1. Pitanje broj: #186469

    Postovani profesore,molim za pomoc i savet,moja cerka koja trenutno ima 20god,prosle godine je operisala "cistu"(jer su rengenolozi 4 puta videli da je cista u skrgnom luku),Posle operacije na maksofacijalnoj hirurgije ,PH nalaz je pokaxao da se ne radi o cisti vec i inficiranom linfnom cvoru,Dobili smo upute za analize,da se utvrdi zbog cega je doslo do infekcije(mantu propa i test na tularemiju),mantu proba je bila negativna a test na tularemiju pozitivan.Obratili smo se infektologu i odmah je primila 10garamicina ( 160mg u jednoj doz),2 kutije dovicina.. Posle sest meseci (navodim da je bila prehladjena)ponovo se na istom mesti javlja oteklina koja u roku od dva tri dana postaje bolna,ponovo ista terapija. Kada sam htela da je ponovo tedtiram na tularemiju,infektolog mi je reko da nema potrebe i da je ona jos uvek pozitivna,jel bakterija ostaje duze vreme u organizmu. S obzilom da se njoj posle operacija dva puta javila potpuno ista otelina,molim Vas recite mi koliko dugo moze bakterija biti u organizmu i da li svaki put treba da prima tu istu terapiju. Zabrinuta sam pa bih Vas molila za vase misljenje.Hvala puno.

    Odgovoreno: 04. 08. 2021.
    • tularemija je zoonoza, visoko kontagiozna infekcija, koja se stiče u kontaktu s glodarima, pticama, ređe ubodom artropodnih insekta, tako da nisam ubeđen u dijagnozu, ukoliko nema epidemioloških podataka u tom pravcu. Nespecifični limfadenitisi na vratu koji prat virusne i bakterijske infekcie gornjih respiratornih puteva su mnogo češći uzročnici, tularemija je retkost.

      Evo o lečenju iz užbnika. Lečenj može biti neefikasno uz pojavu relapsa, no prognoza je dobra

      The preferred drug is

      Streptomycin 1 g IM every 12 hours for adults and 15 mg/kg IM every 12 hours for children for 7 to 10 days for moderate to severe disease

      •  

      Chloramphenicol 12.5 to 25 mg/kg IV every 6 hours or doxycycline 100 mg orally 2 times a day for 14 to 21 days is added if there is evidence of meningitis.

      Alternatives to streptomycin include the following:

      • Gentamicin 1 to 2 mg/kg IM or IV every 8 hours (for moderate to severe disease)

      • Doxycycline 100 mg orally every 12 hours (for mild disease)

      • Chloramphenicol 12.5 to 25 mg/kg IV every 6 hours (used only for meningitis because there are more effective and safer alternatives)

      • Ciprofloxacin 500 mg orally every 12 hours (for mild disease)

      In a mass casualty setting if parenteral treatment is not feasible, oral doxycycline or ciprofloxacin may be used for adults and children. However, relapses occasionally occur with all of these drugs, and they may not prevent node suppuration.

      Continuous wet saline dressings are beneficial for primary skin lesions and may diminish the severity of lymphangitis and lymphadenitis. Surgical drainage of large abscesses is rarely necessary unless therapy is delayed.

      In ocular tularemia, applying warm saline compresses and using dark glasses give some relief. In severe cases, 2% homatropine 1 to 2 drops every 4 hours may relieve symptoms.

      Intense headache usually responds to oral analgesics.

      Prevention of Tularemia

      When entering endemic areas, people should use tick-proof clothing and repellents. A thorough search for ticks should be done after leaving tick-infested areas. Ticks should be removed at once (see sidebar Tick Bite Prevention ).

      When handling rabbits, hares, and rodents, especially in endemic areas, people should wear protective clothing, including rubber gloves and face masks, because organisms may be present in the animal and in tick feces on the animal’s fur. Wild birds and game must be thoroughly cooked before eating.

      Water that may be contaminated must be disinfected before use.

      No vaccine is currently available, although one is currently under review by the U.S. Food and Drug Administration (FDA). Antibiotic prophylaxis with 14 days of oral doxycycline or ciprofloxacin is recommended after high-risk exposure (eg, a laboratory accident).

      Prognosis for Tularemia

      Mortality is almost nil in treated cases and about 6% in untreated cases of ulceroglandular tularemia. Mortality rates are higher for type A infection and for typhoidal, septicemic, and pneumonic tularemia; they are as high as 33% for untreated cases. Death usually results from overwhelming infection, pneumonia, meningitis, or peritonitis. Relapses can occur in inadequately treated cases. One attack confers immunity.

Ostavite komentar