Proteus infections

Last years the attention of infectiologists is involved with the new infection contaminations caused by nonconventional microorganisms. The special place is occupied with a proteus infection contamination. Its intestinal form (P. vulgaris, etc.) proceeds especially hardly at children of the early age, also pyoinflammatory diseases (first of all urinary system), caused P are dangerous. mirabilis, P. rettgeri and P. morganii.

Aetiology

Proteuses are Gr +, the polymorphic, fine, threadlike rods, differing very active motility. The dimensions of cells compound 0,3 - 3 microns. P. morganii, and also P. rettgeri it is ready less polymorphic, they are nonmotile or inactive.

Proteuses possess toxic (develop an endotoxin) and hemolitic properties, and also various degree of biochemical activity. At strains P. vulgaris lecithinase activity, while at P is found. mirabilis this factor of pathogenicity was absent. Besides, Proteuses possess ability to adhesion. The organellas defining adhesion of a microbic cell of a Proteus, cilia are. Adhesive activity of Proteuses can be defined by means of D-D-refractory with erythrocytes of a chicken or the Guinea pig. Direct dependence between adhesive ability of uropathogen Proteuses and their resistance to antibiotics is taped. So in experiences with highly adhesive isolates (P. rettgeri) it is shown, that on one uroepithelial a cell bacteriemic cells, and in experiences with low adhesive isolates (P are fixed till 60-65. mirabilis) - no more than 18-19 bacteria. Besides, strains of Proteuses, refractory to preparations quinolinic a number, possessed high adhesiveness (an index of adhesiveness 55,1 (15,0) whereas among isolates sensitive to antibiotics this indicator was more, than in 2 times more low (20,2 (15,0) is more often.

Proteuses are rather steady in an external environment and even are capable to keep vital activity in weak solutions of Phenolum and other disifectants. Resistance to many antibiotics is taped also. In the nature of a bacterium of sort Proteus eurysynusic: in water of open reservoirs, sewage, in the earth, on vegetables, in cankering organic matters. These microorganisms - saprophytes, quite often they dwell on a skin and mucosas, and also in an intestine of the human and animals.

Pathogenesis and clinic

Acute intestinal proteus with an infection contamination children of early age with the lowered immune responsiveness, with an unfavorable premorbidal background, and also after an uncontrolled prescription of antibiotics most often are ill. The lesion GASTROINTESTINAL TRACT most often proceeds in the form of a gastroenteritis, a gastritis and a colienteritis. Very often acute intestinal proteus infection contaminations it is accompanied by toxicosis symptoms - rise in temperature, vomiting, appetite disturbance, short-term cramps, change of character of a chair and its increase is observed also.

Data about complications at a proteus infection contamination are not numerous. There are, in particular, observations, that the complications caused by an acute intestinal infection contamination proteus - klebsiellae aetiologies, in the form of an anaemia and development of a syndrome of intravascular coagulation have arisen at 20 % of the diseased. The case of complication after a serious acute intestinal proteus infection contamination in a kind hemolithic - an uremic syndrome (Gasser's) with clinical symptoms of an acute hemolitic anaemia, a thrombopenia and acute renal insufficiency is described.

As to an intrahospital infection contamination, according to 1983 most often (33,5 %) Proteuses are found in pus from postoperative wounds of urological patients and patients with trophic ulcers (33,5 %). Clinical implications of such form of a proteus infection contamination are rather various. Lesions of Ministry of Railways, otites, cholecystites, pyeses of wounds and septic conditions are most frequent. Infestations of newborns are especially dangerous - hit of Proteuses in an umbilical wound can lead to a bacteriemia or meningitis development.

Inspection of medical staff of traumatologic both urological units of hospitals and analysis of the presented stuffs have allowed to conclude, that in traumatologic unit at traumatic is purulent-septic infection contaminations the medical staff role, as infection contamination source is not excluded. Drifts of a proteus infection contamination of urinary pathes meet statistically more often, than intrahospital infestations that allows to assume, that at the is purulent-septic infection contaminations caused by Proteuses, the endogenous infection contamination is possible. The basic source at intrahospital infestations are patients proteus is purulent-septic infection contaminations of urinary pathes (61 %).

The given diseases can be transferred is contact-household (drift with a catheter, other urological instruments), and also air-drop pathes.

Diagnostics

The bacterioscopic method allows to make imprisonment before trail at presence in smears of an investigated stuff (pus, a traumatic discharge, fields of a burn tissue, an excrement etc.), Gram-negative rods.

Bacteriological method. For abjection of Proteuses use Endo media more often, etc. On an agar medium "creeping" growth (crowding N-forms), and strains incapable of swarming is observed form large with equal edges of colony (O-form). From fluid mediums use nutrient broth, triptokazein a broth and peptonic water. At growth in such mediums Proteuses form superficial Membranula in a kind a veil of figurative scurf with benthonic growth and very unpleasant odour. Optimum growth P. mirabilis and P. vulgaris it is noted on 1 % an agar at temperature 20-25 degree. To cultivation apply the enriched nutrient mediums - selenite medium, medium Dregalsky with addition of cholic salts. The best growth of Proteuses becomes perceptible on bloody and tryptophan an agar. Bacteriological diagnostics includes definition of a sort and a kind of the originator and a serotyping of strains on About - and to N-antigenes by means of an agglutination test on glass. For sort definition study enzymatic activity of the originator in relation to carbohydrates, urea hydrolysis, Citras recycling, ability to a deamination and decarboxylation, ability to inhibit activity of antibiotics. For diagnosis statement it is necessary to specify degree lecithinase, and also hemolitic and leukocytic activity. For revealing antigen (Ag) and Ab antibody to P. mirabilis it is used high-strung solidphase enzyme immunoassay (EIA).

Treatment

The majority of strains P. mirabilis are sensitive to Penicillinum in high concentrations, to ampicillin, Tetracyclinum, gentamycin, and also to cephalosporin antibiotics. A bacteriuria caused P. mirabilis, can be quickly liquidated by means of any of these antibiotics. For treatment of the diseases caused P. vulgaris Levomycetinum, Monomycinum and streptomycin are used.

Preventive maintenance includes carrying out common sanitary actions, observance of a sanitary regimen in child care centres and hospitals.