Sinusitis

Mycobacteria are gram-positive. Atypical mycobacteria. Pathogens of atypical mycobacteriosis

Genus Mycobacterium.

Mycobacteria are acid-fast, non-motile, gram-positive, rod-shaped (straight or curved) bacteria capable of forming filamentous and mycelial structures. They are characterized by a high content of lipids and waxes in the cell walls, which ensures resistance to alcohols, acids, alkalis, disinfectants, drying and exposure to sunlight, poor stainability with dyes, high hydrophobicity, and pathogenicity.

Along with acid resistance, an important characteristic of mycobacteria is slow growth on nutrient media, especially mycobacterium tuberculosis. Another feature of mycobacteria is the formation of pigments; some species form pigment in the dark.

Among pathogenic mycobacteria, the main causative agent of human tuberculosis is M.tuberculosis (Koch's bacillus), M.bovis is the causative agent of tuberculosis in cattle and M.leprae is the causative agent of leprosy. Diseases in humans can also be caused by M.avium, the causative agent of avian tuberculosis, and about 20 other potentially pathogenic species that can cause atypical forms of lesions in humans (mycobacteriosis).

Mycobacterium tuberculosis (Koch bacillus).

Morphological properties typical for mycobacteria. These are thin straight or slightly curved rods with granular formations in the cytoplasm; coccoid structures and L-forms can occur. Acid-stable (high content of lipids and mycolic acid in the cell wall). They have acid-labile granules (Much granules) in the cytoplasm. Gram-positive, poorly dyed with aniline dyes, Ziehl - Nielsen they are painted bright red.

Cultural properties. They grow in aerobic and optionally anaerobic conditions. They grow very slowly - within a few weeks. Mycobacteria need protein and glycerol, growth factors. The most commonly used are dense egg media of Levenstein-Jensen, Finn II, synthetic and semi-synthetic liquid media.

On solid media, growth is noted on days 15-40 in the form of a dry, wrinkled, cream-colored coating (R-form); the colonies resemble cauliflower in appearance. In liquid media, growth is observed in the form of a surface film.

Koch's bacillus is stable in the external environment and persists in dried biosubstrates for up to several weeks.

Pathogenicity factors. The pathogenic properties of the tuberculosis bacillus and the biological reactions with which the macroorganism responds to the introduction of the pathogen are associated with the characteristics of its chemical composition, the high content of lipids and their composition (the presence of fatty acids - phthioid, mycolic, tuberculostearic etc., phosphatides and other fractions).

The main factor is a toxic glycolipid - “cord - factor”, easily detected when cultivated in liquid media. It ensures close proximity of mycobacteria in the form of braids, tourniquets, and cords. Cord factor has a toxic effect on tissues and also blocks oxidative phosphorylation in macrophage mitochondria (protects against phagocytosis). Two more of their most important characteristics are associated with the chemical composition of mycobacteria:

- ability to cause pronounced HRT reaction, detected using a tuberculin test - “HRT of tuberculin type”.

Antigenic structure. Mycobacterium tuberculosis has a complex and mosaic set of antigens. Antigenically, M. tuberculosis is most similar to M. bovis and M. microti. There are cross-reacting antigens with corynebacteria and actimomycetes. Antigenic properties are practically not used to identify mycobacteria.

Epidemiology. The main routes of infection are airborne droplets and airborne dust. The main source of infection is a person with tuberculosis. Overcrowding of residence plays a special role; in Russia, places of detention, refugee camps, people without a fixed place of residence and other socially disadvantaged groups of the population are of greatest importance. In a relatively small percentage of cases, tuberculosis is caused by infection from animals (usually through milk) by M.bovis.

Pathogenetic features.

During life, a person repeatedly comes into contact with mycobacterium tuberculosis, but not all infected people develop the tuberculosis pathological process. This depends on many factors and, above all, the body’s resistance.

Most often, infection occurs through the respiratory tract. Mycobacteria that enter the body are captured by alveolar and pulmonary macrophages. May develop at the site of contact primary affect (bronchopneumonic focus). Next, the pathogen is transported to regional lymph nodes, causing an inflammatory reaction - lymphangitis and lymphadenitis. Primary affect, lymphangitis and lymphadenitis - primary complex (primary focus of tuberculosis), characterized by the formation of granulomas in the form of tubercles along the lymphatic tract and nodes ( tuberculosis or tuberculosis).

The formation of granulomas is a cellular response of DTH to a number of chemical components of mycobacteria. In the center of the granuloma, in the focus of necrosis (caseous decay), there are mycobacteria. The lesion is surrounded by giant multinucleated Pirogov-Langhans cells, they are surrounded by epithelioid cells and on the periphery - lymphocytes, plasma and mononuclear cells.

Outcomes of the primary lesion:

- with sufficient resistance organism, the reproduction of the pathogen in granulomas stops, the focus is surrounded by a connective tissue capsule and becomes calcified (calcium salts are deposited). This process is determined by the formation non-sterile infectious immunity to the causative agent of tuberculosis. Nonsterility - the ability of mycobacteria to persist for a long time in the primary focus and wait in the wings (sometimes after several decades);

- with insufficient resistance- increased caseous decay of the focus, caseous pneumonia, severe primary pulmonary consumption and generalized tuberculosis (disseminated or miliary tuberculosis with granulomas in various organs).

Secondary tuberculosis. The secondary tuberculosis process - reactivation of the pathogen as a result of weakening resistance is observed under stress, nutritional disorders and in the elderly. Foci of caseous decay appear in the lungs with the formation of cavities, damage to the bronchi and small blood vessels.

Immunity. The basis of non-sterile infectious and vaccine immunity in tuberculosis is cellular immunity in the form of delayed-type hypersensitivity (DTH), mediated by T lymphocytes and macrophages. T lymphocytes, with the participation of proteins of the major histocompatibility system class I, recognize cells infected with Mycobacterium tuberculosis, attack and destroy them. Antibacterial antibodies bind to various antigens of the pathogen, form circulating immune complexes (CIC) and promote their removal from the body.

Allergic transformation (HRT) to the tuberculosis bacillus indicates the formation of acquired immunity and can be detected using a tuberculin test. This test is quite specific. Old Koch tuberculin is a concentrated filtrate of sterilized mycobacterial components. The purified preparation PPD (Koch's new tuberculin containing tuberculoproteins) is used primarily for staging intradermal Mantoux test. Using this sample, individuals subject to revaccination are selected. A positive Mantoux test result cannot be considered as a mandatory sign of an active process (this is actually an indicator of HRT), and a negative result does not always indicate its absence (anergy, immunodeficiency).

Immunoprophylaxis involves intradermal injection of an attenuated strain of B. bovis known as bacillus Calmette-Gérin (BCG). In Russia, vaccination is carried out for newborns (5-7 days of life), revaccination - at 7-12-17-22 years of age and older with a negative Mantoux test (i.e., the absence of cellular non-sterile = vaccine or infectious immunity - HRT).

Laboratory diagnostics. Microscopic, bacteriological, biological, allergological, serological and molecular genetic methods are used.

Microscopic diagnostics includes microscopy of native material, the use of accumulation methods, and luminescent diagnostics. Microscopy of native pathological material(sputum, fistula discharge, bronchial lavage water, urine) in Ziehl-Neelsen stained smears allows identifying red acid-fast bacilli with a concentration of mycobacteria of at least several hundred thousand/ml. Saving methods(eg flotation) increase the sensitivity of microscopy to several thousand microbial bodies/ml. Fluorescence microscopy using acridine orange or auramine - rhodamine - the most sensitive and effective bacterioscopy method, sensitivity - 500-1000 mycobacteria / ml. Allows you to identify mycobacteria with altered cultural and tinctorial properties.

Bacteriological method(inoculation on nutrient media) allows you to detect mycobacteria at a concentration of 200-300/ml. It is most effective before or at the beginning of treatment; at the end of treatment it is inferior in effectiveness to the luminescent method. The disadvantage is the duration of obtaining results - from 2 to 12 weeks. The advantage is the ability to assess the virulence of a culture and determine sensitivity to drugs. Accelerated isolation methods have been developed. According to Price's method, the material is placed on a glass slide, treated with sulfuric acid, washed with saline and added to a nutrient medium with citrated blood. The glass is removed after 3-4 days and stained according to Ziehl-Nielsen.

Gold standard - biological sample on guinea pigs, allows the determination of up to 10 mycobacteria per ml. The spread of resistant and modified mycobacteria has reduced the sensitivity of the method. The method requires compliance with regulatory conditions and is used in large specialized laboratories.

Allergological methods- These are widely used skin tests with tuberculin and in vitro allergy diagnostic methods (RTML, PPN - an indicator of neutrophil damage, etc.).

Serological methods are numerous (RSK, RA, RPGA), but due to lack of specificity they are little used.

The most perfect genetic methods, they are not yet used enough in practical laboratories.

Among methods for identifying mycobacteria Two approaches have the greatest practical value:

Methods for differentiating M.tuberculosis and M.bovis from other mycobacteria;

Methods for differentiating M. tuberculosis and M. bovis.

There are a number of methods for differentiating the two main types of mycobacteria from the rest. Of these, the simplest and most accessible is to assess growth on an egg medium containing salicylic sodium at concentrations of 0.5 and 1.0 mg/ml. On these media, unlike other mycobacteria, M. tuberculosis and M. bovis do not grow.

To differentiate M. tuberculosis from all other types of mycobacteria, including M. bovis, use niacin test(determination of nicotinic acid synthesized by M. tuberculosis in large quantities, detected using cyanide or thiocyanate compounds by a bright yellow color). Mycobacterium tuberculosis also shows a positive nitrate reduction test. The growth rate and the nature of pigment formation are taken into account. Cytochemical methods are used to identify the cord factor (virulence) by the strength of the bond of dyes - neutral red or Nile blue when treated with alkali.

This type of mycobacteria has been identified in 60 species of mammals. Cattle and, less commonly, camels, goats, sheep, pigs, dogs, and cats pose an epidemic danger to humans. Sick animals excrete mycobacteria in milk, sputum, and excrement. A person becomes infected by caring for sick animals or consuming raw milk and dairy products (the pathogen can survive in cheese and butter for more than 200 days). This pathogen accounts for up to 5% of tuberculosis cases (a high proportion of bovine type tuberculosis is in Yakutia and other territories with a high incidence of tuberculosis in animals).

Mycobacterium leprosy is the causative agent of leprosy (leprosy) - a generalized chronic infection with predominant damage to the ectoderm derivatives (integumentary tissues and the peripheral nervous system).

Cultural properties. They are very poorly cultivated on nutrient media. The main diagnostic method is bacterioscopic. Differentiation from Mycobacterium tuberculosis can be carried out in a bioassay on white mice (M.leprae is not pathogenic for them).

Epidemiology. The disease is slightly contagious. Genetic predisposition and individual resistance to infection are important. Infection occurs through household contact and airborne droplets. They keep patients in leper colonies (the main way of prevention is isolation).

Clinical and pathogenetic features. The incubation period is very long (from 4-6 years). There are tuberculoid (more benign) and lepromatous (more severe) forms.

Treatment long-term, sometimes lifelong. The main drugs are sulfones, the drugs of choice are dapsone, rifampicin, clofazimine.

Lecture No. 6. Family Enterobacteriaceae. Genus Salmonella.

General characteristics of the Enterobacteriaceae family.

Bacteria of this family are the most common causative agents of intestinal infections. They share a number of common features. These are short, non-spore forming rods with rounded ends, motile (peritrichs) or immobile, some have capsules. Aerobes or facultative anaerobes. A negative Gram stain is characteristic. They grow well on regular nutrient media with meat extract. On most solid media, enterobacteria form round, convex, shiny S- (smooth) colonies, as well as flat, uneven and granular R- (rough) forms, often due to the loss of the capsule. They are characterized by the fermentation of glucose (and other carbohydrates) with the formation of acid and gas. In relation to lactose, they are divided into lactose-fermenting and lactose-non-fermenting. Catalase is positive, reducing nitrates to nitrites.

The Enterobacteriaceae family includes more than 20 genera, uniting more than 100 species of bacteria that live in the soil, on plants, and are part of the microbial biocenoses of the intestines of animals and humans. The genera Escherichia, Salmonella, Shigella, Yersinia, Proteus, Klebsiella, etc. are of greatest importance for humans. To differentiate genera, biochemical characteristics are used mainly; for classification within genera and species, the study of the antigenic structure (O-, H- and K-antigens) is used. .

O-antigen represented by lipopolysaccharides (LPS) of the outer membrane. Strains lacking the O antigen form R colonies and are usually avirulent.

H-antigen - thermolabile proteins are found only in motile (flagellar) species.

K-antigen- thermostable polysaccharides of the capsule and outer shell.

In the pathogenesis of lesions caused by enterobacteria, LPS (endotoxin released when bacteria are destroyed), various enterotoxins, invasiveness and adhesion factors (flagella, etc.), and pathogenicity enzymes are important.

Genus Salmonella.

Salmonella is a large group of enterobacteria, among which various serotypes are the causative agents of typhoid fever, paratyphoid fevers A, B and C and the most common foodborne toxic infections - salmonellosis. Based on their pathogenicity for humans, Salmonella are divided into pathogenic for humans - anthroponoses (cause typhoid fever and paratyphoid A and B) and pathogenic for humans and animals - zoonoses (cause salmonellosis). Despite the significant differences between Salmonella in antigenic characteristics, biochemical properties, and the diseases they cause, according to the modern, but insufficiently convenient and perfect classification, two species are distinguished - S.bongori and S.enteritica. The latter is divided into subspecies, of which the subspecies choleraesuis and salamae are the most important. The subspecies choleraesuis contains the largest proportion of known Salmonella serovars (about 1400 of about 2400).

Morphology. Straight gram-negative rods measuring 2-4 x 0.5 µm. Motile due to the presence of peritrichial flagella.

Cultural and biochemical properties. Facultative anaerobes, grow well on simple nutrient media. Optimum pH - 7.2-7.4, temperature - +37. Metabolism - oxidative and fermentative. Salmonella ferment glucose and other carbohydrates to produce acid and gas (the Salmonella typhi serotype does not cause gas formation). Usually lactose (on media with this carbohydrate - colorless colonies) and sucrose are not fermented. Oxidase is negative, catalase is positive. The Voges-Proskauer reaction is negative.

Based on their biochemical (enzymatic) properties, Salmonella are divided into four groups. Characteristic signs of salmonella - hydrogen sulfide formation, lack of indole production and aerobic activity. For isolation, differential diagnostic media (bismuth - sulfite agar, Endo, Ploskirev, SS agar) and enrichment media (selenite broth, bile broth, Rappoport medium) are used. S-forms form small (from 1 to 4 mm) transparent colonies (on Endo medium - pinkish, on Ploskirev medium - colorless, on bismuth - sulfite agar - black, with a metallic sheen). In liquid media, S-forms give uniform turbidity, R-forms give a sediment.

Antigenic structure. O-, H- and K-antigens are isolated. The group of K-antigens includes Vi-antigens (virulence antigens). Due to its more superficial location (than O-antigens), Vi-antigen can prevent agglutination of Salmonella cultures with O-specific serum (shielding). To differentiate Salmonella, a scheme (serological classification) is used Kaufmann-White.

According to the structure of O-antigens, Salmonella are divided into O-groups(67 serogroups), each of which includes serological types, differing in the structure of H-antigens. The belonging of Salmonella to a specific serovar is established by studying the antigenic structure in accordance with the Kaufmann-White scheme. Examples: serotype S.paratyphi A belongs to serogroup A, S.paratyphi B belongs to serogroup B, S.paratyphi C belongs to group C, S.typhi belongs to serogroup D.

Pathogenicity factors.

1.Adhesion and colonization factors.

3.Endotoxin (LPS).

4. Heat-labile and heat-stable enterotoxins.

5. Cytotoxins.

6. Virulence plasmids and R-plasmids are essential.

7. Vi - antigen inhibits the action of serum and phagocytic bactericidal factors.

The main factors of the pathogenicity of Salmonella are their ability to penetrate macrophages and multiply in the lymphoid formations of the mucous layer of the small intestine (Peyer's patches, solitary follicles), as well as the production of endotoxin.

Pathogenesis of lesions. The differences in clinical forms of diseases caused by Salmonella depend on the virulence and dose of the pathogen and the state of the body's immune system. The usual dose that causes clinical manifestations is 10 6 - 10 9 bacteria; a smaller dose is sufficient for immunodeficiencies, hypochlorhydria and other diseases of the gastrointestinal tract.

The following main forms of salmonella infection are distinguished:

Gastrointestinal;

Generalized (typhoid-like and septicopyemic variants);

Bacterial carriage (acute, chronic, transient).

Significant pathogenetic features of the infectious process caused by serotypes S.typhi, S.paratyphi A,B are the basis for distinguishing typhoid-paratyphoid diseases into an independent nosological group. Each phase of pathogenesis corresponds to a clinical period of the disease and its own laboratory examination tactics. The main phases are the introduction of the pathogen (corresponding to the incubation period), primary localization of the pathogen (prodromal period), bacteremia (first week of the disease), secondary localization of Salmonella (the height of the disease - 2-3 weeks), excretory-allergic (convalescence - 4 weeks of the disease).

Salmonella that enter the mouth enter the epithelial cells of the duodenum and small intestine through endocytosis. They easily penetrate epithelial cells, but do not multiply here, but pass and multiply in the lymphatic apparatus of the small intestine. Salmonella multiply predominantly in the lamina propria (primary localization), which is accompanied by a local inflammatory reaction of the mucous membrane, an influx of fluid into the lesion and the development of diarrhea syndrome (gastroenteritis). Enterotoxins increase the level of cyclic adenomonophosphate (cAMP), an increase in the level of histamine and other biologically active substances, and vascular permeability. Water and electrolyte disturbances are observed, hypoxia and acidosis develop, which aggravate the pathological process with a predominance of vascular disorders. Some Salmonella are destroyed with the release of endotoxin and sensitization (HRT) of the lymphatic apparatus of the small intestine occurs.

From the mucous membrane, salmonella can enter the lymph and then into the bloodstream, causing bacteremia. In most cases, it is transient in nature, because Salmonella are eliminated by phagocytes.

Unlike other salmonella, the causative agents of typhoid and paratyphoid fever, having penetrated the bloodstream, are able to survive and multiply in phagocytes. They can multiply in the mesenteric lymph nodes, liver and spleen and cause generalization of the process. After the death of phagocytes, Salmonella enters the blood again. In this case, Vi-antigen inhibits bactericidal factors.

When salmonella die, endotoxin is released, which inhibits the activity of the central nervous system (typhoid - from the Greek typhos - fog, confusion) and causes prolonged fever. The action of endotoxin can cause myocarditis, myocardial dystrophy, and infectious and toxic shock.

As a result of bacteremia, a generalized infection of the gallbladder, kidneys, liver, bone marrow, and dura maters occurs (secondary localization of Salmonella). Secondary invasion of the intestinal epithelium, especially Peyer's patches, occurs. In the wall sensitized by salmonella, allergic inflammation develops with the formation of the main dangerous complication - typhoid ulcers. Long-term carriage of Salmonella in the gallbladder is observed with the release of the pathogen in feces, pyelonephritis, bleeding and intestinal perforation when Peyer's patches are affected. Then the formation of post-infectious immunity occurs, elimination of the pathogen and healing of ulcers or the formation of bacterial carriage (in Western Siberia, often against the background of chronic opisthorchiasis).

The causative agents of salmonellosis are other serotypes of salmonella that are pathogenic for humans and animals (S.typhimurium, S.enteritidis, S.heldelberg, S. newport and others). The pathogenesis of salmonellosis is based on the action of the pathogen itself (its interaction with the host body) and endotoxin that accumulates in food products infected with salmonella. In the classic version, Salmonella toxicoinfection is gastroenteritis. However, when the intestinal lymphatic barrier breaks, generalized and extraintestinal forms of salmonellosis can develop (meningitis, pleurisy, endocarditis, arthritis, liver and spleen abscesses, pyelonephritis, etc.). The increase in generalized and extraintestinal forms of salmonellosis is associated with an increase in the number of immunodeficiency states, which is of particular importance in HIV infection.

A separate problem is posed by hospital strains of Salmonella (usually individual phages of S.typhimurium), which cause outbreaks of nosocomial infections mainly among newborns and weakened children. They are transmitted mainly through contact and household contact from sick children and bacteria carriers; they are highly invasive, often causing bacteremia and sepsis. Epidemic strains are characterized by multiple drug resistance (R-plasmids), high resistance, including to high temperatures.

Epidemiological features. Characterized by widespread distribution. The main reservoirs of salmonella are humans (causative agents of typhoid fever and paratyphoid A) and various animals (other serotypes of salmonella). The main pathogens are polypathogenic. The main sources of infection are meat and dairy products, eggs, poultry and fish products. The main routes of transmission are food and water, less often - contact. Characterized by an extreme multiplicity of reservoirs and possible sources of infection. Farm animals and birds are of primary importance.

Laboratory diagnostics. The main method is bacteriological. Based on the pathogenesis, the optimal time for bacteriological studies for gastrointestinal forms is the first days, for generalized forms - the end of the second - the beginning of the third week of the disease. When examining various materials (stool, blood, urine, bile, vomit, food debris), the highest frequency of positive results is observed in the study of feces; for the causative agent of typhoid fever and paratyphoid fever - blood (blood culture).

Research is carried out according to a standard scheme. The test material is inoculated on dense differential diagnostic media - highly selective (bismuth sulfite agar, brilliant green agar), medium selective (Ploskirev's medium, weakly alkaline agar), low selective (Endo and Levin agars) and in enrichment media. Rapoport medium is used for blood culture. On bismuth-sulfite agar, Salmonella colonies acquire a black (rarely greenish) color. The grown colonies are subcultured onto media for primary (Russell's medium) and biochemical (hydrogen sulfide, urea, glucose, lactose) identification. For preliminary identification, the O1-salmonella phage is used, to which up to 98% of salmonella are sensitive.

To identify cultures in RA, polyvalent and monovalent O-, H- and Vi-antisera are used. First, polyvalent adsorbed O- and H-sera are used, and then the corresponding monovalent O- and H-sera are used. To identify the causative agents of typhoid fever and paratyphoid fever, antibodies to the O2 (S.paratyphi A), O4 (S.paratyphi B), O9 (S.typhi) antigen are used. If the culture is not agglutinated by O-serum, it should be examined with Vi-serum. To quickly detect Salmonella, polyvalent luminescent sera are used.

Serological studies are carried out for diagnosis, as well as identification and differentiation of various forms of carriage. RA (Widal reaction) is used with O- and H-diagnosticums and RPGA using polyvalent erythrocyte diagnosticums containing polysaccharide antigens of serogroups A, B, C, D and E and Vi-antigen.

Treatment- antibiotics (chloramphenicol, etc.). Antibiotic-resistant strains are often identified. It is necessary to determine the antibiotic resistance of isolated cultures.

Specific prevention can be used primarily against typhoid fever. A chemical sorbed typhoid monovaccine is used. Vaccination is currently used mainly for epidemic indications.

Genus Mycobacterium.

Mycobacterium tuberculosis (Koch bacillus).

Koch's bacillus is stable in the external environment and persists in dried biosubstrates for up to several weeks.

- ability to cause pronounced HRT reaction, detected using a tuberculin test - “HRT of tuberculin type”.

Pathogenetic features.

Outcomes of the primary lesion:

Laboratory diagnostics. Microscopic, bacteriological, biological, allergological, serological and molecular genetic methods are used.

Allergological methods- These are widely used skin tests with tuberculin and in vitro allergy diagnostic methods (RTML, PPN - an indicator of neutrophil damage, etc.).

Serological methods are numerous (RSK, RA, RPGA), but due to lack of specificity they are little used.

The most perfect genetic methods, they are not yet used enough in practical laboratories.

Among methods for identifying mycobacteria Two approaches have the greatest practical value:

Methods for differentiating M.tuberculosis and M.bovis from other mycobacteria;

Methods for differentiating M. tuberculosis and M. bovis.

M.bovis .

M.leprae .

Clinical and pathogenetic features. The incubation period is very long (from 4-6 years). There are tuberculoid (more benign) and lepromatous (more severe) forms.

Treatment long-term, sometimes lifelong. The main drugs are sulfones, the drugs of choice are dapsone, rifampicin, clofazimine.

In addition to vitamins, minerals and acids, there are a number of substances that a person needs or, on the contrary, does not need to maintain health. We will talk about such substances (lacto- and bifidobacteria, probiotics and prebiotics, alkaloids, GMOs, soy and aphrodisiacs) in this article.

Lactobacilli

The intestinal mucosa of any person is a habitat for a huge number of different types of bacteria that can harm the body or, on the contrary, be beneficial. Bacteria that are beneficial include lactobacilli (or lactobacilli), which enter the body mainly from fermented milk products.

By the way, lactobacilli are the first microorganisms that a newborn encounters in his life: passing through the birth canal, the baby receives these beneficial microbes from the mother.

Benefits of lactobacilli

Transformation of lactose, which is contained in the whole product, directly into lactic acid, which provides favorable conditions for the complete digestion of food.
Prevention of the development of intestinal diseases. The fact is that lactobacilli produce substances that have pronounced antibiotic properties that suppress the growth of putrefactive bacteria.
Reducing the risk of developing cancer. Thus, lactobacilli suppress the functions of enzymes that affect the formation and reproduction of cancer cells.
Strengthening the immune system through the synthesis of vitamin K, thiamine, riboflavin, iron, calcium, selenium and iodine.
Improving metabolism and metabolic processes.

BUT! One should not attribute miraculous properties to lactobacilli, remembering that products containing these bacteria are only an auxiliary measure in the treatment of diseases of the digestive system and dysbiosis.

What foods contain lactobacilli?

Lactobacilli provoke lactic acid fermentation, which is why they are widely used in the production of fermented milk products.

The maximum amount of lactobacilli is contained in the following fermented milk products:

yoghurts;
kefir;
fermented baked milk;
soft cheeses;
curdled milk;
cottage cheese;
sour cream.

Probiotics

Probiotics are microorganisms beneficial to human health. Probiotics include living microorganisms (namely lactic acid bacteria, bifidobacteria and yeast) present in the intestines of a healthy person.

Normally, the human body should contain about 1 – 1.5 kg of probiotics (this is the amount that ensures the full functioning of not only systems and organs, but also the immune system). But the realities are far from the norm: for example, in fact, the human body contains about one tenth of the established norm of probiotics, while in many people almost all healthy microflora is completely replaced by pathogenic ones.

Benefits of probiotics

Strengthening the immune system.
Synthesis of vitamins K and B.
Improved digestion.
Neutralization of toxins and pathogenic bacteria.
Neutralization of the harmful effects of antibiotics on the body.
Elimination and treatment of diarrhea.
Reducing the manifestations of allergies.
Elimination of inflammation.
Maintaining normal metabolism.
Fighting infections.
Improving the condition of the skin.

What foods contain probiotics?

One of the main sources of probiotics is yogurt, which will help cope with diarrhea, flatulence, and other digestive disorders.

In addition to yogurt, probiotics are present in the following foods:

soft cheeses;
kefir;
curdled milk;
fermented baked milk;
cottage cheese;
miso soup (miso is a fermented soybean product);
tofu (or soy cheese);
sauerkraut;
pickled cucumbers and tomatoes;
sourdough bread;
artichokes;
onions;
soaked apples;
leek;
banana.

Important! The effectiveness of probiotics increases significantly when they are consumed simultaneously with prebiotics, which are not digested in the intestines, but create a favorable environment for both the growth and functioning of healthy intestinal microflora.

Prebiotics

Prebiotics are the remains of food substances that are not digested by gastric enzymes, as a result of which they are not absorbed in the upper parts of the gastrointestinal tract, but end up in the lower parts, where probiotics “feed” on them, which has a beneficial effect on the functioning of not only the intestines, but the whole body.

Benefits of prebiotics

Strengthening the immune system.
Strengthening intestinal motility.
Eliminate constipation.
Increasing the effectiveness of probiotics.

What foods contain prebiotics?

Food sources of prebiotics:

chicory root;
raw Jerusalem artichoke;
dandelion greens;
garlic;
onions;
leek;
raw asparagus;
raw wheat bran;
bananas;
wheat flour;
cornflakes;
oatmeal;
beer;
strawberry.

Bifidobacteria

Bifidobacteria are found in the body in large quantities (for example, during breastfeeding, bifidobacteria make up about 80–90 percent of the normal intestinal flora of children). Moreover, most of them are concentrated in the large intestine, representing the basis of its parietal and cavity microflora. With the help of bifidobacteria, the reproduction and spread of both putrefactive and pathogenic microbes in the body is suppressed.

The benefits of bifidobacteria

Reducing the risk of developing various allergic reactions.
Restoration of intestinal microflora.
Prevention of the development of dysbacteriosis.
Reducing cholesterol levels.
Restoration of liver and kidney function.
Reducing the risk of developing cancer.
Normalization of digestion.
Stimulation of intestinal motility.
Promoting the synthesis and absorption of vitamins and amino acids.
Strengthening the immune system.
Preventing the development of constipation and flatulence.
Inhibition of the action of carcinogens.

What foods contain bifidobacteria?

Important! Products containing bifidobacteria are characterized by fairly high dietary properties, since they contain a number of biologically active compounds, including amino acids, fatty acids, vital enzymes, and antibiotic substances, not to mention micro- and macroelements.

But it is important to use this truly healing product correctly.

Firstly, kefir should not be drunk cold or warm (this drink should be at room temperature).

Secondly, kefir is consumed in small sips.

Alkaloids

Alkaloids are organic substances that contain nitrogen.

There are a huge number of such substances in nature, they have different chemical formulas and have different effects on the human body. Most alkaloids have a bitter taste. Alkaloids are produced by the breakdown of amino acids.

Benefits of alkaloids

Elimination of pain syndrome.
Relieving spasms.
Helping to quickly stop bleeding.
Decreased blood pressure.
Calming the nervous system.
Protecting the body from the action of pathogens.
Inhibition of the development of tumors in the body.
Elimination of symptoms of intoxication.

Important! There are alkaloids that are dispensed only as prescribed by a doctor because they are drugs or dangerous poisons (such alkaloids include, for example, morphine and cocaine).

What foods contain alkaloids?

In addition to plants, alkaloids are present in some types of mushrooms and in marine organisms.

Interesting fact! A unique alkaloid is produced by tropical frogs. And the human body also produces substances similar in their chemical properties to alkaloids (we are talking about serotonin and adrenaline, which in some sources are called alkaloids, which is not a mistake).

Caffeine

The alkaloid caffeine belongs to the class of mild and non-aggressive stimulants that increase brain activity.

Benefits of caffeine

Stimulating the heart.
Increased physical and mental activity.
Stimulating the nervous system.
Promotes the production of stomach acid, which significantly improves the digestion process.
Constriction of blood vessels.
Increased urination.
Relief of headaches, which is used in the treatment of migraines.
Stimulating breathing.
Eliminate drowsiness.
Increased blood pressure.

Important! With prolonged and regular use of caffeine, a disease called “theism” (or “caffeineism”) may develop. This disease is a mental dependence on caffeine and is manifested by the following symptoms:

nervousness;
irritability;
unreasonable anxiety;
trembling in the body;
muscle twitching;
insomnia;
headaches;
rapid heartbeat.

Important! Caffeine and other central nervous system stimulants should not be taken in the following conditions:

excessive excitability;
insomnia;
diseases of the cardiovascular system;
severe hypertension;
atherosclerosis;
polycystic disease.

Important! Caffeine consumption leads to increased loss of minerals from bone tissue.

What foods contain caffeine?

Caffeine is found in more than 60 types of plants and products used as dietary supplements and components for various medications.

But the most common of them are the following:

coffee tree;
guarana;
mate;
cocoa;
kola nuts.

Interesting fact! White chocolate does not contain caffeine.

Nicotine

The alkaloid nicotine is found in plants from the Solanaceae family (mainly tobacco and shag), and the biosynthesis of this substance occurs in the roots, while it accumulates in the leaves.

The history of the spread of nicotine is interesting. Thus, the French ambassador Jean Nicot, who served at the royal court of Portugal, sent dried leaves, as well as tobacco seeds, to the French queen Catherine de Medici, who suffered from migraines. To get rid of migraines, Jean Nico recommended putting dry tobacco leaves crushed to a powdery state into the nose. Subsequently, tobacco was grown in gardens by order of Catherine de Medici.

The use of nicotine increases the concentration of adrenaline in the blood, which leads to increased blood pressure, increased heart rate, significantly increased respiration and increased blood glucose levels.

Nicotine also increases the level of dopamine, which excites the reward centers of the brain. In turn, such pleasure centers are responsible for the pain threshold.

Nicotine is a toxic substance, but when consumed in small doses (for example, through smoking), this alkaloid acts as a psychostimulant.

However, nicotine does more harm to the body than good: for example, nicotine suppresses appetite, which leads to weight loss.

Important! Long-term and repeated consumption of nicotine leads to the development of physical and mental addictions, which are quite difficult to get rid of.

In addition, constant use of nicotine can provoke the following diseases and dysfunctions:

hyperglycemia;
arterial hypertension;
atherosclerosis;
tachycardia;
arrhythmia;
angina pectoris;
ischemia;
heart failure;
heart attack;
cancer of the lungs, tongue and larynx;
gingivitis;
stomatitis.

What products contain nicotine?

As mentioned above, the highest nicotine content is found in plants from the Solanaceae family.

But this alkaloid is also present in eggplants, cauliflower, potatoes, and tomatoes (tomato juice is especially rich in nicotine).

This begs a completely reasonable question: how many vegetables do you need to consume to replace one cigarette?

One cigarette contains 10 mg of nicotine, and most of this alkaloid is destroyed during the smoldering of a lit cigarette (thus, when smoking a cigarette, a person receives about 0.5 - 3 mg of nicotine). To replenish this amount of nicotine, you will have to eat 5 kg of eggplants, at least 12 kg of new potatoes and drink about 10 liters of tomato juice.

Conclusion: It is simply impossible to completely switch to vegetable sources of nicotine, although they can still provide some help in getting rid of such a bad habit as smoking.

Alcohol

Speaking about substances that slowly but surely destroy our body, we cannot fail to mention alcoholic beverages.

I would like to immediately note that alcohol in small quantities is not only not harmful to health, but is also beneficial, since it helps lower cholesterol, prevents the formation of blood clots, dilates blood vessels, and also increases blood circulation. As a result, the risk of developing cardiovascular diseases is reduced. In this case, it is advisable to give preference to red wine, the daily norm of which is no more than two glasses.

But excessive consumption of alcohol (including beer, liqueurs and vermouth) leads to disruption of the body as a whole, because alcohol does not act selectively, it damages the body almost instantly, and in all directions at once.

While the liver is trying to cope with ethanol, some of the already absorbed alcohol negatively affects the functions of the brain, as well as the cardiovascular system. But that’s not all: at the same time, the functioning of the stomach, pancreas, and intestines is disrupted. Often the complex of damaging factors is so extensive that it can provoke severe alcohol intoxication, which leads to death or severe disability.

I wanted to debunk several myths about alcohol.

Alcohol helps you stay warm

To warm up, just drink 50 g of vodka or cognac (as you know, alcohol dilates blood vessels and normalizes blood supply to internal organs). But subsequent doses will increase blood flow only in the skin, causing it to turn red and create a pleasant feeling of warmth. But this feeling will quickly disappear, since with subsequent doses of alcohol, heat transfer will also increase, that is, the body will cool down even faster.

Alcohol increases appetite

And this is true, and only 25 g of strong alcoholic drink is enough to whet your appetite. In this case, alcohol is drunk half an hour to an hour before meals.

Alcohol effectively fights stress

Alcohol helps you relax after a hard week of work, but for such relaxation, 50 ml of cognac or a glass of wine is enough. But after the first 50 ml the mood improves and I want to continue the “banquet”. As a result, it becomes even sadder, and the short-lived feeling of celebration and euphoria is replaced by a feeling of hopelessness.

Alcohol helps lower blood pressure

A small dose of alcohol (for example, 100 ml of dry red wine) can indeed weaken the tone of the vascular wall, but alcohol also increases the heart rate. As a result: the more you drink, the higher your blood pressure.

High-quality alcohol is not harmful to health

Any alcoholic drink without exception poisons the body. The only question is that cheap alcohol does not undergo the proper degree of purification, and therefore contains so-called fusel oils, which greatly enhance the toxic effect of alcohol.

Beer is not alcohol

This statement has no right to exist, since beer (albeit in small quantities) contains alcohol.

Alcohol contains no calories

Contains, and a very large amount. And the stronger the drink, the more calories it contains.

Alcohol is not washed down, but eaten

Many are of the opinion that alcohol should be consumed as a snack, without even suspecting that snacks are different from snacks. Thus, cold snacks (like juices, fruit drinks and compotes) very poorly neutralize alcohol, which is quickly absorbed into the blood. But hot and fatty dishes, on the contrary, suppress the absorption of ethanol, thereby reducing the severity of intoxication. Therefore, it is better to have hot snacks.

What foods contain alcohol?

Interesting fact! We associate the word “alcohol” with a liquid obtained through fermentation. But there are products in which alcohol is present in the form of fructose, which directly enters the fermentation process in the body, thereby forming alcohol in the blood.

Foods and drinks containing alcohol (alcohol):

all alcoholic and low-alcohol drinks;
kvass;
kumiss (oriental drink);
kefir;
yogurt;
curdled milk;
fruit juices (the fact is that when making juices a special concentrate is often used, the basis of which is alcohol);
chocolate;
lollipops;
cakes;
bananas (especially overripe ones);
sauerkraut;
apples;
grape;
citrus;
sour cream;
black bread.

Yeast

If we are already talking about fermentation products, then we cannot help but pay attention to yeast, the benefits and harms of which we will discuss below.

Yeast is a protein product that contains live cultures, microorganisms, and bacteria. The proteins that they contain are perfectly absorbed by the body, not inferior in quality to proteins that enter the body with meat, milk or fish.

Yeast is rightfully considered the richest source of mineral elements, as well as amino acids and vitamins (potassium and phosphorus, magnesium and calcium, iron and folic acid, B vitamins, methionine and lecithin).

Benefits of yeast

Maintaining optimal balance of intestinal microflora.
Accelerates the healing of wounds and burns (due to this property, yeast is used for skin diseases).
Improving the secretion of gastric glands.
Improving the absorption capacity of the intestine, which is used in the treatment of ulcers, gastritis, colitis and enterocolitis.
Strengthening the immune system.
Reducing cholesterol levels.
Relief of pain due to neuritis.
Increased physical activity and performance.
Improving overall tone and well-being.
Increased appetite.
Activation of the pancreas.
Improving food absorption.
Normalization of metabolic processes.
Promoting the elimination of toxins.
Strengthening nails and hair.

But! Not all yeast is equally beneficial. The fact is that baker's yeast enters gluten capsules during the baking process. Already in the intestines, yeast is released from such capsules, beginning to harm the body, damaging the mucous membrane and disrupting the intestinal microflora. Moreover, when entering the blood plasma, such yeast absorbs vitamins, microelements and proteins that are vital for the normal functioning of the human body. At the same time, the yeast begins to release its metabolic products, which are toxins.

Such large-scale “activity” of yeast leads to intoxication and weakened immunity, and this is fraught with chronic diseases and the development of tumor processes.

Conclusion! Live baker's yeast should be avoided!

Important! Yeast products are not recommended for use in case of individual intolerance, kidney disease or gout.

What foods contain yeast?

Soybeans

Soybean is an annual herbaceous plant from the Legume family.

Soy is famous for its high content of complete protein, B vitamins, as well as iron, calcium and essential fatty acids. This cholesterol-free product has taste properties that make it possible to make a wide range of different meat and dairy products from soy.

Today there is a lot of controversy regarding the benefits and harms of soy. I would like to immediately note that only natural soy is useful, which in terms of the amount of protein it contains is superior to such products as fish, eggs, meat (and soy proteins are absorbed by 90 percent, which cannot be said about animal proteins).

Benefits of soy

Preserving the beauty of skin and hair.
Protecting the body from the negative effects of the environment.
Regulation of cholesterol levels.
Reducing the risk of developing heart and vascular diseases.
Improving kidney function in diabetes.
Normalization of fat metabolism.
Promoting weight loss.
Strengthening the immune system.
Normalization of metabolism.
Improving the functioning of brain cells.
Strengthening the nervous system.
Binding and removal from the body of radionuclides, as well as heavy metal ions.

Harm of soy

Hormonal imbalance.
Suppression of the functions of the endocrine system (especially for children).
Increased risk of miscarriage.
Cerebrovascular accident.
Increased risk of developing Alzheimer's disease.

But such harm to the body is caused by the consumption of genetically modified soybeans, which today are present in a large number of products that we consume daily.

What foods contain soy?

Food sources of soy:

miso (thick soybean seed paste);
natto (boiled soybean seeds);
soy flour;
soybean oil;
soy milk;
soy meat (prepared on the basis of low-fat soy flour);
soy sauce;
pace;
tofu;
Yuba (dried foam skimmed from the surface of soy milk).

If we talk about genetically modified soybeans, it is present in sausages, semi-finished meat products (dumplings, ravioli, pancakes with meat), dairy drinks, mayonnaise, margarine, pasta, chocolate, candies and even in baby food products. The presence of soy in the product is indicated by markings on the label E479 and E322.

GMO

GMOs (or genetically modified organisms) contain a foreign gene that has been artificially introduced through genetic engineering techniques.

Why is such a targeted change in the genotype of an organism necessary?

It's very simple. Firstly, the population of planet Earth is rapidly increasing, and, consequently, the problem of hunger is becoming urgent.

Secondly, with the help of genetic engineering, new plant varieties are created that are resistant to unfavorable environmental conditions and pests. In addition, artificially bred plants have better growth and taste qualities (not to mention the accelerated growth and high productivity of such plants).

But not everything is so simple, because during selection the natural course of life is disrupted, which, at the simplest level, significantly harms the food chain. As a result, today we eat orange carrots, although initially this product was purple, and hundreds of species of many vegetables and fruits have disappeared from the face of the earth in the process of modification.

Thus, on the one hand, we have the opportunity to eat beautiful and juicy vegetables and fruits, and, on the other hand, agricultural crops gradually turn from a storehouse of vitamins and nutrients into “empty” products.

Finally, the third reason why GMOs are confidently “walking” across the planet is the benefit, both for breeders and for farmers who, while growing GMOs (genetically modified products), do not incur losses due to poor harvests or widespread animal pestilence.

So is the use and consumption of GMOs harmful or beneficial? Let's try to understand this issue.

And let's start with the fact that the transgene itself, consumed by a person, does not cause serious harm to his health, since it is not able to independently integrate into the human genetic code. But while such a gene “walks” throughout the body, it provokes the synthesis of proteins, which is fraught with severe allergies. And this is just the tip of the iceberg.

Harm of GMOs

Decreased immunity.
Disruption of the gastric mucosa.
Metabolic disorder.
Increased risk of developing cancer (transgenes, when integrated into the gene apparatus of microorganisms located in the intestine, lead to mutations that provoke the development of cancer cells).
Infertility (during animal studies it was found that frequent use of OAB leads to the inability to conceive a child).
Development of antibiotic-resistant intestinal microflora.

What foods contain GMOs?

Products containing GMOs are divided into three categories:

Products that contain GM ingredients (we are talking about transgenic corn and soybeans). These protein enhancers are used to improve the texture, taste and color of the product.
Products of processing of transgenic raw materials. These products include soybean curd and milk, chips, as well as corn flakes and tomato paste.
Transgenic products that are directly consumed as food.

But how can one determine the presence of GMOs in a particular product (especially considering the fact that today almost every one of them is labeled “GMO-free”)?

First of all, you need to carefully read the label on the product you are purchasing. If the label states that the product was made in the USA and contains soybeans, corn, rapeseed or potatoes, then there is a high probability that GM components were used in its production (GMOs are the main reason that Today, 70 percent of Americans are diagnosed with allergies).

Here is a list of E-additives that indicate the content of GMOs or their derivatives in the product: 322, 101 and 101A, 150 and 415, 153 and 160d, 161c and 308-9, 471 and 472a, 473 and 475, 476b and 477, 479a and 570, 572 and 573, 620 and 621, 622 and 633, 624 and 625, 951.

Particularly noteworthy is the presence in the product of such sweeteners as aspartame, aspasvit and aspamix, which can be produced using GM bacteria. These substances are prohibited in a number of countries because they can cause loss of consciousness syndrome. Aspartame, for example, is found in soda water, chewing gum, diet sodas, and ketchup.

List of products that often contain GMOs:

soybeans and by-products;
corn and by-products (flour, cereal, popcorn, corn oil, chips, starch);
tomatoes and offal;
potatoes and offal;
zucchini and offal;
sugar beets and by-products;
wheat and by-products;
rice and offal;
carrots and offal;

Important! It is useful to know in person not only products containing GMOs, but also their manufacturers, including:

Kelloggs (Kelloggs) - specializes in the production of breakfast cereals and corn flakes.
Nestle is a well-known manufacturer of chocolate, coffee and baby food.
Heinz (Hayents) - produces baby food, ketchups, sauces.
Hersheys is a manufacturer of chocolate and soft drinks.
Coca-Cola, Mars (Mars), PepsiCo and McDonalds - as they say, these companies do not need advertising.
Danon (Danone) - the main direction of this company is the production of yoghurt, kefir, cottage cheese, and baby food.
Similac (Similac) is a manufacturer of baby food.
Cadbury (Cadbury) - sells chocolate and cocoa.

Aphrodisiacs

Aphrodisiacs are substances that increase vitality in general and sexual desire in particular. They got their name in honor of the Greek goddess of beauty and love, Aphrodite. And the word “aphrodisiac” itself is translated from Greek as “love pleasure.”

Aphrodisiacs not only increase potency, but also help eliminate frigidity, they prevent premature ejaculation, and also increase the duration of sexual intercourse.

What is the secret of the love properties of aphrodisiacs?

Firstly, Most aphrodisiacs have high nutritional value and contain many vitamins and microelements, and this contributes not only to proper metabolism, but also to rapid restoration of strength.

Secondly, Some aphrodisiacs contain enzymes that are similar in properties to human sex hormones (there are aphrodisiacs that contain substances that promote the production of sex hormones by the body itself).

Thirdly, natural aphrodisiacs enhance the formation of endorphins (hormones of happiness), which are known to intensify sexual desire, enhance erotic fantasies, and make a person relaxed and happy.

What foods contain aphrodisiacs?

Shrimp, oysters, caviar

Avocado

This fruit contains many vitamins and natural hormones that help increase potency, primarily in men.

Nuts

They saturate the body without burdening the stomach, so energy will be spent on enjoying the pleasures of love, and not on the process of digesting food.

Chocolate

Dark chocolate is the best stimulant for women because it contains caffeine and theobromine (these substances awaken erotic feelings by promoting the production of female hormones). It is also interesting that the very smell of chocolate provokes the production of endorphins.

Onions and garlic

Yes, yes, yes! These vegetables, which have an unpleasant odor, have a beneficial effect on libido.

Spices

Cardamom, fennel, dill, anise, red pepper, curry invigorate, cinnamon, ginger, improve blood circulation, stimulate blood flow to the genitals.

Strawberry

This tasty and beautiful berry contains endorphins that improve mood and heighten the senses.

Oatmeal

It has been proven that oatmeal can regulate sexual desire, while in men this product regulates spermatogenesis and increases the concentration of testosterone in the blood.

Dates

This fruit, rightfully considered the sweetest on planet Earth, enhances sexual stamina due to its high content of fructose, glucose, and carbohydrates.

Honey

Increases sexual desire due to the fact that it contains boron in large quantities, which improves mood and promotes the emergence of sexual desire.

Important! All aphrodisiac products should be consumed fresh. They should not be subjected to prolonged heat treatment (it is advisable not to salt such products). But the consumption of carbohydrates, alcoholic beverages, fatty and fried foods should be reduced to a minimum, since they suppress sexual desire.

Food sources of aphrodisiacs:

game meat;
cereals;
legumes;
sauerkraut;
flax seeds;
grenades;
apples;
wine;
celery;
asparagus;
raisin;
bananas;
dried apricots;
mango;
melon;
passion fruit;
cherry;
eggs.

Herbal aphrodisiacs:

bergamot;
geranium;
ylang-ylang;
vanilla;
yohimbe (this aphrodisiac is made from the bark of an African tree);
pumpkin seeds;
sagebrush;
ginseng root;
St. John's wort;
Ginkgo biloba.

Atypical mycobacteriosis is a series of granulomatous-type diseases provoked by mycobacteria. The name of the disease includes the term atypical, since the causative agent of the disease differs from classical pathogenic mycobacteria that cause the development of skin tuberculosis.

Mycobacteria are anaerobic, non-motile microorganisms that do not form spores. The most important characteristic of these bacilli is their acid resistance and high lipid content in the cell walls.

Today, about five dozen different mycobacteria are known. Among them are:

Definitely pathogenic. These include M. tuberculosis, M. Bovis, M. Leprae, which also cause leprosy.
The remaining types of mycobacteria are classified as opportunistic and are called atypical.

Reasons for development

Atypical mycobacteria.

The cause of mycobacteriosis is infection with a certain type of mycobacteria.

You can become infected with mycobacteria in different ways - contact, airborne droplets, dust. Moreover, a person suffering from atypical mycobacteriosis does not pose a particular danger to others. Infection mainly occurs through contact with the environment.

For example, the mycobacterium M. Avium can be present in vapors from bodies of water, so infection often occurs during swimming. Poultry is often the source of infection. Mycobacteria can also live in soil.

Of course, the mere fact of contact with mycobacteria does not mean that the disease will necessarily develop. Persons with reduced immunity (local and general) are predisposed to mycobacteriosis. There are often cases of infection with mycobacteria in patients with obstructive pulmonary disease, cystic fibrosis of lung tissue, and bronchiectasis. Provoking factors include injuries, including,.

Clinical picture

The clinical picture of mycobacteriosis caused by atypical mycobacteria is characterized by varied symptoms. Manifestations of the disease depend on the type of mycobacteria, the route of their penetration, age, gender, etc.

Bather's granuloma or pool granuloma

The causative agent of this disease is Mycobacterium marinum - mycobacteria that live in sea water. Penetration of mycobacteria occurs through damage to the skin (scratches, abrasions, etc.). Infection can occur when swimming in seawater pools, cleaning aquariums containing marine life, or cleaning sea fish.

The incubation period for this type of skin disease caused by mycobacteria averages 2.5 weeks. At the site of penetration of mycobacteria on the skin, a node with a warty or surface covered with small scales is formed. The node has a bluish-reddish color.

This disease is more common in representatives of the stronger sex aged 10-40 years. The resulting knot does not cause pain, has a fairly dense consistency and is cold to the touch. As a subjective sensation, itching is sometimes noted, but, usually, patients are more worried about the formation of a cosmetic defect.

If the node is located above the joint, it may lead to limitation of its mobility. When pressing on the node, slight pain is sometimes noted.

As the disease develops, an ulcer may form at the site of the node, covered with purulent or hemorrhagic crusts. Ulcers are observed at the bottom. In some cases, daughter nodes and fistulas form around the ulcer.

Bather's granuloma is a disease with a long course. At the site of a healed ulcer, it forms.

In the sporotrichoid form of the disease, soft subcutaneous nodes are formed, which look like swellings with a diameter of about 2 cm. The nodes are located linearly, along the location of the lymphatic vessel at a distance from the primary ulcer. When the swelling is located above the joints, the clinical picture of the disease resembles bursitis or inflammatory arthritis.

The disseminated form of swimmers' granuloma is extremely rare. Typically, this type of disease is observed in people with a reduced immune status - HIV patients, taking immunosuppressants, etc. In this case, in addition to the primary focus located at the site of penetration of mycobacteria, the formation of numerous linear nodes is observed. The localization of nodes depends on the method of infection. In swimmers, the legs are usually affected; in aquarists, the dominant arm is affected. In the disseminated form of the disease, there is an increase in lymph nodes located near the primary site.

Buruli ulcer

The causative agent of the disease is Mycobacterium ulcerans. This type of mycobacteria enters the body through lesions on the skin. The disease is more common in tropical countries, mainly in young people. Women get sick somewhat more often.

Since the natural habitat of mycobacteria such as Ulcerans has not been established, it is difficult to say how infection occurs. It is believed that infection occurs through minor injuries - pricks from a thorn, a cut on a plant leaf, etc.

The incubation period of this disease is 3 months, so not all patients remember the microtrauma, which became the “entry gate” for mycobacteria.

Clinically, the disease is manifested by the appearance of a dense node, which quickly degenerates into a non-painful ulcer. Ulcers with this disease can be very large, spreading to the skin of almost the entire affected limb. Most often, ulcers are localized on the legs, since it is the skin of the legs that is most often injured during walks in nature or as a result.

With Buruli ulcer, usually there are no symptoms of general intoxication, the lymph nodes are not changed.

Other types of atypical mycobacteriosis

Atypical mycobacterioses caused by Mycobacterium, Mycobacterium abscessus and Mycobacterium chelonae are very common. These mycobacteria typically penetrate skin breaks and cause wound infections.

There is a geographical principle in the spread of infection. Thus, in European countries, skin infections caused by mycobacteria of the fortuitum type are more common. On the American continent, cases of infection with mycobacteria of the chelonae type are more common.

These mycobacteria are common in the environment and can be found in water, soil, dust, and in wild or domestic animals.

Mycobacteria are introduced through wounds on the skin, and half of the cases of infection occur in wounds after operations and injections.

The incubation period lasts about a month, but sometimes it takes longer - up to 2 years.

At the site of penetration of mycobacteria, a dark red node first forms, which transforms into a cold abscess without pronounced signs of inflammation. After opening the abscess, separation of serous fluid is observed. In individuals with low immune status, a disseminated form of the disease with the formation of multiple abscesses and joint damage is possible. This type of disease develops with the hematogenous spread of mycobacteria throughout the body.

Diagnostic methods

The basis for diagnosing microbacteriosis is culture on media for mycobacteria. For examination, discharge from ulcerative surfaces or biopsy material is taken. Additionally, the material is inoculated using conventional media, this allows us to exclude the presence of secondary infection with other bacterial infections.

Treatment

Minocycline is used to treat the disease.

The basis of treatment for skin lesions caused by mycobacteria is antibacterial therapy. The drug of choice for combating mycobacteria is usually minocycline. It is possible to use other antibiotics, taking into account the sensitivity of mycobacteria.

If mycobacteria show poor sensitivity to conventional antibacterial agents, rifampicin is prescribed in combination with ethambutol. By the way, rifampicin is also successfully used in the treatment of...

When treating Buruli ulcers, antibiotics are often ineffective. If the affected area is large, the affected tissue is excised and the patient’s own skin is implanted.

For disseminated forms of skin diseases caused by mycobacteria, anti-tuberculosis drugs are used.

Patients, as a rule, are offered hospitalization at the initial stage of treatment, since in order to select the most effective drug it is necessary to constantly monitor the course of the disease. The general course of treatment for skin infections caused by mycobacteria can last up to a year.

During long-term treatment of the disease with antibiotics, hepaprotectors should be prescribed to protect the liver and probiotics to prevent the development of dysbiosis.

In the process of treating diseases caused by mycobacteria, it is necessary to provide the patient with adequate nutrition. It is recommended to limit exposure to open sun.

Treatment with folk remedies

For the treatment of skin infections caused by mycobacteria with folk remedies, it is recommended to choose recipes aimed at generally strengthening the immune system

For diseases caused by atypical mycobacteria, it is recommended to take aloe vera preparations with honey. Vitamin teas made from rose hips, mint, raspberries, and currants are useful.

Prevention and prognosis

Prevention of the development of skin diseases caused by mycobacteria involves preventing skin damage. The prognosis for these diseases is favorable, however, these skin infections require long-term treatment.

1. How are mycobacteria classified?
Extensive taxonomic work has been carried out to classify more than 40 species of mycobacteria. In the 1950s Runyon classified atypical mycobacteria based on their growth rate, ability to produce pigment, and colony characteristics. Mycobacteria are also divided into obligate pathogens for humans - transmitted through direct person-to-person contact, facultative - found in the environment, and non-pathogenic. Classification of pathogenic mycobacteria

	OBLIGATE	OPTIONAL
Slow growing
M. tuberculosis
M. bovis
M. africanum
Photochromogenic - group 1 according to Runyon (the ability to form a yellow-orange pigment in the light)
M. kansasii
M. mar/lit
Scotochromogenic - group II according to Runyon (the ability to form an orange-red pigment in the dark)
M. scrofulaceum
M. szulgai
Non-photochromogenic - Runyon group III (inability to form pigment)
M. avium-intracellulare
M. haemophilum
M. xenopi		X
M. ulcerans		X
Fast growing - group IV according to Runyon (growth within 7 days)
M. fortuitum		X
M. chelonei ssp.abscessus		X
M. chelonei ssp. chelonei		X

2. What is characteristic of the color of mycobacteria?
Mycobacteria are aerobic, non-spore-forming, non-motile bacilli with a high lipid content in the cell wall. The most important color feature of mycobacteria is acid fastness, which is attributed to the ability to retain carbolic fuchsine after washing with acid or alcohol. They have the same property Nocardia, Rhodococcus and, to a lesser extent, Corynebacterium.

TUBERCULOSIS

3. Name three mycobacteria of the tuberculosis complex.
This M. tuberculosis, M. bovis And M. africanum. Under special conditions, an attenuated strain M. bovis(Bacillus Calmette-Guerin (BCG) is also capable of causing the disease. Tuberculosis most often affects the lungs, but any organ, including the skin, can become infected. Cutaneous tuberculosis is characterized by a wide range of lesions, depending on the route of transmission, the virulence of the microorganism and the immune microorganism status. Vulgar (tuberculous) lupus and scrofuloderma, rare in themselves, are the two most common forms of cutaneous tuberculosis. Classification of skin tuberculosis

	PRIMARY INFECTION (NON-IMMUNIZED ORGANISM)	SECONDARY INFECTION (IMMUNIZED ORGANISM)
Exogenous infection Primary inoculation tuberculosis (tuberculosis chancre)
Warty skin tuberculosis
Endogenous distribution
Tuberculous lupus
Scrofuloderma
Acute miliary tuberculosis
Official tuberculosis

4. Explain the differences between primary and secondary tuberculosis infection.
Primary infection occurs in a previously uninfected body. Secondary infection occurs in a body that has already been infected with tuberculosis, either by reactivation of a pre-existing primary site of infection, or as a result of endogenous spread to new areas, or as a result of endogenous reinfection.

5. How does the tuberculosis pathogen get into the skin?
Skin tuberculosis can be contracted in three ways. Exogenous infection develops when its source is located outside the body (primary inoculation tuberculosis [tuberculous chancre] and warty cutaneous tuberculosis). The second way of infection is its spread endogenously, which occurs due to local involvement of the skin (scrofuloderma), spread through the lymphatic (tuberculous lupus) or blood vessels (tuberculous lupus and miliary tuberculosis). The third way of spreading the infection is autoinoculation of the pathogen from the focus of active tuberculosis of an internal organ (original tuberculosis).

6. Who is at risk of getting tuberculosis?
In the United States, the incidence of tuberculosis declined until 1984, when it reached its lowest level. Since 1985 it began to grow at an alarming rate. Overcrowding in urban areas, intravenous drug use, the cessation of tuberculosis programs and, most importantly, the emergence of the AIDS epidemic all combined to worsen the situation. At-risk groups include the elderly, homeless urban residents, alcoholics, drug addicts, intravenous drug users, prisoners, agricultural workers who move from place to place, ethnic minorities and people living with HIV.

7. What is PPD?
PPD stands for tuberculin purified from protein (Purified Protein Derivative). A positive reaction to this intradermal test is considered an indicator of previous exposure to the pathogen. A false positive reaction may be due to the presence of non-tuberculous mycobacteria in the body and BCG vaccination. A negative reaction does not exclude the presence of tuberculosis.

8. What is the “calling card” of tuberculosis during histological examination?
Tubercle, consisting of giant cells and a mass of cheesy necrosis varying in volume. This pattern, however, can be observed in other infections and is not pathognomonic.

9. When does a person develop primary tuberculous chancre?
Primary tuberculous chancre develops after direct penetration M. tuberculosis into the skin. The pathogen cannot penetrate intact skin, so infection occurs through small cuts and abrasions. Unusual cases of “venereal” infection during sexual intercourse were also described, as well as transmission of the pathogen during mouth-to-mouth artificial respiration and circumcision performed by a rabbi with tuberculosis.

10. Describe the clinical manifestations of primary tuberculous chancre.
Primary tuberculosis occurs in people of all age groups, but most often in children and young adults. Most often, lesions are located in the face, mucous membranes (conjunctiva and oral mucosa) and on the lower extremities. The lesion develops 2-4 weeks after infection and is a small, painless, non-healing, well-circumscribed ulcer. 3-8 weeks after the onset of infection, regional lymphadenopathy occurs, the lymph nodes become denser, but remain painless. The first PPD test may be negative, and the diagnosis is confirmed by culture.

11. What is an “anatomist’s wart”?
Anatomist's wart (also known as cadaveric tubercle, prosector's wart, warty cutaneous tuberculosis, verrucous tuberculosis) occurs in individuals who have already had contact with the infection and are newly infected from the outside. Reinfection occurs through small cuts and abrasions. Due to their professional activities, medical students, pathologists and laboratory technicians who become infected during autopsies, as well as farmers raising livestock, are at greater risk of getting sick due to their professional activities.

12. How does an anatomist’s wart manifest clinically?
There is usually a single lesion on the hand or finger. The lesion is not disturbing and gradually grows, turning from a small papule into a hyperkeratotic warty plaque, which can be confused with a regular wart (see figure). Regional lymph nodes, as a rule, are not involved in the process. Differential diagnosis should be carried out with blastomycosis, chromomycosis and infections caused by atypical mycobacteria.
Warty skin tuberculosis. Hyperkeratotic, warty, crusty plaques that develop at the site of entry of the pathogen

13. Is there a connection between lupus vulgaris and lupus erythematosus?
No. Lupus erythematosus is an autoimmune connective tissue disease, and lupus vulgaris is a form of cutaneous tuberculosis. The term "lupus" is used to describe an area of the lesion that appears to have been "gnawed by a wolf." The term "vulgar" means "ordinary" or "ordinary". Both of these terms are used separately in the names of various, unrelated diseases.

14. Describe the clinical manifestations of tuberculous lupus.
Tuberculous lupus is a chronic, progressive form of cutaneous tuberculosis that spreads from other sites and involves the skin or mucous membranes either directly or hematogenously or lymphogenously. In 40% of patients, it is based on existing lymphadenitis, and in 10-20% it is lung damage. Most often the head, neck, and especially the nose, cheek, and earlobe are involved in the process. The lesion may grow and involve the mucous membranes of the mouth, nose and conjunctiva. The primary skin lesion is a brownish-red spot or papule that is soft in consistency and does not bother the patient (see Figure A on the next page). Diascopy, a test in which a flat piece of glass is gently pressed against a skin lesion, can help diagnose tuberculous lupus. In this case, a characteristic “apple jelly” type staining will be noted in the lesion. The most serious complication of long-standing lupus tuberculosis is the development of squamous cell carcinoma at the site of the lesion (see Figure B).

Lupus vulgaris(tuberculous lupus). A. Reddish-brown plaque. IN. Lupus vulgaris with squamous cell carcinoma

15. What is scrofuloderma?
Scrofuloderma is a form of cutaneous tuberculosis that occurs as a result of the spread of infection from the affected lymph nodes, bones, joints or epididymis directly to the overlying skin. The most common sites of lesions are the lateral surfaces of the neck and the parotid, submandibular and supraclavicular areas of the skin. The disease begins with the appearance of a hard subcutaneous node. As it develops, extensive necrosis occurs with the formation of a mass of soft dough-like consistency. Next, ulceration occurs with the formation of a fistulous tract, from which a necrotic cheesy mass can be released (see figure).
Scrofuloderma. An ulcerated nodule ranging in color from red to purple. The lesion is caused by the transfer of infection from the underlying lymph node

16. How is vaccination against tuberculosis carried out?
BCG vaccine (Bacillus Calmette-Guerin), which uses a live attenuated strain M. bovis. For this reason, its use is contraindicated in patients with impaired immunity due to the risk of developing disseminated forms of infection caused by M. bovis.

17. What drugs are used in the treatment of tuberculosis?
First-line chemotherapy drugs include isoniazid, rifampin (rifampicin), pyrazinamide, ethambutol, and streptomycin. The key drug in the treatment of tuberculosis is isoniazid, and the second most important is rifampin. Several 6- and 9-month treatment regimens are currently approved by the Centers for Disease Control and Prevention. The 6-month regimen involves an intensive 2-month course of treatment with three or four drugs, followed by isoniazid and rifampin for 4 months.

18. List the main side effects of anti-tuberculosis drugs. First-line anti-tuberculosis drugs and their main side effects

PREPARATION	SIDE EFFECT	SPECIAL NOTES
Isoniazid	Peripheral nerve neuritis Hepatitis	From pyridoxine deficiency Occurs in 1-2%, the risk is increased in people over 35 years of age
Rifampin	Hepatitis Orange coloring of secretion	Can permanently stain contact lenses
Most often in the elderly

19. Describe the factors that contribute to the emergence of cross-resistance of tuberculosis to drugs immediately.
Patient non-compliance with drug therapy is a leading factor in the development of cross-resistance. Intravenous drug use, homelessness, and HIV infection also contribute to the spread of drug-resistant tuberculosis. Resistance is widespread in Asia, Latin America and Africa. In the United States, pockets of drug-resistant disease are located in New York, Miami and Michigan. The illness of medical workers is a serious problem.

20. Are there any special features in the treatment of skin tuberculosis?
In principle, treatment for skin tuberculosis is similar to that for pulmonary tuberculosis. Small lesions in tuberculous lupus or warty skin tuberculosis can be excised, but treatment should include standard anti-tuberculosis therapy. Surgical drainage for scrofuloderma can shorten the treatment period.

ATYPICALMYCOBACTERIA

21. How does infection with atypical mycobacteria occur?
Atypical mycobacteria are ubiquitous and are found in soil, water, domestic and wild animals. These microorganisms are usually saprophytic and non-pathogenic. Unlike M. tuberculosis they are not transmitted from person to person. Impaired immunity, organ damage, surgical interventions, as well as minor cuts and abrasions are the few clinical conditions that allow these microorganisms to cause disease. Depending on geographic location, atypical mycobacteria may be responsible for 0.5-30% of all mycobacterial infections.

22. What is a “basin” granuloma?
Basin granuloma is called M. marinum. This microorganism is ubiquitous in aquatic environments, including both fresh and salt water. It enters the skin through small cuts and abrasions when a person swims in the pool or cleans aquariums. After a 2-3 week incubation period, a small purple papule appears at the site of introduction of the microorganism. Gradually it grows into a plaque with a color ranging from red to purple. The sporotrichoid form can appear as purple nodules located along the lymphatic vessels. Lesions usually occur in the most traumatized areas - hands, feet, elbows and knees.

23. What is Buruli ulcer?
Buruli ulcer caused by M. ulcerans, found in regions with hot tropical climates, and most often in Africa, Australia and Mexico. The pathogen enters the skin through small cuts, mainly on the extensor surfaces of the extremities. After 4-6 weeks, a tumor forms under the skin, which then ulcerates. An ulcer with necrosis in the center has pitted edges and can grow to include the entire limb (see figure).
Buruli ulcer in the elbow area caused by M. ulcerans

24. Describe the clinical manifestations of mycobacterial (Avium-intracellulare) complex (MAC) in patients with and without AIDS.
MAC including both M. avium, so and M. intracellulare, has acquired particular significance in connection with HIV infection. In non-AIDS patients, it usually manifests itself as damage to the lungs. Rarely occurring skin disease can be a manifestation of both direct intradermal infection and dissemination of the disease. Skin lesions vary widely and include ulcers, abscesses, deep nodules, or inflammatory plaques. In patients with AIDS, MAC usually manifests itself as a disseminated disease (damage to the lungs, lymph nodes, gastrointestinal tract, bones). There are isolated reports of cases of isolated skin lesions.

25. What atypical mycobacteria become infected during surgical procedures?
Fast growing mycobacteria M.fortuitum And M. chelonei They are ubiquitous and can survive in the absence of nutrients and exposure to high and low temperatures. These microorganisms can be found in water, soil, dust and damp places in the hospital. Hospital-acquired infections have led to osteomyelitis of the sternum after open-heart surgery, contamination of gentian violet used to mark the skin before surgery, and hampered hemodialysis, breast augmentation surgery, and the use of indwelling catheters. Infection can also occur at home through puncture wounds, open fractures and other injuries. The incubation period lasts about a month.

26. What are some of the main manifestations of M. kansasii infection?
M. kansasii belong to the group of photochromogenic acid-fast bacilli. They are found in all parts of the world, including the United States, especially in the southwest and midwest. Men, older people, urban residents and people with high socio-economic status are more likely to get sick. The infection usually manifests as pulmonary lesions in patients with chronic obstructive pulmonary disease. Cutaneous manifestations include cellulitis and ulceration in a sporotrichoid pattern.