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Sumy state university medical institute




НазваSumy state university medical institute
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Дата06.06.2013
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Subjects of Research work

  • Features of course of typhoid in modern terms.

  • Modern methods of specific diagnostics of typhoid.

  • Problems of etiotropic treatment of typhoid.

  • Modern looks to pathogenesis of chronic transmitter of S. typhi.

  • ^

    Ways of sanitation of chronic transmitters of S. typhi.


ІІІ DIARRHOEA SYNDROME IN CLINIC OF INFECTIOUS DISEASES. SALMONELLOSIS. FOOD TOXICOINFECTION. INFECTIOUS DISEASES OF VIRAL ETIOLOGY WITH MAINLY FECAL-ORAL MECHANISM OF TRANSMISSION (ENTEROVIRUS DISEASEES, ROTAVIRUS INFECTION). POLIOMYELITIS


Duration - 2 hours.


1 Actuality of theme: the problem of acute enteroideas with a diarrhoea syndrome has the actuality and today, because of her wide prevalence, considerable frequency of development of severe, complicated forms of disease and postinfectious violations of digestion, is characteristic. The viral infections of GIT are less known to the general practitioners, than bacterial: part of viruses is 30-40% of acute episodes of diarrhoea for the children of early age, among which the "first violin" is played by a rotavirus infection (60-80%). Such diseases, as salmonellosis, food toxicoinfection, enterovirus diseases, poliomyelitis, are accompanied by diarrhoea syndrome.


2 Educational aims of class (with pointing of mastering level, that planned)

2.1 A student must know:

а- 2

  • etiology of salmonellosis, food toxicoinfection, enterovirus infection, rotavirus infection, poliomyelitis, factors of pathogenicity of causative agents;

  • epidemiology;

  • pathogenesis;

  • clinical displays of diseases with a typical course;

  • clinical-epidemiological features;

  • pathogenesis, terms of development and clinical displays of complications;

  • laboratory diagnostics;

  • principles of treatment;

  • principles of prophylaxis;

  • tactic in the case of origin of the urgent conditions;

  • prognosis.


2.2 A student must be able:

а- 3

  • to observe basic rules at a sick-bed;

  • to take the history of disease and estimate epidemiology data;

  • to inspect a patient and determine basic symptoms and syndromes, ground a clinical diagnosis for timely direction of patient in an in-patient department;

  • to provide differential diagnostics;

  • on the basis of clinical inspection in good time to recognize possible complications, urgent conditions;

  • to draw medical documentation after establishment of preliminary diagnosis;

  • to work out a plan of laboratory and additional inspection of patient;

  • to interpret the results of laboratory inspection;

  • to work out an individual plan of treatment taking into account epidemiology data, degree of severity, complications, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;

  • to work out a plan of antiepidemic and prophylactic measures, give recommendations about the regimen, diet, inspection, supervision in a reconvalescence.



^ 3 Materials of before class of free work

3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)

Discipline

To know

Able

1

2

3
^
Preceding disciplines

Microbiology

Properties of causative agents of salmonellosis, enterovirus infection, rotavirus infection, food toxicoinfections, poliomyelitis. Methods of specific diagnostics

To interpret the results of specific methods of diagnostics

Physiology

Parameters of physiological norm of organs and systems of man; indexes of laboratory inspection are in a norm (CBC, urines, biochemistry of blood, parameters of AAC, electrolytes and др)

To estimate data of laboratory inspection

Physiopathology

Mechanism of violation of functions of organs and systems at the pathological conditions of different genesis

To interpret pathological changes on results of clinical and laboratory inspection

Immunology and allergology



Basic concepts of object, role of the system of immunity, in infectious process, influence on the term of elimination of causative agent from organism of man

To estimate data of immunological research



Epidemiology

Epidemic process (source, mechanism of infection, ways of transmission); prevalence of disease in Ukraine and in the world

To take the epidemiology history, provide antiepidemic and prophylactic measures in the hearth of infection

Neurology

Pathogenesis, clinical syndromes of disease

To provide the clinical inspection of patient with the defeat of the nervous system

Propaedeutics of internal diseasees

Basic stages and methods of clinical inspection of patient


To take the history, provide the clinical inspection of patient, determine pathological symptoms and syndromes. To analyse finding

Clinical pharmacology

Pharmakokinetics and pharmacodynamics, side effects of facilities of specific and nosotropic therapy

To prescribe treatment depending on the degree of severity of disease, individual features of patient. To write recipes

^ Subsequent disciplines

Domestic medicine

Pathogenesis, epidemiology, dynamics of clinical displays,

possible complications of infectious diseases. Principles of prophylaxis and treatment

To provide differential diagnostics of diseasees different genesis. To recognize an infectious disease, his complication; to interpret data of laboratory inspection. In good time to hospitalize a patient in an infectious in-patient department. To render the first aid in the case of necessity

^ Intrasubject integration

Infectious diseases

Features of infectious diseases. Principles of diagnostics, treatment, prophylaxis of infectious diseases. Pathogenesis, epidemiology, dynamics of clinical displays, laboratory diagnostics, possible complications of infectious diseases

To provide differential diagnostics of diseasees of different genesis. To recognize an infectious disease, his complication; to interpret data of laboratory inspection. To prescribe treatment. To render the first aid on the before-hospital stage



^ 3.2 Structure-logical chart of maintenance of theme of class

Chart of diagnostics and treatment of salmonellosis (Salmonellosis)

Epidemiology anamnesis:


- using of bad meat products;

- using meat, eggs of water birds;

- contact with persons, which had violation of defecating.










yes. Clinical signs: it is not


- acute beginning of disease – from nausea, numerous vomitting;

- syndrome of gastroenteritis, rarer – syndrome of gastroenterocolitis, gastritis;

- dehydration syndrome;

- pain syndrome (epigastrium→ umbilicalis region→ right iliac region);

- symptoms of generalized forms (typhus-like and septicopiemic)
no







no



yes


yes, salmonellosis. Verification of diagnosis : it is not


- bacteriologic research of stool, vomiting content, scourage, parts of food, blood;

- RIHA and RA salmonellosis diagnosticum;

- immune fluorescence method;

- coprogramm (erythrocytes, leukocytes, mucus)





diagnosis is confirmed: it is not


Formulating of final diagnosis: form, course, severity, etiology, level of dehydration, presence of complications

Differential diagnosis with shigellosis, cholera, FTI, typhus-paratyphoid diseases, thrombosis of mesenteric vessels





Treatment:


- gastric? Intestinal lavage;

- rehydration therapy;

- detoxication therapy (enterosorbents);

- diet № 4;

- substitutional threapy (enzymes);

- etiotropic threapy (severe course, generalized)






Recovery: discharge


- clinical recovery;

- decreed group: twice bacteriological research of faeces with negative result, once - bile


Observation:


- during 3 months. (persons of decreated group) monthly inspection and bacteriologic research




Chart of diagnostics and treatment of food toxicoinfection (FTI)

((Toxicoinfectiones alimentares)

Epidemiology anamnesis:



no


- acute beginning of disease;

- syndrome of gastroenteritis (nausea, vomitting, diarrhoea);

- pain syndrome (epi-, meso-, hypogastrium);

- dehydration syndrome (loss of weight, pallor of skin, contractures, tachycardia, hypotonia, oliguria);

- short duration of disease (1-4 days)
yes. Clinical signs:








- bacteriological research of, vomit masses, scourage, parts of food (expressed semination of 1 g of research material, more than 1х10 6/g); determination of one causative agent from different fluids of patient;

- serological research (RA with autostamm);

- - coprogramm (erythrocytes, leukocytes, mucus);

- hemogramm (clotting of blood)
yes, FTI. Verification of diagnosis not





-formulating of final diagnosis (clinically, epidemiologically, bacteriologically, serologically) with determination of form, level of severity, dehydration

Differential diagnosis with cholera, salmonellosis, escherichiosis, poisoning, pancreatitis
yes. A diagnosis is confirmed: it is not





- scorage of stomach;

- prescribing of enterosorbents;

- rehydration therapy;

- diet № 4;

-substitutional therapy (enzymes)
Treatment:




Recovery: discharge


- clinical recovery;

- decreed group – once bacteriological research of stool





- dispanserisation doesn’t provided
Observation:


Chart of diagnostics and treatment of enterovirus diseasees (Morbus Enteroviralis)

Epidemiology anamnesis:





yes. Clinical signs: it is not





- enterovirus diarrhoea: low catarrhal symptoms (stuffiness in nose, cough, hyperemia of mucous membranes), and through 2-3 days dyspeptic symptoms (pain in stomach, diarrhoea, stool 2-7 times a day, sigmoid bowel isn’t in spasm).

- ^ Respiratory (catarhal) form: hyperthermia, muscle pain, stuffiness in the nose, hyperemia in oropharynx.

- Serosal meningitis: general cephalic, hypertensive, focal disorders, meningeal, liquor syndromes.

- Epidemic pleurositis (thoracal form, abdominal form): beginning is acute, headache; pain in extremities prevails, pain gets stronger at change of body position, at respiration.

- ^ Paralytic (polio-like) form: flaccid paresis during 2-8 weeks.

- Epidemic exanthema: maculo-papular rash on face, body, which arises up on 1-2 day of disease on background of fever, pain in muscles.

- Hemorrhagic conjuctivitis: hyperemia, hemorrhages, pruritus, dacryops.

- Herpangina: hyperemia of mucous membranes of soft palate, arches, often small vesiculas with pellucid content, surrounded by red corolla



Yes, enterovirus disease. Verification of diagnosis :




- determination of virus from nasopharynx, stool, at serosal meningitis – from cerebrospinal fluid;

- CFT, RIHA (increasing of titrus in 4 ones);

- biological research (mousekins-suckers, hamsters);

Dynamics of changes of blood: at first – moderate leukocytosis, later lymphocytosis, eosinophylia






Yes. diagnosis is confirmed: not

Treatment:


- hospitalization at severe course and after epidemiological prescriptions;

- pathogenetic theraphy: interferon, desoxiribonuclease, detoxication, rehydration;

- symtomatic therapy: desensitizing therapy, anticonvulsant, sedative;

- severe and complicated forms: glucocorticoids – 1-2 mg/kg;

- serosal meningitis: lumbal punction, dehydration






  • disappearance of clinical symptoms;

  • normalization of laboratory indexes.

- after clinical prescriptions
Recovery: discharge observation:


^ Chart of diagnostics and treatment of rotavirus infection (Rotavirosis)

Epidemiology anamnesis:


- using of food products, which didn’t get heating : non-watered vegetables and fruits;

- contact with patients with diarrhoea and catarrhal violations of upper respiratory ways;

- children before 3 years are ill oftener;

- often disease has character of group erruption;

- winter seasonality





ні



yes. Clinical signs: it is not


  • Acute beginning, watery discharge without pathological addtions with frequency to 10-15 times a day, nausea, vomitting; dehydration at moderate termal reaction and symptoms of general intoxication;

  • Symptoms of rhinitis, pharyngitis, enlargement of cervical lymphatic nodes;

  • Pain in epigastric and umbilical region, strong borbogrymgus in right iliac region;

  • Duration of disease 2-7 days





н ні

ні


no yes, rotavirus infection. Verification of diagnosis :


  • Virological research – determination of rotaviruses in faeces during first 6-8 days of disease with electronic IEA, RCoA, RIA;

  • Serologic research: RN, RIHA with rotavirus AG (diagnostic titrus 1:16 and more);

  • In general blood analysis in acute period – leucopenia with decrewasing of quantity of band cells, with relative lympho- monocytosis;

  • coprogram: in faeces a lot of indigested cellulose, starch kernel, indigested muscular fibres



і

so




Yes. A diagnosis is confirmed: it is not


- -formulating of final diagnosis (clinically, epidemiologically, bacteriologically, serologically) with determination of form, level of severity, dehydration


Differential diagnosis with cholera, shigellosis, eschrichiosis, adenovirus infection, intestinal iersiniosis, protosoal diseases (lambliasis, criptosporidiosis, balantidiasis)



Treatment:





  • Hospitalization after clinicak data, isolation on 10-15 days;

  • diet: abuse of milk and products of milk, abuse of carbohydrates;

  • pathogenetic therapy – rehydration (at first and second levels - oral (rehydron, glucosolan, tea, fruit-drink, mineral water); at severe dehydration – i/v rehydration therapy);

  • polyenzyme medications: mexase, festal, pancreatine;

  • enterosorbents



Recovery: discharge





  • - disappearance of clinical symptoms;

normalization of laboratory indexes.




- children, which suffered from severe form, are under clinical review
Observation:


^ 3.3 List of the recommended literature


Basic:


1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - С. 433-457

2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.

3. E.P. Shuvalova Infectious diseases. Rostov: Phoenix, 2001. - 953 p.


Additional:

4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.

5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.


^ 3.4 Materials for self-control

3.4.1 Questions for self-control

1 Feature of causative agent of salmonellosis, enterovirus diseases, rotavirus infection and poliomyelitis. Reasons of origin of food toxicoinfection.

2 Factors of pathogenicity of these causative agents.

3 Source of infection and factors of transmission.

4 Pathogenesis.

5 Classification.

6 Basic clinical syndromes.

7 Clinical displays depending on severity of course.

8 Specific complications.

9 Differential diagnosis.

10 Plan of inspection of patient.

11 Methods of specific diagnostics.

12 Interpretation of results of laboratory research.

13 Specific therapy: doses, ways of introduction, duration of treatment.

14 First aid to the patient.

15 Rules of discharge from an in-patient department.

16 Prophylaxis and measures in hearth.


^ 3.4.2 Tests for self-control

To choose right answers

Variant 1

1 In pathogenesis of gastrointestinal forms of salmonellosis basic value has:

A infectious factor;

B allergic factor;

C toxic factor;

D septic factor;

E immune factor.


2 Antigen structure of salmonellas :

A - О-, Н-, К-, Vi -antigens;

B - only О-antigen;

C - only Н-antigen;

D - only К-antigen;

E - only Vi -antigen.


3 Source of infection at FTI:

A - all answers are true;

B sick people;

C animals;

D bacillicarriers;

E people and animals.


4 Mechanism of transmission at FTI:

A - respiratory;

B - fecal-oral;

C - transmissible;

D contact;

E - contact, fecal-oral.

5 Ways of transmission of infection at the gastrointestinal form of salmonellosis :

A - alimentary;

B - vertical;

C - transmissible;

D - all answers are true.


6 Source of infection at salmonellosis:

A poultry;

B pigs, cattle;

C cats and dogs;

D - all answers are true.


7 Bacteria carrying at a salmonellosis can be:

A - acute, chronic, transitory;

B - acute, subclinical, transitory;

C - chronic, subclinical, low-grade;

D - there is not a right answer.


8 To the generalized forms of salmonellosis behave:

A - subalgid;

B -algid;

C - typhoid, septicopyemic;

D - there is not a right answer.


9 In pathogenesis of gastrointestinal form of salmonellosis basic value has:

A allergic factor;

B toxic factor;

C septic factor;

D immune factor.


10 In pathogenesis of generalized forms basic value has:

A infectious-toxic factor;

B - infectious;

C - toxic;

D allergic.


Variant 2

  1. Clinical forms of poliomyelitis :

A - meningeal;

B - abdominal;

C - spinal;

D - all answers are true;

E - there is not a right answer.


2 Morbidity of poliomyelitis prevails in:

A summer-autumn months;

B- spring-autumn;

C- winter;

D- does not depend on season


3 Etiotropic therapy of enterovirus infection :

A absents;

B antibacterial preparations;

C antihistaminic preparations;

E vitaminotherapy.


4 Mechanism of transmission of enterovirus infection :

A - vertical;

B - transmissible;

C - fecal-oral;

D respiratory.


5 What seasonality is characteristic for enterovirus infection?

A - winter;

B - summer;

C - seasonality is not characteristic;

D - spring.


6 Source of infection at enterovirus infection:

A sick man, virus carrier;

B animals;

C rodents;

D - all answers are true.


7 To the paralytic form of poliomyelitis behaves to:

A - spinal;

B - pontial;

C - bulbar;

D - mixed;

E - all answers are true.


8 To the unparalytic form of poliomyelitis behaves all, except:

A - inapparent;

B - abortive;

C - meningeal;

D - mixed.


9 Laboratory diagnostics of poliomyelitis includes:

A - IEA;

B - RIHA;

C determination of antibodies in an excrement;

D - all answers are true.


10 Contra-indications for vaccination of poliomyelitis:

A immunodeficient condition (innate or acquired);

B oncologic diseases;

C anaphylactic reactions on Neomycinum and streptomycin;

D - all answers are true.


Variant 3

1 Basic mechanism of transmission of rotavirus infection :

A - there is not a right answer;

B - fecal-oral;

C - transmissible;

D vertical.


2 Latent period of rotavirus infection :

A - 10 days;

B - 1-2 months;

C - 6 months;

D - 1-5 days;

E - 2 days.


3 Where is rotavirus replicates :

A - in the enterocytes of villus of small intestine;

B - red corpuscles;

C - in hepatocytes;

C - in kidney pelvis;

E - in lymphoid tissue?


4 Determination of virus of the rotavirus infection is maximal on:

A - on a 3-5th day;

B - on the 15th day of disease;

C - in the 1th day of disease;

D - in a week;

E - on the 7-10th day of disease.


5 Who is more frequent ill on rotavirus infection:

A adults;

B elderly people;

C children;

D - all answers are correct


6 Reconvalescence lasts:

A - 10 days;

B 1 month;

C - 4-5 days;

D - 7-10 days.


7 Is there specific vaccine of rotavirus infection:

A - exists in Europe and USA;

B - does not exist;

C - does exist in Ukraine and Russia?


8 Seasonality:

A - summer;

B - spring;

C - winter;

D - not characteristic.


9 What types of rotaviruses exist:

A - A, B, C;

B - A, B, C, D, E;

C - A;

D - A, C


10 Genome of rotavirus contains:

A 1 fragment;

B 10 fragments;

C 3 fragments;

D 11 fragments;

E 22 fragments.


^ Standards of right answers

Variant 1: 1 - C; 2 - E; 3 - A; 4 - B; 5 - A; 6 D; 7 - A; 8 - C; 9 - B; 10 - A.

Variant 2: 1 - B; 2 - A; 3 - A; 4 - C; 5 - B; 6 - A; 7 - E; 8 D; 9 - A; 10 -

Variant 3: 1 - B; 2 D; 3 - A; 4 - A; 5 - C; 6 - C; 7 - A; 8 - C; 9 - B; 10 -


3.4.3 Tasks for self-control

Task 1

The patient Т., 17 years, entered infectious department with complaints about paroxysmal pain in the muscles of back and thorax. Pain increases at changing of position of body, during breathing, cough. Disease began acutely with fever to 38,7 0С, chill, headache. Then pain appeared in muscles. At examination skin in area of back and breast without changes.

1 What clinical form of enterovirus disease is observed for this patient?

2 With what diseases is it necessary to provide differential diagnostics of this clinical form?


Task 2

A woman ate the piece of cake, which stood on a table during days. The common condition became worse in 4 hours. Nausea, paroxysmal stomach-ache, single vomiting appeared. Skin is pale, tongue is covered by a white raid. Temperature of body did not rise, diarrhoea have not been observed.

1 Diagnosis.

2 With what diseases is it necessary to provide differential diagnostics?


Task 3

Patient А., 30 years appealed to the hospital. Became ill acutely. Complaints about chill, increase of temperature to 38,5 0С, nausea, vomiting, fetid stool 7 times, without admixtures, pain in epigastrium and on motion in large intestine. 10 hours prior to a disease ate meat of duck, which was kept 12 hours at room temperature.

1 Formulate a diagnosis.

2 With what diseases is it necessary to provide a differential diagnosis?
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