Wąglik to odzwierzęca choroba zakaźna. W przebiegu postaci skórnej tego schorzenia obserwuje się charakterystyczne zmiany skórne ewoluujące do owrzodzenia pokrytego czarnym strupem, które swoją barwą przypomina węgiel. Jakie są objawy wąglika, jak przebiega rozpoznanie i leczenie choroby?
Wąglik wywołany jest przez gram-dodatnią laseczkę Bacillus anthracis. Wśród ludzi schorzenie szerzy się poprzez bezpośredni kontakt z zakażonymi zwierzętami roślinożernymi i produktami pochodzenia zwierzęcego. Wrotami zakażenia jest uszkodzona skóra, a także układ oddechowy i pokarmowy. Wąglik występuje wśród zwierząt na całym świecie, zwłaszcza w rejonach o niskich standardach sanitarnych. U ludzi zakażenie notowane jest sporadycznie, ale zdarza się głównie u hodowców zwierząt i pracowników zatrudnionych w przetwórstwie zwierzęcym.
Okres wylęgania wynosi około 1-14 dni. U ludzi choroba przebiega głównie w postaci skórnej (95 proc. przypadków), płucnej lub żołądkowo jelitowej.
Jakie są objawy wąglika?
W postaci skórnej do zakażenia dochodzi wskutek wniknięcia patogenu w miejscu przerwania ciągłości tkanek, np. otarcia naskórka, rany, lub poprzez błony śluzowe. Laseczki Bacillus anthracis powodują zakażenie miejscowe. Zmiana skórna podlega charakterystycznej ewolucji. Początkowo pojawia się czerwona plamka, która zmienia się w swędzący guzek, a następnie powstaje pęcherzyk, który pęka. Poniżej poziomu skóry zaczyna powstawać owrzodzenie pokryte strupem – zmiana jest otoczona naciekiem zapalnym i jest bezbolesna. Po kilku dniach strup odpada, zmiana goi się i pozostawia po sobie bliznę. Zmiany skórne w większości przypadków zlokalizowane są na rękach, głowie lub karku, rzadziej na tułowiu i nogach. Gojenie się trwa około 6 tygodni. Postać skórna, która nie jest powikłana posocznicą i poddana antybiotykoterapii, nie jest zagrożeniem dla życia człowieka – śmiertelność wynosi około 5 proc. (20 proc. wśród chorych nieleczonych).
Postać żołądkowo-jelitowa jest rzadką postacią wąglika. Dochodzi do niej w wyniku spożycia zanieczyszczonego mięsa, skażonego, surowego mleka oraz wody. Obserwowane w praktyce klinicznej objawy dotyczą nudności, wymiotów, gorączki powyżej 40 stopni Celsjusza, bólu brzucha, krwawej biegunki. Wraz z chorobą rozwija się posocznica, która bardzo szybko prowadzi do wstrząsu i zejścia. Do zgonu może dojść w przeciągu 2-5 dni od wystąpienia pierwszych objawów choroby. Śmiertelność w przypadku postaci żołądkowo-jelitowej jest wysoka i wynosi około 25-60 proc.
Najgroźniejszą postacią wąglika jest postać płucna, która rozwija się na skutek inhalacji zbyt dużej ilości przetrwalników. U pacjentów początkowo obserwuje się ostrą infekcję górnych dróg oddechowych trwającą przeważnie od 2 do 4 dni. Następnie dochodzi do ciężkiej niewydolności oddechowej z posocznicą, co prowadzi do zejścia w ciągu doby. Śmiertelność w przypadku płucnej postaci wynosi praktycznie 100 proc.
Jakie są powikłania wąglika?
Wąglik, w zależności od drogi zakażenia, może nieść za sobą powikłania. W przypadku postaci skórnej najczęściej są to blizny, rzadziej obserwuje się rozsiew zakażenia drogą naczyń chłonnych, rozwój sepsy i zapalenie opon mózgowo-rdzeniowych. W przypadku zakażenia przez spojówkę może dojść do zbliznowacenia i trwałego uszkodzenia oka ze ślepotą.
Z kolei wąglik jelitowy może powodować owrzodzenia przełyku i jelit, rozwój krwotocznego zapalenia w węzłach chłonnych krezki lub powstania martwicy krwotocznej.
W jaki sposób przebiega rozpoznanie i leczenie wąglika?
Wąglik rozpoznawany jest na podstawie wywiadu (uwzględnienie pobytu w strefie endemicznego występowania choroby lub kontakt z chorym zwierzęciem/produktami pochodzenia zwierzęcego), obrazu klinicznego i diagnostyki laboratoryjnej. Podstawą rozpoznania schorzenia jest wyizolowanie laseczek wąglika z krwi lub innych tkanek. Rozpoznanie potwierdza się hodowlą lub wykrywając DNA bakterii w badaniu PCR.
Leczenie polega na podawaniu antybiotyków. Istotne jest również wdrożenie intensywnej terapii podtrzymującej oraz wyrównanie gospodarki wodno-elektrolitowej, a także zaburzeń krzepnięcia. W praktyce klinicznej stosuje się również leczenie objawowe, polegające na utrzymaniu ciśnienia krwi, podawaniu leków przeciwgorączkowych i przeciwbólowych. Chorzy, którzy ze względu na chorobę są długotrwale unieruchomieni, wymagają profilaktyki żylnej choroby zakrzepowo-zatorowej oraz gimnastyki oddechowej. U pacjentów z zaburzeniami oddychania stosuje się wspomaganie oddychania.
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