Traditional antipyretic drugs (paracetamol, acetylsalicylic acid) do little to help eliminate fever with an allergic subsexis, but as part of a comprehensive treatment can have a beneficial effect.
There is no single generally accepted scheme for the treatment of pathology due to insufficiently studied etiology and pathogenesis.
Usually used complex therapy aimed at combating infectious factors, reducing the activity of inflammatory processes. In severe cases, prescribe drugs to reduce the activity of the immune system.
The main components of therapy are:
- Antibacterial therapy. Use drugs of a broad spectrum of activity, mainly – penicillin. The efficacy and validity of the use of antibiotics for this allergic pathology is disputed by some specialists, however, the best results of treatment with their prescription are statistically proven than without it.
- Anti-inflammatory therapy. Apply various drugs from the group of nonsteroidal anti-inflammatory drugs – acetylsalicylic acid, diclofenac sodium, indomethacin, ibuprofen. In difficult severe cases and with severe hyperthermia, glucocorticoids can be prescribed – only they are capable of reducing body temperature in the event of an allergic subsepsis for a short time.
- Immunosuppressive therapy. In severe cases, short-term use of cytostatics is possible to reduce the severity of immune responses. Especially often they are used for lesions of the heart and pronounced inflammation of the joints.
Some doctors consider the appointment of salicylates with this pathology ineffective and prefer the combination of antibiotics with glucocorticoids. Separate cases of effective use of antihistamines are noted. Patients are shown bed rest, during periods of lower body temperature – walking in the fresh air. Careful monitoring of laboratory blood parameters is necessary for the early detection of signs of rheumatoid arthritis and other collagen diseases.
Auxiliary treatment is aimed at reducing side effects from long-term antibiotics and NSAIDs (protection of the gastric mucosa, restoration of intestinal microflora), restoration of water-salt metabolism, impaired as a result of increased sweating.
Allergic subsepsis, or Wissler-Fanconi disease, was isolated into a separate nosological unit in the 40s of the 20th century (in 1943 by G. Wissler and, independently of him, in 1946 by G. Fanconi). The etiology and many stages of the pathogenesis of the syndrome is currently not well understood. Typically, the disease affects children aged 3-8 years, however, described the cases of the development of pathology in infants in the first weeks of life.
There is no exact data on the prevalence of subsepsis, mainly because of the complexity of its differential diagnosis with some forms of reactive arthritis, Still syndrome and true sepsis. Some authors believe that Wissler-Fanconi syndrome is one of the stages of development of this collagenosis.
Causes of Allergic Subsepsis
The etiology of the disease is currently not precisely established, it is studied by experts in the field of clinical allergology, immunology, infectiology and a number of other medical fields. Despite the clinical picture characteristic of sepsis, the blood cultures of patients are almost always sterile, which indicates that the infection is only a triggering factor for the immunological response.
A number of patients with allergic subsepsis in the history have frequent episodes of intolerance to pollen, household dust, some foods and medicines. It is not known whether the allergic reaction is a link in the pathogenesis of the disease or simply indicates an altered reactivity of the patient’s body and an impaired state of its immune system.
In the blood of some individuals with Wissler-Fanconi’s disease, antinuclear antibodies and other indicators of autoimmune pathological processes are detected. It combines the disease with a number of autoimmune pathologies, such as Still’s syndrome, rheumatism, reactive polyarthritis. The fact that subsepsis is prone to spontaneous disappearance with the patient’s recovery contradicts his consideration as the initial stage of collagenosis.
There is a hypothesis that several diseases of various origins can manifest themselves with this symptom complex. The lack of clarity in the development of pathology makes it difficult to develop effective etiotropic therapy, therefore, treatment is carried out symptomatically through the integrated use of drugs from different groups.
Pathogenesis of allergic subsepsis
Due to the poor knowledge of the etiology of allergic subsepsis, there are many gaps in understanding the pathogenesis of this condition. According to the most common theory of the development of Wissler-Fanconi syndrome, a systemic perverted immunological reaction occurs under the influence of a focus of a bacterial infection of an acute or chronic nature.
It is believed that the development of the reaction provokes septicemia, in which the pathogen’s antigens massively enter the bloodstream. Due to the nature of the reactivity, the complement system is activated (mainly in the tissues of the skin and articular membranes). This leads to the appearance of a characteristic rash and arthralgia. In the cells of the epidermis, an increased number of complement components is found.
The pathogenesis of fever and hyperthermia in the case of subsepsis is presumably explained by the activation of macrophages and the release of many pyrogens by them. Unclear are the aspects of the appearance of antinuclear antibodies, neutrophilia and pronounced leukocytosis characteristic of true sepsis. It is believed that the appearance of antibodies to the cell nucleus indicates the transformation of allergic subsepsis into true collagenosis, which worsens the prognosis of the disease. The pathogenesis of the development of heart lesions (myocarditis and pericarditis) in this condition is unknown. They are noted in a small percentage of patients, extremely rarely lead to complications, are prone to spontaneous recovery.
Symptoms of an allergic subsepsis
In most cases, the disease begins acutely, against the background of complete health, without any prerequisites or prodromal phenomena. In rare cases, allergic subsepsis occurs shortly after suffering a sore throat or respiratory disease.
The first manifestation of pathology becomes high temperature (up to 38-39 ° C), fever has a continuous or intermetting character with periodic sharp rises and drops in temperature with a frequency of 2-3 days. The decrease in temperature after the peak lasts 10-18 hours and is accompanied by profuse sweating. The total duration of the period of hyperthermia can be up to several weeks or months.
In the first hours after the temperature rises, rash of an erythematous or urticar nature occurs on the skin. Frequent localization of the rash – the skin of the legs and arms, less often they are recorded on the skin of the chest, face, abdomen. Skin elements may become less pronounced and reappear, the frequency of lesions often coincides with periods of rising and falling temperatures and febrile manifestations. Patients complain of mild skin itching in the area of rashes.
In some patients, subcutaneous consolidations in the form of nodules are found, similar to those of rheumatism. At the height of the attack, there is an increase in various groups of lymph nodes – mainly inguinal, axillary, cervical.
Allergic subsepsis is characterized by articular manifestations of varying severity – from non-intense pain to significant swelling and redness. More often affects the joints of the hands (interphalangeal, radiocarpal, elbow), in some cases, joints of the spine and lower extremities may be inflamed. Localization of articular lesions may change with each attack of the pathology. Against the background of high temperature, sometimes pain in the abdomen, muscles, myocarditis develops, pain appears in the heart area. With fever, disorders of the central nervous system are possible: sleep disturbances, anxiety, confusion.
Allergic Subsepsis Complications
Complications of allergic subsepsis are rarely registered. The most serious consequence of the disease is the development of true collagenosis – juvenile rheumatoid arthritis or rheumatism. Among other complications, heart failure is extremely rare due to the development of myocarditis or pericarditis, liver damage. Fever can provoke exacerbation of the chronic diseases of various organs existing in the patient.
In younger patients (3-4 years), there is a high risk of recurrent episodes after a period of remission. High temperatures sometimes cause febrile seizures.
When diagnosing an allergic subsepsis, an immunologist or pediatrician pays attention to the clinical picture of the pathology, the results of laboratory blood tests. Radiography and electrocardiography are prescribed as additional studies. It is important to eliminate as soon as possible the true sepsis, which requires urgent antibiotic therapy and other emergency measures. Also, as part of the diagnosis of Wissler-Fanconi disease, methods are used to differentiate this condition with typical collagenosis, for example, juvenile rheumatoid arthritis.
Carry out the following diagnostic activities:
- Inspection and collection history. Hyperthermia is found, a rash on the hands and feet of a different nature, it is possible to identify seals in the skin that are similar to rheumatic nodules. Palpation of the lymph nodes determines their increase and pain, some joints are painful when pressed, the skin in their projection is hyperemic. Anamnesis often indicates the presence of allergic diseases.
- Laboratory blood test. In general, a blood test reveals a sharp leukocytosis, a small neutrophilia is possible with a weak neutrophilic left shift and an increase in the number of eosinophils. At a height of fever, ESR increases significantly. Blood biochemistry confirms hyperglobulinemia (by increasing the concentration of IgG and IgM), reducing the level of albumin and complement components, sometimes antinuclear antibodies are recorded.
- Instrumental studies. When a cardiac pathology is attached to the ECG, signs of myocarditis are recorded – an irregular rhythm, changes in the ST segment, and various types of blockades in the conduction system. When conducting chest x-ray is determined by the strengthening of the pulmonary pattern, overlay on the pleura and signs of pleurisy. Ultrasound examination of the abdominal cavity indicates an increase in the size of the liver (in the midst of fever) and, rarely, of the spleen.
Differential diagnosis of allergic subsepsis is performed with true sepsis, juvenile rheumatoid arthritis and other types of collagenosis – for this purpose, patients are prescribed a number of additional studies.
Sowing blood on nutrient media shows its sterility, which excludes bacteremia and systemic infection. To exclude rheumatoid arthritis, a synovial membrane biopsy is performed on the affected joints with a further histochemical study.
Forecast and prevention of allergic subsepsis
The prognosis of allergic subsepsis is usually favorable, but careful monitoring of the condition of patients is required in order to avoid the development of complications. Damage and inflammation of the joints in the absence of rheumatoid arthritis does not limit their mobility after stopping the attack. Myocarditis and inflammation of the serous membranes, as a rule, can also be cured without consequences. Attacks of fever can last up to 2-4 months, after which they are able to spontaneously disappear.
Subsequently, the emergence of new episodes of subsepsis is possible, however, as the child grows, they become more fleeting and easier. In the absence of complications, the effects in adults are absent. Due to insufficiently studied causes and pathogenesis of the disease, preventive measures have not been developed.