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Różyca – jakie są objawy choroby i jak przebiega leczenie?

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Erysipelothrix rhusiopathie to bakteria występująca u ssaków oraz u zwierząt morskich – ryb, krabów, fok i wielorybów. Kontakt z zakażonym tym patogenem materiałem pochodzenia zwierzęcego, np. z ością, może powodować u ludzi różycę. W przypadku postaci skórnej schorzenie zazwyczaj objawia się rumieniowo-obrzękowymi zmianami skórnymi.

Różyca u ludzi jest stosunkowo rzadką chorobą. Jej występowanie obserwuje się najczęściej wśród osób pracujących z chorymi zwierzętami, m.in. u rolników, weterynarzy, pracowników zoo czy kucharzy. Do zakażenia dochodzi zazwyczaj poprzez wniknięcie bakterii przez uszkodzoną skórę. Patogen wywołujący różycę jest odporny na czynniki środowiskowe, m.in. na gnicie i wysuszenie. Do zakażeń częściej dochodzi w okresie letnim, gdyż wyższa temperatura sprzyja rozwojowi bakterii.

Różyca może nawracać

Zazwyczaj choroba występuje pod postacią skórną. W nielicznych przypadkach może rozwinąć się postać posocznicowa lub narządowa, kiedy bakterie poprzez naczynia krwionośne rozsiewają się do serca, powodując zapalenie wsierdzia, kości (martwica kości), stawów, mózgu i płuc.

W różycy skórnej zmiany najczęściej pojawiają się w obrębie grzbietowej części rąk i palców dłoni. Schorzenie objawia się zazwyczaj wykwitami rumieniowo-obrzękowymi, które są ostro odgraniczone od skóry. Zainfekowana skóra jest ocieplona, napięta, błyszcząca i zaczerwieniona oraz obrzęknięta. Zmiany mają tendencje do obwodowego szerzenia się, ale rzadko towarzyszą im objawy ogólnoustrojowe. Pacjenci mogą odczuwać ból, świąd i pieczenie.

W przypadku postaci posocznicowej lub narządowej może wystąpić gorączka, a także nacieki zapalne skóry ze zmianami pęcherzowymi i martwiczymi. Jeżeli jednak do zakażenia doszło inną drogą, niż poprzez skórę, zmiany skórne mogą być nieobecne.

Rozpoznanie i leczenie różycy

Różyca może utrzymywać się kilka tygodni. Całkowicie ustępuje po wdrożeniu antybiotykoterapii, jednak nie daje odporności i może wystąpić ponownie. Dlatego po wyleczeniu pacjenci powinni stosować profilaktykę w celu uniknięcia ponownego zakażenia, np. u osób mających zawodowo kontakt z materiałem pochodzenia zwierzęcego, poprzez stosowanie odpowiedniej ochrony rąk, stosowania się do zasad higieny, dezynfekcji oraz unikania skaleczeń skóry.

W przypadku podejrzenia choroby należy zgłosić się do lekarza rodzinnego. Klinicysta powinien przeprowadzić wywiad z pacjentem, by ustalić, czy mogło dojść do kontaktu z zakażonym materiałem zwierzęcym, np. ością lub kością. Lekarz może również zalecić biopsję skóry w celu przeprowadzenia badań mikrobiologicznych. W postaci uogólnionej materiałem do badań może być krew.

Różyca skórna może ustąpić samoistnie w ciągu 2-4 tygodni, jednak w praktyce klinicznej zalecane są antybiotyki z grupy penicylin lub innych antybiotyków, np. erytromycyny. W przypadku łagodnego przebiegu choroby lek podawany może być doustnie, natomiast w cięższych, zwłaszcza w postaci uogólnionej – zalecana jest hospitalizacja, podawanie antybiotyku dożylnie i objawowe leczenie powikłań.

Źródła:

mp.pl

J. Drobiński, E. Bartkowiak-Białas, Infekcyjne zapalenie wsierdzia powikłane niewydolnością krążenia oraz ostrą niewydolnością nerek wywołane pałeczką różycy – opis przypadku, Anestezjologia i Ratownictwo 2010; 4: 99-110

 

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