the oval or may be larger. The lymph nodes are usually larger than the lymph nodes, which may be accompanied by inflammation around the lymph nodes. Area lymph nodes usually appear with fever or after a fever 2-3 days. It is the discovery of the area that helps to guide the search for ulcers. Secondary systemic lymphadenitis: usually appear after lymphadenopathy, less swelling, movement and pain lighter than the area, see in the armpits, groin, neck, elbows. In Vietnam, 100% of patients with ticks are swollen.

Ban: Appears at the end of the weekend and the beginning of the second week of the disease. Usually the rash, the size from millet to 1cm in diameter. The rash grows throughout the body (back, chest, abdomen, limbs) except for the palms, soles of the feet, about 10% of patients have hemorrhage. You exist from a few hours to a week.

Cardiovascular syndrome is very common in cardiovascular lesions in the fever, such as:

Valasia stretches the skin often ruddy, conjunctiva conjunctiva with lots of red blood rays (this is a symptom to distinguish it from malaria and typhoid). Sometimes there are cases of bleeding under the skin, nosebleeds, gastrointestinal bleeding, coughing up blood, ...

There is a manifestation of myocarditis: fuzzy heart, extra systolic, reduced blood pressure.

Respiratory symptoms may experience not typical pneumonia or bronchitis. Other:

About digestive: Patients often have constipation in fever days, sometimes can diarrhea for a few days, pain in the epigastrium like gastritis but these symptoms are usually ruined when Ceremony. The liver and spleen may be large but usually only fluttering ribs, less pain.

urinary tract: may have protein in the urine, sometimes there is a cylinder but only fleeting. Potential:

There is no clinical manifestation but blood tests see Rickettsia antibodies.

This form is more common, the frequency is 10 times higher than the typical form.

Cut:

Mild, not typical symptoms, easily diagnosed with other infections.

Heavy form:

There are cardiovascular, respiratory, nervous, hemorrhage, easy to die.

Transmission route of Tick's diseaseTick

Carrier fever is a disease that transmits people through intermediaries, which is Orientia Tsutsugamushi.

The infected person when burning larvae.

Patients are unable to transmit the disease to others.

People at risk for Tick's disease

groping and larvae like to live in a porous, moist, cool soil, in the caves, along the coast of the stream rivers and streams, the shady place, the bushes and the low trees have seed Come.

The risk object may be burned by larvae include:

Persons living, labor in outbreaks

Runner -to -field people

The army is picnic

Siters or lying on the lawn, leaving hats or tying hammocks to tree stumps

Prevention of Tick's disease

Luminue the bushes around the house, clean the weeds.

Spraying larvae.

Mouse kill and rodents.

When entering the mountains or dense trees, you need to wear long -sleeved clothes, gloves, socks covering the body.

Do not lie on the lawn or moist land, do not dry clothes on the lawn to avoid larvae sticking to sticking.

Do not use preventive antibiotics because it is less effective and expensive.

Currently, there is no vaccine.

Diagnostic measures for Tick's disease

Diagnosis is based on clinical and testing standards.

Clinical symptoms: fever and ulcer syndrome - lymphadenopathy - Ban with characteristic ulcer

Epidemiology: Living or going through the epidemic.

Blood test:

Find antigens:

Orientalis isolation: can be isolated bacteria on mice, chicken embryos, animal cells, used mainly at the research institute.

Giemsa dyeing or giamen and screening on microscopes.

Find antigens with direct fluorescent immune reaction (DIF: Direct Immunofluorescence Assay).

PCR engineering (Polymerase Chain Reaction).

Serum reaction:

The Weil - Felix reaction (using the Oxk antigen of Proteus Mirabilis): The sensitivity and specificity are not high but the price is low, easy to implement should be used the most. P>

Complication testing test

indirect immune response (IFA: Indirect Immunofluorescence Assay

Immune reaction enzyme (Elisa: enzyme Linked Immunosorbent Assay

Test IIP (indirect immune antibody test)

Quick Test (RFA: Rapid Flow Assay).

Distinguish diagnosis:

Worsional disease: also have fever, congestion, red eyes, muscle pain, rash and lymph nodes but no characteristic ulcers, often bleeding under the skin. >

Typhoid: There is also a long sauce, li, pyrolysis but very sparse, abdominal abdominal distention, pelvic yoke and no characteristic ulcer.

Dengue sauce: The fever usually lasts an average of 6-7 days, but in the classic dengue fever is thicker, the joint pain is clearer and in Dengue dengue, the bleeding is Or appear when the fever is over, there is no characteristic ulcer.

Malaria: Although Tien Phat malaria has a fever continuously, but then it also moves into a cycle fever with 3 stages of cold - hot - sweating, no ulcers specific , blood tests for malaria parasites.

Tick's disease treatments

Treatment of tick fever includes specific treatment and symptomatic treatment.

Specific treatment:

Antibiotic therapy:

sulfamid works with Rickettsia but only for mild and today's rarely used because of the vascular endocarditis fever, which is easy to cause edema, embolism, if sulfamid treatment is easy. Causes glomerular damage, renal tubules.

The most common and effective antibiotic with groping sauce is chlorocid and tetracyclin. Because these two drugs only have bacteria, not to kill bacteria, Rickettsia still lives and exists in lymph nodes, in the endothelial hammock system for many days, months and easy to relapse.

Dosage and usage:

Chlorocid or Tetracyclin: First day: 2g/day (for people about 50kg), high doses of 2g starting tend to cut faster sauce. The following days: 1g/day, use until the fever is 2-3 days; Total dose: 6-7g. High doses do not reduce the ability to produce antibodies, so it does not affect the results of serum reactions and does not cause any complications for the patient.

ciprofloxacin and azithromycin also work well in the treatment of tick fever.

Can use Doxycycline tablets 100mg x 2 capsules/day for adults, use 7 to 15 days.

Should indicate treatment for the second phase in 3-4 days, to prevent recurrence.

Antibiotic therapy in combination with corticosteroids:

Some cases after using antibiotics for a few days the temperature still does not get better, can be used in combination with cortancyl (if not contraindicated) at a short -term average dose : cortancyl tablets 5mg x 4 tablets/day, used for 2-3 days will cool down faster.

Symptomatic treatment:

Supplementing water - Electrolytes: In patients with ticks, there is often a long high fever and poor eating, so it is easy to have dehydration and electrical substances prize. Therefore, patients drink enough water and infusion.

Cardiovascular aid: Patients with fever in the heart often experience myocarditis, endocarditis of blood vessels need to use cardiovascular medications such as: Ouabain, Spartein, Coramine. >

Improve the body's resistance: Supplement vitamins, eat enough quality.

sedative, reduce fever (when high fever).

Treatment of superinfection if any.

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