What is taiga encephalitis. Taiga Encephalitis. When she appeared
On the territory of Eurasia, a number of flaviviruses carried by ticks were found. Many of them are known as cauteride diseases of farm animals, such as sheep fighters (in the UK).
The incidence of very strong geographical differences is characteristic. The main risk factors are to stay on nature and the use of raw milk, especially goat.
The incubation period lasts 7-14 days, perhaps longer.
Taiga Spring-summer encephalitis, as a rule, proceeds sharper and harder than Central European encephalitis, immediately starting with neurological symptoms. It is characterized by high mortality and high frequency of residual neurological defects, mainly sluggish palsy of the muscles of the neck, shoulder belt, shoulder and torso.
At an early stage of the disease, the virus can be isolated from the blood. After attaching neurological symptoms in the blood and IGM antibodies, IgM antibodies are detected. Sometimes at an early stage, thrombocytopenia develops, as in some other flavivirus infections transmitted by ixodic ticks (for example, in the disease of the cancean forest).
The etiotropic treatment of these infections does not exist.
In Austria, Germany and Russia, effective inactivated vaccines against tick-borne encephalitis with aluminum salts as an adjuvant are produced. The vaccine against the tick-borne encephalitis of Austrian production provides antiviral immunity if it is added twice with an interval of 0.5-3 months. The remaining vaccines are approximately as effective. In rare cases, vaccination is complicated by Guillana Barre syndrome, so it is shown only to people living in natural foci or visiting them in the spring-summer period.
In vitro neutralizing antibodies to the Central Encephalitis virus react with the taiga-summer encephalitis virus and vice versa, but whether vaccination provides cross-defense protection in the field, is unknown.
In natural foci, 0.2 to 4% of ticks are infected, so in the case of discovery on the body, the ticks arises about the immunoprophylaxis. It is possible to immediately resort to the introduction of immunoglobulin against tick-borne encephalitis, although its effectiveness has not been studied in controlled studies. In any case, the drug cannot be administered after the development of infection, as this may aggravate its current.
1. Mite Spring-Summer, or Taiga, Encephalitis (ENCEPHALITIS ACARLNA ORLENTALLS)Brief historical data. In certain areas, respectively, the natural foci of Spring-summer encephalitis undoubtedly met since the times of deep antiquity.
In 1935, the Soviet researcher A. G. Panov gave the first clinical description of this disease, and in 1937 by complex expeditions working in Taiga regions of Eastern Siberia under the leadership and with the participation of E. N. Pavlovsky, A. L. Smorodintsev, L . A. Zilbera, V. D. Solovyova, etc., issues of epidemiology, clinical picture and prevention of this disease were studied in detail. Selected strains of the pathogen - the filtering virus - then undergo a thorough study. Recently, methods of specific disease prophylaxis are being developed using a viral vaccine.
Etiology. The disease is caused by special types of filtering virus (ENCEPHALOPHILUS SILVESTRIS), pathogenic for humans, as well as for some types of monkeys. Heating up to 100 ° and the action of various disinfectants ceases the vital activity of the virus; The causative agent of merettes when it gets into an external environment.
Epidemiology. The mite spring-summer encephalitis is characterized by a pronounced natural foci, i.e., for its distribution, a certain set of climatic and soil conditions is needed, the presence of appropriate vegetation and terrain landscape, ensuring the possibility of the existence of carriers of infection - pasture ticks.
Tick-borne encephalitis occurs not only in the inhabitants of the Taiga districts, but also in other areas that are natural foci of infection; The economic development of forest arrays in these foci can be accompanied by the appearance of cases of disease.
Pathogenesis and pathological anatomy. Spreading the current of the blood from the site of the bite of a person with an infected tick, the filtering virus - the causative agent of the disease - quickly reaches the cells of the central nervous system, is introduced into them and causes degenerative changes.
Especially with "Nervous cells of the front horns of the cervical spinal cord and the core of the oblong brain are affected; along with necrotic and dystrophic changes in nerve cells, the picture of neuronophage is developing. Clinical picture. The incubation period continues on average about 2 weeks with fluctuations from 8 to 20 days. The disease begins acutely. After a small photo transmission, the temperature rises per day to 39.5-40 ° and keeps on these figures 5-7 days. At the end of the feverish period, the temperature is reduced critical "or accelerated lysis. Approximately one-third of all cases the temperature curve is two-wave.
During the first 2-3 days of the disease, harsh headaches are observed, breaking throughout the body, re-vomiting. When examining the patient, the attention of hyperemia of the face and conjunctiva stops. With a serious flow, consciousness is darkened, meningal phenomena are noted (the rigidity of the occipital muscles, the symptoms of Kernig and Brudzinsky). In the blood in patients with aezinophylline and lymphopenia. Frequently stubborn, the drowsiness of patients, relative bradycardia.
The spinal fluid is transparent, leaks under high pressure, the protein content and uniform elements in it compared with the norm increased; Panda reaction is positive. It is not uncommon to meningeal forms of the disease.
In some part of patients from the 2-3rd day of the disease, the sluggish paralysis of the upper limbs and muscles of the neck develop.
In serious cases of illness, there are such pathological phenomena as ambiguity of speech, accumulation, difficulty swallowing, depending on the lesion of the nuclei of the IX, X, XII pairs of cranial nerves in the brain stem.
After decreasing the temperature, the period of recovery begins, but not all patients are completely restored by motor functions - in a number of people who have undergone spring-summer encephalitis, resistant paralysis remains.
Sometimes tick-encephalitis leaks in atypical and very light shapes, but also the development of sluggish paralysis of persistent character is possible.
Transferred disease leaves durable immunity.
Forecast. Most patients have a favorable forecast for life. Female outcome is observed in 1-1.5% of cases; He may come on the 4-5th day of the disease or after a decrease in temperature. In some cases, paralysts of the neck muscles and the entire shoulder belt are developed (65).
Diagnosis. Given the epidemiological data (staying in the focus of encephalitis, tick bites) and a clinical picture (acute start with an increase in temperature, meningeal phenomena, the nature of the spinal fluid, the development of the 2-4th day of the disease of the sludge paralysis of the upper limbs and neck, as well as bulbar disorders In severe occasions), tick-borne encephalitis recognize.
Conducting a differential diagnosis, epidemic meningitis should be borne, poliomyelitis, raw tit, North Asian rickettsiosis (tick-borne rack).
From laboratory methods of confirmation of the diagnosis, virological studies have been developed: a complement binding reaction, detection in the serum of the patient with virus substralizing antibodies.
Treatment. Currently, a specific antiserum is used to treat tick-borne encephalitis (a sickness of 40-50 ml is introduced in the early durations of 40-50 ml per day for 2-3 days, with the first injection in the method described on page 73).
The specified serum is obtained by immunization of horses by the culture of the filtering virus - the causative agent of the disease.
An intravenous infusion of a 40% glucose solution is recommended daily by 40 ml inwards, an antihistamine DIMEDROL antihistamine preparation is 0.05 g 3 times a day for 5-6 days, intramuscular injections of vitamin Bi-thiamine bromide by 0.01-0.015 g Once a day for 10-12 days.
Each patient needs careful individual care. Assign an easily dismantled, high-calorie semi-liquid food, rich in vitamins, especially with and complex V.
Allow the recovery to get up from bed not earlier than 2 weeks after the temperature decreases.
With the development of sluggish paralysis, it is necessary to use physiotherapy and strictly dosed therapeutic physical culture.
Prevention. All persons working in the natural foci of tick-borne (spring-summer) encephalitis must examine the body 2 times a day and destroy the ticks sucking; And also inspect underwear and clothing. If we lubricate the skin in the place where the tick was suiced, then it can be easily removed.
To protect against tick bites, we need to wear special overalls, tightly covering the neck and brushes; Behind the overalls are sewn tightly, and in front of the double row of buttons. Cuff and overall collar lubricate with substances that scare ticks (dimethylphthalate or other scaping fluids). It is necessary to wear rubber boots; In the absence of their pants must be filled into leather boots. In places of people, people burn grass and fallen leaves and take all measures to destroy rodents. The terrain infected with ticks should be treated with DDT or hexahloran with aircraft.
An auxiliary role in the prevention of spring-summer encephalitis is played by vaccinations: a specific vaccine is administered subcutaneously, containing a weakened pathogen - a filter tick-borne encephalitis virus killed by formalin. Vaccine is introduced 2-3 ml with intervals of 7 days; Duration of immunity up to 1 year. Sanitary education is needed to live in areas with the natural foci of this infection.
2. Summer-autumn comlarn, Japanese, Encephalitis (ENCEPHALITIS JAPONICA)
The disease is caused by a special type of filtering virus (ENCEPHALOPHILUS JAPONICUS), which is transmitted to a healthy person with his mosquito bite. 6 different types of mosquitoes serve as carriers and infection reservoir. The disease is mainly distributed in Japan, individual cases of summer-autumn encephalitis were registered in the Far Eastern areas of the USSR. The period of the end of the summer and the beginning of the fall, when the maximum mosquito flutter occurs, is the season of diseases by mosquito encephalitis. There are diseases of domestic animals caused by the bite of infected mosquitoes.
With the bite of a person in contaminated Komar, the filtering virus penetrates the blood flow. The incubation period is 10-15 days. During the first 5 days of the disease, the causative agent can circulate in the patient's blood, contained in the spinal fluid.
The central nervous system is selectively affected by the virus with the development of edema and island changes of both the white and gray matter of the brain. Typically, the brain shells are affected. At the beginning of the disease after the chills, the temperature is rapidly rising, reaching 40-40.5 °. Then there are sharp headaches, the total drierness, meningeal and encephalitic symptoms, often consciousness darkened.
In some patients, severely pronounced general intoxication and general-based phenomena may proceed with the pattern of comatose states or with motor anxiety. The clinical course of the disease is short, the symptoms are developing very sharply. In the study of blood, relative lymphopod and aezosinophilia are found. In the spinal fluid, high pressure, increased cytosis and the increase in the amount of protein are detected.
With a favorable course of the disease, the temperature decreases to the 5-6th day, and the patient begins to recover. In severe cases, death is possible. Due to the absence of specific treatment, mortality is high.
Sometimes there are easily flowing atypical and erased forms of encephalitis, which are important in epidemiology. When making a diagnosis, it is necessary to take into account the stay in the endemic area, the season, the presence of mosquito bites and the symptoms of the clinical picture with the obligatory control of the spinal fluid.
From laboratory diagnostic methods, the complement binding reactions are used, the determination of virus-bearing antibodies in serum and in the spinal fluid.
All patients are subject to mandatory hospitalization.
Treatment. Attempts are made to use for the treatment obtained by immunization of horses by the culture of the pathogen antiserism (40-50 ml per day subcutaneously); However, due to its insufficient efficiency, it has maintained up to date, the value of symptomatic therapy (intravenous glucose infusion, subcutaneous infusion of the physiological solution, inward vitamins). It is advisable to appoint inside the prozer. - 0.015 g 2 times a day. With swallowing disorders use nutritional enemas.
Prevention is to apply the measures of individual protection of people from mosquitoes (see "Malaria" and "Pappatachi fever"), oiling of water bodies in the field of mosquito farms, the destruction of the latter by spraying powders and emulsions of DDT or hexahloran. A wide clearing of terrain is needed near settlements and parking people.
In the foci of infection of all persons subjected to the danger of infection, vaccinate the vaccine cooked from the brain of mice infected with the standard strain of the summer-autumn encephalitis virus; In this vaccine, the virus is killed by formalin.
Scientists of antiquities probably came across such severe pathology as Encephalitis, but since medical knowledge was only born, there were no exact diagnostic methods, and the views on microorganisms were absent at all, then the inflammatory processes of the brain, often accompanied by an increase in body temperature, simply refer to fevers, change Consciousness in which no one is surprised to this day.
As medical science develops, it has been accumulated fairly confirmation that inflammation is possible not only in the apparent fabrics, but also in the internal organs, and the brain is not an exception. Neurological symptoms Against the background of bright signs of intoxication and fever makes it possible to suspect encephalitis during the examination of the patient, although not always the exact cause of the disease is not always possible.
The causes and shapes of the brain inflammation are quite diverse, but a special place occupies a tick of encephalitis, which makes up a dangerous independence of the disease, often entailing a tragic outcome. We will pay particular attention to the tick-borne encephalitis.
Despite all the diversity of the causes and types of encephalitis, the manifestation of its rather stereotypes during the severe course of the disease, but if the inflammation of the nervous tissue accompanies other ailments, it is not so easy to recognize encephalitis. It happens, for example, that a change in consciousness, headache, vomiting and other signs of disadvantaged in the brain are written off on intoxication, fever, dehydration. By and large, if encephalitis is of a secondary character in other severe diseases and develops as a complication, then the patient is already obtaining a fairly wide range of drugs, and in the hospital there is an opportunity to quickly conduct relevant research. This can not be said about the special form of brain damage - tick-borne encephalitis. Tick \u200b\u200bbite not everyone raises the desire to explore it for the presence of infection, and then the disease can cause surprise.
The inflammation of the brain tissues is a difficult process that circumsides in the worst death to death, in the best - to gross changes in the activity of the nervous system and regular disability. A relatively favorable outcome at encephalitis, although it happens, but quite rare, so any suspicious symptoms regarding the brain lesion should not be ignored by the doctor.
Types and causes of inflammation in the brain
Depending on the cause, allocate:
- Encephalitis of infectious origin (viral, bacterial, fungal).
- Toxic encephalitis in poisoning by various poisons.
- Autoimmune encephalitis.
- Post.
In most cases, viruses or bacteria entering the brain with blood flow or lymph become the perpetrators of encephalitis. Some microorganisms immediately choose the nervous fabric as the most favorable habitat (neurotropic viruses), others come there with a serious flow of infectious disease of another localization.
With flu, measles, HIV infection, rubella or windmill, brain lesions are secondary and characteristic of severe forms of these diseases, while rabies, herpes viruses, tick-borne encephalitis initially choose the nervous tissue for its livelihoods without affecting other organs . Most neurotropic viruses tend to cause epidemic outbreaks of disease with a clear seasonality and geographic features. In hot countries with an abundance of blood-sucking insects, in a taiga, where the activity of the ticks is very high, the outbreaks of encephalitis are registered quite often, therefore the alertness among medical workers of these regions is extremely high in periods of maximum risk of infection, and the population is informed about the possible consequences of the disease and is actively vaccinated.
Bacterial encephalitis is somewhat less common, can proceed with purulent inflammation and involvement in the process of soft cerebral shell (meningoencephalitis).
The main way to spread the infection to the brain is the hematogenic (with a blood current), when, after the bite of a mosquito or tick, viruses fall into the bloodstream and sent to the nervous tissue. The contact-household path of transmission, air-dropleted (Herpes), alimentary with infection through the gastrointestinal tract (enteroviruses) is also not excluded.
However, microbes are not always the cause of brain damage. In terms of cases, encephalitis develops against the background of the toxic effects of different poisons (heavy metals, carbon monoxide), an autoimmune process, an allergic reaction.
Frequent vaccinations, non-compliance with the deadlines specified in the vaccination calendar, can also cause inflammation of the brain substance. ADHA vaccines are considered the most dangerous in this respect, against natural smallpox and rabies, which may contain live microorganisms and under certain conditions to cause complications in the form of brain lesions.
It is often not possible to establish a precise cause of the disease, therefore localization, prevalence and course of encephalitis are also taken into account. If the inflammatory process began initially in the brain, and the changes are limited to the nervous cloth, the encephalitis will be called primary. In this case, most often the culprit will be a neurotropic virus. On secondary encephalitis they say when there are prerequisites for subsequent brain involvement in the pathological process with other diseases: severely flowing cort or flu, imminent disorders, malignant tumors, autoimmune process, HIV infection, etc. The allocation of these forms is reflected in Subsequent tactics of patient treatment.
The inflammatory process can affect mainly white matter of the brain (leukoenetephalitis), or gray (Corra), then they talk about polymentiancephalitis. Inflammation and white, and gray substance, together with conductive nervous ways, is the most severe shape of the brain damage - pankencephalitis. In some cases, not only the substance of the brain is involved, but also its shell, in particular, vascular, such a state is called meningoencephalitis.
What happens during encephalitis?
Changes in the nervous tissue at encephalitis are rather stereotypes, and only in some cases it is possible to detect signs of a particular disease (rabies, for example). The value for the body and the consequences of any inflammatory changes in the brain are always serious, so do not once again remind of their danger.
Edema, hemorrhage, clusters of blood cells of inflammatory rows (leukocytes), the destruction of shells and neurons' processes themselves lead to irreversible changes, and the low ability of nervous tissue to regeneration does not give a patient a chance for a favorable outcome and restoring lost functions.
The structures of the subcortical nuclei, the white substance, the oblongable brain and the trunk, are often damaged, so manifestations are not limited to general-selling symptoms, and paralysis, respiratory disruption, function of the cardiovascular system, and so on.
In addition to damage to nerve cells, the patient's condition is aggravated by the increasing edema of the brain, which certainly accompanies any inflammation regardless of its nature and location. Increased in volume, the enemy brain is poorly felt in the cranial box, the intracranial pressure increases, and the patient's condition is progressively deteriorating. Along with the damage to the vital nerve centers, the edema can cause a fatal outcome for encephalitis.
In a bacterial infection, inflammation often acquires the character of the purulent, spreading on a soft cerebral shell. In such cases, in addition to the foci of purulent melting in the brain tissue, a peculiar "cap" is formed or, as elsewhere called, an "purulent cape", enveloping the already suffering brain. Such a state is very and very dangerous, and delay with medical help can cost life.
Manifestations of encephalitis
Signs of encephalitis are determined by the cause, localization of the focus of inflammation, the course of the disease, but in most cases, on the background of focal neurological changes, general symptoms of brain lesions are also expressed. These include:
- Headache, more often intense, throughout the head, without clear localization.
- Nausea and vomiting, which does not bring relief, which makes it possible to exclude the pathology of the gastrointestinal tract in favor of the brain.
- Violation of consciousness - from mild drill to coma with a loss of reaction to external stimuli.
- Cramps.
- Fever at which the temperature usually exceeds the threshold of 38 degrees and is poorly reduced, since it is associated with the damage to the corresponding structures of the brain.
Focal symptoms of encephalitis are predetermined by the fact that pathological changes are most pronounced in what the brain. Thus, patients can lose the ability to coordinate movements in the involvement of the cerebellum, vision disrupts when the occurrence of the occipital fraction, expressed changes in the intellectual sphere and behavioral reactions accompany inflammation in frontal fractions.
Encephalitis can occur in the form of a so-called abortive form, when the symptoms of brain lesions are limited to moderate pain in the head and the rigidity of the occipital muscles. If there are such symptoms, fever, signs of respiratory or gastrointestinal infection, it is necessary to investigate the spinal fluid to exclude the brain pathology.
Tick-borne encephalitis
Wrongs to learn a little more about inflammatory processes in the brain, it is not difficult to note that most of the information on this problem is devoted to the tick-borne encephalitis. This is not surprising, because the tick-like encephalitis, being an independent disease, is amazing absolutely healthy persons of any age and gender, and seasonality and massiness of infection by the causative agent of infection are forced to navigate the essence of the disease not only by health workers, but also from the risk group.
The danger of tick-borne encephalitis is that in almost all cases he leaves after himself persistent neurological violations that not only limit the subsequent vital activity of the passing, but also capable of pending his bed forever. In children, the disease occurs heavier than in adults, and residual phenomena and dangerous consequences can radically change the life of a small man far from the best side.
A bit of history
For the first time, published descriptions of the seasonal disease occurring with the defeat of the nervous system, appeared at the end of the XIX century. In the first third of the last century, large-scale scientific studies were conducted, which gave their fruits: the pathogen was highlighted (virus), a carrier (tick) was installed, a clinical picture of the illness was described in detail, approaches in treatment and, which is very important, preventive measures.
However, the study of tick-borne encephalitis, as well as any other infectious disease, has not passed without tragic episodes, when selfless work of scientists led to their death.
The development of Siberia and the Far East in the 30s of the last century, the development of industry and strengthening the border required the inflow to these regions of qualified personnel, and along with the construction of numerous correctional institutions led to the resettlement of a huge number of people for whom the climate and natural features of the terrain were alien. Sometimes the attention of A. G. Panova attracted mass outbursts of seasonal disease with the defeat of the central nervous system. Already in 1937, an expedition was organized under the guidance of Professor L. A. Zilbera, the participants of which came close to the study of the nature of encephalitis.
Thanks to the efforts of virologists, infectiousists, with the active assistance of Khabarovsky neurologists, who did not have a hazardous disease, the infection was established, which turned out to be a virus, as well as the most likely carrier - an Xodek mite, a favorite habitat of which taiga regions are considered.
The disease did not gear anyone. Most of those whom the tick bites were raised by encephalitis, and the risk of death remained and remains rather high. Among those affected by a cunning infection, many scientists, employees of virological laboratories, doctors who conducted research on field conditions. Thus, one of the primaries of the virus nature of the tick-borne encephalitis M. P. Chumakov became infected during the opening of the deceased patient. The acute form of the disease was replaced by chronic and pursued a scientist until the end of life. Without looking at the hearing impairment and motor disorders, Academician of Chumakov continued to actively work for many years, and his body bequeathed to study the chronic form of encephalitis, which took his decades. One of the entomologists, B. I. Pomeranians, which carried out the search of the infection carrier, died after the tick bite from the severe form of encephalitis.
Not without politics. Shortly after the start of the expedition, its head was arrested, Professor Zilber and two more employees, who were suspected of spreading Japanese encephalitis in the region, however, the charge was false, and 1937 was marked by the discovery of the tick-borne encephalitis virus due to the selfless Russian scientist.
Where does an infection come from?
As noted above, tick-free encephalitis is distributed in the forest and forest-steppe zones of Siberia, the Urals, the Far East, in many countries of the Central and Western part of the Eurasian continent (France, Germany, Poland, Belarus, the Baltic region). Cases of tick-borne encephalitis are also fixed in Mongolia and the wooded part of China. Every year only in Russia for medical help after the tick bite, more than half a million people are treated, among which there are children. The infection is particularly hard for residents of the Far East, where the frequency of severe complications and deaths is especially high.
In nature, the tick-borne encephalitis virus is found in animals and birds - rodents, wolves, moose, large livestock, which serve as a power source for ticks, infecting them at the same time. The person among them turns out to be accidentally, but for the tick does not matter whose blood it will eat and to whom the virus will give.
There is a pronounced seasonality of the disease, whose peak falls on the spring-summer period. The culprits of this are also anodic ticks, which, after a long winter hibernation, crawl into the surface and start hunting. Ticks are hunting in the literal sense, that is, wait for the victim and attack.
Hungry ticks prefer to expect prey in shady shrubs or grass, crawling out of a forest litter and spreading up to a height of one and a half meters. This is happening if the forest is visited, but it must be remembered that the tick and himself can "come" to the house: with flowers, branches, clothes, pets, so even a family member, avoiding forestry walks can suffer.
Thanks to the ability to feel the change in the concentration of carbon dioxide in the environment and thermal radiation, the tick accurately determines the approach of the food source and attacks. Without having the ability to jump or fly, he clings or falls on his sacrifice. On the human body, the tick is always crawling up, reaching fine and delicate skin of the neck, abdomen, chest, axillary zones. Since in the saliva insects there are substances with anticoagulant and anesthetic properties, the bite can not be noticeable immediately, so it will not work out as a mosquito or midge. Moreover, if the females are embarrassed for a long period of time, the males do it quickly, therefore the tick bite itself can pass unnoticed, then the reason for the disabilities and the subsequent development of the disease is not at all. The female may remain on the human body for many days, and only sprawling with blood and having increased in weight in a few dozen, and even one hundred times, leaves the sacrifice.
The risk group on viral tick-borne encephalitis can be attributed to foresters and other workers, whose activity is related to visiting forests, geologists, road builders, tourists, avid lovers to collect mushrooms and berries or just walk and arrange picnics in nature. In endemic to encephalitis, regions may be unsafe.
You can get tick-borne encephalitis not only in the forest, but also in urban parks and squares, in garden and summer cottages. It is worth remembering about this, intending to walk in the shade of trees, even within the city feature.
In addition to the transmissible path of transmission of infection (through the insect bite), cases of infection with the use of raw goat or cow's milk are described. It happens in children who give raw milk of private squeezing. Boil destroys the encephalitis virus, so you should not neglected such a simple procedure, especially when it comes to the smallest.
Features of the flow of tick-borne encephalitis
The tick-borne encephalitis virus, hitting the bloodstream, is directed to the nervous tissue, hitting the brain bark, white substance, subcortical nuclei, cranial nerves, spinal roots, causing paresis and paralysis, change of sensitivity. The involvement of various brain structures may cause seizures, disturbances of consciousness up to coma, brain edema. The older the patient, the higher the risk of complications and severe disease, and after 60 years, the likelihood of death is especially high.
Like any other infection, tick-borne encephalitis takes place with a hidden period, during which signs of the disease may not be at all.
On average, the incubation period lasts 1-2 weeks, a maximum of 30 days, when the infection pathogen is repaid hard in the human body. By the end of the hidden flow, weakness, driers, lubrication in the body, temperature rise, that is, the symptoms characteristic of many infectious diseases, so it is so important to establish a tick bite, because it is not so easy to suspect encephalitis in such cases.
Depending on the predominance of one or another sign of the disease, the shape of the flow of tick-borne encephalitis was highlighted:
- Feverish.
- Meningheal.
- With focal damage to nervous tissue.
- Chronic flow options.
The first three forms refer to acute encephalitis, and the share of feverish and meningeal varieties accounts for about 90% of all cases of disease. Much less often is diagnosed with chronic mite encephalitis, which can leak over the years, continuously progressing and leading to persistent neurological disorders.
Without focusing on the detailed description of all sorts of symptoms of damage to the nervous system, it is worth indicating the development of three main syndromes in patients:
- Common infectious nature.
- Meningheal.
- Syndrome of focal pathology of the nervous system.
Signs of a general infectious nature are associated with enhanced breeding of the virus and its propagation not only in nervous tissue, but also other parenchymal organs, as well as the impact on the walls of the vessels. In patients there is a strong fever with a temperature rise of up to 39-40 degrees, chills, weakness, pain in the muscles and bones, dyspeptic disorders are possible.
Meningkeal syndrome is associated with the lesion of a soft cerebral shell and an increase in intracranial pressure. It includes the strongest headache, nausea, multiple vomiting, not bringing relief, violation of consciousness, photophobia, convulsions, psychomotor arousal.
The syndrome of focal neurological disorders is associated with damage to the specific departments of the nervous system and manifests itself by paralymps, paresis, the sensitivity impairment and function of the cardiovascular, respiratory system, convulsive syndrome.
The feverish form of the disease is characterized by a favorable forecast and rapid recovery. This is the most soft form of the flow of tick-borne encephalitis, which flows almost without damaging the virus of the nervous tissue. Symptoms are reduced to an increase in temperature, general features of the infectious process (nausea, weakness, headache). Fever and flu-like changes are holding around three to five days, after which the recovery begins.
The meningeal version of the course of encephalitis is considered the most frequent, and manifestations are in headaches, pain in the eyes, nausea and vomit. In addition to characteristic symptoms, it is possible to detect changes in the spinal fluid. Signs of lesion of brain shells in the form of muscle rigidity and other meningeal symptoms will easily determine the health worker of any specialty, so the diagnosis of this form of the disease after the tick bite does not cause great difficulties. Fever lasts about one or two weeks, and then recovery comes. The meningadeal form is considered favorable, although the consequences in the form of headaches can accompany the patient for quite a long time.
The shape of the tick-borne encephalitis with focal neurological disorders is the rare and, at the same time, the most severe for the flow and consequences. Mortality with it reaches 40% with the Far Eastern infection type. With the simultaneous lesion of the brain shells and the brain substance (meningoencephalitis) the course of the disease is very heavy: fever, nausea and vomiting, headache, convulsions up to Epistatus, violation of consciousness in the form of nonsense, hallucinations, coma. The recovery process is delayed up to 2 years or more, and the consequences in the form of paralysis and muscle atrophy are stored for life.
In addition to large hemispheres, the brain trunk is damaged, spinal roots and peripheral nerves. These cases are accompanied by persistent paralysis, strong pain syndrome and inevitably lead to serious violations that converts a previously healthy person in a disabled person, chained to bed, which is not able to move and even speak. Such patients remain deep disabled people, followed by constant care and observation, because even the reception of food turns into a problem.
In children, the disease proceeds hard and more often registered in boys of younger school age. Forms of the flow of infection are similar to those described for adults. The symptoms of brain lesions are developing rapidly and leave the consequences in the form of epilepsy, paralysis, etc. In children more often than in adults, complications are observed in the form of convulsive syndrome and hyperkinesov - involuntary excessive movements with limb, head, torso, which are sometimes lifeline. Since the child often does not know about the danger of tick bites, and even more so, it does not explore carefully skin cover after walking in the forest or park, the task of prevention and timely detection of bloodsowing insects lies on their parents.
Video: Consequences of tick-borne encephalitis
Identification and treatment of tick-borne encephalitis
The diagnosis of encephalitis is based on a characteristic clinical picture, data on the visits to forests, the presence of the fact of suction of the tick. Laboratory methods are used to confirm the diagnosis, allowing to detect specific antibodies (proteins) that are generated in the patient's body in response to the introduction of the virus. When applying to a doctor, the first thing to do with the patient will be offered to pass the blood in which increased leukocytes, accelerated ESP, can be detected, but these changes are non-specific and accompany many other diseases, so it is important to carry out serological studies on the search for antibodies.
No less important is the analysis of a liquor, in which the content of lymphocytes and protein increases, and the leakage of it under pressure indicates intracranial hypertension. It is worth noting that it is not always possible to investigate the spinal fluid. For example, at a coma and violations of the function of the oblong brain, this manipulation is contraindicated, and the doctors are forced to wait for the stabilization of the patient's condition. At the same time, with a relatively light fevering form of the disease, there are no changes in the liquor, and the diagnosis is based on the search for antiviral antibodies.
An invaluable benefit may bring an analysis of the tick for the presence of a tick-borne encephalitis virus in it, so it is not easy to remove it when it is detected on the body, and also save and transfer to the appropriate laboratory. If concerns about the infection of the tick are confirmed, that is, the ability to prevent the disease in advance and begin treatment as early as possible.
Treatment of tick-borne encephalitis requires mandatory hospitalization into the separation of intensive therapy. Patients showing a strict bed regime with a minimum of all sorts of stimuli. Rational nutrition plays an important role, especially since the infection is accompanied by a violation of the function of digestive organs.
Assignable therapy includes:
Video: What to do after transferred encephalitis?
Prevention of tick-borne encephalitis
The rule "the disease is easier to prevent than to treat" works very well with regard to tick-borne infections, and therefore preventive measures are of paramount importance in the foci of dissemination of the disease.
The prevention of tick-borne encephalitis includes nonspecific measures that it is desirable to follow and know those who live in dangerous areas and attend the habitat of ticks. Specific prophylaxis is to use vaccines on developed schemes.
When visiting forests and other habitats of ticks, you need to comply with simple rules:
- Clothes should be as closed as possible, overalls are preferred, mandatory cake or cap, and the neck and head is better protected by a hood. Collar, sleeveless cuffs, socks must fit tightly to the skin surface. If possible, we should wear light and monophonic clothes so that in the event of a tick attack, it was easier to notice. Houses of clothing need to shake and desirable to leave her away from the residential premises;
- It is useful as often as possible inspecting the skin not only itself, but also to ask others, because the head of the head, the back, the rear surface of the neck is quite problematic to carefully consider even with the help of a mirror;
- Plants and other items brought from the forest may well become a source of a tick for all family members, therefore it is better to avoid similar "souvenirs". Pets must also be examined, because they can become a victim of "bloodsuckers";
- If necessary, overnight in the forest, it is better to choose seats without grass, open areas with sandy soil to minimize the likelihood of tick attack;
- The use of repellents applied to the skin, as well as acaricides for clothing processing helps to protect against insects, so do not be neglected by this method of prevention. Children should handle adults, and when walking with kids, you need to take into account their tendency to shove your fingers into the mouth, so it is better to leave the hand brushes without processing.
If the tick then attacked, then it is necessary to remove it correctly either contact the medical institution (an injury, ambulance station). At home, to extract the "blood blood", the place of the bite is allowed to lubricate with vegetable oil, and ticks to capture with tweezers or thread, riding it around the neck, while making swing movements, as if unscrewing the insect of the skin. It happens that when trying to remove the tick, the body breaks it off, and the head remains in the skin. In such cases, it is necessary to immediately access the specialist, since the risk of infection is maintained.
The specific prevention of tick-borne encephalitis consists in vaccination of the population of endemic areas of the area, as well as visitors. Among the locals, the proportion of vaccinated should not be below 95%, and special attention is paid to persons whose professional activities are related to the habitat of ticks.
The standard of vaccine-philaxis is considered to be the introduction of the drug twice with subsequent revaccination once a year. The effect will be in the event that vaccination has been carried out at least two weeks before departure to endemic focus or before the epidemic season. Vaccination from tick-borne encephalitis can be made both in case of suction of the tick and the planned according to the standard scheme, which implies a minimum of one revaccination. Emergency prevention is carried out in the first day after the insect bite.
In addition to tick-borne encephalitis, there are, although much less often, secondary inflammatory processes in the brain, complicating the course of other diseases - the tumors of the hematopoietic system, sepsis, measles and windmills, traumatic damage. Approaches to therapy with such states are determined by the nature of the underlying disease and symptoms of brain lesion.
In the case of tickless infections, vigilance and caution when visiting the habitat of blood-sucking insects, timely detection and removal of the tick, vaccination and early appeal to the specialists largely allow to reduce the risk of infection, as well as to improve the results of therapy in the development of encephalitis.
Video: Encephalitis in the program "Live Great!"
The mite encephalitis is a viral natural-based disease with the defeat of the central nervous system. The causative agent of tick-borne encephalitis is a tick-borne encephalitis virus related to the group of arboviruses.
It has varying degrees of sustainability. When heated to 60 ° C dies for 10 minutes, with boiling - 2 minutes. Quickly destroyed with ultraviolet irradiation, exposure
disinfectants.
Distinguishable nosogeographic species: East, Western and two-wave. The carrier of the pathogen of fever is the ixodic ticks:
Ixodes Persulcatus prevails in the eastern regions;
Ixodes Ricinus lives in Western regions.
3-6 days after the blood circulation of the infected animal, the virus penetrates into all the organs of the tick, concentrating in the sexual apparatus and salivary glands. The virus lives in the glue for 2-4 years. In various locations, the infection of the tick reaches from 1 to 20%.
The tank of the tick-borne encephalitis virus is rodents, wild mammals and some birds.
The contamination of a person occurs when biteing by infected ticks. The longer the bloodsuit, the greater the likelihood of infection.
When crushing the ticks, infection can occur through damaged skin, mucous membranes of the eye.
There is also an alimentary path of infection: when eating raw goat or cow's milk.
The following types of diseases are distinguished:
Natural foci in wildlife conditions;
Foci, resulting from human economic activities;
Secondary foci - near settlements, when ticks live on pets.
In Russia, tick-earth encephalitis is registered in the Far East, the Urals, in Siberia, the European part of Russia.
Piczabasablasia falls on May, July, the end of the autumn.
This is due to an increase in the number and increasing tick activity.
The entrance gate at the bite of the tick is the skin, and with an alimentary path of transmission - the mucous membrane of the digestive tract.
The virus hematogenically and lymphogenously enters the internal organs, the central nervous system, causing an inflammatory response in the nerve cells. A gray substance of the head and spinal cord is involved in the pathological process, including motor neurons of the spine and brain (brain barrel).
The incubation period lasts from 3 to 21 days.
Currently, preventive vaccinations in epidemiological indications are carried out in areas endemic in tick-borne encephalitis.
Population living in an enzyotic terrain on tick-borne encephalitis;
The persons who arrived on this territory performing the following works: agricultural, hydro-elevative, construction, in the excavation and movement of soil, procurement, comradized, geological, deratization, disinsectional;
Faces working on logging, leather clearing;
Persons operating with the creation of tick-borne encephalitis causative cultures.
Vaccination is carried out from four years of age, revaccination - after 1 year, then every 3 years.
There are several varieties of vaccine against tick-borne encephalitis (Table.
Table 33. Vaccines against tick-borne encephalitis
|
Emergency prevention of tick-borne encephalitis is carried out by an immunoglobulin of a person against tick-borne encephalitis (Russia). It is produced in ampoules of 1.0 ml.
For the prevention of tick-borne encephalitis, the dose is 0.1 ml / kg of body weight, after the tick bite, 0.1 ml / kg is introduced no later than 4 days (Table 34).
The protective effect of the vaccine manifests itself after 24 hours and persists within 1 month.
Table 34. Schemes for using tick-borne encephalitis vaccine
| Name | Permissible | Period of Vlkdiniyin | Period revakshchtshіn |
||||||||||||||
| Vaccine For maple encephalitis for adults and children | From 3 years | Subcutaneously and deltoid we seek I spring - 0.3 ml. II accele - 0.3 md | After 1 year, IT to least 1 3 years | ||||||||||||||
| Enipei R. | From 3 years | In] | Moodscs4] 10. I spring - 0.3 mil. II OSєEIMIO - 0.3 ml | After 1 year, ISM must 1 3 × | ||||||||||||||
| FSM E- 11 mm mind | Older 16 l p | Intramuscularly 1 and II VACPNNAIN NI ^ 5 MD interval 1-3 months. ILL - except 1 3- 12 months | 3 years | ||||||||||||||
| FSM E- Immun | C (- ■ months] [Universal infection is universal, but most infected people proceed in the form of asymptomatic carriage. In the place of introducing meningococcal infection, the inflammatory process develops, meningococcus penetrates into the blood, meningococcum develops. When the meningococci penetration is hematogenically, when they fall into the subarachnoid space, there is inflammation of the brain shells, in the future the inflammatory process is localized on the surface of large hemispheres and the base of the brain and in the spinal cord. The duration of the incubation period is from 1 to 10 days. The clinically primary localized forms are distinguished: Meningococcality; Acute naphorgitis; Pneumonia. Hematogenous-generalized forms are also found: Meningococcum; Meningitis; Meningococcum and meningitis; Rare forms that are manifested by endocarditis, arthritis, iridocykpit. In severe cases, the inflammatory process captures the brainstant. In the process of reverse development, the connecting and wedding rebirth of inflammatory changes occurs. This leads to the development of the adhesive process, oblusting peri vascular paths. In addition to activities aimed at sources of infection, activities in the focus, an increase in non-specific sustainability of people is used by active immunization with the help of meningococcal vaccines, in particular polysaccharide vaccines A and C, as well as vaccines from the group of group B (Table 35). The following categories of persons are subject to vaccinations: Children over 2 years old; Teens and adults in the foci of infection caused by meningococcus A and C; Persons of increased risk of infection, which include: children of children's preschool institutions, students of the 1st school classes, teenagers from organized teams united by a hostel; Children from family hostels in disadvantaged sanitary epidemiological conditions with increasing incidence of 2 times. Vaccinations are made from 1 year old, revaccination is carried out in 3 years. Table 35. Applied Meningococcal Vaccines
Vaccines of types A and C create immunity in children over 2 years old, which is preserved for 3 years. Immunization of the entire population Vaccine A + C is carried out with a sharp rise in incidence. Such vaccination is carried out in the foci of infection. Usually vaccination is carried out in the first 5 days after contact. In accordance with the order of the Ministry of Health of the Russian Federation No. 375 children from the center of meningitis under the age of 7 years it is recommended to introduce immunoglobulin human: under the age of 2 years at a dose of 1.5 ml, over 2 years - 3 ml. PostAscital reaction When vaccine vaccine type A, local sickness and hyperemia of the skin are noted, the temperature is rare to subfebrile numbers. These symptoms disappear in 2 days. Vaccine A + C (Meningo A + C) gives little reactions. Mentsevak ACWY can cause a local response in the form of redness, soreness at the injection site. |
- Who is this - the taiga enemy?
This terrible disease, called "Taiga Encephalitis", struck the brain of people. I discovered it in the Siberian Taiga, where more than half of the sick died.
- When did she appear?
The development of Siberia in the pre-war years was accompanied by the arrival of a large number of people from the European part of the country. They were victims of the disease.
In the years of the first five-year plans, our country, which began unprecedented in spisup, the construction of heavy industry enterprises needed a large amount of raw materials - coal, ores, oil. Inventory reserves in Western areas were limited, it was necessary to look for new deposits.
The Soviet government allocated huge funds for the development of the uncharted regions of Siberia and the Far East. In Taiga, the first detachments of scouts went: geologists, engineers, topographers. They were looking for ore deposits, oil, coal and other minerals. The construction of new villages and cities began.
Troubled it was time. Our country has strengthened its oriental borders, fearing the attacks of Japanese militarists. Dozens of echelons with people moved to the east. They were brought by builders and workers engineers.
A large number of volunteers traveled on the call of the party to build new cities in the taiga, laying roads, develop riches of subsoil, erect power plants, develop endless Siberian expanses. In Taiga, everyone had enough space.
Already in 1934 and 1935, reports from neuropathologists A. Panova and A. Shapoval, who worked in the Far East, began to receive messages from the Far East, which among people who mastered Taiga, had some new, unknown illness. Hundreds of man fell ill. The incomprehensible disease hit the brain and the human motor system.
The disease began with the hardest convulsions, the strongest headache, vomiting, clouding, and then the loss of consciousness. Very often the tragic end was assumed: paralysis developed, and after him death. Testing painful suffering, died every third-fourth sick. The hands or feet corrected were paralyzed, the neck did not hold her head, many lost her ear. Young, strong, healthy people have turned into heavy disabled people for several days.
Doctors understood that some kind of pathogenic began strikes the brain sections, murdering muscles, vision or hearing. Here, perhaps, everything that was known about the mysterious disease.
Military doctors noted two features. The disease, as a rule, arose only in the warm season, in spring and summer. With the onset of the fall, the disease stopped, and in winter the disease completely disappeared, so that the next spring arise again. Later for this reason, she was called: "Spring-Summer Taiga Encephalitis."
Another feature: the young, the most stronger. The disease was striking mostly only people who came to Taiga, not local residents. The cause of the disease was unknown. How and what it was called, incomprehensible. Old-timers said only that in certain areas of the taiga it is impossible to walk: death is lost, and local residents bypass them. However, now people had to go there and walked. The disease sometimes hit the whole detachments of pioneers.
One massive case of incomprehensible illness was San in 1934, when a party of topographers and geologists suffered in the taiga. Twenty people, landing out of the train in the Khabarovsk area, loaded horses and went for intelligence in Taiga. On the road, the expedition stayed for the night in several villages, and then deepened in the Taiga Debrist. Topographers were supposed to make maps of this area, and geologists lead the searches for valuable minerals. It was at the beginning of summer.
Taiga met an expedition to fresh greens and flowers. Everything seemed interesting and tempting. Young people rejoiced to interesting work that expected them.
Two weeks later, two saddled horses returned from the Taiga. At one of them was a person unconscious in very serious condition. He was placed in the hospital. For five days, no one for a minute leaving him one, doctors and sisters fought with death, trying to save the patient. But nothing helped.
And what could they do if no doctor knew how to cure from this nobody did not know the disease. She overtook the young man immediately, and now, a week later, a mysterious microbe, quickly spreading, spread throughout the body, struck the nervous system, reached the most important life centers. Indecent hordes of small enemies have been commissioned in the human body.
In search of the geological party, several detachments of redarmeys with conductors from local hunters were sent. Searches lasted about a week, and finally found the geologists camp. At the edge of the forest, at the stream, there were tents, horses were peacefully grained, but people who could tell about misfortune, did not turn out in the camp. All geologists were in the tents, most of the already died, and the rest were unconscious. Alive brought to the hospital and have been treated for a long time.
First, doctors thought that people got sick with heavy flu, since the disease struck everyone at the same time. However, later, when they became corrected, it was found that most developed heavy paralysis hands, feet, neck muscles and backs. It became clear that the disease was struck by the brain and in nature, the encephalitis are already known at that time - inflammation of the brain.
Then the outbreaks of this disease became increasingly discussed in various parts of Siberia, where geologists worked, looking for minerals, topographers that laid new routes in the taiga, builders who prevail bridges, roads and new villages. The disease was amazed and the detachments of the Red Army, who were placed in the taiga, guarded and strengthened our border.
Many died, others became disabled. Thousands of people threatened the danger. No serums and drugs for the treatment of new disease science did not know.
By 1937, such a situation was formed that the task of the development of Siberian wealth, its expanses and subsoil was posed under threat of a breakdown. People were afraid to go to Taiga, because many of them from there were either not returned, or remained for the whole life with paralyzed or deaf cripples. The disease blocked the road in Taiga.
- What was done?
- All possible and even impossible.
"But it was very dangerous, right?"
Yes, and some scientists paid their lives or health. Now their names know the whole world, more precisely, the scientist world. After all, people quickly forget, and more often do not know at all, which is happening behind the walls of the laboratories.
The study of Taiga Encephalitis has become one of the most exciting pages of the history of Soviet medicine. In Taiga, fearless doctors and virologist scientists went. It was truly obsessed people, and they went to Siberia to reveal the mystery. The time was released minimal, time is given tough. They were obliged to find the cause that caused the death of thousands of people. But it was important to make not only it; The main task of researchers was the development of funds for the prevention and treatment of the hardest disease, the creation of a drug for reliable protection of people who went to the Far East of hundreds of thousands of people.
In those years, there were only two laboratories in our country who studied viral diseases in humans. In Moscow, there was the Central Virological Laboratory of Naroscital RSFSR, and led it a famous scientist, Professor L. Zilber. There were also very young virologists E. Levkovich, M. Chumakov, A. Shubladze. In Leningrad, at the Institute of Epidemiology and Microbiology named after L. Pasteur, the department of virology and bacteriology was led by Professor A. Smorodintsev, who was then 36 years old. His faithful associates were A. Drobyshevskaya, O. Chalkina, V. Korshunova, with whom he studied the flu and made the world's first vaccine vaccine.
From 1937 to 1940, the Soviet government and the drug addict of the USSR regularly sent to the Taiga Debrist of the Far East of the Expedition of Researchers to study encephalitis.
There were four such expeditions. The first was led by Professor L. Zilber, and the remaining three is Professor A. Smorodintsev. Entomologists, who were looking for insects - infection carriers, commanded a military doctor, a famous specialist in this area - Academician E. Pavlovsky.
Without thinking, left the scientists from Moscow and Leningrad, sparkling the surgical laboratory, the quiet, filled with the Spring Sun of the libraries' halls and went east to the taiga wilderness to fight the unknown enemy. Brave researchers did not have any means of protection against the mysterious enemy. Many employees of these expeditions paid their health, even their own lives for the right to reveal the secret and defeat the causes of severe ailment.
The first expedition headed in the spring of 1937 to the Far East from Moscow. Together with researchers, several thousand small four-legged expedition participants were driving: mice, guinea pigs, rabbits. The long way was to pass: after all, at the time of the train to Khabarovsk walked 13 days.
From the very beginning, the expedition was divided into two detachments.
The northern squad on arrival at the destination should have remained in Khabarovsk, study all reports on the mysterious disease, to engage in supply and organization. This detachment was headed by the head of the expedition L. Zilber. The southern detachment was led by a young woman - Virologist E. Levkovich. They uploaded to the Eval Station and deepened in Taiga. There was a continuous rain, the road was splashing. It was necessary to hide well from the rain and the cold of animals. In addition to animals, scientists brought with them in taiga and complex equipment: thermostats, glacier, centrifuge, microscopes.
Immediately, at the arrival, the expedition settled in the logger of lumberjacks, where several new houses were built, tents were stretched. They put houses for Big Vivaria, where the cells were placed with laboratory animals, on which scientists were going to conduct experiments, looking for a pathogen of a mysterious disease.
The expedition worked under difficult conditions. Sleep accounted for in bad barracks, not protected from heat or rain. Mosquitoes and Moshcar clouds attacked people. In one of the houses lost among swamp trees, they arranged a laboratory, nearby the Taiga hospital was located.
People who have suffered a terrible disease and remaining crippled in the hospital. Most of them were pale, thin, with twisted spinal cubs, drooped heads, sideways. Some were paralyzed hands, others - legs. A very many rumors were amazed, there was a common weakness, apathy, memory loss.
The work began with the analysis of the histories of the disease and survey of persecuted. Already soon after arriving at the Far East of the expedition, it was possible to establish that people who communicated with a sick person were never ill. A healthy person directly from the patient was not infected: it was confirmed by the observations of family members of the families, for medical personnel who treated them. It should look for some other ways to transmit infection from one person to another.
Found prey brought to the laboratory, and there Virology took blood from animals, then they pulled them, removed the lungs, liver, spleen, brain and other organs, rubbed them into mortars, prepared tissue suspensions. From the insects also prepared suspensions, and all these materials were infected, they infected and infected all new and new laboratory animals from the morning to the evening.
The materials were injected into the blood and through the mouth, made injections into the brain and in the abdominal cavity. After all, no one knew where the pathogen of a mysterious disease can be the pathogen and what way to introduce it to a laboratory animal. They did not know and what to choose animals - mice, rats, guinea pigs, rabbits or monkeys - so that they have a disease that seems to have been observed in people.
They did not find dead animals in the taiga, and this testified that the disease does not hit animals, even if the pathogen is in their body. You can imagine this tremendous work. After all, even if the infection is hidden in some chipmunk or protein, it is not necessarily sits in that animal, which scientists caught. Maybe only every hundredth or thousandth is infected with forest animals, and maybe they are even less likely.
Days and nights satisfied researchers in a small laboratory. Thousands of mice passed through their hands. Animals methyl, infected, were distributed through cells, the surveillance and recorded the results in laboratory magazines.
Somehow, torrential rains began in the midst of work. The swollen river broke through the dam, the water penetrated the vivarium, to the room where animals were located. The results of multi-month observations were threatened. Working on the belt in the water, scientists pulled the cells with mice and rabbits into the land.
By making many analyzes and sowing of patients with patients, the expedition found that conventional microbes are not clear in the occurrence of encephalitis: there were no such microbes in the blood of patients. It remained only to suspect the viral nature of the disease.
Where do patients with encephalitis should be an alleged virus? - asked themselves the question of scientists. According to the logic of things, the answer was one: not otherwise as in the brain.
To test this assumption, scientists have opened the people who died from the encephalitis of people, took their head and spinal cord fabrics, prepared a suspension and infected with laboratory animals. After 8-10 days, part of the mice fell ill. They lay helpless, with paralyzed legs. Mice developed typical paralyts, then the animals began to die. This testified that the infectious beginning is indeed in the brain of the sick people.
Scientists took the brain of the sick mice, rubbed it, prepared a suspension and filtered it through porcelain filters that did not miss the microbes. The filtrate was infected with fresh mice. They developed encephalitis, which confirmed the assumption of the viral nature of the disease. The first strains of the encephalitis virus were highlighted almost simultaneously in the northern detachment of E. Levkovich and M. Chumakov and in the southern detachment of A. Shebolda-How, A. Shubladze and L. Zilber.
The danger that lasted the researchers at every step, made it felt. The first misfortune happened in August 1937 with one of the Virologists of the Expedition, a completely young man M. Chumakov.
Two years before departure to the expedition, he defended his master's thesis on microbiology, and now the disease overtook him. Chumakov fell ill with typical encephalitis. In the hardest condition, he was taken from the taiga first to the hospital in Khabarovsk, and then taken to Moscow. It turned out that the virus, followed by the scientist hunted and finally caught, leaving him and penetrated the brain.
M. Chumakova rescued, having grabbed him, cooked from the blood recovered after the human encephalitis. However, Chumakov has a hearing impairment and hand paralysis. Infection in this case occurred at the opening of the corpse or during the experiments of the ticks on the encephalitis infected with the encephalitis virus and forest bevels.
The entomologists in the taiga continued to hunt the ticks, mosquitoes, blindders and other insects, and Moshcar, in turn, hunted people. Brownish hungry insects have been thrown on the live bait from all sides, as scientists sat calmly, exposing one hand to not screaming the midges. When the insect attached to get drunk, he was carefully filmed and lowered into the test tube. Excoring from the heat, said with gnus, people often felt that they were close to fainting. But their poses were invariably calm, and movements are careful and accurate.
For several hours, entomologists hunting in the forest, getting the necessary material. In addition to flying, they collected and crawling bloodsuckers - ticks. They were filmed from livestock, which is published in the glades near the bonfires, scaring Moshkar. The ticks were wanted in the grass, making it, and then protracted. This monotonous work was carried out day after day. In the end, it was possible to draw the curves of the appearance and disappearance of certain insects.
Doctors were sitting in local hospitals, studying the history of disease.
And finally, the work gave some fruit. It was established that at all past years the diseases happened only in the spring-summer period. Scientists accounted for a special curve of the appearance of the disease, the development of the greatest number of cases, and then disappear. When comparing curves, it turned out that the disease appeared no earlier than in the first decade of May. Consequently, Encephalitis infection occurred even earlier - in mid-April. And blinded, for example, started to fly only at the end of May and could not be carriers of the disease.
From the very beginning, scientists thought that the disease was distributed by mosquitoes. Comers are generally an unimportant reputation. However, much has not been linked to the true position of things. Mosquitoes are paid only in the summer: their earliest appearance is marked in the second decade of May. In addition, they live in raw places. Cases of encephalitis always appeared in the spring and hit many people where there were no swamps and in mom.
In the end, suspicion fell on ticks. Many people who, fortunately did not die, but recovered, told that, before sick, were bugged by ticks. Yes, and in time, everything coincided: it was in the spring that the reproduction of most ticks occurred. Only one snag remained: dozens of various types of ticks lived in a taiga, and which of them could be infectious was unknown.
Indirect guidelines for the tick-over transfer of encephalitis to people, the ability of ticks to receive a virus from a sick animal and transmitting it to a fresh animal through a bite was obtained in 1937 M. Chumakov.
The study of ticks continued.
It was traced that the tick female laying eggs in the ground. The larvae hang out of the eggs. Hungry larva climbs on the grass or bushes and sits, raising the front legs. When any animal runs by, she attacks him and squeezed. The nymph is from the larva - a small tick, which is then turning into an adult insect.
The tick sits on paths laid in the taiga, and promotes prey. Sading to her, he drinks blood for three to six days and swells so that its dimensions increase to one centimeter. Only after that falls off. In each of its transformations, the tick is powered only once. Larvae and nymph are usually embarrassed to small rodents, and an adult tick is to a large animal and man.
Scientists, comparing the time of appearance and reproduction of ticks, established that this is exactly the coincidences with the curve of diseases by encephalitis. Pliers appear, and after a few days, encephalitis begins. Disappeared - pliers, and by itself the epidemic is stopped.
Academician Pavlovsky and Professor of the Smorodinians concluded that the encephalitis should have a permanent source in nature, hidden from the human eye "Fortress". Dozens of various animals and birds inhabiting Taiga were caught to verify this assumption. Examined many pets.
The work was facilitated, since at this time in Japan managed to buy a big part of the monkeys. They were taken by a steamer at the Far East, and scientists infected these animals with the collected materials. Many of them contained a virus that caused a disease from monkeys, very similar to spring-summer encephalitis, developing in humans.
Rockies and droops, hedgehogs, chips and field mice, many pets - they all wore an infectious start in the body. Thus, the "tank" of the virus was found. It turned out that the ticks transfer the encephalitis virus to the chips, pools and other animals in the taiga.
In addition, pets keeping preserving pets: goats, sheep, horses, pigs, cows, dogs. They are also biting ticks and bring infection to their body, but these animals do not hurt encephalitis.
But the most important thing was that the virus may remain in the intestine of these bloodsowing insects for a very long time and even transmitted to the offspring. Moreover, later scientists have proven that the virus is multiplied in the plane, which is a long and permanent owner of this pathogen.
Academician Pavlovsky formulated the theoretical substantiation of the natural foci of tick-borne encephalitis. In certain areas of the country, the virus is helped to survive and persist in nature the associated animals and bloodsowing insects. The virus breeds in the body of the tick, the tick is biting an animal or a bird living in the taiga, and infects them, from these animals new ticks transfer infection to other animals. Thus, the disease is continuously supported.
If a person came to this zone, he necessarily became an object for attacking ticks, and if these ticks were inflated, a person could consider himself doomed.
It remained to explain another riddle. Sometimes among the sicks were small children and old men who did not go to the forest and could not be fused by ticks. In addition, there were many cases when whole families had fallen.
For a long time, scholars were sought and found in the end elementary simple answer: in all such cases there were goats in the source. Living near forest arrays, where ticks infected with a virus, goats became an object of attack. The encephalitis virus, as it turned out, is well multiplied in the goat's body and falls into the milk. Using the incipipated milk of goats, people are infected and ill against encephalitis. This is the second way to distribute this terrible infection.
Already in Moscow, on his return from the expedition, the laboratory assistant N. Utkin, and later - N. Kagan, Researcher of the Viral Department of the All-Union Institute of Experimental Medicine.
At that time, it was believed that encephalitis could be infected only in the taiga, from the bite of a tick, so the laboratory staff, although and observed all precautions when working with contagious material, but no one was insured against accidental infection, especially since protective vaccines did not exist . As Utkin and Kagan infected, it is definitely unknown. Both of them died. Therapeutic serum was not helped, prepared from the blood of the passing. All attempts by doctors save them ended in failure. Urns with their ashes are still kept at the Museum of the Virology Institute named after D. Ivanovsky.
- How did you manage to protect people from tick-born encephalitis?
- the only reliable way was the vaccine.
- How soon have it been able to get it?
- after a year.
When the first expedition returned to Moscow, then the question immediately arose what to do next. After all, it was not enough to find out that the tick-borne encephalitis was to call this disease, scientists - caused by viruses and is transmitted by people with ticks living in a taiga. This disease will not stop. It was necessary to find any effective funds using which the state could protect people who were in Taiga.
In the Far East, at the time, relations with Militarist Japan have deteriorated sharply. She focused on our borders a huge Kwantung army, aiming, and then attacked friendly Mongolia,
The redarmeys, guarding the eastern frontiers of our Motherland, became victims of encephalitis. The first thing that scientists were able to recommend are in villages, cities and army camps located in Siberia, sanitary and epidemiological recreation activities: destroy ticks near settlements. The number of diseases decreased, but about two thousand people and about half of the patients, as a rule, died every year. It turned out to destroy the ticks extremely difficult, expensive and not effective enough.
At this time, the All-Union Institute of Experimental Medicine was organized in Moscow. There were many problems important for health care, but the task of finding means to defeat the tick encephalit was considered. To manage the department of Virology was appointed invited from Leningrad 36-year-old Professor Smorodintsyv. By this time he was already well known for the development of the world's first flu vaccine.
In the laboratory, where they worked with encephalitis viruses, all foreign access was prohibited. Entering the laboratory, people stepped through a high threshold barrier. Laboons worked in two dense coats, rubber gloves and special masks. From the experimental animals they fell a large, bent arc protective glass to the virus from the syringe or pipette if some error occurs, did not splash on the face or body of the researcher.
On the laboratory table dozens of healthy and infected mice. And the high threshold is made in case the experimental mouse runs away. After all, animals who fled from the laboratory can disseminate infection, biting someone.
The observations conducted in the Far East showed that people who had suffered with encephalitis acquired long-term immunity to this disease and were not re-inflicted. Then A. Smorodinians set the task before their team to learn to artificially create the same immunity, find a vaccine that protects against the disease. How to cook it, no one knew.
The scientist decided that in the laboratory it is necessary to accumulate enough virus, and then weaken it or inactivate it. Perhaps the preparation obtained will retain the ability to cause the formation of antibodies, as did the encephalitis viruses in natural conditions.
Any vaccine is a kind of virus concentrate, weakened or inactivated. Usually these are the same viruses that cause a disease. Scientists are subjected to their special processing, during which the destructive properties of viruses are eliminated.
The introduction of the vaccine stimulates the mobilization of the body's protective forces: antibodies are formed that can neutralize the "wild" street virus. They appear in the blood shortly after vaccination and after 2-4 weeks reach very high concentrations. It is they who neutralize the virus if he penetrates the body.
Endless experiments began. Scientists worked literally in three shifts, many even spent the night in the laboratory. Time rushing. Smorodins, together with Kagan and Levkovich, were looking for ways to create a vaccine. To do this, they infected mice, and then used their brain to relax the virus from one animal to another. Many of these passages of the virus conducted scientists.
Having experienced the harmlessness of the vaccine on healthy mice, in the end they realized that a living virus was not weakened by repeatedly conducted through animals. He remained the same pathogenic as he was at first. It was at that time a kagan died.
When it turned out that a living virus is unsuitable for vaccinations, it was decided to neutralize the causative agent, but so as to keep his ability to cause immunity to encephalitis.
Smorodinians and Levkovich accumulated the virus in the brain of mice, infecting thousands of animals. Then they pulled them, removed the brain, crushed it and rubbed into mortar with glass beads. This allowed to obtain a thin homogeneous mass, which was dissolved in a special saline solution. The liquid was purified from chips of cerebral cells on centrifuge at high speed. As a result, a transparent material was obtained, which contained significant concentrations of the virus. Then this solution remained only inactivated by formalin.
When the vaccine was ready, the question arose where and how to experience it. The first experiments spent on small laboratory animals, and then on monkeys. Experiments have shown that the vaccine does not cause harm, stimulates the formation of antibodies and protects monkeys from the subsequent infection with their living virus of tick-borne encephalitis.
In the spring of 1938, the Smorodinians and Levkovich prepared the first ampoules with the drug, which they considered suitable for people. It was necessary to prove that the vaccine would not harm the vaccinated. After all, it contained large quantities of encephalitis virus, the truth is inactivated by formalin.
Scientists did not even think of who would first receive vaccine injections to prove its harmlessness. This meant by itself. The creators of the vaccine and the laboratory staff introduced it and after careful medical observation were convinced that for several months after vaccination no side effects arise.
When the harmlessness of the vaccine turned out, it was necessary to make sure of its protective efficiency. Having found that after vaccination in the blood, antibodies for encephalitis virus were formed, the researchers went to a huge risk and infected themselves with a wild taiga virus. They introduced themselves to the blood very large amounts of virus, much large than the human body falls into the tick bite. The faith in success turned out to be justified: the vaccine was defended by scientists, they did not get sick.
After further testing, the vaccine began to produce in fairly large quantities so that everyone who needed to protect against encephalitis in connection with the departures to work in Taiga. Already by the spring, more than 20 thousand people who left for the Far East were able to instill. The events gave a tangible effect. By the fall, it was possible to find out that almost all the grafts were protected. They successfully worked in the taiga, although they were repeatedly subjected to tick bite. Most of them did not arise from the disease.
Evaluation of the effectiveness of the vaccine against tick-borne encephalitis, conducted in a year, showed that the number of diseases decreased by 2.5-4 times. It was good for a start, but not enough, because some percentage of vaccinated was completely sick.
Survey of blood serums received from many thousands of people in that year, and analyzing the incidence of encephalitis in Siberia, scientists came to the conclusion that the first vaccinations protect people just one year. Only during this short time in the blood remained sufficient amounts of antibodies.
Vaccine against encephalitis was prepared from killed viruses. On the introduction of such a killed virus, which could not multiply in the body, the answer was weaker, a much smaller amount of antibodies was formed. This quantity was enough for a year. Then antibodies were destroyed, and the man again became susceptible. He risked again to get sick and get sick.
Scientists have established that protection is significantly enhanced if the vaccine is noted more than once, and three-four. Such a cycle vaccinations should have repeated every two years. Naturally, it was not entirely convenient, but allowed everyone who began to work in the conditions of an unjugible Siberian taiga (hunters, lumberjacks, participants of geological and other expeditions and primarily military), to securely protect against tick-borne encephalitis.
It is possible to imagine the scale of this huge preventive work, which was called upon to protect the health of millions of people on the huge territory of Siberia and the Far East.
In 1941, the approval of state premiums of three degrees for outstanding scientific developments made in our country was announced. The Soviet government highly appreciated the dedicated work of researchers fought in a tick with tick-borne encephalitis, which studied the nature of this disease and creating the world's first effective vaccine. In 1941, the work of E. Pavlovsky, A. Smorodintseva, E. Levkovich, P. Petrishcheva, M. Chumakova, V. Solovyova and A. Schubladze was noted by the state premium of the first degree.
- Did it mean that with encephalitis it was finished?
No, only the initial stage of work ended. Scientists were able to only move the cornerstone and respond to the first two questions: what is caused and how encephalitis is distributed.
- But since the vaccine was created, it remained only to instill everyone in need, isn't it?
This approach is too simplified. After all, the vaccine was inactivated, and the immunity created by it was not only short-term, but not enough durable.
In the postwar period, many expeditions sent to various zones of the Soviet Union found that tick-borne encephalitis occurs not only in the Siberian taiga, but the people literally affects all forest territories. The disease was also in the Urals, and in Karelia, and in the southern regions.
These studies of virologists and epidemiologists who managed Chumakov and Smorodinians, found out the nature of the diseases of the diseases that were called "Omsk hemorrhagic fever", "two-wave meningoencephalitis" and so on.
The tick-borne encephalitis virus was everywhere collected his harvest: from the shores of the Pacific Ocean to the White Sea and Belarus. Moreover, the research of Soviet scientists has been supervised to engage in the same work and virologists of other countries. A few years have passed, as the foci of tick-borne encephalitis revealed first in Czechoslovakia, and then in Hungary and Romania, in Finland and Poland. The foci of tick-borne encephalitis associated with very related viruses was found in various countries of Asia and America.
True, in Siberia, Encephalitis has a heavier clinical course and ruffles 20-30 percent of the sick, while in European countries the country disease flows easier and mortality with it 10 times lower.
The economic activity of man has a significant impact on the preservation of tick-borne encephalitis foci. Often, it generally leads to their liquidation or reduction as a result of cutting down forests and the subsequent unincounding of the Earth.
On the other hand, the foci of encephalitis is often expanding if people are intensively mastering the forests, replace the coniferous species of trees deciduous. A person always leads to meals in forest areas of pets that become objects of attacks of ticks, and then transmit a virus to people who use their milk.
In recent years, experts estimate that in our time in the territory of the Soviet Union of the constant danger of infection with tick-borne encephalitis, about 20 million people are subjected. And in those places where forest arrays are saturated with a large number of infected ticks, it can be infected annually to 25-40 percent of residents. True, not all falls, but these numbers are significant.
Studying insect habits, scientists found that, attacking a man, the tick always crawls on his clothes only from the bottom up. Therefore, in order to protect against the tick and not to give it to the skin, the pants need to be well refilled in the boots, and the shirt is under the trouser belt. If at the same time the cuff shirts is still tightly, the tick is practically unable to get to the human body. Various liquids or ointments produced by our industry, scaring insects, reliably guard a person from ticks.
In many areas of the country, where the fabric infection with ticks is very high, the state has in recent years active extermination with the help of various insecticides. For this, airplanes and helicopters spray or pollinate forests for insects Forest arrays around villages, timber industrial facilities, rest houses and sanatoriums. Forest pollination is carried out in autumn, and then in spring when the poison easier reaches the ticks on the trees. Annual pollination by such insecticides sharply reduces the number of ticks and significantly reduces the risk of infection of people with encephalitis.
Some robust opponents of the vaccine proposed to fight tick-borne encephalitis, destroying animals - virus carriers. But it is unreal. It is now known that on the territory of the Soviet Union is constantly infected with the tick-borne encephalitis virus of more than 100 types of mammals and birds. Their total number is many hundreds of millions of individuals, which means that nothing can be done with them. They support constant foci of infection in nature, and at the same time ecological equilibrium, which is always dangerous to break.
Currently, it is possible to protect against this disease, and the only reliable way is to actively vaccinate all people who have to work or live in the forests, where infection nests.
All these years, virologists actively worked on improving the quality of the vaccine, given that the old drug produced on the brain tissue of white mice, often caused the development of local inflammatory reactions, and in some, however, very rare, cases gave general complications.
In 1964, the researchers were used to grow tick-borne encephalitis viruses instead of a brain of mice single-layer fabric cultures. This method was so successful that since 1966, the entire method produced in the USSR inactivated vaccine against tick-borne encephalitis was prepared only on the culture of the tissue. As a result, all side effects completely disappeared, because in the vaccine no longer contaminated her previously protein brain tissue mice.
Curious work of statistics that are interested in everything in light, including tick-borne encephalitis. They recently counted that from all people who in recent years have become infected with tick-borne encephalitis, 90 percent were bugged with ticks and only 10 percent became infected as a result of using infected milk.
If ticks bite mostly adults, since they are working in forest areas, then among those who have infected with milk are more than half children. The majority of infection by encephalitis through milk accounted for the pre-Ural and the Middle Urals. This is Kirov, Perm, Sverdlovsk region and the Udmurt ASSR. The randral was simple: here the population contains many goats, and here pliers live in large quantities - carriers of tick-borne encephalitis viruses.
If in the previous years, the ticks have become basically only people who worked in Taiga conditions, now 80 percent of victims are tourists or vacationers. And then the case is explained simply: those who work in the forests are necessarily vaccinated, and it creates reliable protection. And people who go to the forest for mushrooms, relax or travel, do not turn to doctors and therefore fall after attacking infected ticks.
Today, the attention of the whole country is riveted to the construction of the Baikal Amur highway for the construction of the Baikal-Amur highway. This railway line opens access to the wealth of Eastern Siberia. After all, there are deposits of coal, iron, copper, nickel ores. There, underground, oil and gas reserves are hidden.
Construction of this road with a length of more than three thousand kilometers is carried out in very difficult geographical conditions. It crosses dozens of rivers, overcomes the mountain ranges and impassable Taiga. Builders have to force the swamps and fop, demolish the hills and mountains, pass multi-kilometer tunnels.
Before starting construction, there was very thorough biological exploration of the whole area. And they found that very many areas of the highway should cross the taiga, where massive foci of tick-borne encephalitis are located. Immediately organized the production of a significant amount of vaccine to instill construction workers, engineering personnel and all persons who will live on the highway.
The inactivated vaccine used is now prepared in large quantities on tissue cultures at the Moscow Institute of Poliomyelitis and viral encephalitis and in Tomsk Sera and Vaccine Institute. All people vaccinations are made repeatedly. Initially, three injections with an interval in two weeks. Then all past vaccinations must be subjected to single revaccination for four years to acquire reliable protection.
In recent years, Moscow scientists have significantly improved the quality of the vaccine by submitting it to additional cleaning on specially developed filters from large-parenched glass. This method made it possible to remove all polluting proteins from vaccines, which sometimes gave unwanted local reactions, and also significantly increase the protective activity of the drug.
The observations of many thousands of grafts showed that the incidence of vaccination decreases at least four times. In addition, those who are still falling, the disease is much easier, and mortality at all ceased.
The selfless work of Soviet scientists and the widespread use of the killed vaccines allowed the victory over the encephalitis, this taiga killer.
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