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Pestilent infections

Tuberculosis. Penetration into the brain tissue of Mycobacterium tuberculosis always happens a second time. Therefore, the frequency of tuberculosis lesions of the central nervous system is closely related to the incidence of this infection in various regions and populations. Two main forms of this infection develop in the brain: tuberculous meningitis and tuberculoma.

Tuberculous meningitis. In almost all cases, the pathogen reaches the subarachnoid space in a hematogenous manner, which may be a component of miliary dissemination or the result of spreading from a tuberculous focus (see Chapter 14). In particular, tubercle bacilli can enter the subarachnoid space from osteo-articular lesions, especially in destructive spondylitis. Clinically, tuberculous meningitis in most cases occurs in subacute form. The exudate has a gelatinous or cheesy (caseous) appearance and is determined in the largest amount in cisterns of the base of the brain and around the spinal cord (“cisterns” is the common name for extensions of the subarachnoid space in the sulci and grooves of the base of the brain; they separate the cistern of the lateral fossa, intersection cistern, cerebellar cerebral and interpeduncular cisterns). In the vascular and arachnoid membranes, close to the cortical vascular branches, small (1–2 mm in diameter) whitish tubercles can be found. Obstruction of the CSF current develops, as a result of which hydrocephalus is more or less expressed. Under the microscope, the fibrin-caseous character of the exudate with a large number of lymphocytes, plasma cells and macrophages is determined. Only occasionally can there be giant Langhans cells. As a rule, obliterating endarteritis is noted, leading to a significant narrowing of the lumen of the affected arteries, which results in minor heart attacks of the brain or cranial nerve roots. In the latter case, histological changes are confirmed by intravital focal neurological symptoms.

The pressure of the cerebrospinal fluid is increased. It may be light and transparent, but often cloudy ("milky"). In its sediment, one can often see a delicate network of fibrin. In the abundant protein mass under a microscope, a large number of lymphocytes and macrophages are found. The glucose content in the liquor is reduced. In addition, from the sediment of cerebrospinal fluid obtained by centrifugation, you can select the alcohol and acid-resistant tubercle bacilli.

Tuberculoma. It is an encapsulated focus of caseous necrosis. In regions where tuberculosis is spread significantly, tuberculoma is a common cause of extensive intracranial lesion. In adults, it is usually found in the cerebral hemispheres, and in children, more often in the cerebellum. Both macro- and microscopically determine a rather wide connective tissue capsule, in the thickness of which ordinary tuberculous tubercles with giant Langkhans cells are clearly visible. In the caseous necrotic center, only occasionally can mycobacteria be detected, stained according to the Ziehl-Nielsen method.

Syphilis. The causative agent of this infection (see Chapter 14), Treponema pallidum, penetrates the central nervous system at the beginning of the secondary stage of the disease, which is accompanied by some increase in the content of protein and cells in the CSF.
However, the symptoms of transient meningoencephalitis in this case rarely develops. Neurosyphilis is represented by two main forms: tertiary and parenchymal (quaternary) neurosyphilis.

Tertiary neurosyphilis. It can manifest itself in the form of subacute meningitis. At the same time, lymphocytes and plasma cells penetrate into the subarachnoid space, and periarteritis develops, a sign of meningovascular syphilis. Oblique endarteritis may also occur, resulting in ischemic lesions of the brain substance, as well as the roots of the cranial and spinal nerves. Occasionally, syphilis can cause hypertrophic cervical pachymeningitis. In this form of damage, the hard and arachnoid sheaths of the brain thicken and fuse. Gliosis develops in the spinal cord, and the roots of the nerves can be compressed. Gummas are found in the meninges, in particular, in those areas of the membranes that cover the convex surfaces of the cerebral hemispheres, as well as the cerebellum. In gummas, necrosis, periarteritis phenomena, infiltration by lymphocytes and plasma cells are detected.

Parenchymal neurosyphilis. The pathogenesis of this form remains unknown. Symptoms of the disease can occur with a long delay in relation to the primary infection: sometimes after 20 years. Developing subacute encephalitis is accompanied by progressive paralysis, mental disorders and progressive dementia. Among the main histological changes, lymphoplasmacytic perivascular clutches in the brain substance and subarachnoid space should be called. In the absence of treatment, progressive atrophy of the brain is noted, in which narrow and rounded gyri, wide grooves, dilated ventricles and signs of granulomatous ependymatitis are visible.

In addition to the brain, the spinal cord is affected with this form of syphilis. Spinal cord sinus (tabes dorsalis) occurs as a result of degenerative changes in the posterior roots and the posterior columns of the spinal cord. In this case, the fibers involved in the regulation of the temperature of tissues and proprioceptor connections (functions of mechanoreceptors located in the tissues of the musculo-articular system and perceiving the stretching or contraction of these tissues) are selectively affected.

Rear roots become gray and shriveled. The spinal cord is also reduced, in particular in the anteroposterior dimensions. This is due to demyelination and wrinkling of the rear pillars affected by Wallerian degeneration (see above). In the dry of the spinal cord, the roots of the lumbosacral nerves are more often affected, but sometimes (and especially severe), the roots of the cervical nerves (tabes cervicalis). In both cases, a large number of cells, mainly lymphocytes, as well as protein, are found in the cerebrospinal fluid. The level of IgG having oligoclonal origin often increases. The Wasserman reaction (A.Wassermann; a type of complement-binding reaction when the patient's serum is exposed to a syphilis with the corresponding antigen) is usually positive.

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Pestilent infections

  1. Non-purulent otitis media, unspecified. H-65.4
    {foto61} Outcome of treatment: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, decrease
  2. Other acute nonpurulent otitis media. H-65.1
    {foto57} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, hearing loss, discharge from
  3. Other chronic nonpurulent otitis media. H-65.3
    {foto60} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, decrease
  4. Bacterial and viral airborne infections: influenza, parainfluenza, adenoviral infection, respiratory syncytial infection. Bacterial bronchopneumonia, lobar pneumonia.
    1. Supplement: Lung atelectasis is _______________________. 2. Clinical and morphological form of bacterial pneumonia is determined by 1. type of inflammation 3. etiological agent 2. area of ​​damage 4. body response 3. In case of lobar pneumonia, the consistency of the affected lobe 1. dense 2. flabby 3. not changed 4. The ability of the virus to selectively affect cells and tissues
    An analysis of the HIV epidemic gives grounds to fully consider it as a venereal disease, the epidemiological and clinical features of which are very similar to syphilis. HIV infection has a number of causative agents of STIs, in particular pale treponema, biological properties, and in the spread of HIV infection, as well as other STIs, play a crucial role
  6. in infectious diseases (typhoid paratyphoid infection, typhus, yersineosis, meningococcal infection)
    In epidemic typhus: a rash appears on the 4-5th day of the disease, has a roseolous-petechial nature: roseola is 2-4 mm in diameter, with indistinct edges, small hemorrhages occur in the center of some rosesol, secondary petechiae, small hemorrhages can be found next to the skin - primary petechiae. Localized rash predominantly, but on the skin of the lateral surfaces of the chest and abdomen, internal
  7. Children's infections: measles. scarlet fever, diphtheria, meningococcal infection.
    1. The transmission path of meningococcus 1. contact 4. transmissible 2. alimentary 5. airborne 3. parenteral 2. Complications of the second period of scarlet fever 1. arthritis 4. glomerulonephritis 2. vasculitis 5. purulent meningitis 3. neck phlegmon 6. parenchymal neuritis 3 Supplement: 1. Myocarditis in diphtheria is caused by the action of ________________________. 2. With multiple blockage of small bronchi
  8. Abstract. Intestinal infections and their prevention. Distinctive signs of intestinal infections from foodborne microbial poisoning, 2011
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  9. Perinatal infection with intrauterine infections
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  10. SESSION 12 Asepsis and antisepsis. Wounds: types of wounds, examination of the wounded, first aid. Suppuration of wounds. Acute and chronic surgical infection. Specific wound infection.
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  11. The general concept of HIV infection and HIV prevention in surgery
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  12. Viral infections and infections of presumably viral etiology
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  13. Characteristics of streptococcal infection
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    Cytomegalovirus causes various diseases. The most severe lesions occur in immunocompromised patients and in newborns. CMV is able to persist in the host in a latent state after an acute infection. Reactivation may occur during the development of immune suppression, which is accompanied by viral replication in the epithelium of the kidney ducts, secretory glands and its excretion with
  17. Food infections
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