Diagnosis: CKD, manifested arteritis, subacute flow, moderate severity, and damage to the locomotor system.
The history of the disease in relation to infectious diseases.
Diagnosis: IUD, manifestible arteritis, subacute flow, moderate severity, with damage to the locomotor system.
Complaints of the patient (at the time of admission and at the time of keration)
- For permanent weakness, fatigue
- Tearing pain in the head, Heaviness in the head
- elevated blood pressure (up to 210/110 mm Hg)
On May 6, 2003, a tick in the area of the left popliteal hollow was sucked into the cemetery on the parental day. A spot of reddish color, 1 cm in diameter, appeared in the bite’s place. Kleshcha immediately after the bite was taken to the point of seroprophylaxis, where the NRIF was performed, which caused a negative result on the antibodies to the AG of Borrells. On the sucking site, there was a reddish spot in the diameter of about 1 cm, without edema. In the same place, they injected bitsillin-5.
After 21 days, NRIF was re-administered, which revealed antibody titer at the 1: 160 Hormone Hormone. By this time, the patient had already noted weight in the head, weakness, sweating, knee pain, muscle aches.
Initially, the treatment was carried out at the Infectious Disease Department of the Third Hospital from 6 to 27 June 2003 with the diagnosis of: . Treatment: doxycycline; suprastin, rixoxine. Discharged with the titre AT 1: 160 (when it was 1: 160). The feeling after discharge is close to satisfactory. In the summer, there was a conjunctivitis.
From 5.10.2003 marked a sharp deterioration of the state, complaining of: constant weakness, fatigability, sweating, sensation of torsion in the head, gravity in the head, knee pain, increased blood pressure (|| | max to 210/110 mm Hg. Art.).
The patient lives in a well-equipped apartment alone. Observes personal hygiene, the use of unwashed vegetables, fruits, not boiled water, raw milk is denied. Pets are not kept at home. Pediculosis denies.
May 6, 2003 was bitten by an Ixod mite in a cemetery, which could be on the patient about half an hour. The clam was removed from the patient, after which she was taken to a prophylactic point where the RNIF was performed, giving a negative result to the Borrelian antigens.
A reddish spot in the diameter of approximately 1 cm without edema was observed at the bite site.
After 21 days, NIFF was re-administered, which revealed the titre of 1: 160 Borrelian antigen. By this time, the patient already noted the severity in the head, weakness, sweating, knee pain, muscle aches.
Immunological status: angina – often in childhood (up to 2 classes); || 156 = == Professional harm – emotional stress.
Earlier, about 20 years ago, was using river fish, but after diagnosis of cholecystitis, the patient was advised not to have a river fish, which she has done since then. Beyond the Tomsk region in the next six months did not go.
Probable source of infection – Ixodic tick
Transmission mechanism – Transmissive
Infection transmission path – contact
Anamnesis of life
The sick was born on August 20, 1942, was fed with breast. In physical and mental development it corresponded to age.
Porcine measles, frequent acute respiratory diseases, including angina (up to 2 classes). Immune childhood does not remember. The presence of bad habits denies. Menarche with 13 years of age, regular, 3 days in 28 days, painless. He has two children (2 children – 25 and 28 years old), healthy. Has transferred 2 pregnancies and 2 genera.
Transferred operations and diseases:
Appendectomy – 1970
Operation on the thyroid gland on a thyroid gland
Chronic colitis, chronic cholecystitis, cataract 0d
Urolithiasis – detected in 1992.
Tuberculosis, venereal, mental illness denies.
GB II stage, 3 degree
Children deny the presence of chronic diseases. The man suddenly died in 2002.
Status praesens communis
General condition of the patient of moderate severity. Body temperature 36,7. Consciousness is clear. The position of the patient in bed is active.
Lymph nodes: single, movable, elastic, painless, the skin above nodes is not changed, movable.
Thyroid gland is not enlarged.
Joints Shoulder, elbow, radial, interphalangeal, hip, ankle normal configuration, painless, with active and passive movement, no restriction of mobility, crackling and fluctuation is absent.
The development of the skeleton is correct, the head of the usual form is proportional to the other parts of the body, the ratio between the face and the body. brain section of the skull is correct;
Type of respiration of the abdomen, depth and rhythm are preserved, the frequency of respiratory movements of 18 per minute, the auxiliary muscles in the act of respiration do not participate.
No apparent changes in the region of the heart are detected. Visible ripple in the region of the heart and the epigastric region is absent.
Upper thrust on 1 cm from the midlectric line, positive, limited, not strengthened. When palpation of pain points in the region of the heart is not revealed.
Tones are heard: clear
- I tone on the top, coincides with the apical impulse, the pulse on the ray artery, is heard after a long pause, louder than II tone, lower than the tone of the II tone.
- II tone on the basis heart, louder than I tone, higher than ton tone, listening after a short pause.
- Accent II tone over the aorta.
No side noises detected.
When examining the vessels the capillary, the venous pulse is not determined.
On the right hand 160/110 mm Hg. Art.
On the left hand 160/110 mm Hg. Art.
Pulse pressure 50 mm. ht Art.
Arterial pulse on the arterial arteries
The following pulse properties are noted:
- on both hands symmetrical
- frequency 88 av . in mines
- pulse of moderate voltage
- pulse of normal size
- shape of pulse wave correct
- vascular wall not condensed
STUDY OF BROWN BODY BODIES
Belly soft, both sides are symmetrical, the abdominal wall participates in the act of breathing uniformly, hernial protrusions and postoperative scarring is not present. The muscle tone of the anterior abdominal wall is moderate. Subcutaneous venous network, visible peristalsis of the intestine, flatulence are absent. Thickness of the skin folds at the navel level 4 cm.
There are no data indicating the presence of free fluid in the abdominal cavity.
Palpation of the abdomen
Surface palpation: palpation of the abdomen soft, painless, The higurous protrusions are absent.
A) Sigmoid – is located correctly on the middle third of the approximate distance (perpendicular from the navel to the line joining the apex idiopathic bone and kelp bundle), diameter 2.5 cm, elastic; the wall is smooth, smooth; mobility is 3-4 cm, painless, there is no rash with palpation.
B) Blind gut – is located in the middle third of the distance from the navel to the ridge of the ileum, diameter 4-5 cm; elastic; the wall is smooth, mobility is sufficient (2 cm); painless, urticaria is determined.
B) Upward and downward colon – not palpated
D) The transverse colon is not palpable
Percussion: The border of the lower edge of the stomach is 2 cm above the navel.
Auscultation: The border of the lower edge of the stomach corresponds to that in percussion. No splash noise is detected.
Palpation The wall of a large curvature of the stomach is even, elastic, movable (2 cm), painless. The gatekeeper is not palpable.
The pancreas: The zones of Schofar and Gubergrits are painless. Pain with palpation at the point of Meio-Robson is absent
– Upper boundary – Upper edge 6 ribs.
– Lower border: the liver does not protrude beyond the edge of the edge arc.
Palpation of the liver :
On arrival: the edge of the liver is smooth, slightly rounded, tight-elastic, painless.
Symptoms of Kerah, Murphy, Curvoise, Pekarsky, Boas, frenicus-negative symptoms.
NERVOUS SYSTEM AND ORGANS OF FEATURES
Mental development corresponds to norm, sleep is bad (presomnitic insomnia); the mood is stable, the response to the surrounding is adequate. The attitude to your illness is adequate, contact with others is good. Tendons, pupillary reflexes without abnormalities. Pathological reflexes (Babinsky, Rossolimo, Gordon, Schefer negative), muscle ligaments of the nape of the nape, no symptoms of Kernig, Brudzinsky (upper, middle and lower) negative. Sample of Romberg: mild instability with closed eyes, swaying in the anterior-posterior fissure. : there is no mistaking, pain and tactile sensitivity is preserved. Violations of the higher brain functions (apraxia, agraphy, aphasia, agnosia) have not been revealed.
Preliminary diagnosis and its justification
SBB, manifestation zearthritic form, subacute flow, moderate severity, and damage to the locomotor system.
The diagnosis is based on
– complaints (weakness, fatigue , sweating, sensation of torsion of the head, headache, knee pain, muscle aches, elevated blood pressure ( max to 210/110 mm Hg)
– an epidemiological anamnesis (a bite of ixodic tick on May 6, 2003)
Laboratory research plan
- Detection of antibodies to Borrelia in serum using RNIF, IFA with AG Borrelia and PCR.
- OAM .|| 620
- Coagulogram (we are interested in PTI to determine the safety of the protein synthesis of the liver)
- Ultrasound of the abdominal organs Cavity.
- X-ray examination of knee joints.
- Wasserman’s reaction