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Sumy state university medical institute




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^ Materials of after-class free work

Subjects of Research work :

Features of course of cholera in modern terms.

Modern methods of specific diagnostics of cholera.

Problems of etiotropic treatment of cholera today.

Modern looks to pathogenesis of cholera.

  • Pathogenesis of hypovolemic shock.

  • DIC-syndrome. Etiopathogenesis, clinic, intensive therapy.



^ V INTESTINAL INFECTIOUS DISEASES WITH PRIMARY DEFEAT OF COLON : SHIGELLOSIS, AMEBIASIS. PROTOSOAL INTESTINAL INVASION: GIARDIASIS, BALANTIDIASIS


Duration - 2 hours.


1 Actuality of theme: shigellosis occupies one of leading places in the structure of acute intestinal infectious diseases. Since 1998. there is a height of morbidity. From data of State committee of statistics of Ukraine, morbidity on shigellosis increased from 21,4 to 100 thousands population in 1997 to 34,7 in 2009 and for today remains high.

In the last decade shigellosis is characterized by easier course, rare forming of chronic forms and decline of lethality. But now a situation became worse substantial character: level of morbidity rose, cases became more frequent severe and protracted shigellosis.

In Ukraine the sporadic cases of amoeba dysentery meet mainly on south. In countries CIS most unhappy are the states of Middle Asia and Transcaucasia, where a transmitter is educed in 15-35% habitants.

Special value the problem of amebiasis acquires now in connection with expansion of contacts with different countries, by the increase of number of tourist and business journeys to the regions with hot climate. Activating of own invasion, which courseed in form subclinic transmitter, is possible, what is assisted by overburning, change of terms of feed and other

Actuality of balantidiasis is conditioned by absence of watchfulness from the side of doctors to this pathology, by the risk of development of severe complications which can threaten to life of patient, and also enough high percent of lethality - 10-30 %, that contingently complications and general exhaustion, joining of sepsis. Reasons of distribution of balantidiasis in Ukraine are a low social and sanitary-hygenic level of population, absence of the proper attention of doctors to this disease.

The committee of experts of WHO considers a giardiasis a precinctive disease for many countries of the world, in which periodically there are "sporadic epidemics of disease". It is calculated, that in Africa, Asia and Latin America the number of infested arrives at 200 millions man. Although at most persons an invasion flows without symptoms, nevertheless the clinical displays of giardiasis annually come to light at 500 000 infested. In developing countries a giardiasis is one of principal reasons of acute or persistent diarrhoea. There is giardiasis in the USA and Great Britain - one of most often registered intestinal invasions of man. In Ukraine amount infested approximately 10 %makes by the lamblias of adults, among children, especially junior age, it aquires 30-40 %, and in some closed child's collectives - 70 %.


2 Educational aims of class (with pointing of mastering level which is planned)

2.1 A student must know:

а- 2

  • etiology of shigellosis, amebiasis, giardiasis, balantidiasis;

  • factors of pathogenicity of causative agent;

  • epidemiology of shigellosis, amebiasis, giardiasis, balantidiasis;

  • pathogenesis;

  • clinical displays of shigellosis, amebiasis, giardiasis, balantidiasis;

  • clinical-epidemiological features of shigellosis, amebiasis, giardiasis, balantidiasis;

  • pathogenesis, duration of origin and clinical displays of complications of shigellosis, amebiasis, giardiasis, balantidiasis;

  • laboratory diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis;

  • principles of treatment of shigellosis, amebiasis, giardiasis, balantidiasis;

  • principles of prophylaxis of shigellosis, amebiasis, giardiasis, balantidiasis;

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

  • prognosis of shigellosis, amebiasis, giardiasis, balantidiasis;

  • rules of discharge of reconvalescents from an in-patient department;

  • rules of the observation.




    1. A student must be able:

а- 3

  • to observe the basic rules of work at the sick-bed of shigellosisом, amebiasisом, giardiasis, balantidiasisом;

  • to take the case history with the estimation of epidemiology data at shigellosis, amebiasis, giardiasis, balantidiasis;

  • to inspect a patient and determine the basic symptoms of shigellosis, amebiasis, giardiasis, balantidiasis;

  • to provide differential diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis;

  • to draw medical documentation in fact of establishment of diagnoses of shigellosis, amebiasis, giardiasis, balantidiasis;

  • to work out a plan of inspection of patient;

  • to interpret the results of laboratory inspection;

  • to work out an individual plan of treatment taking into account epidemiology data, stage of disease, severity of the condition, concomitant pathology;

  • to work out a plan of antiepidemic and prophylactic measures in the hearth of infection;

  • to give recommendations in relation to the regimen, diet, inspection, examinations in the period of reconvalescence.



3 Materials of before class of independent work

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

Discipline

To know

Able

1

2

3

Previous disciplines

Microbiology

Property of shigellas, amoebae, lamblias, balantidium

To interpret the results of specific methods of diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis

Physiology

Parameters of physiological norm of organs and systems of man; indexes of laboratory inspection in norm (general analysis of blood, urines, biochemistry of blood, parameters of AAC, electrolytes)

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 laboratory inspection at the parafunctions of organs and systems of different genesis

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 an organism of



To estimate data of immunological researches

1

2

3




man. Immunological aspects of chronic transmitter




Epidemiology

Epidemic process (source, mechanism of infection, ways of transmission) at shigellosis, amebiasis, giardiasis, balantidiasis; prevalence of pathology in Ukraine and in the world

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

Surgery

Clinical-laboratory signs of perforation of ulcer of small intestine, enterorrhagia, tactician of the first aid, signs of defeat of colon.

In good time to diagnose these complications, prescribe a corresponding inspection, render the first aid

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 antibacterial and antiprotosoal preparations and facilities of pathogenetic therapy



To prescribe treatment depending on age, individual features of patient, to choose the optimal regimen of reception and dose



1

2

3







preparation, to write recipes

Reanimation and intensive therapy

Urgent conditions:

- enterorrhagia;

- enterobrosia with development of peritonitis

In good time to diagnose and render the first aid at the urgent conditions: enterorrhagia, enterobrosia with development of peritonitis

^ 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 of different genesis. To recognize an infectious disease, its 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

To provide differential diagnostics of diseasees of different genesis. To recognize infectious



1

2

3




diseasees. Pathogenesis, epidemiology, dynamics of clinical displays, laboratory diagnostics, possible complications of infectious diseases

disease, his complication; to interpret data of laboratory inspection. To prescribe treatment. To render the first aid on the before-hospital stage


3.2 List of the recommended literature

Basic:

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

3.3

Chart of diagnostics and treatment of shigellosis(Dysenteria)

Epidemiology anamnesis:





Yes. Clinical signs. no




and Yes, shigellosis. Verification of diagnosis : it is not




Yes. A diagnosis is confirmed: it is not





Treatment:






Recovery. Discharge:





Observation:


Chart of diagnostics and treatment of amebiasis (Аmoebiasis)

Epidemiology anamnesis:










yes Clinical signs: not











Yes, amebiasis. Verification of diagnosis : it is not


no




yes. A diagnosis is confirmed


yes







Treatment:





Recovery. Discharge:





Observation:


Chart of diagnostics and treatment of balantidiasis
^

Epidemiology anamnesis:



Acute course:

- at beginning: fever, chill, headache, flatulance, sometimes nausea, vomitting;

- at height of disease: diarrhoea to 15-20 times a day, plentifull faeces, fluid, mephitic, with addition of mucus and blood, sometimes pus;

    • Decereasing of weight.

^ Chronic recidive balantidiasis:

- abdomen is flatulated, painfull in region of caecum and colon ascendance;

- hepatomegaly;

- stool 2-3 times a day;

- чередование обострений (10-30дней) и ремиссии на протяжение 3-6 месяцев
yes. Clinical signs: it is not


- parasitoscopia of fresh faeces (live balantidiums, which move quickly);

- serologic reaction: CFT, precipitation in agar, immobilisation;

- determination of balantidiums on Pavlova’s medium;

    • rectoromanoscopia: focal or diffuse infiltrative-erosive-ulcerous colitis
yes, balantidiasis. Verification of diagnosis it is not

yes. A diagnosis is confirmed. no







- formulating of diagnosis;

- determination of form, complications

Differential diagnosis with disenteria, amebiasis, disbacteriosis etc.









T
- all patients undergo hospitalization;

- antibiotics - monomycin, oxitetracyclin;

- antiprotosoal – metragil, delagil, aminarson;

- antihistamine drugs;

- vitamine therapy;

- detoxication therapy on prescriptions


reatment

Recovery: observation


  • Clinical recovery;

  • Three negative researches of faeces during week










  • observation during year;

  • control research of faeces on balantidiasis (triple a year)






Chart of diagnostics and treatment of giardiasis(Lambliosis)

Epidemiology anamnesis:


- visiting of places with bad sanitary conditions, using of water,vegetables, fruits without adequate heating; unobservance of rules of personal hygiene











yes. Clinical signs:


- beginning is acute at massive invasion;

- acute form: stool without mucus and blood appears, decreasing of appetite, nausea; flatulance, borbogour; belchng with gase.

^ Chronic form: diskinesia of intestines of hypo- or hypermotoric type; pain in epigastrium, right subcostal region; stool is not stabile (diarrhoea interchanges with constipation); diskinesia of billiary ways; decreasing of weight, feeling disorders, often at children intolerability of lactose




- parasitoscopia: determination of vegetative forms of lamblias in duodenal content or cystas in faeces; determination of lamblial antigens in faeces (RIIF);IEA
yes, giardiasis. Verification of diagnosis :


no





yes. A diagnosis is confirmed: it is not


- to differentiate with gastrointestinal form of salmonellosis, amebiasis, shigellosis, acute appendicitis, syndrome of malapsorption etc.

- formulating of diagnosis with determination of form, level of severity







Treatment:


- in ambulatory conditions: intilamblious drugs: metronidazol, clion-D, metrogil, trychopol, ornidazol, tinidazol; symptomatic therapy; substitutive medications; antihystamine drugs






Recovery. Discharge: observation:



- absence of clinical symptoms, cystas of lamblias in duodenal content and faeces (three negative analyses with interval 3 days)



^ 3.4 Materials for self-control

3.4.1 Questions for self-control

1 Feature of causative agents of shigellosis, amebiasis, balantidiasis, giardiasis.

2 Factors of pathogenicity of Sh. dysenteriae, Entamoeba histolitica, Balantidium coli, Lamblia intestinalis.

3 Source of infection and factors of transmission.

4 Pathogenesis of shigellosis, amebiasis, balantidiasis, giardiasis.

5 Classification of shigellosis, amebiasis, balantidiasis, giardiasis.

6 Basic clinical syndromes of shigellosis, amebiasis, balantidiasis, giardiasis.

7 Clinical displays depending on severity of course.

8 Specific complications of shigellosis, amebiasis, balantidiasis, giardiasis.

9 Differential diagnosis of shigellosis, amebiasis, balantidiasis, giardiasis.

10 Plan of inspection of patient with shigellosisом, amebiasisом, balantidiasisом, giardiasis.

11 Methods of specific diagnostics of shigellosis, amebiasis, balantidiasis, giardiasis. Interpretation of results of laboratory research.

12 Specific therapy of shigellosis, amebiasis, balantidiasis, giardiasis: doses, duration of treatment.

13 First aid to the patient with shigellosis, amebiasis, balantidiasis, giardiasis.

15 Rules of discharge of reconvalescents from an in-patient department.

16 Prophylaxis and measures in a hearth.


^ 3.4.2 Tests for self-control

To choose right answers


Variant 1

1 Dysentery belongs to:

A - food toxicoinfection;

B - blood infections;

C - enteroideas;

D - viral diarrhoea;

E - food intoxications.


2 causative Agent of shigellosis :

A pale treponema;

B fusiform stick;

C - Sh. Dysenteriae;

D - Clostridium perfringens;

E - Clostridium botulinum.


3 Source of infection at shigellosis:

A food;

B man;

C water;

D grazing animals;

E canned foods.


4 Factors of transmission at shigellosis:

A foods, articles of way of life, which are muddy faeces of patient;

B poor quality vegetables;

C unwashed fruit;

D - all mentioned;

E milk products.


5 Duration of latent period of acute dysentery :

A - 2 weeks;

B from 1 to 7 days;

C - all right;

D - 2-3 hours;

E - 6-24 hours, continuation is possible to 10 days.

6 What preparation is mostly used for antibiotic therapy shigellosis:

A - Bicillini - 5 intramuscular for 1500000 ME 1 time per day;

B - Sol. gentamуcini sulfatis 4 % intramuscular 1 ml 3 times per day;

C - Тab. Tetracyclini 0,25 4 times per days;

D - Laevomycetini succinatis solubil.0,5 intramuscular 4-6 times per day;

E - Тab. Rovamicini 3000 МЕ 3 times per day?


7 Differential diagnostics at shigellosis:

A - all mentioned;

B unspecific ulcerous colitis;

C amebiasis;

D dysbacteriosis.


8 Complications of shigellosis :

A- intensifying of piles, crack of anus, bleeding (rarely);

B- acute appendicitis, enterorrhagia;

C- perforation of ulcers, peritonitis;

D- the expressed cachexy.


9 What complications of shigellosis can arise up for children:

A bronchopneumonia, infections of urinary ways;

B mixedema;

C ichtiosis;

D artralgia?


10 Duration of dispansery observation at shigellosis:

A - 12 months;

B - 3 days;

C - 3 months after discharge from an in-patient department;

D 1 month.


Variant 2

1 Amebiasis belongs to:

A - enteroideas;

B - viral diarrhoea;

C - to food intoxications;

D - food toxicoinfection;

E - infectious protosoal infection.


2 causative Agent of amebiasis :

A pale treponema;

B fusiform stick;

C - Sh. Dysenteriae;

D - Entamoeba histolitica;

E - Clostridium botulinum.


3 Source of infection at amebiasis:

A food;

B sick man, cystocarrier;

C water;

D greeze animals;

E canned foods.


4 Factors of transmission at amebiasis:

A foods, articles of way of life, which are muddy faeces of patient;

B poor quality vegetables;

C water, foods which are not exposed to the thermal heating;

D milk products.


5 Duration of latent period of intestinal amebiasis :

A - from 1-2 weeks to 3 months;

B - from 1 to 7 days;

C - all right;

D - 2-3 hours;

E - 6-24 hours, continuation is possible to 10 days.

6 What preparation is most often used for antibiotic therapy amebiasis:

A - Bicillini - 5 intramuscular 1500000 ME 1 one time per day;

B - Sol. gentamуcini sulfatis 4 % intramuscular 1 ml 3 times per day;

C - Tab. Tetracyclini 0,25 4 times per day;

D - Tab. Metronidasoli 0,5 4 times per day

E - Tab. Rovamicini 3000 МЕ 3 times per day?


7 Intestinal complications of amebiasis :

and is a perforation with peritonitis;

B – amoeboma of bowels;

in amoeba appendicitis;

D - all mentioned.


8 What clinical forms are distinguished at amebiasis:

A - all mentioned;

B - dermic;

in - intestinal;

D – out-intestinal?


9 To out-intestinal amebiasis attribute:

A amoeba hepatitis;

B amoeba abscess of different organs (lungs, brain, spleen);

C amebiasis of skin;

D - all answers are true.


10 Differential diagnostics at amebiasis:

A unspecific ulcerous colitis;

B - all answers are true;

C dysentery;

D dysbacteriosis;

E balantidiasis.


Variant 3

1 To what group of infectious diseases balantidiasis belongs:

A - intestinal;

B - transmissive;

C - respiratory tracts;

D - external covers;

E - wound?


2 Source of infection at balantidiasis:

A pigs;

B is a man;

C cows;

D sheep;

E - all answers are true.


3 Way of infection balantidiasis :

A - fecal-oral;

B - transmissible;

C - contact;

D drop, respiratory;

E - all answers are true.


4 Passing of cystic form to vegetative at balantidiasis takes place in:

A - ascending departments of colon;

B - stomach;

C - small intestine;

D - descending departments of colon;

E - all answers are true.


5 Reproduction of B. coli takes place :

A - caecum;

B - in a rectum;

C - in an iliac bowel;

D - in a sigmoid bowel;

E - all answers are true.


6 Ulcers at balantidiasisе localized:

A - in the places of bends of intestinal wall, in a colon;

B - in the place of transition of iliac bowel in a blind;

D - in appendix;

E - all answers are true.


7 Features of ulcers at balantidiasisе:

A - located along folds, laciniate, a bottom is covered by the necrotizing masses;

B - located across folds, laciniate, bottom clean;

C - with even edges, a bottom is covered by the necrotizing masses, located across folds;

D is a bottom clean, with even edges, located along folds;

E are ulcers shallow, covered by a fibrinous raid, located across folds.


8 whether the defeat of myocardium is Possible at balantidiasis:

A - yes;

B - no?


9 Clinical forms of balantidiasis all, except:

A - subacute;

B - acute;

C - subclinical;

D - chronic continuous;

E - chronic recrudescent.


10 Latent period at balantidiasis:

A - 1-3 weeks;

B - 2-3 days;

C - 14-28 days;

D - 1-2 months;

E - 3-5 weeks.


Variant 4

1 causative Agent of giardiasis is:

A - Lamblia intestinalis (Giardia lamblia);

B - Lamblia lumbricalis;

C - Lamblia coli;

D - B.cereus;

E - Cytrobacter.


2 Lamblia intestinalis belongs to:

C - bacteria;

B - protosoa, exists in vegetative and cystic forms;

C - riccketsia;

D - mycoplasma;

E - protosoa, exists only in a vegetative form.


3 Vegetative forms of lamblias parasitize in:

A - colon;

B - duodenum;

C - small intestine;

D - rectum;

E - caecum.


4 Cystas of lamblias are in:

A - stomach;

B - small intestine;

C - caecum;

D - colon;

E - duodenum.


5 Source of infection at giardiasis:

A insects;

B people and rodents;

C rodents (mise, rats);

D snakes;

E - only people.


6 Mechanism of transmission at giardiasis:

A - fecal-oral;

B - contact;

C - alimentary;

D domestic;

E - wound.


7 whether Can to the lamblia exist in bilious ways:

A - can not;

B - can only in a gall-bladder;

C - can as cystas;

D - can as a vegetative form;

E - yes, always?


8 Clinical forms of giardiasis :

A - transitory, latent, subclinical;

B - septic, generalized;

C - latent, acute, chronic;

D - chronic, septicopiemic, generalized;

E - latent, subclinical, initially-recrudescent.


9 Latent period at giardiasis:

A - 1-3 weeks;

B - 2-3 days;

C - 1-3 months;

D - 10 weeks;

E - 30-60 days.


10 For a giardiasis characteristically:

A acute beginning, watery excrement without mucus, pain in an epigastrium, subfebrility;

B gradual beginning, flatulence, watery excrement with the admixtures of mucus;

C constipations, flatulence, febrile temperature, pain in the left iliac area;

D subfebrility, constipations, gradual beginning, flatulence.


^ Standards of right answers

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

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

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

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


^ 3.4.3 Tasks for self-control
1   ...   5   6   7   8   9   10   11   12   ...   16

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