Dragi doktore moj sin koji sada ima pet godina se prošle godine razboleo od mononukleoze. Imao je povišenu temperaturu, bolove u grlu, uvećanu jetru i slezinu, kao i uvećanu limfnu žlezdu na vratu. Sada godinu dana posle toga on i dalje ima tu istu limfnu žlezdu na vratu koja se nije smanjila. To nas veoma plaši, da li je to neki problem?
Pocituvani! Na 20.01.2009. god. Kaj mene e dijagnosticirana bruceloza, koja što e lekuvana so (rifampicin, vibramicin i lidaprim), 45 dena. Vo izminatiot period go sledevme titarot koj sekoj mesec variraše. Poslednite 3 meseci bab testot beše slabo pozitiven, a wrihtovata reakcija-negativna. 4 meseci pred otkrivanjeto na bolesta, ne možev da zabremenam. Sega me interesira dali možam i ponatamu da razmisluvam za bremenost, i dokolku zabremenam, dali moži da ima posledici na plodot? Odnapred vi blagodaram.
Možete pročitati detaljnije o bolesti iz udžbenika;
brucellosis is caused byBrucella sp, which are gram-negative bacteria. Symptoms begin as an acute febrile illness with few or no localized signs and may progress to a chronic stage with relapses of fever, weakness, sweats, and vague aches and pains. Diagnosis is by culture, usually from the blood. Optimal treatment usually requires 2 antibiotics—doxycycline ortrimethoprim/sulfamethoxazole plusgentamicin,streptomycin, orrifampin.
The causative organisms of human brucellosis areB. abortus (from cattle),B. melitensis (from sheep and goats), andB. suis (from hogs).B. canis (from dogs) has caused sporadic infections. Generally,B. melitensis andB. suis are more pathogenic than otherBrucella sp.
The most common sources of infection are farm animals and raw dairy products. Deer, bison, horses, moose, caribou, hares, chickens, and desert rats may also be infected; humans can acquire the infection from these animals as well.
Brucellosis is acquired by
Direct contact with secretions and excretions of infected animals
Ingesting undercooked meat, raw milk, or milk products containing viable organisms
Inhaling aerosolized infectious material
Rarely, person-to-person transmission
Most prevalent in rural areas, brucellosis is an occupational disease of meatpackers, veterinarians, hunters, farmers, livestock producers, and microbiology laboratory technicians. Brucellosis is rare in the US, Europe, and Canada, but cases occur in the Middle East, Mediterranean regions, Mexico, and Central America.
Because very few organisms (perhaps as few as 10 to 100) may cause infection via aerosol exposure,Brucella sp are potential agents of biological terrorism.
Patients with acute, uncomplicated brucellosis usually recover in 2 to 3 wk, even without treatment. Some go on to subacute, intermittent, or chronic disease.
Complications
Complications of brucellosis are rare but include subacute bacterial endocarditis, neurobrucellosis (which includes acute and chronicmeningitis, encephalitis, and neuritis),orchitis, cholecystitis, hepatic suppuration, andosteomyelitis (particularly sacroiliac or vertebral).
Symptoms and Signs
The incubation period for brucellosis varies from 5 days to several months and averages 2 wk.
Onset may be sudden, with chills and fever, severe headache, joint and low back pain, malaise, and occasionally diarrhea. Or onset may be insidious, with mild prodromal malaise, muscle pain, headache, and pain in the back of the neck, followed by a rise in evening temperature.
As the disease progresses, temperature increases to 40 to 41° C, then subsides gradually to normal or near-normal with profuse sweating in the morning.
Typically, intermittent fever persists for 1 to 5 wk, followed by a 2- to 14-day remission when symptoms are greatly diminished or absent. In some patients, fever may be transient. In others, the febrile phase recurs once or repeatedly in waves (undulations) and remissions over months or years and may manifest as FUO.
After the initial febrile phase, anorexia, weight loss, abdominal and joint pain, headache, backache, weakness, irritability, insomnia, depression, and emotional instability may occur. Constipation is usually pronounced. Splenomegaly appears, and lymph nodes may be slightly or moderately enlarged. Up to 50% of patients have hepatomegaly.
Brucellosis is fatal in < 5% of patients, usually as a result of endocarditis or severe CNS complications.
Diagnosis
Blood, bone marrow, and CSF cultures
Acute and convalescent serologic testing (not reliable forC. canis) and PCR assay
Blood cultures should be obtained; growth may take > 7 days, and subcultures using special media may need to be held for up to 3 to 4 wk, so the laboratory should be notified of the suspicion of brucellosis.
Samples of bone marrow and CSF may also be cultured.
Acute and convalescent sera should be obtained 3 wk apart. A 4-fold increase or an acute titer of 1:160 or higher is considered diagnostic, particularly if a history of exposure and characteristic clinical findings are present. The WBC count is normal or reduced with relative or absolute lymphocytosis during the acute phase. Serologic testing is not reliable forC. canis.
PCR assay can be done on blood or any body tissue and can be positive as early as 10 days after inoculation.
Treatment
Doxycyclineplus either rifampin, an aminoglycoside (streptomycinor gentamicin), or ciprofloxacin
Activity should be restricted in acute cases of brucellosis, with bed rest recommended during febrile episodes. Severe musculoskeletal pains, especially over the spine, may require analgesia. Brucellaendocarditis often requires surgery in addition to antibiotic therapy.
If antibiotics are given, combination therapy is preferred because relapse rates with monotherapy are high. Doxycycline 100 mg po bid for 6 wk plusstreptomycin1 g IM q 12 to 24 h (or gentamicin 3 mg/kg IV once/day ) for 14 days lowers the rate of relapse. For uncomplicated cases,rifampin600 to 900 mg po bid for 6 wk can be used instead of an aminoglycoside. Regimens using ciprofloxacin 500 mg po bid for 14 to 42 days plusrifampinor doxycycline instead of an aminoglycoside have been shown to be equally effective.
In children<8 yr, trimethoprim/sulfamethoxazole (TMP/SMX) and oral rifampin for 4 to 6 wk have been used.
Neurobrucellosis and endocarditis require prolonged treatment.
Even with antibiotic treatment, about 5 to 15% of patients relapse, so all should be followed clinically and with repeat serologic titers for 1 yr.
Prevention
Pasteurization of milk helps prevent brucellosis. Cheese that is made from unpasteurized milk and is aged<3 mo may be contaminated.
People handling animals or carcasses likely to be infected should wear goggles and rubber gloves and protect skin breaks from exposure. Programs to detect infection in animals, eliminate infected animals, and vaccinate young seronegative cattle and swine are required in the US and in several other countries.
There is no human vaccine; use of the animal vaccine (a live-attenuated preparation) in humans can cause infection. Immunity after human infection is short-lived, lasting about 2 yr.
Postexposure antibiotic prophylaxis is recommended for high-risk patients (eg, those who have unprotected exposure to infected animals or laboratory samples or who received animal vaccine). Regimens include doxycycline 100 mg po bid plusrifampin600 mg po once/day for 3 wk; rifampin is not used for exposure to the vaccine withB. abortus (strain RB51), which is resistant torifampin.
Key Points
Brucellosis is acquired by direct contact with secretions and excretions of infected animals or by ingestion of contaminated food or dairy products.
Infection typically causes fever and constitutional symptoms, but specific organs (eg, brain, meninges, heart, liver, bones) are rarely affected.
Most patients recover in 2 to 3 wk, even without treatment, but some develop subacute, intermittent, or chronic disease.
Diagnose using cultures of blood, bone marrow, or CSF and acute and convalescent serologic testing.
Treat most patients with 2 antibiotics, typicallydoxycyclineplus either rifampin, an aminoglycoside, or ciprofloxacin; monitor patients up to 1 yr for relapse.
Pre 3 meseca mi je dijagnostikovan hepatitis bakutni. Pijem vec 2,5 meseca zefix lek. Icr vrednost mi je bila u februaru 1.05, a u martu 1,11. Koja icr vrednost je normalna, tj. šta znače ove promene icr vrednosti u mom slučaju? Hvala.
Poštovani, brat mi se već dve nedelje muči sa visokom temperaturom. Najpre je počelo sa 37.2 par dana, ali zanemario je. Prošle nedelje je već imao i 39 stepeni, pa padne u toku dana. Varira izmedju 38 i 39 stepeni. Onda padne u toku dana i tako u krug. Nema prehladu, ne curi mu iz nosa, ne kašlje. Bio je kod lekara, nema na plućima nista. Vadio je krv i dao mokracu i stolicu na analizu. Jedino što je pozitivno nađeno u nalazu je adeno igg 1. 36 a normalno je ispod 1. 1. Iscrpljen je od svega, a nikako da nađemo način da temperaturu jednom za svagda oborimo. U toku noći kao vulkan se podigne i izmuči ga. Molim Vas, imate li neku sugestiju, terapiju? A tek ove nedelje će lekari nešto predložiti. A hteo bih da čujem bar od nekog stručnjaka u vezi ovih problema šta predlaže. A pre 3 godine takođe je imao adenovirus, pa smo mislili da se to ne vraća? Pozdrav!
Nije za brigu, vremenom će proći.
Ukoliko ste izlečeni možete bezbedno u trudnoću.
Možete pročitati detaljnije o bolesti iz udžbenika;
brucellosis is caused by Brucella sp, which are gram-negative bacteria. Symptoms begin as an acute febrile illness with few or no localized signs and may progress to a chronic stage with relapses of fever, weakness, sweats, and vague aches and pains. Diagnosis is by culture, usually from the blood. Optimal treatment usually requires 2 antibiotics—doxycycline or trimethoprim/sulfamethoxazole plus gentamicin, streptomycin, or rifampin.
The causative organisms of human brucellosis are B. abortus (from cattle), B. melitensis (from sheep and goats), and B. suis (from hogs). B. canis (from dogs) has caused sporadic infections. Generally, B. melitensis and B. suis are more pathogenic than other Brucella sp.
The most common sources of infection are farm animals and raw dairy products. Deer, bison, horses, moose, caribou, hares, chickens, and desert rats may also be infected; humans can acquire the infection from these animals as well.
Brucellosis is acquired by
Direct contact with secretions and excretions of infected animals
Ingesting undercooked meat, raw milk, or milk products containing viable organisms
Inhaling aerosolized infectious material
Rarely, person-to-person transmission
Most prevalent in rural areas, brucellosis is an occupational disease of meatpackers, veterinarians, hunters, farmers, livestock producers, and microbiology laboratory technicians. Brucellosis is rare in the US, Europe, and Canada, but cases occur in the Middle East, Mediterranean regions, Mexico, and Central America.
Because very few organisms (perhaps as few as 10 to 100) may cause infection via aerosol exposure, Brucella sp are potential agents of biological terrorism.
Patients with acute, uncomplicated brucellosis usually recover in 2 to 3 wk, even without treatment. Some go on to subacute, intermittent, or chronic disease.
Complications
Complications of brucellosis are rare but include subacute bacterial endocarditis, neurobrucellosis (which includes acute and chronic meningitis, encephalitis, and neuritis), orchitis, cholecystitis, hepatic suppuration, and osteomyelitis (particularly sacroiliac or vertebral).
Symptoms and Signs
The incubation period for brucellosis varies from 5 days to several months and averages 2 wk.
Onset may be sudden, with chills and fever, severe headache, joint and low back pain, malaise, and occasionally diarrhea. Or onset may be insidious, with mild prodromal malaise, muscle pain, headache, and pain in the back of the neck, followed by a rise in evening temperature.
As the disease progresses, temperature increases to 40 to 41° C, then subsides gradually to normal or near-normal with profuse sweating in the morning.
Typically, intermittent fever persists for 1 to 5 wk, followed by a 2- to 14-day remission when symptoms are greatly diminished or absent. In some patients, fever may be transient. In others, the febrile phase recurs once or repeatedly in waves (undulations) and remissions over months or years and may manifest as FUO.
After the initial febrile phase, anorexia, weight loss, abdominal and joint pain, headache, backache, weakness, irritability, insomnia, depression, and emotional instability may occur. Constipation is usually pronounced. Splenomegaly appears, and lymph nodes may be slightly or moderately enlarged. Up to 50% of patients have hepatomegaly.
Brucellosis is fatal in < 5% of patients, usually as a result of endocarditis or severe CNS complications.
Diagnosis
Blood, bone marrow, and CSF cultures
Acute and convalescent serologic testing (not reliable for C. canis) and PCR assay
Blood cultures should be obtained; growth may take > 7 days, and subcultures using special media may need to be held for up to 3 to 4 wk, so the laboratory should be notified of the suspicion of brucellosis.
Samples of bone marrow and CSF may also be cultured.
Acute and convalescent sera should be obtained 3 wk apart. A 4-fold increase or an acute titer of 1:160 or higher is considered diagnostic, particularly if a history of exposure and characteristic clinical findings are present. The WBC count is normal or reduced with relative or absolute lymphocytosis during the acute phase. Serologic testing is not reliable for C. canis.
PCR assay can be done on blood or any body tissue and can be positive as early as 10 days after inoculation.
Treatment
Doxycycline plus either rifampin, an aminoglycoside (streptomycin or gentamicin), or ciprofloxacin
Activity should be restricted in acute cases of brucellosis, with bed rest recommended during febrile episodes. Severe musculoskeletal pains, especially over the spine, may require analgesia. Brucella endocarditis often requires surgery in addition to antibiotic therapy.
If antibiotics are given, combination therapy is preferred because relapse rates with monotherapy are high. Doxycycline 100 mg po bid for 6 wk plus streptomycin 1 g IM q 12 to 24 h (or gentamicin 3 mg/kg IV once/day ) for 14 days lowers the rate of relapse. For uncomplicated cases, rifampin 600 to 900 mg po bid for 6 wk can be used instead of an aminoglycoside. Regimens using ciprofloxacin 500 mg po bid for 14 to 42 days plus rifampin or doxycycline instead of an aminoglycoside have been shown to be equally effective.
In children < 8 yr, trimethoprim/sulfamethoxazole (TMP/SMX) and oral rifampin for 4 to 6 wk have been used.
Neurobrucellosis and endocarditis require prolonged treatment.
Even with antibiotic treatment, about 5 to 15% of patients relapse, so all should be followed clinically and with repeat serologic titers for 1 yr.
Prevention
Pasteurization of milk helps prevent brucellosis. Cheese that is made from unpasteurized milk and is aged < 3 mo may be contaminated.
People handling animals or carcasses likely to be infected should wear goggles and rubber gloves and protect skin breaks from exposure. Programs to detect infection in animals, eliminate infected animals, and vaccinate young seronegative cattle and swine are required in the US and in several other countries.
There is no human vaccine; use of the animal vaccine (a live-attenuated preparation) in humans can cause infection. Immunity after human infection is short-lived, lasting about 2 yr.
Postexposure antibiotic prophylaxis is recommended for high-risk patients (eg, those who have unprotected exposure to infected animals or laboratory samples or who received animal vaccine). Regimens include doxycycline 100 mg po bid plus rifampin 600 mg po once/day for 3 wk; rifampin is not used for exposure to the vaccine with B. abortus (strain RB51), which is resistant to rifampin.
Key Points
Brucellosis is acquired by direct contact with secretions and excretions of infected animals or by ingestion of contaminated food or dairy products.
Infection typically causes fever and constitutional symptoms, but specific organs (eg, brain, meninges, heart, liver, bones) are rarely affected.
Most patients recover in 2 to 3 wk, even without treatment, but some develop subacute, intermittent, or chronic disease.
Diagnose using cultures of blood, bone marrow, or CSF and acute and convalescent serologic testing.
Treat most patients with 2 antibiotics, typically doxycycline plus either rifampin, an aminoglycoside, or ciprofloxacin; monitor patients up to 1 yr for relapse.
Coxsackie mycotlasmen je meni nepoznat, sve te enterovirusne infekcije prolaze spontano.
Nije mi poznato da se akutni hepatitis leči, a u prilogu vodič dobre prakse.
Bez pregleda nije baš uputno davati dijagnoze. Ipak idite kod infektologa na pregled.
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