Scarlatina. Before

Scarlatina. Before introduction in wide practice of an antibioticotherapia at a scarlatina complication in the form of infectious allergic arthritis was often enough observed. Besides, at serious buy cipro online septic forms of a scarlatina there were purulent streptococcal arthritises. Sometimes serous arthritises were combined with other late (metatonsillar) complications, more often with a myocarditis and a nephritis. It is necessary to mean, that after a scarlatina, as well as after streptococcal quinsy, the rheumatic disease also proceeding with a lesion of joints can develop. Differential diagnostics of a rheumatic arthritis will be separately surveyed. Thus, at a scarlatina it is possible to allocate 3 versions of arthritises: infectious-allergic, rheumatic, purulent (septic). Now early appointment of Penicillinum reliably warns development of all variants of an arthritis. However in the absence of an antibioticotherapia (appointment preparations, even in a combination to «antirheumatic agents» and so forth) they can develop.
From three versions of scarlatinal arthritises the easiest and short-term is an infectious-allergic arthritis. It appears in the end of 2nd or in the beginning of 3rd week of illness when already there pass all implications of the acute period of a scarlatina (is normalised the body temperature, the eruption disappears and so forth), can remain only enlarged lymph nodes and a skin ecdysis in exanthema places. Large joints are amazed, they swell up a little, movements in them painful and are moderately limited. At a puncture the serous exudate can be received. The arthritis proceeds rather not for long and passes without any residual phenomena. Unlike a rheumatic arthritis at it there are no other implications of rheumatic disease. The septic arthritis is purulent. It is one of the secondary hematogenic centres of a sepsis who always proceeds in the form of serious disease. From other kinds of a sepsis (staphylococcal, caused rods and so forth) It differs that gives in to a penicillin therapy (streptococcuses have high sensitivity to antibiotics groups), that can have differentsialno-diagnostic value.
Purulent arthritises at a typhoid, paratyphoids, generalised forms of a salmonellosis and a listerosis have much in common in the mechanism of occurrence and local disturbances. Arthritises are purulent complications of the given illnesses, develop in the height period, more often on 2nd week from the disease beginning. Large joints (knee, coxofemoral, talocrural, ulnar, humeral) are amazed, as a rule. Purulent process grasps articulate a cartilage, blasting it, and further can pass to subchondral sites of a bone with formation abscesses. The purulent arthritis can serve as the centre from which the sepsis further develops. Patients complain of strong pains in the amazed joint, the pain amplifies at attempt to make movement in a joint. Joint contours smoothed, the skin over it is stretched, , hot to the touch. At a joint cavity puncture it is possible to receive pus at which crops it is possible to allocate a microbe-infecting agent. At a blood analysis become perceptible a leukocytosis and ESR rising that is uncharacteristic for an uncomplicated typhoid, paratyphoids and other salmonelloses. For differential diagnostics other implications of illness matter also. The typhoid, paratyphoids and generalised forms of a salmonellosis become complicated a purulent arthritis in the period of height of illness when it is available all characteristic symptoms - rozeolezno-papuleznaja an eruption, liver and lien augmentation, a high fever, etc. Only on the basis of clinical semiology to differentiate this group of arthritises it is impossible. Specification of the nosological form is spent on the basis of originator allocation (from blood, pus, than excrements), is more rare . In the absence of laboratory acknowledgement at the given clinical semiology the typhoid diagnosis (clinically), complicated by a purulent arthritis is established.
At purulent arthritises, besides a lesion of joints, the eruption condensed on the person, in the field of large joints becomes buy rimonabant now perceptible erythematic or , the generalised lymphadenopathy, an acute tonsillitis, mononuclear character of peripheric blood (without atypical ), that allows to differentiate arthritises from . For diagnosis acknowledgement originator allocation is used (from blood, pus, a spinal liquid), are less informative researches (an agglutination test, ).
The sepsis of a various aetiology (staphylococcal, pneumococcal, , pyocyanic, etc.) is often accompanied by development of purulent arthritises. Usually they are the secondary centres, but can be and primary. One joint is in most cases amazed, round it the expressed tumescence is formed, in inflammatory process are involved cartilaginous, osteal and surrounding tissues. The arthritis or arthritises appear against the hardest septic process and consequently character of a lesion of joints does not cause doubts in such patients. At carrying out of differential diagnostics of the most important decoding of an aetiology of a sepsis that is carried out by microbe-originator allocation is.