Educational literature for medical students
ND Yushchuk, YY Vengerov
and pharmaceutical education of Russian universities as a textbook for medical students
Moscow "Medicine"
UDC 616.9-022 (075.8) BBK 55.14
R e c e n z n t:
AK Takmalaev - Doctor of Medical Sciences, Professor, Head of the Department of Infectious Diseases, Peoples' Friendship University of Russia.
Yushchuk N.D., Vengerov Yu.Ya.
Yu98 Infectious Diseases: Textbook. - M .: Medicine, 2003 .-- 544 p .: ill .: l. silt - (Textbook. Literature. For students of medical universities.) ISBN 5-225-04659-2
The textbook was prepared by the team of authors taking into account the modern achievements of infectology and the relevance of individual nosoforms in accordance with the program on infectious diseases for the medical faculties of medical universities. It can be used as a teaching aid on infectious diseases for sanitary and hygienic faculties of medical universities, training in the course of tropical medicine.
For medical students.
Foreword ................................................. ........................................... |
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Introduction ................................................. .................................................. |
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GENERAL QUESTIONS OF INFECTIOUS PATHOLOGY |
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1. Classification of infectious diseases. Infectious pro |
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cess and infectious disease .............................................. ............ |
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2. The main features of infectious diseases ............................ |
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3. Diagnostics ............................................... ........................................ |
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4. Treatment ............................................... .................................................. |
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5. Emergencies in the clinic of infectious diseases. ... ... ... |
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PRIVATE QUESTIONS OF INFECTIOUS PATHOLOGY |
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6. Bacteriosis ............................................... ........................................... |
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Sadylonellosis ................................................. ........................ |
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6.1.D) Abdominal ty f ........................................... ..................... |
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6.p £ Paratyphoids A, B .......................................... .................... |
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6.1.37 "" Salmonellosis ............................................ ....................... |
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6.2. Dysentery (shigellosis) .............................................. .............. |
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6.3. Escherichiosis ................................................. ............................... |
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6.4. Foodborne diseases ................................................ ... |
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6.5. Cholera................................................. ...................................... |
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6.6. Yersiniosis ................................................. ........................... |
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6.6.G7> Pseudotuberculosis ............................................. ............. |
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■ £ .6.2. Yersiniosis ................................................. .................... |
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6.6.37 Plague .............................................. .................................. |
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6.7. Klebsiellosis ................................................. ........................... |
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6.8. Pseudomonas aeruginosa infection ................................................ ....... |
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6.9. Campylobacteriosis ................................................. ............... |
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6L<1 Листериоз................................................................................ |
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6'11. "Brucellosis ............................................ .................................... |
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(T.IZ Tularemia ............................................. ................................... |
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6.13.h Anthrax .............................................. ......................... |
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6.14. Streptococcal infections ................................................ |
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6.14.1. Scarlet fever................................................. .................. |
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6.14.2. Erysipelas ................................................. ............................. |
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6.14.3. Angina................................................. ......................... |
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6.15. Pneumococcal infections ................................................ |
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6.16. Staphylococcal infections .............................................. |
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£ D7. Meningococcal infection ................................................ |
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6.18. Diphtheria................................................. ............................... |
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6.19. Whooping cough and parapertussis ............................................... ........ |
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6.20. Hemophilus influenza infection ..................................... |
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6.21. Legionellosis ................................................. ........................... |
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6.22. Spirochetoses ................................................. ......................... |
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6.22.1. Epidemic relapsing fever (lice). ... ... ... |
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6.22.2. Endemic relapsing fever (tick-borne |
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recurrent borreliosis) .......................................... |
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6.22.3. Leptospirosis................................................. ........... |
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6.22.4. Ixodid tick-borne borreliosis (Lime-boron- |
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reliosis, Lyme disease) .......................................... |
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6.22.5. Sodoku ................................................. ...................... |
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6.22.6. Streptobacillosis ................................................. .... |
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6.23. Clostridioses ................................................. ...................... |
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6.23.1. Tetanus (tetanus) .............................................. .. |
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"at £ 6.23.2" Botulism .......................................... ......................... |
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6.24. Benign lymphoreticulosis (felinosis, b |
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cat scratch disease) ..................................... |
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6.25. Sepsis................................................. .................................... |
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7. Eikketsiosis ............................................... ...................................... |
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<С2Л^Эпидемйческий сыпной тиф. Болезнь Брилла................ |
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7.2. Endemic (flea) rash ty f .......................... |
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7.3. Tsutsugamushi Fever ................................................ ....... |
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7.4. Marseilles fever ................................................ ....... |
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7.5. Tick-borne typhus of North Asia ............................ |
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7.6. Rocky Mountain spotted fever ................................ |
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7.7. Australian tick-borne rickettsiosis .............................. |
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7.8. Vesicular rickettsiosis ................................................ ... |
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7.9. Q fever (coxiellosis) ............................................ .... |
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7.10. Ehrlichiosis ................................................. ............................. |
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8. Chlamydia ............................................... ...................................... |
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B. Pornitosis ............................................... .................................... |
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9. Mycoplasmosis ............................................... ................................. |
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9.1. Mycoplasma pneumoniae - infection .............................. |
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10. Viral infections .............................................. ......................... |
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- (10.1. Viral hepatitis ............................................ .................. |
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10.1.1. Hepatitis A................................................ ................... |
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10.1.2. Hepatitis E ................................................ ................... |
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10.1.3. Hepatitis B................................................ ................... |
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10.1.4. Hepatitis D ................................................ ................ |
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10.1.5. Hepatitis C ................................................ ................... |
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10.1.6. Hepatitis G ................................................ ................ |
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10.1.7. Diagnostics and differential diagnostics 288 |
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10.1.8. Treatment................................................. .................... |
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10.1.9. Forecast................................................. .................... |
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10.1.10. Prevention ................................................. ......... |
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10.2. HIV infection............................................... ...................... |
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10.3. Acute respiratory diseases ................................. |
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10.3.1. Flu................................................. ...................... |
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10.3.2. Acute respiratory viral infections. ... ... |
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10.3.2.1. Adenovirus infection ....................... |
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10.3.2.2. Parainfluenza ................................................ |
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10.3.2.3. Respiratory syncytial infection |
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tion ................................................. ........... |
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10.3.2.4. Coronavirus infection ..................... |
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10.3.2.5. Rhinovirus infection ....................... |
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10.3.2.6. Reovirus infection ............................ |
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10.3.2.7. Diagnostics and differential |
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diagnostics.............................................. |
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10.3.2.8. Treatment................................................. .... |
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10.3.3. Severe acute respiratory syndrome. ... ... ... |
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10.4. Enterovirus infections ................................................ ... |
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10.4.1. Coxsackie enterovirus infections - ECHO |
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10.4.2. Polio................................................. ........... |
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10.5. Herpetic infections ................................................ ..... |
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10.5.1. Herpes infection (herpes simplex). ... ... ... |
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10.5.2. Chickenpox................................................ .......... |
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10.5.3. Shingles ai .......................................... |
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10.5.4. Infectious mononucleosis (Epstein- |
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Barr virus mononucleosis) .............................. |
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10.5.5. Cytomegalovirus infection ............................ |
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10.6. Measles................................................. ......................................... |
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10.7. Rubella................................................. ............................... |
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IGL &. Mumps (mumps infection) ............ |
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[О ^ Viral diarrhea ............................................. ...................... |
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10.9.1. Rotavirus infection ....................................... |
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10.9.2. Norwalk virus infection .............................. |
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10.10. FMD ................................................. ...................................... |
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10.11. Natural spa .............................................. .................. |
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10.12. Cowpox................................................ .......................... |
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10.13. Smallpox ................................................ .......................... |
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10.14. Phlebotomy fever ................................................ ..... |
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10.15. Hemorrhagic fevers .............................................. |
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10.15.1. Yellow fever................................................ ... |
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10.15 ^ -Dengue fever ............................................. .......... |
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Balantidiasis ................................................. ........................... |
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J2.3. Malaria ................................................ ................................ |
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12.4. Leishmaniasis ................................................. ...................... |
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12.5. Toxoplasmosis ................................................. ......................... |
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12.9.1. American trypanosomiasis (Chagas disease) 475
12.9.2. African trypanosomiasis (sleeping sickness). ... 476
13. Actinomycosis ............................................... ................................................ |
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14.Micose .............................................. .............................................. |
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14.1. Aspergillosis ................................................. ........................... |
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14.2. Histoplasmosis ................................................. ......................... |
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14.3. Candidiasis................................................. ............................... |
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14.4. Coccidioidosis ................................................. ...................... |
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15. Helminthiasis ............................................... ............................................. |
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15.1. Nematoses ................................................. ........................... |
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15.1.1. Filariasis ................................................. ............. |
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15.1.2. Ascariasis ................................................. .................. |
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15.1.3. Toxocariasis ................................................. ............... |
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15.1.4. Trichocephalosis ................................................. ........... |
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15.1.5. Enterobiasis ................................................. ............... |
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15.1.6. Ankylostomiasis ................................................. .... |
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15.1.7. Strongyloidosis ................................................. ........ |
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15.1.8. Trichinosis................................................. ............. |
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15.2. Trematodes ................................................. ........................ |
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15.2.1. Schistosomiasis ................................................. ........... |
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15.2.2. Opisthorchiasis ................................................. ............... |
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15.2.3. Fascioliasis ................................................. .................. |
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15.3. Cestodosis ................................................. ............................. |
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15.3.1. Teniarinhoz ................................................. ............. |
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15.3.2. Teniosis ................................................. ........................ |
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15.3.3. Cysticercosis ................................................. ............. |
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15.3.4. Diphyllobothriasis ................................................. ...... |
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15.3.5. Echinococcosis (hydatid) ..................................... |
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15.3.6. Alveococcosis ................................................. ........... |
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Application................................................. ......................................... |
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Bibliography................................................ .............................. |
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Subject index................................................ .......................... |
Abbreviations frequently used in the text
anti-HBcAg - antibodies against HBcAg anti-HBeAg - antibodies against HBeAg anti-HBsAg - antibodies against HBsAg
Antibodies against hepatitis C virus |
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Antibodies against hepatitis D virus |
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Antibodies against hepatitis E virus |
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Aspartate aminotransferase |
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HAV (HAV) - hepatitis A virus |
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HBV (HBV) - hepatitis B virus |
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HCV (HCV) - hepatitis C virus |
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BTD (HDV) - hepatitis D virus |
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HEV - hepatitis E virus |
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Human herpes virus |
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AIDS virus |
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Herpes simplex virus |
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Epstein-Barr virus |
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Hepatitis A |
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Hepatitis B |
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Hepatitis C |
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Hepatitis D |
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Hepatitis E |
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Hepatitis G |
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Delayed type hypersensitivity |
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Blood-brain barrier |
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Disseminated intravascular coagulation |
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Artificial lung ventilation |
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Histological activity index |
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Infectious toxic shock |
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Immunofluorescence |
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Linked immunosorbent assay |
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Creatine phosphokinase |
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Fluorescent antibody method |
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Macrocyte-phagocytic system |
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Acute renal failure |
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Acute respiratory viral infection |
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Circulating blood volume |
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Fibrin degradation products |
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Polymerase chain reaction |
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Hepatic encephalopathy |
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Agglutination reaction |
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Hemagglutination aggregate reaction |
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The reaction of agglutination and lysis of leptospira |
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Hemagglutination reaction |
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Immunofluorescence reaction |
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Coagglutination reaction |
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Neutralization reaction |
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Indirect hemagglutination reaction |
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RTPHA - passive hemagglutination inhibition reaction
Reticuloendothelial system |
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Acquired immunodeficiency syndrome |
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Toxic shock syndrome |
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Ultrasound procedure |
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Ultraviolet irradiation |
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Organophosphorus compounds |
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Chronic active hepatitis |
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Chronic hepatitis |
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Chronic persistent hepatitis |
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Chronic renal failure |
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Cytomegalovirus |
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CMVI - cytomegalovirus infection |
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central nervous system |
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Electroencephalography |
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HBcAg - bovine antigen of hepatitis B virus |
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Antigen "e" (infectivity) of the hepatitis B virus |
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Hepatitis B virus surface antigen |
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Varicella-zoster virus |
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Foreword
In connection with the adoption in 2002 of a new program on infectious diseases for the medical faculties of medical institutes, the further development of infectious diseases as a scientific discipline, the emergence and spread of new infectious diseases, a change in the morbidity structure, the development and implementation of new methods of diagnostics and In the treatment of infectious diseases, an urgent need arose to publish a new textbook "Infectious Diseases", which reflects the requirements of the new program and the achievements of science and practice in the field of infectious diseases.
This textbook was prepared by the authors with the active participation of the research and teaching staff of the Department of Infectious Diseases with the course of epidemiology of the Moscow State Medical and Dental University. In the general part, the main features of infectious diseases, methods of their diagnosis and treatment, including emergency conditions, are presented, which allows avoiding repetitions when describing certain nosological forms.
The material is located in an agreed etiological classification of infectious diseases. The volume of material corresponds to the role of each nosological form in human pathology. The description of diseases that were not included in the program (highlighted in type), but play an essential role in infectious pathology, makes it possible to use the textbook as a guide for trainees in the course of tropical medicine, as well as for the training of residents and the specialization of doctors in infectious diseases.
Device for infectious diseases hospital (department)... Infection hospitals (departments) are located, if possible, on the outskirts of settlements, away from the main highways, water sources. During the construction of the hospital, the required minimum land area per bed is taken into account - 200 m2
The number of beds in the hospital depends on the population of the city, district (200-500 and more beds); the same applies to infectious diseases departments in district, city and regional hospitals (20-40 beds in rural areas and 40-100 beds in cities and large settlements). They are guided by the following calculation: 1.4 beds per 1000 population.
The infectious diseases hospital should include the following units: admission department (emergency room); departments for hospitalization of patients; boxed departments or separate boxes for accommodation of patients with diseases of unknown etiology, mixed infections; department (wards) to provide assistance to patients with conditions requiring urgent intervention; catering unit; laundry; X-ray department (office); laboratory; pharmacy; disinfection department (chamber); economic and technical service; administrative and managerial staff.
In the case when the infectious diseases department is part of a district, city or regional hospital, a number of services (catering, pharmacy, administrative, laboratory, X-ray room) may be common. The laundry and disinfection chamber should only be serviced by the infectious disease ward.
Admission department (rest)... In the admission department (rest), incoming patients are received; establishing a diagnosis; taking material for research; sanitization of patients; filling out the documentation for applicants; triage of patients; transportation of patients to departments; processing of patients' belongings; transport handling; emergency information from sanitary and epidemiological institutions about incoming patients; providing emergency care to patients; issuance of certificates on the condition of patients.
In large hospitals, patients are treated around the clock. If at night there are few patients, then the doctors on duty at the hospital are responsible for receiving them.
In cases where infectious diseases departments are part of a district, city or regional hospital, patients are admitted in a separate emergency room or separate examination boxes of the hospital emergency room.
The device of the admission department (rest) must ensure the flow principle of work with patients, when they do not contact each other at all stages of reception, processing and transportation.
Each observation box must have a separate entrance and exit, an examination room, a sanitary unit, a washbasin for personnel, chairs, a couch, a medical cabinet with a set of instruments and medicines, a thermostat and a sterilizer, disinfectant solutions and equipment, bottles and Petri dishes with media, the necessary documentation , stretchers, clothes for applicants, bags for personal clothes of patients.
The reception area should have a rest room for doctors on duty, a shower for staff, a room for clean linen, clothing sets for working with conventional infections, a telephone and an information desk. The number of observation boxes depends on the size of the hospital, but there should be at least four of them: for patients with intestinal infection, droplet infection (except for scarlet fever), as well as for patients with scarlet fever, etc. Near the admission department, it is necessary to equip a platform for sanitizing transport used to deliver patients.
The order of work in the admission department is as follows: at the signal of a doctor who diagnosed an infectious disease, the patient is transported by a disinfection station machine to an infectious diseases hospital (department). Upon arrival at the admission department, the accompanying medical worker hands over the referral to the doctor on duty, who indicates in which box the patient can be received. A doctor, a nurse and a nanny enter this box, put on gowns, scarves, hats and, if necessary, masks. The nanny and the sister undress the patient; the doctor conducts a survey and examination, decides on the diagnosis, prescribes the necessary research and treatment, the type of treatment of the patient's body, the procedure for transportation, and also indicates to which department (section), box or ward the patient should be delivered. When distributing patients, the doctor takes into account: nosological forms of diseases and their severity, age, sex of patients, duration of the disease, the presence of homogeneous complications and contact with other infectious patients.
In cases where the patient was not delivered by special transport, which, of course, should be an exception, the doctor indicates the method of handling the transport. A nurse and a nanny or a disinfector perform the treatment right there on the site. Special transport is handled by an employee of the disinfection station. After the patient undergoes sanitation, they put on hospital clothes and, accompanied by a nurse, are sent to the department (box).
Personal clothing is filled with a receipt, one copy of which is given to the patient (attached to the medical history), and the other is placed in a clothes bag, which is immediately transferred to the disinfection chamber. In those cases when patients arrive at night (and the camera works only in the daytime), a powdered disinfectant is poured into bags with clothes of patients with typhoid and paratyphoid fever in an amount of 20-25 g per set (it is necessary to use drugs that do not cause discoloration of clothing).
Depending on the clinical manifestations of the disease in patients, according to the doctor's prescription, blood is taken from a vein for sowing on bile or sugar broth, a smear from the mucous membranes of the pharynx and nose (on a diphtheria bacillus or other flora), feces (for typhoid-paratyphoid diseases, dysentery) and etc.
If necessary, patients are provided with emergency assistance - intubation, removal from shock, collapse, stopping bleeding, the introduction of the first doses of therapeutic sera.
In the admission department, a medical history and an application for a catering unit are filled in and the following documents are kept: a register of patients admitted, a register of consulted patients, emergency notifications (summary), a register of persons who communicated with patients with children's droplet infections (according to data from preschool child care institutions), a logbook for taking material for research and a log of duty. This journal and case history are completed by a physician who reviews the summary sent to the regional sanitary and epidemiological agency. Upon admission of patients with typhus, botulism, salmonellosis and some other infections, they report by phone to the sanitary-epidemiological station.
After completing the examination and reception, the staff takes off the dressing gowns, hats, masks in the box. After receiving the patient, the room is wet treated; the brushes and washcloths with which the patient was washed are boiled. Discharge of the patient, wash water, in the absence of a chlorinating unit, is collected in containers, poured with a disinfectant solution (chlorine-lime milk) or covered with bleach (liquid materials) and after a certain exposure (2 hours) is poured into the sewer. The instruments that were used when receiving the patient are sanitized, and the dressing gowns, hats, kerchiefs and masks are disinfected. A stretcher or wheelchair on which patients were transported are also subject to processing.
If necessary, the doctor on duty calls for a consultation with an experienced doctor or the necessary specialists. If the doctor still has doubts and the question of the diagnosis has not been resolved, the patient is sent to a separate box. The same is done in relation to patients with mixed infections who were in contact with other patients.
Infectious department... Infectious departments are used for hospitalization, examination and treatment of infectious patients. The number of departments in an infectious diseases hospital can be different - from 3-4 to 10-16 and more. The average number of beds in each of them is 40-60. In departments for hospitalization of young children, as well as for adult patients with some types of infections, the number of beds may be smaller. The approximate staffs of the department are as follows: the head of the department - 1; residents - 2; senior nurse - 1; nurses on duty - 5-6; mistress sister - 1; nurses - 5-6; barmaids - 2.
Branches can be located in separate buildings (pavilion type) or in the same building; in this case, they must have their own entrance and exit to the hospital courtyard.
Each department consists of wards (for 2-4 beds each), a pantry, a room for doctors, a manipulation room, and a sanitary unit.
When placing patients, it is necessary to adhere to the following recommendations: the volume of the room allocated for one patient should be 18-20 m3, the floor area is 7-8 m2, the distance between the beds is 1 m. The temperature in the wards should be at least 16-18 ° C, humidity - about 60%; regularly ventilate the room with transoms, vents, central supply or combined ventilation.
The pantry should have a separate passage to the courtyard for delivering food and taking out food leftovers. In the event that the departments are located in a multi-storey building, food delivery is carried out using special elevators. In the pantry, a stove is installed for heating food, boiling dishes, supplying cold and hot water; there should be: a tank for soaking dishes, a tank for food residues, racks for drying dishes, tables for serving food and cutting bread, various dishes, as well as the necessary equipment.
In the sanitary unit of the department, a bathtub, a shower installation, and washbasins for washing patients in the department are equipped. The toilet consists of separate cabins, the number of which depends on the number of beds in the department (1 point for 12-20 people). A sanitary inspection facility for medical personnel is also envisaged.
The department maintains the following documentation: case histories, a patient register, a register of blood transfusions and its components, a register of nosocomial infections, and prescription cards.
In the history of the disease, passport data, complaints of the patient upon admission, medical history, life history, epidemiological history, objective research data, preliminary diagnosis, diaries indicating the necessary research, therapy and epicrisis are entered. The results of various laboratory tests are pasted into the medical history on a separate sheet (the diagram of the medical history is given in the appendix).
To ensure correct sorting of incoming patients, separate hospitalization of patients with mixed infections, unexplained diseases or unidentified contacts, boxed departments, boxes are needed, the number of beds in which should be 25% of the total number of beds in the hospital (in old hospitals, 15-20% are allowed). The best option are boxes built according to the scheme proposed by the domestic engineer E.F. Meltzer.
The hospital catering unit is usually located in a separate building, with underground tunnels being the best way to deliver food to the departments; in the buildings there are special elevators. In other conditions, food is delivered to the departments by barmaids.
The laundry is built and equipped in such a way as to ensure the flow of linen in only one direction: a room for receiving and sorting linen, then a room for boiling and washing. Subsequently, the laundry goes to the dryer, after the dryer to the ironing room and finally to the dispensing room.
In the disinfection department of the hospital, steam or paraformalin disinfection chambers are installed, each of which is equipped in such a way as to ensure a direct flow of things coming for processing: on the one hand, a room for receiving, sorting and loading the chamber, on the other, for unloading the chamber, placing and issuing of things. The cameras operate according to a certain mode, depending on the form of pathogens and the type of clothing.
»
RABIES Rabies is an acute viral disease characterized by damage to the nervous system with the development of severe encephalitis. Clinical diagnosis Incubation period The incubation period lasts from 12 to 90 days (rarely up to 1 year). The precursor stage lasts 2-3 days. General malaise, headache. The first symptoms of a mental disorder: fear, anxiety, depression, insomnia, irritability. Subfebrile condition. In the area of the bite - burning, itching, hyperesthesia, the scar swells, reddens. The arousal stage lasts 2-3 days. Hydrophobia, aerophobia, auditory and visual hallucinations, hypersalivation. Attacks of clouding of consciousness, aggressiveness, violent psychomotor agitation. Fever, respiratory and cardiovascular disorders. The paralysis stage lasts 18-20 hours. Consciousness is clear, lethargy salivation, hyperthermia, paralysis of the muscles of the tongue, face, limbs, respiratory muscles and heart. Laboratory diagnostics 1. Viroscopic method. Detection of Babesh-Negri bodies in ammonium horn cells (used for postmortem diagnosis). 2. Virological method. Isolation of the virus from the saliva of patients, suspension of brain tissue or submandibular salivary glands of the deceased by infecting mice (intracerebrally) or hamsters (intraperitoneally), as well as in tissue culture. 3. Immunofluorescence method. Investigate sections of brain tissue, treated with a specific luminescent serum, in order to detect AG of the rabies virus. Measures in relation to patients and contact persons Hospitalization. Required. Insulation of contact. Not produced. The bitten animals are monitored for 10 days. Rabid and rabid animals are destroyed and their brains are sent for laboratory testing. Specific prophylaxis 1. Dry rabies vaccines such as Fermi and CAV are used for active immunization according to conditional and unconditional indications. Indications for vaccination, the dose of the vaccine and the duration of the course of immunization are determined by doctors who have received special training. 2. Antirabies immunoglobulin from horse serum is used to create immediate passive immunity. Non-specific prophylaxis Prevention of vagrancy of dogs and cats, prophylactic immunization of pets, careful initial treatment of bitten wounds. BOTULISM Botulism is a foodborne illness caused by the toxin of the botulinum bacillus, which occurs with damage to the central nervous system. Clinical diagnostics The incubation period is from 2 hours to 8-10 days (usually 6-24 hours). The onset is often sudden with symptoms of general weakness, headache, dizziness, dry mouth. Visual impairment (diplopia, blurred vision near), further impairments progress - dilated pupils, ptosis of the eyelids, accommodation paralysis, strobism, nystagmus. Paralysis of the soft palate (nasal, choking). Paralysis of the muscles of the larynx (hoarseness, aphonia) and the muscles of the pharynx (impaired swallowing). Violation of articulation, paresis of mimic and masticatory muscles, muscles of the neck, upper limbs, respiratory. Consciousness is preserved. Tachycardia, hypotension, deafness of heart sounds. Laboratory diagnostics The material for the study can be vomit, wash water (50-100 ml) of the stomach, feces, urine (5-60 ml), blood (5-10 ml). The research is conducted in two directions: 1. Detection of botulinum toxin and determination of its type in a neutralization experiment on white mice. 2. Isolation of the pathogen using special methods of cultivation of anaerobes. A preliminary answer (based on the results of a bioassay) in 4-6 hours. The final one is on the 6-8th day. Measures in relation to patients and contact persons Hospitalization. Obligatory, early. Insulation of contact. In the outbreak, all persons who have consumed an infected product with the sick are subject to medical observation for 12 days. These individuals receive specific prophylaxis (see below). Conditions of discharge. Clinical recovery. Admission to the team. After clinical recovery. Clinical examination: Long-term asthenization requires limiting physical activity and monitoring for several months. According to indications - supervision of a neuropathologist Specific prophylaxis 1. Anti-botulinum therapeutic and prophylactic antitoxic sera of types A, B, C, E are used to prevent botulism for persons who have consumed an infected product simultaneously with patients. 2. Botulinum polyanatoxin types A, B, C, E are used to immunize people who come into contact with botulinum toxin (laboratory assistants, experimenters) and the population in disadvantaged areas. Non-specific prophylaxis Compliance with the technology of food processing, excluding the possibility of accumulation of botulinum toxins in them. Abdominal fever and paratyphoid fever Typhoid and paratyphoid fever are acute infectious diseases characterized by bacteremia, fever, intoxication, lesions of the lymphatic apparatus of the small intestine, roseolous skin rashes, enlargement of the liver and spleen. Clinical diagnostics Incubation period from 1 to 3 weeks (average 2 weeks). The onset is often gradual. Weakness, fatigue, weakness. Headache. Fever. Increased intoxication. Sleep disturbance, anorexia. Constipation, flatulence. In the initial period, symptoms come to light: lethargy, bradycardia, dicrotic pulse, muffled heart sounds, dry wheezing in the lungs; tongue coated with a grayish-brown bloom and thickened, clean from the edges and tip of the tongue, catarrhal tonsillitis, enlarged liver and spleen. By the beginning of the 2nd week, the symptoms reach their maximum development: intoxication (impaired consciousness, delirium) increases, elements of a roseolous-papular rash appear on the skin of the upper abdomen and lower chest. Bradycardia, pulse dicrotic, blood pressure decreases, heart sounds are muffled. Tongue dry, covered with a dense, dirty brown or brown coating. Severe flatulence, often constipation, less often diarrhea. Rumbling and soreness in the right iliac region. In the blood - leukopenia, in the urine - protein. Complications: bleeding, perforation With paratyphoid fever A in the initial period, there are: fever, facial flushing, conjunctivitis, scleritis, catarrhal phenomena, herpes. Exanthema is polymorphic and appears earlier. With paratyphoid B, a shortening of the period of the disease is noted, in the initial period toxicosis and gastrointestinal disorders are more pronounced, typhoid-like and septic forms are possible. With paratyphoid C, there are typhoid, septic and gastrointestinal forms. Laboratory diagnostics 1. Bacteriological method0. From the first days of the disease, at the height of the fever (during a relapse), 5-10 ml of blood is inoculated into bile (selenite) broth (50-100 ml) in order to isolate blood culture. To isolate the pathogen, you can examine feces, urine, scraping with roseol, bone marrow punctate. The material is inoculated onto enrichment media or directly onto dense differential diagnostic media. Culture of blood, urine, feces, scraping with roseola can be repeated every 5-7 days.Bacteriological examination in order to isolate the causative agent of typhoid and paratyphoid fever can be subjected to sputum, pus, abdominal exudate, cerebrospinal fluid (for special indications). 2. Serological method. From the 5-7th day of illness, with an interval of 5-7 days, a blood test is carried out in order to detect AT and increase their titer in RA and RPHA, separately with O-, H- and Vi-diagnosticums. 3. To identify typhoid paratyphoid bacterial carriers, a bacteriological study of bile and feces is carried out (after giving a saline laxative). An indirect indication of the carriage of bacteria can be the detection of Vi-antibodies. Measures in relation to patients and contact persons Hospitalization. Required. Leaving the patient at home is allowed with the permission of the epidemiologist. Insulation of contact. Not carried out. Medical observation is established within 21 days from the moment of hospitalization of the patient (daily thermometry, a single bacteriological examination of feces and blood tests in the RPHA). Three-fold phaging is carried out. When the pathogen is isolated from the feces, a re-examination of the feces, as well as urine and bile, is carried out to determine the nature of the carrier. With a positive result of RPHA (titer above 1:40), a single bacteriological examination of feces, urine and bile is performed. Workers of food enterprises and persons equated to them, with a positive result of bacteriological and serological tests, are considered as chronic carriers and are not allowed to work. Their further observation and examination are carried out in the same way as for convalescents (see below). Conditions of discharge. Clinical recovery and a threefold result of bacterial examination of stool and urine (on the 5th, 10th and 15th day of normal temperature) and a single bacteriological examination of bile (for 12-14 days of normal temperature). Persons who have not received antibiotics are discharged no earlier than the 14th day of normal temperature. Admission to the team. Reconvalescents of typhoid fever and paratyphoid fever (except for employees of food enterprises and persons equated to them) are allowed into the team without additional examination. Reconvalescents - employees of food enterprises and persons equated to them, are not allowed to work in their specialty for a month, by the end of which their feces and urine are examined five times. If these individuals continue to isolate the pathogen, they are transferred to another job. 3 months after clinical recovery, they examine stool and urine five times with an interval of 1-2 days and bile once. In case of a negative bacteriological examination result (one month after recovery), these persons are allowed to work in their specialty with monthly bacteriological examination of stool and urine in the next two months and once a study of bile and staging an RPHA with cysteine - by the end of the 3rd month. A single isolation of the pathogen after 3 months after recovery leads to the removal of these persons from work with a change in profession. Pupils of schools and boarding schools are admitted to the collective, and in case of detection of a carrier, they are removed from duty at the catering unit and canteen. Preschoolers-carriers of bacteria are not allowed into the team and are sent to the hospital for follow-up examination. Clinical examination: All patients who have had typhoid fever and paratyphoid fever (except for employees of food enterprises and persons equated to them) are observed for 3 months. In the first 2 months, a medical examination and thermometry are carried out weekly, in the 3rd month - once every 2 weeks. The bacteriological examination of feces and urine is carried out monthly, the study of bile is carried out 3 months later, simultaneously with the setting of RPHA with cysteine. If the result is negative, it is removed from the register, if it is positive, it is followed-up treatment, removal from duty in the catering unit and the canteen. Employees of food enterprises and persons equated to them are examined quarterly (feces and urine - once) for 2 years, and then 2 times a year - until the end of their employment. At the end of the 2nd year, they are given RPHA with cysteine and, if the result is positive, a fivefold bacteriological examination of stool and urine and a single dose of bile is performed. Vaccinations in modern conditions of relatively low incidence of typhoid fever cannot have a significant impact on the course of the epidemic process. Vaccinations, both in a planned manner and according to epidemiological indications, are carried out taking into account the level of communal improvement of populated areas. Non-specific prophylaxis General sanitary measures (improving the quality of water supply, sanitary cleaning of populated areas, sewerage, control of flies, etc.). VIRAL HEPATITIS Viral hepatitis is a group of etiologically heterogeneous diseases, accompanied by a predominant liver damage - an increase in its size and impaired functional ability, as well as symptoms of intoxication expressed to varying degrees. Clinical diagnostics Incubation period Viral hepatitis A is transmitted by the fecal-oral route, the disease is acute, cyclical, characterized by short-term symptoms of intoxication, transient liver disorders, benign course. The incubation period is 10 to 45 days. Viral hepatitis B is transmitted by the parenteral route, characterized by a slow development of the disease, a long course, the possibility of the formation of chronic hepatitis and cirrhosis of the liver. The incubation period is from 6 weeks to 6 months. Viral hepatitis C is transmitted exclusively by the parenteral route, clinically occurs as hepatitis B, only severe forms are less common, but more often a chronic process is formed with an outcome in liver cirrhosis. The incubation period is from several days to 26 weeks. Viral hepatitis delta is transmitted by the parenteral route, proceeds as a coinfection (simultaneously with hepatitis B) or as a superinfection (layered on chronic hepatitis B, on the carrier of the hepatitis B virus). Viral hepatitis E is transmitted by the fecal-oral route, clinically as hepatitis A, but more often gives severe forms, up to the development of fulminant forms with a fatal outcome, especially in pregnant women. The incubation period is 10 to 40 days. Preicteric period with signs of syndromes: flu-like (fever, chills, headache, weakness), dyspeptic (anorexia, nausea, vomiting, abdominal pain, diarrhea, fever), arthralgic (pain in joints, muscles), asthenovegetative (weakness, sleep disturbances , headache, irritability), catarrhal. At the end of the period, the urine darkens, the feces become discolored, the liver enlarges. Icteric period. Increased jaundice, general weakness. Pain in the liver, itchy skin. Sometimes the spleen is enlarged. Bradycardia, lowering blood pressure. Precom. Sharp increasing weakness, weakness, persistent vomiting, anorexia, sleep impairment, tachycardia, decreased liver and increased jaundice. Dizziness, tremors. Hemorrhages. Coma. Prolonged excitement is replaced by a lack of response to stimuli. The pupils are dilated, tendon reflexes are absent. Shrinking the size of the liver. Post-icteric period. A slow decrease in the size of the liver, functional liver function tests are pathologically changed. Convalescence period. The size of the liver is normalized, its functional state is restored, asthenovegetative syndrome can be observed. Laboratory diagnostics 1. Methods of immuno- and serodiagnostics. During the incubation period, preicteric and all subsequent phases of the course of hepatitis B, the serum is examined for the presence of hepatitis B virus surface antigen (HBsAg), as well as for the hepatitis B virus internal antigen (anti-HBc). During the incubation and prodromal periods and at the beginning of the acute stage of the disease, HBsAg is found in the serum. From the end of the prodromal period, in the acute period, in the period of convalescence, anti-HBs and anti-HBc antibodies are detected, the latter with greater constancy and in higher titers. To detect antigen and antibodies to viruses A, B, C, delta, radioimmunological and immunological methods are used using commercial test systems. In hepatitis A, blood serum is examined for the presence of anti-HA antibodies of the IgM class. During the period of convalescence, antibodies of the IgG class appear, which persist for many years. 2. In preicteric and during all periods of the disease, the level of activity of alanine and aspartate aminotransferases (ALT and AST) is determined in the blood. With hepatitis, the activity of aminotransferases increases (the norm is 0.1-0.68 mmol / l / h). 3. From the end of the preicteric period in blood serum taken on an empty stomach, determine the content of bilirubin: total (norm 3.4-20.5 μmol / l), the ratio between bound (direct) and free (indirect) in the norm 1: 4; put thymol (norm 0-4 units of turbidity) and sublimate (norm 1.6-2.2 ml mercuric chloride) samples. In patients with hepatitis, the bilirubin content increases (mainly due to the bound fraction), the thymol test rate increases, and the sublimate test decreases. 4. At the beginning of the icteric period, bile pigments are found in the urine, which are normally absent. 5. The severity of the disease can be judged by a decrease in the level of beta-lipoproteins (normally 30-35%), prothrombin index (normally 93-100%), changes in the content of serum protein fractions. Measures in relation to patients and contact persons Hospitalization. Required. Suspects in the disease are placed in diagnostic wards, isolation at home is allowed for 1-3 days for laboratory examination. Insulation of contact. Not carried out. Medical supervision is established for contacts with a patient with viral hepatitis A for 35 days. For this period, it is prohibited to transfer contacts to other groups and children's institutions. The admission of new children, as well as the admission of contact children to healthy groups is allowed with the permission of the epidemiologist, subject to the timely introduction of immunoglobulin. Conditions of discharge. Good general condition, absence of jaundice, decrease in the liver or a tendency to decrease it, normalization of the level of bilirubin and other indicators. The activity of aminotransferases should not exceed the norm by more than 2-3 times. Detection of HBsAg in convalescents is not a contraindication to discharge. Admission to the team. Reconvalescents of hepatitis A are considered disabled for 2-4 weeks, depending on the severity of the disease, the condition at discharge and the presence of concomitant diseases. They are released from heavy physical exertion for 3-6 months. Reconvalescents of hepatitis B can return to work no earlier than in 4-5 weeks. The terms of release from heavy physical activity should be 6-12 months, and if indicated, even longer. Clinical examination: All convalescents are examined in 1 month by the attending physician of the hospital. Children-convalescents of hepatitis A are examined in a polyclinic after 3 and 6 months and in the absence of residual effects are removed from the register. Children who have had hepatitis B are summoned to the hospital for examination also after 9 and 12 months. Convalescent adults of hepatitis A in the presence of residual effects are examined in the clinic after 3 months and can be removed from the register. Adults who have had hepatitis B are examined at the polyclinic after 3, 6, 9 and 12 months. All convalescents (adults and children) with residual effects are monitored in the hospital monthly until complete recovery. According to indications - readmission to hospital Specific prophylaxis Detection and monitoring of carriers of the viral hepatitis B antigen. The identified carriers of the B antigen are registered in the centers of the State Sanitary and Epidemiological Surveillance. Dispensary observation and registration of carriers should be concentrated in the office of infectious diseases. The account is carried out during the entire period of antigen detection. Clinical and biochemical examination of HBsAg carriers should be carried out immediately after antigen detection, after 3 months and then 2 times a year during the entire period of HBsAg detection. Of the biochemical indicators, it is recommended to investigate the dynamics: the content of bilirubin, protein sediment samples (sublimate, thymol), the activity of transamin (ALT, ASAT). Preference should be given to determining the activity of AST, since this enzyme reflects the presence of minimal inflammation in the liver. In addition to conventional methods, an ultrasound scan of the liver structure (echohepatography) is recommended. If HBsAg is re-detected 3 and 6 months after its initial appearance, as well as in the presence of minimal clinical and biochemical changes, a diagnosis of chronic viral hepatitis is made and hospitalization in an infectious diseases hospital is required to clarify the depth of liver damage. The mode and nature of work depend on the severity of the pathological process in the liver. Healthy carriers are removed from the register when the HBsAg test is five times negative during the year with an interval of 2-3 months. For the prevention of hepatitis A according to epidemic indications, immunoglobulin is used. The drug is administered within 7-10 days from the onset of the disease to children from 1 to 14 years old, as well as to pregnant women who have contact with the sick in a family or institution. In preschool institutions, with incomplete isolation of groups, immunoglobulin should be administered to children of the entire institution. Non-specific prophylaxis Disinfection: control over water supply, sanitary condition and maintenance of food facilities and children's institutions; sanitary cleaning of populated areas, sanitary and epidemiological regime in health care facilities, prevention of parenteral infection. FLU Influenza is an acute infectious disease characterized by symptoms of specific intoxication, catarrh of the upper respiratory tract, a tendency to epidemic and pandemic spread. Clinical diagnostics Incubation period 1-2 days. The beginning is acute. General intoxication (fever, weakness, weakness, sweating, muscle pain, headache, pain in the eyeballs, lacrimation, photophobia). Dry cough, sore throat, rawness in the chest, hoarseness, nasal congestion, nosebleeds. Hyperemia of the skin, hyperemia and graininess of the pharynx, scleritis. Bradycardia, decreased blood pressure, muffled heart sounds. In the blood - neutropenia, monocytosis. Laboratory diagnostics 1. Virological method. From the first days of the disease, a study of washings from the mucous membrane of the pharynx and nose is carried out in order to isolate the virus (in developing chicken embryos). 2. Immunofluorescence method. From the first days of the disease, smears are examined - prints from the mucous membrane of the inferior nasal concha, treated with a specific luminescent serum, in order to detect the antigens of the influenza virus. 3. Serological method. Paired sera are investigated in the hemagglutination reaction (RTGA) and RSK in order to detect AT and increase their titer. Measures in relation to patients and contact persons Hospitalization. According to clinical indications. Insulation of contact. In preschool groups, medical supervision and separation of contacts with other groups are carried out for up to 7 days. Conditions of discharge. After clinical recovery, no earlier than 7 days from the onset of the disease. Admission to the team. After clinical recovery, no earlier than 10 days from the onset of the disease. Clinical examination: For children-convalescents, a sparing regimen is established for at least 2 weeks after clinical recovery. Specific prophylaxis 1. Live influenza vaccine for intranasal use is vaccinated according to epidemic indications to persons over 16 years of age. Monovaccine or divaccine are inoculated three times with an interval of 2-3 weeks. 2. Live influenza vaccine for children is vaccinated according to epidemic indications in children 3-15 years old. Monovaccine or divaccine are inoculated three times with an interval of 25-30 days. 3. Live influenza vaccine for oral administration is vaccinated according to epidemic indications in children and adults. Mono- or divaccine is administered three times with an interval of 10-15 days, for the purpose of emergency prophylaxis - twice within 2 days. 4. Anti-influenza donor immunoglobulin is used to prevent influenza in epidemic foci. Non-specific prophylaxis Restriction of visits by sick pharmacies and polyclinics, and healthy, especially children, entertainment activities: wearing masks, using oxolinic ointment, airing, UFO and disinfection of premises. DYENTERIA Dysentery is an infectious disease of the gastrointestinal tract caused by microbes of the genus Shigella, in which the mucous membrane of the large intestine is mainly affected, manifested by colitis syndrome. Clinical diagnosis The incubation period is 1-7, usually 2-3 days. The main symptoms of dysentery are general intoxication (fever, loss of appetite, vomiting, headache). Neurotoxicosis according to the meningoencephalic variant (loss of consciousness, convulsions, meningism phenomena). Colitis syndrome (cramping abdominal pain, tenesmus, rumbling and splashing along the colon, spasmodic sigmoid colon, scanty stools with mucus, blood streaks, sometimes pus, in the form of "rectal spitting", compliance, anus gaping or rectal prolapse). In a mild form, the temperature is subfebrile, the intoxication is mild, the symptoms of colitis are moderate, the stool is up to 5-8 times a day, there are no blood impurities. With a moderate form of hyperthermia, symptoms of general intoxication and colitis syndrome are expressed, stool up to 10-12 times a day. In severe form, neurotoxicosis is pronounced, hyperthermia, colitis syndrome, stool in the form of "rectal spitting" more than 12-15 times a day. Laboratory diagnostics 1. Bacteriological method. From the first days of the disease, a three-fold (the first - before the start of etiotropic therapy) examination of feces is carried out in order to isolate the pathogen and its identification. The medium for the primary inoculation is Ploskirev's medium. For the study, portions with an admixture of mucus are taken immediately after natural bowel movements. If it is impossible to carry out inoculation at the site of material sampling, it is placed in test tubes with a preservative (glycerin mixture) and stored for no more than 12 hours at 2-6 (C. 2. Serological method. From the end of the 1st week, passive hemagglutination reaction (RPHA) is examined paired sera for the detection of antibodies and their titer 3. Coprocytological examination is carried out from the first days of the disease.Detection of mucus, neutrophilic leukocytes, erythrocytes, intestinal epithelium cells in a smear from feces allows to judge the intensity of the inflammatory process and its localization. sigmoidoscopy can be used for diagnostic purposes. According to clinical and epidemiological indications. Insulation of contact. Not carried out. Medical observation is established for 7 days to detect recurrent diseases in the outbreak. In addition, workers of food enterprises and persons equated to them, children and personnel of preschool institutions (when repeated cases of the disease appear there), organized preschoolers from apartment centers are subjected to a single bacteriological examination of stool in the first 3 days of observation. Bacteria carriers are hospitalized to clarify the diagnosis. With the simultaneous appearance of diseases in several groups of a preschool institution, all contact children, group personnel, food workers, and all other service personnel are examined bacteriologically. The frequency of the survey is determined by the epidemiologist. Conditions of discharge. Not earlier than 3 days, after clinical recovery, normalization of stool and temperature; negative result of a single control bacterial examination of feces, carried out not earlier than 2 days after the end of etiotropic therapy. Workers of food enterprises and persons equated to them, who have suffered bacteriologically confirmed dysentery, and organized preschoolers are discharged after suffering dysentery after a single bacteriological examination. With a positive result of bacteriological examination in the hospital before discharge, treatment is continued. A positive result of bacteriological research after a repeated course of etiotropic therapy determines the need to establish dispensary observation for such persons. Admission to the team. It is carried out without additional examination. Children from orphanages and boarding schools are not allowed on duty at the catering unit and in the canteen for 1 month (those who have suffered an exacerbation of chronic dysentery - within 6 months). Preschoolers who have suffered an exacerbation of chronic dysentery are admitted to the team after 5 days of medical observation, with good general condition, normal stool and temperature and a negative result of a single bacteriological examination. With continued bacterial excretion, organized preschoolers are not allowed into the team. Workers of food enterprises and persons equated to them, with bacterial excretion for more than 3 months, are considered as patients with a chronic form of dysentery and are transferred to work not related to food. Clinical examination: Organized preschoolers are followed up for a month with a single bacterial examination of stool at the end of the disease period. Within 3 months, with a monthly bakisledovaniya and examination by a doctor, the following are observed: - Persons suffering from chronic dysentery, confirmed by the release of the pathogen; - bacteria carriers, long-term release of the pathogen; - Persons suffering from unstable stools for a long time; - employees of food enterprises and persons equated to them. Workers of food enterprises and persons equated to them, suffering from chronic dysentery, are followed up for 6 months with a monthly bacteriological examination. After this period has expired, in case of complete clinical recovery, these persons can be admitted to work in the specialty. Non-specific prevention Sanitary supervision of water supply, sewerage, collection and disposal of sewage; sanitary control at food industry and public catering enterprises, health education. DIPHTHERIA Diphtheria is an acute infectious disease caused by a diphtheria bacillus, characterized by an inflammatory process with the formation of a fibrinous film at the site of introduction of the pathogen and phenomena of general intoxication. Clinical diagnosis The incubation period is from 2 to 10 days (usually 7 days). Diphtheria of the oropharynx. Catarrhal. Weakness, moderate pain when swallowing, subfebrile condition. Congestive hyperemia and swelling of the tonsils, lymphadenitis. Islet. Moderate fever and intoxication. Enlargement and swelling of the tonsils with islands of fibrinous films. Enlarged painful lymph nodes. Filmy. The beginning is acute. Fever, intoxication. Swelling and swelling of the tonsils. Stagnant dull hyperemia of the mucous membrane. Plaques are solid, dense, whitish, after their removal - erosion. Swollen and tender lymph nodes. Common. The spread of films beyond the tonsils, fever, severe intoxication, lowering blood pressure, muffled heart sounds. Toxic. General intoxication, fever. Edema of cervical tissue (subtoxic - unilateral near the lymph nodes, I degree - to the middle of the neck, II degree - to the clavicle, III degree - below the clavicle). Significant increase and swelling of the tonsils, surrounding tissues. Breathing disorder. Plaques of a dirty gray color, spreading to the mucous membranes of the soft and hard palate. Putrid odor. Damage to the cardiovascular system. Paresis and paralysis. Triad: vomiting, abdominal pain, gallop heart rate. Laryngeal diphtheria. The beginning is gradual. Moderate intoxication. Laryngeal stenosis (stage I - hoarseness, rough "barking" cough; stage II - noisy breathing, aphonia, retraction of pliable places, participation in the act of breathing of auxiliary muscles; stage III - hypoxia, anxiety, drowsiness, cyanosis). Diphtheria of the nose. Mild intoxication, nasal discharge, nasal mucosa - films and erosion. Laboratory diagnostics 1. Bacteriological method. In the first 3 days of illness or the patient's stay in the hospital, a study of material taken from the lesion is carried out (mucus from the pharynx and nose, a smear from the conjunctiva, from the vagina, wound discharge, pus from the ear, etc.), in order to isolate the pathogen. Material from the throat is taken no earlier than 2 hours after eating. Media for primary inoculation: blood tellurite agar, quinosol medium, Lefleur's medium. Approximate accelerated methods: a) microscopy of material from a swab; b) the material is taken with a swab, previously moistened with serum and potassium tellurite solution. The tampon is placed in a thermostat and after 4-6 hours, according to the color change and on the basis of microscopy of the smear from the tampon, the answer is given. 2. Serological methods. a) study of blood serum in RPHA in order to detect antibacterial antibodies and increase their titer; b) determination of the antitoxin titer in blood serum by the Jensen method in the first days of the disease (before the administration of antitoxic serum). A titer of 0.03 IU / ml and below is indicative of diphtheria, a titer of 0.5 IU / ml and above is against diphtheria. 3. In order to identify the contingents subject to revaccination, RPHA with diphtheria erythrocyte antigenic diagnostics is performed. Measures in relation to patients and contact persons Hospitalization. Mandatory for sick and suspicious persons, as well as carriers of toxigenic microbes. Carriers of atoxigenic microbes are not hospitalized and are not removed from the team. Insulation of contact. It stops after the isolation of the patient or the carrier of toxigenic microbes, final disinfection and a single negative result of bacterial examination of the mucus of the pharynx and nose. Medical observation of the contact is carried out within 7 days from the moment of hospitalization of the patient or carrier. Conditions of discharge. Isolation of patients and carriers of toxigenic microbes is stopped after clinical recovery and a negative result of a two-fold bacteriological examination of the mucus of the pharynx and nose, carried out with an interval of 1 day, 3 days after the end of treatment. Admission to the team. Reconvalescents of diphtheria are admitted to the team without additional examination. Reconvalescents-carriers of toxigenic microbes with repeated and prolonged sowing continue treatment in the hospital. They can be admitted to the immune team no earlier than 60 days from the day of clinical recovery, subject to constant medical supervision until the carriage is terminated. For the team, where the carrier of the toxigenic bacillus is admitted, medical supervision is established in order to identify persons with diseases of the nasopharynx, their treatment and examination; only correctly vaccinated children are accepted again. Clinical examination: Carriers of toxigenic microbes are subject to medical supervision and bacterial examination until two negative results are obtained. Carriers of atoxigenic microbes with pathological processes in the nasopharynx are subject to treatment Specific prophylaxis 1. DTP vaccine is used to vaccinate children under 3 years of age who do not have whooping cough. 2. Children from 3 months to 6 years old who have had pertussis, have not been vaccinated with DTP vaccine before, and have contraindications for DTP vaccination (sparing method of immunization) are vaccinated with ADS vaccine. 3. ADS-M-toxoid is vaccinated in children and adolescents from 6 to 17 years old, as well as adults. Non-specific prophylaxis Measures to combat bacterial carriers (identification, isolation, treatment). MEASLES Measles is an acute infectious viral disease characterized by fever, intoxication, catarrh of the upper respiratory tract and mucous membranes of the eyes, a staged rash of maculopapular rash. Clinical diagnosis The incubation period is 9-17 days (with seroprophylaxis - 21 days). The initial catarrhal period lasts on average 3-4 days: fever, general malaise, lethargy, weakness, decreased appetite, sleep disturbance, headache, runny nose, scleritis, conjunctivitis, dry cough. From the 2-3rd day - a decrease in temperature, increased runny nose, rough cough, enanthema, Belsky-Filatov-Koplik spots. The period of the rash: increased intoxication, exanthema - spots and papules prone to fusion, on an unchanged skin background, stages are characteristic (1st day - behind the ears, face, neck and partly chest; 2nd day - trunk and proximal extremities; 3rd day - on the entire skin of the extremities). From the 4th day, the fading of the rash in the same order, pigmentation, occasionally peeling. Complications: croup, pneumonia, damage to the digestive tract, otitis media, meningoencephalitis. Mitigated measles (in children who received immunoglobulin): low-grade fever, mild catarrhal phenomena, Belsky-Filatov-Koplik spots and no phased rash, the rash is not abundant, small. There are no complications. Laboratory diagnostics 1. Virological method. From the first days of the disease, a study of washings from the nasopharynx or blood is carried out in order to isolate the virus in a tissue culture. 2. Serological method. Paired sera are examined in RSK or RTGA in order to detect AT and increase their titer. 3. Immunofluorescence method. At the end of the prodromal period and during the period of rash, a study of smears-prints from the nasal mucosa, treated with a special luminescent serum, is carried out in order to isolate measles virus antigens. Measures in relation to patients and contact persons Hospitalization. According to clinical and epidemiological indications (from closed children's institutions, hostels). Insulation of contact. Children who have not been vaccinated against measles and who have not had measles are separated for 17 days from the moment of contact, and those who received immunoglobulin - for 21 days. When the exact day of contact is established, separation begins on the 8th day. For preschoolers vaccinated with live measles vaccine, medical supervision is established for 17 days from the moment of contact. Conditions of discharge. Clinical recovery, but not earlier than the 4th day, and in the presence of complications (pneumonia) - not earlier than the 10th day after the onset of the rash. Admission to the team. After clinical recovery. Clinical examination: Not carried out Specific prophylaxis 1. Measles live vaccine is given to children at the age of 12 months. Those who have not had measles are revaccinated before school at the age of 6-7 years. In outbreaks, for the purpose of emergency prevention of measles, all children over 12 months of age can be vaccinated only up to the 5th day from the moment of contact. 2. Immunoglobulin provides emergency prophylaxis for children who have not had measles and are unvaccinated; contact with a patient with measles - in case of contraindications to vaccination. 3. To assess the strength of the vaccine immunity, serological studies are carried out. Contingent: children, timely and correctly vaccinated against measles, separately for each age group; in collectives where no measles cases have been reported over the past year. Based on the results of examining children 4-5 years old, one can judge the quality of vaccinations given 1-2 years ago, and schoolchildren - about the intensity of vaccine immunity in the long term after immunization or after re-vaccination. The criterion for the protection of measles is the isolation in each study group of no more than 10% of seronegative individuals (with specific antibody titers less than 1:10 in the RPHA). If more than 10% of the students are identified as seronegative and it is impossible to expand the serological examination of all students of this school (vocational school, technical school), with the exception of those who have already been vaccinated. Non-specific prophylaxis Early isolation of the patient. Rubella Rubella is an acute infectious viral disease characterized by minor catarrhal symptoms from the upper respiratory tract, an increase in the occipital and other groups of lymph nodes and a small-spotted rash. Clinical diagnosis The incubation period is 15-21 days. Weakness, malaise, moderate headache, sometimes muscle and joint pain. The temperature is often subfebrile, small catarrhal symptoms, conjunctivitis. Enlargement and soreness of the posterior cervical and occipital lymph nodes. Small-spotted rash, first on the skin of the face and neck, then all over the body. No pigmentation. Complications - arthritis, encephalitis. Laboratory diagnostics Serological method. Paired sera are examined in RPHA in order to detect AT and increase their titer. Measures in relation to patients and contact persons Hospitalization. Not required. Insulation of contact. Women in the first 3 months of pregnancy are isolated from the patient for 10 days from the onset of the disease. Conditions of discharge. Isolation of the patient at home ends 4 days after the onset of the rash. Clinical examination: Not carried out Specific prophylaxis Under development. Non-specific prophylaxis Isolation of patients from the collective. MALARIA Malaria is a long-term infectious disease characterized by periodic attacks of fever, enlargement of the liver, spleen, and progressive anemia. Clinical diagnostics The incubation period for three-day malaria is 10-20 days, for four-day malaria - 15-20 days, for tropical malaria - 8-15 days. The beginning is acute. A tremendous chill for 1.5-2 hours. With three-day malaria, attacks of 6-8 hours every other day, with four-day malaria - 12-24 hours after 2 days, with tropical - a prolonged attack. There is an increase in the liver and spleen. Light icterus. Herpetic eruptions. Laboratory diagnostics Microscopic method. Plasmodia of malaria (blue cytoplasm, bright red nucleus, intra-erythrocytic location) are found in smears from blood or in a "thick drop" stained according to Romanovsky-Giemsa. Measures in relation to patients and contact persons Hospitalization. In tropical malaria - mandatory, immediate; in other cases - mandatory during the epidemic period. Insulation of contact. Not carried out. Conditions of discharge. Clinical recovery, but earlier than 2 days after the disappearance of plasmodia in the blood. Admission to the team. After clinical and parasitological recovery. Clinical examination: Carried out throughout the year. Specific prophylaxis Not developed. Non-specific prophylaxis Destruction of larvae and mosquitoes - carriers of malaria, the use of deterrents. Meningococcal infection Meningococcal infection is an acute infectious disease caused by the meningococcus Neisseria meningitidis, characterized by clinical manifestations of various severity and nature: from mild nasopharyngitis and carriage to generalized forms - purulent meningitis and meningococcemia. Clinical diagnostics The incubation period is from 1 to 10 days (usually 5-7 days). Acute nasopharyngitis. Fever, moderate intoxication, rhinopharyngitis. Meningitis. The onset is acute or sudden. Occasionally a prodrome in the form of nasopharyngitis. Fever, agitation, headache, vomiting, general hyperesthesia, meningeal symptoms, bulging and tension of the large fontanelle. Pose: on the side, with bent legs and head thrown back. Delirium, agitation, impaired consciousness, convulsions, tremors. Tendon reflexes are revived, then reduced. Meningoencephalitis. Pathological reflexes, paresis, paralysis. Meningococcemia. Acute onset, fever, pallor. Rashes on the skin of the abdomen, buttocks, thighs from small hemorrhagic "stellate" elements to large hemorrhagic elements with necrosis in the center on all skin integuments. The clinical picture of infectious-toxic shock, Waters-Friderichsen syndrome: a decrease in temperature to normal values, a drop in blood pressure, a threadlike pulse, shortness of breath, acrocyanosis, general cyanosis, oligoanuria, impaired consciousness, coma, vomiting of "coffee grounds", DIC syndrome. Laboratory diagnostics 1. Microscopic method. From the first days of the disease, gram (-), bean-shaped, intracellular diplococci are found in smears from cerebrospinal fluid sediment, from hemorrhagic loose elements and less often from blood. 2. Bacteriological method. From the first days of the disease, cerebrospinal fluid, blood, nasopharyngeal mucus, material from hemorrhagic loose elements are sown on serum or ascites agar with ristomycin in order to isolate meningococci. 3. Serological method. Paired sera are examined in RPHA in order to detect AT and increase their titer on the 5-7th day of illness and in dynamics. 4. Method of immunodiagnostics. Detection in meningococcal hypertension in blood or cerebrospinal fluid in the reaction of counter immunoelectroosmophoresis (VIEF). 5. Other methods. When examining cerebrospinal fluid, an increase in pressure is detected (the norm is 130-180 mm of water column, or 40-60 drops per minute), cytosis is determined (the number of cells in 1 mm, the norm is up to 8-10), cytogram (norm: lymphocytes 80 -85%), protein (norm 0.22-0.33 g / l), sugar content (norm 0.2-0.3 g / l or 2.8-3.9 mmol / l) and chlorides (norm 120-130 mmol / L, or 7-7.5 g / L). With meningitis: pressure increased, neutrophilic cytosis up to 10,000 in 1 mm, increased protein, decreased sugar and chlorides. In the study of peripheral blood, hyperleukocytosis is revealed with a sharp shift to the left. Measures in relation to patients and contact persons Hospitalization. Mandatory for patients with generalized form. Hospitalization of patients with nasopharyngitis is carried out according to clinical and epidemiological indications. Carriers of meningococcus are not subject to hospitalization. Insulation of contact. It is performed until a single negative result of bacterial examination of mucus from the nasopharynx is obtained. Contact with a meningococcal carrier is not isolated. In collectives - foci of infection, medical supervision is established for 10 days. Conditions of discharge. After clinical recovery and a negative result of a single bacteriological examination of mucus from the nasopharynx, carried out no earlier than 3 days after the end of etiotropic therapy. Admission to the team. Reconvalescents are allowed to the children's team after receiving a negative result of a single bacteriological examination of mucus from the nasopharynx, carried out no earlier than 5 days after discharge from the hospital. Carriers of meningococcus are allowed into the collective after treatment and a negative result of bacterial examination of mucus from the nasopharynx, carried out no earlier than 3 days after the end of the sanitation. Clinical examination: Those who have had meningitis without residual effects are observed for 2 years with an examination by a neuropsychiatrist in the 1st year of observation 4 times and in the 2nd year - 1-2 times. In the presence of residual effects - active treatment and observation for at least 3-5 years. Specific prophylaxis With chemical polysaccharide meningococcal vaccine, vaccinations are carried out for prophylactic purposes and in foci of infection for the purpose of emergency prevention for children over 5 years old and adults. Non-specific prophylaxis General measures are the same as for other airborne infections. Children under 5 years of age who are in contact with the generalized form can use immunoglobulin. Mumps infection Mumps infection (mumps, mumps) is an acute infectious viral disease characterized by damage to the glandular organs and the central nervous system. Clinical diagnosis Incubation period 11-21 days (average 18-20 days). Glandular form. The onset is acute, sometimes with a prodrome (malaise, muscle pain, headache, sleep and appetite disturbances). An increase in temperature, an increase and soreness of the salivary glands (submandibular, sublingual, more often the parotid). Inflammatory changes in the area of the excretory ducts of the glands. Orchitis, pancreatitis, etc. Nervous form. The beginning is acute. Fever, severe headache, vomiting, meningeal syndrome, focal lesions of the brain and cranial nerves. Laboratory diagnostics 1. Virological method. From the 1-5th day of the disease, saliva, blood, less often - cerebrospinal fluid are examined in order to isolate the virus in developing chicken embryos. 2. Serological method. Paired sera (with an interval of 7-14 days) are examined in RTGA in order to detect AT and increase their titer. 3. Other methods. With a nervous form: in the first days, when examining the cerebrospinal fluid, an increase in protein up to 2.5% is revealed, lymphocytic cytosis is within the range of 300-700 cells per 1 mm. With damage to the pancreas, an increase in the activity of blood diastase is detected (normally 32-64 units). Measures in relation to patients and contact persons Hospitalization. According to clinical and epidemiological indications. Insulation of contact. Children under 10 years of age who have not had mumps are separated by 21 days from the moment of contact. When the exact day of contact is established, separation begins on the 11th day. When repeated cases of the disease appear in a child care institution, separation is not carried out. Conditions of discharge. Clinical recovery, not earlier than 9 days from the onset of the disease. With a nervous form - not earlier than 21 days from the onset of the disease, with the development of pancreatitis - a control determination of the activity of blood diastase. Admission to the team. After clinical recovery. Clinical examination: For those who have undergone a nervous form, observation is carried out for 2 years with examination by a neuropsychiatrist for the 1st year 4 times, for the 2nd - 1-2 times. According to indications - examination by an ophthalmologist and an otolaryngologist. Specific prophylaxis. Children aged 15-18 months are vaccinated with live parotitis vaccine. Non-specific prophylaxis Isolation of patients. SALMONELLOSIS Salmonellosis is an acute infectious disease caused by microbes of the genus Salmonella, occurring mainly with lesions of the gastrointestinal tract, less often in the form of generalized forms. Clinical diagnostics The incubation period with the alimentary route of infection is 12-24 hours, with the contact one - 3-7 days. Gastrointestinal form. Gastritis, enteritis, gastroenteritis. The beginning is acute. Fever, epigastric pain, nausea, vomiting. Intoxication (headache, weakness, weakness, anorexia). Stool is liquid, watery, offensive, undigested, dark green in color. Exicosis. Enterocolitis, gastroenterocolitis, colitis. The beginning is acute. Fever, intoxication, nausea, persistent vomiting. epigastric pain. Enlargement of the liver and spleen. Colon spasm and soreness. There may be tenesmus. The stool is liquid with an admixture of mucus, blood, dark green color, in the form of "swamp mud". Prolonged severe toxicosis, less often exicosis, persistent intestinal dysfunction. Typhoid form. The beginning is acute. Fever, intoxication. The skin is pale, dry. Cyanosis. Muffling of heart sounds, bradycardia. Densely coated and thickened tongue, flatulence, infrequent but persistent vomiting, enlarged liver and spleen. Roseolous or roseolopapular rash. Stool is enteric or normal. Septic form. It develops in newborns and debilitated children. Fever with large diurnal ranges. The clinic depends on the localization of the purulent focus. Pneumonia, purulent meningitis, nephritis, hepatitis, arthritis, enterocolitis. Nosocomial salmonellosis, especially in young children, is usually more severe and prolonged, accompanied by significant intoxication and symptoms of gastroenterocolitis. Toxicodystrophic conditions may develop. In children over 3 years old and in adults, nosocomial salmonellosis can be easy. Laboratory diagnostics 1. Bacteriological method. From the first days of the disease, a three-fold (the first - before the beginning of etiotropic therapy) examination of feces is carried out in order to isolate the pathogen. The material for the study can also be vomit, gastric lavage, food debris, if a generalized infection is suspected - blood (in the first days of the disease), urine (from the end of the 2nd week), cerebrospinal fluid, sputum. The primary culture media are selenite (bile broth) or one of the differential diagnostic media for enterobacteriaceae. 2. Serological method. Paired sera (with an interval of 7-10 days) are examined in RA and RPHA in order to detect AT and increase their titer. 3. Coprocytoscopy and sigmoidoscopy make it possible to judge the nature and localization of the inflammatory process in the intestine. Measures in relation to patients and contact persons Hospitalization. According to clinical and epidemiological indications. Insulation of contact. Not carried out. Medical supervision is established for 7 days to detect recurrent diseases in the outbreak. Employees of food enterprises and persons equated to them, children attending nurseries, kindergartens, as well as orphanages and boarding schools are subjected to a single bacteriological examination of stool without suspension from work and removal from the team. With the simultaneous appearance of the disease in several groups of a preschool institution, all children, group personnel, catering workers and all other personnel are examined bacteriologically. The frequency of the survey is determined by the epidemiologist. With nosocomial salmonellosis: - the patient is isolated; - in case of a group disease (outbreak), it is possible to temporarily organize a special department on the spot; - after the removal of the patient, the hospitalization of new patients in this ward stops within 7 days; - contact persons remain in the ward and are subjected to a single bacteriological examination and further clinical observation; - in the event of 3 or more cases of the disease in different wards or when sowing Salmonella from washings or air in different rooms, the department is closed and a bacterial examination of all children, mothers and staff is carried out. Such a department is opened after carrying out a complex of anti-epidemic measures with the permission of the Central State Sanitary and Epidemiological Service. Conditions of discharge. Not earlier than 3 days after clinical recovery, normal temperature and stool; negative result of a single bacterial examination of feces, carried out no earlier than 2 days after the end of etiotropic therapy. Workers of food enterprises and persons equated to them, children under 2 years of age and children attending preschool institutions, are discharged under these conditions after a double negative bacterial examination of feces. Admission to the team. After clinical recovery, with the exception of workers of food enterprises and persons equated to them, and children of creches and orphanages. These persons are not allowed into the team for 15 days after discharge from the hospital (they undergo a three-time bacteriological examination of feces with an interval of 1-2 days). When the pathogen is isolated, the observation period is extended for another 15 days, etc. Chronic carriers of Salmonella are not allowed in nurseries and children's homes, and workers of food enterprises and persons equated to them are transferred to work not related to food. Bacteria-carriers-schoolchildren (including boarding schools) are not allowed on duty at the catering unit and canteen. Clinical examination: Workers of food enterprises and persons equated to them, children under 2 years of age and organized preschoolers are observed for 3 months with monthly examination of stool Specific prophylaxis Polyvalent salmonella bacteriophage is used for prophylactic purposes according to epidemiological indications to all persons who have communicated with patients or excretors of Salmonella. Non-specific prophylaxis Sanitary and veterinary supervision of the slaughter of livestock and poultry. Compliance with the rules of storage and preparation of food. Deratization. SIBERIAN ULCER Anthrax (anthrax, malignant carbuncle) is an acute infectious disease belonging to the group of zoonoses, characterized by severe intoxication, fever, occurring in the form of cutaneous and visceral forms. Clinical diagnostics The incubation period is from several hours to 8 days (on average 2-3 days). Skin form. With a carbunculous variety, at the site of the entrance gate of the infection - a spot, papule, vesicle, pustule, ulcer, necrosis, regional lymphadenitis. From the 2nd day of illness - intoxication with a rise in temperature to 39-40 (C, cardiovascular disorders. The duration of intoxication is 5-6 days, the local process is 2-4 weeks. Edematous, bullous, erysepeloid varieties of the skin form are possible. Pulmonary form. After a short incubation period (up to 1 day), a sudden rise in temperature to high numbers, runny nose, lacrimation, photophobia, chest pain, cough, intoxication, headache, vomiting, increasing cardiovascular failure. Death. Gastrointestinal form. Intoxication. Acute abdominal pain, bloody vomiting with bile, bloody diarrhea, intestinal paresis, inflammation of the peritoneum, effusion, perforation of the intestinal wall, peritonitis. Death in 2-4 days. Septic form. Generalization of the process occurs quickly without previous local phenomena. On the skin - profuse hemorrhages, lungs and intestines are affected. Meningeal syndrome. Death occurs on the first day. Laboratory diagnostics 1. Microscopic method. Examine for the presence of capsules smears prepared from the contents of vesicles or carbuncle, stained according to Gram. 2. Immunofluorescence method. Examine smears prepared from the above materials and treated with a specific luminescent serum. 3. Bacteriological method. Examine the material (see above) inoculated into dense (MPA) and liquid (MPB) media in order to isolate the pathogen. For the same purpose, a bioassay is performed by intraperitoneal infection of white mice. The material for research can also be blood, sputum, feces, cadaveric material. 4. Allergic method. From the first days of the disease, an allergic skin test with anthraxin is performed. 5. Detection of the pathogen antigen and antibodies to it by ELISA. Measures in relation to patients and contact persons Hospitalization. Mandatory, immediate - to the infectious diseases department or separate wards. For care, a separate medical staff is allocated. All secretions are disinfected. Insulation of contact. Not carried out. For persons who have been in contact with sick animals or who have been in close contact with a sick person, medical supervision is established for 8 days. They are given emergency prophylaxis with anthrax immunoglobulin and antibiotics. Conditions of discharge. In the cutaneous form - after epithelialization and scarring of ulcers at the site of the fallen off scab, in other forms - after clinical recovery. Admission to the team. After clinical recovery. Clinical examination: Not carried out Specific prophylaxis 1. With the anti-ulcer live dry vaccine STI for people, routine vaccinations are carried out according to professional indications by the cutaneous and subcutaneous method. 2. Anti-anthrax immunoglobulin and antibiotics carry out emergency prophylaxis of the disease in persons who have had direct contact with infected material, no more than 5 days after eating infected food or after skin contact. Non-specific prophylaxis Reducing and eliminating morbidity among domestic animals. Destruction of food products and disinfection of raw materials obtained from sick animals. Acquired Immunodeficiency Syndrome (AIDS) Acquired Immunodeficiency Syndrome (AIDS) is a viral, slow-flowing infection caused by the human immunodeficiency retrovirus, transmitted sexually, parenterally and vertically, characterized by a specific predominant lesion of the T-helper lymphocytes, leading to the development of immunodeficiency. Clinical diagnosis The incubation period is from 2-4 weeks to 5 years. In the acute febrile phase "mononucleosis" syndrome: angina, fever, lymphadenopathy, hepatosplenomegaly; flu-like syndrome; asthenic serous meningitis or meningoencephalitis; transient exanthema. In the asymptomatic phase, seroconversion appears (antiviral antibodies in the serum). Persistent generalized lymphadenopathy: enlargement of the cervical, occipital, behind the ear, elbow and other groups of lymph nodes; vegetative-vascular disorders; there is an imbalance in the immune system. PreSPID - weight loss up to 10%; fungal, viral, bacterial lesions of the skin and mucous membranes; exacerbation of chronic foci of infection: sweating, prolonged diarrhea, fever, signs of immunodeficiency. AIDS - weight loss of more than 10%, hairy leukoplakia, pulmonary tuberculosis, persistent bacterial, fungal, viral, protozoal lesions of the skin and internal organs, localized Kaposi's sarcoma. Generalization of all infections, disseminated Kaposi's sarcoma, damage to the nervous system, AIDS marker diseases. Laboratory diagnostics 1. Serological method. Numerous diagnostic test systems are produced for the detection of antibodies to HIV antigens by enzyme-linked immunosorbent assay. The primary positive result requires mandatory confirmation using the immunoblotting technique. 2. Immunoinduction. Using a set of poly- and monoclonal antibodies in the blood of patients and HIV-infected, both complexes and individual antigenic determinants of HIV can be detected. 3. Virological research. Isolation of HIV is carried out only in specialized centers. 4. Genetic methods. In the DNA from the blood cells of patients and HIV-infected, the nucleotide sequences of the virus can be detected. Measures in relation to patients and contact persons Hospitalization. Issues of isolation and hospitalization of AIDS patients and HIV-infected are resolved collectively by epidemiologists, clinicians, and staff of the AIDS Center. Insulation of contact. Not carried out. For contacts from the foci of HIV infection, dispensary observation is established in the AIDS center and the infectious diseases office for 1 year, with a blood test for HIV by ELISA once a quarter. Admission to the team. Admission to the collective of AIDS patients and HIV-infected people will be decided collectively by epidemiologists, clinicians, and AIDS Center staff. Clinical examination: It is carried out in the AIDS center, the terms are not regulated. Specific prophylaxis Not developed. Non-specific prophylaxis Prevention of sexual transmission of HIV infection: - use of condoms during sexual intercourse. Parenteral route of infection: - disinfection and sterilization of medical instruments, widespread use of single-use medical instruments. Personal preventive measures: - work in overalls, use of gloves. In case of contamination of hands with blood (blood serum), it is necessary to "pinch" the skin with a cotton ball dipped in a disinfectant (chloramine, bleach, alcohol), and then wash your hands with soap and water. Tick-borne typhus Typhus tick-borne (North Asian rickettsiosis) is an acute infectious disease with a benign course, characterized by the presence of primary affect, fever and skin rashes. Clinical diagnosis The incubation period is 4-9 days. The beginning is acute. Fever, headache, insomnia. Inflammatory reaction at the site of the tick bite and regional lymphadenitis. Polymorphic roseolous-papular rash with a characteristic localization on the skin of the trunk, buttocks, extensor surface of the limbs, sometimes on the face, palms and soles with subsequent pigmentation. Bradycardia. Arteriovenous hypotension. Children have a milder course of the disease. Laboratory diagnostics 1. Bacteriological method. From the first days of the disease, the pathogen is isolated from the blood by infecting developing chicken embryos. 2. Serological method. From the 2nd week of the disease, paired sera are examined in RA, RPHA or RSC with rickettsial antigen in order to detect AT and increase their titer. Measures in relation to patients and contact persons Hospitalization. According to clinical indications. Insulation of contact. Not carried out. Conditions of discharge. Clinical recovery not earlier than 10 days from the onset of the disease. Admission to the team. After clinical recovery. Clinical examination: It is recommended to limit physical activity for 3-6 months. Specific prophylaxis Not developed. Non-specific prophylaxis Deratization and disinsection in epidemic foci. Wearing overalls and examining clothing and body surfaces to detect and remove ticks. The removed ticks are destroyed, the bite site is treated with solutions of iodine, lapis or alcohol. CHOLERA Cholera is an acute intestinal infection caused by Vibrio cholerae, characterized by gastroenteric manifestations with rapid dehydration of the body due to loss of fluid and electrolytes with vomit and feces. Clinical diagnostics The incubation period is from several hours to 5 days. Lightweight form. Weight loss - 3-5%. Moderate thirst and dryness of the mucous membranes. Mild short-term diarrhea. Exicosis I degree. Moderate form. Weight loss - 5-8%. Hemodynamic disorders (tachycardia, hypotension, cyanosis, cold extremities). Thirst, oliguria. The stool is frequent, plentiful, quickly loses its fecal character (a type of rice water), an admixture of mucus, blood. Rumbling of the intestines, flatulence. Vomiting. Exicosis II degree. Severe form (algid). Weight loss is more than 8-12%. Severe hemodynamic disorders (drop in blood pressure, pulse of weak filling, muffled heart sounds, cyanosis, cold extremities, anuria). Sharpened facial features, dry sclera, aphonia. Hypothermia. Frequent vomiting and diarrhea. Convulsions. Exicosis III-IV degree. Laboratory diagnostics 1. Bacteriological method (carried out in the laboratories of the OOI). From the first days of the disease, repeated studies of feces and vomit are carried out in order to isolate the pathogen. Media for primary inoculation: 1% peptone water with potassium tellurite, alkaline agar. The preliminary answer is in 12-16 hours, the final answer is in 24-36 hours. 2. Serological method. Paired sera are examined in RA and RPHA in order to detect AT and increase their titer. Measures in relation to patients and contact persons Hospitalization. Strictly obligatory for patients and carriers of vibration. Insulation of contact. In exceptional cases, with a widespread infection, quarantine is established on the territory of the outbreak with the isolation of contacts with patients, vibrio carriers, who died from cholera and infected objects of the external environment, as well as those leaving the quarantine territory. For these persons, medical supervision is established for 5 days with three-fold (within a day) bacterial examination of stool. Vibrio carriers and patients with acute gastrointestinal diseases are identified and hospitalized. The medical staff of the hospital and the observer is transferred to the barracks position. Conditions of discharge. Clinical recovery, negative results of a three-time bacteriological examination of stool (for 3 consecutive days) and a single bacteriological examination of bile (portions B and C), carried out no earlier than 24-36 hours after antibiotic treatment. Workers of food enterprises and persons equated to them, as well as those suffering from liver and biliary tract diseases, are examined for 5 days (five-fold bacterial examination of feces and one-time bile examination) with a preliminary administration of a laxative before the first examination. Admission to the team. Persons who have had cholera and vibrio carriers are admitted to the team immediately after discharge from the hospital. Children are allowed no earlier than 15 days after discharge and five times daily bacterial examination of bowel movements. Clinical examination: Persons who have undergone cholera and vibrio carriers are observed throughout the year. Bacteriological examination (with preliminary giving of a laxative) is carried out: in the 1st month, 1 time in 10 days, in the next 5 months - 1 time per month, then 1 time in 3 months. With prolonged vibrio-carrier with damage to the liver and biliary tract - inpatient treatment. Persons who are in the focus of cholera and have suffered acute gastrointestinal diseases are observed for 3 months with a monthly bacteriological examination for pathogenic intestinal flora, including cholera vibrio. When the outbreak is eliminated, workers of food enterprises and persons equated to them, medical workers and organized preschoolers who were in the outbreak of cholera are subjected to bacteriological research for vibrio carriers 1 time within 1 month, then once in April-May. Employees of food enterprises and persons equated to them, when hired for a year after the elimination of the outbreak, are examined three times daily for vibrio carriers. Specific prophylaxis 1. Cholera vaccine is used for subcutaneous prophylactic vaccinations for children and adults. 2. Cholerogenanatoxin is vaccinated in adults and children from 7 years of age. Non-specific prevention Sanitary supervision of water supply, sewerage, collection and disposal of sewage; sanitary control at food industry and public catering enterprises, health education. Plague Plague is an acute infectious disease characterized by a severe form of general intoxication, specific damage to the lymph nodes, lungs and other organs. Clinical diagnostics The incubation period is from several hours to 10 days (usually 3-6 days). The onset is sudden. High fever, intoxication, impaired consciousness, delirium. Damage to the cardiovascular system. Toxic shortness of breath. Enlargement of the liver and spleen. In the bubonic form, lymphadenitis, suppuration and dissection of the bubo. In case of a bubonic cutaneous form, a pustule, sharp soreness, then an ulcer. In the pulmonary form - severe intoxication, high persistent fever, previously progressive decline in cardiovascular activity, respiratory failure, cough, sputum with blood. In the septic form, severe sepsis with severe hemorrhagic syndrome. Laboratory diagnostics 1. Bacterioscopic method (carried out in the laboratories of the OOI). From the first days of the disease, smears from sputum, bubo punctate (less often mucus from the pharynx), stained according to Gram and methylene blue, are examined in order to detect the pathogen. 2. Bacteriological method (carried out in the laboratories of the ROI). From the first days of the disease, sputum, bubo punctates, blood, mucus from the pharynx are examined in order to detect the pathogen. Primary inoculation medium: Hotinger agar or special media. The same material is used to infect laboratory animals. 3. Serological method. From the end of the 1st week, blood serum is examined in RA and RPHA and antigen neutralization reactions in order to detect AT. 4. Method of immunodiagnostics. From the first days of the disease, blood serum and pathological material are examined in the reaction of inhibition of passive hemagglutination (RTPHA) and the reaction of neutralization of antibodies (PHAT) in order to detect the antigen. 5. Detection of the pathogen antigen and antibodies to it by ELISA. Measures in relation to patients and contact persons Hospitalization. Mandatory, urgent, with isolation in a room with preliminary disinfection, deratization and disinfestation. The medical staff works in a full anti-plague suit. All patient secretions are disinfected. Insulation of contact. All persons who have been in contact with a sick person or with contaminated objects are subject to strict isolation for 6 days with three daily temperature measurements. Temperature-sensitive persons are transferred to an isolator for the final diagnosis. Careful medical supervision with double temperature measurements is established for the medical staff serving patients. Conditions of discharge. Complete clinical recovery (with bubonic form - no earlier than 4 weeks, with pulmonary - no earlier than 6 weeks from the day of clinical recovery) and a negative result of a three-fold bacterial examination (bubo punctate, throat swabs and sputum smears). Admission to the team. After clinical recovery and three-fold bacterial examination. Clinical examination: Conducted within 3 months Specific prophylaxis Plague live dry vaccine is vaccinated in adults and children from 2 years of age according to epidemic indications. Nonspecific prophylaxis Prevention of the import of the disease from abroad and the occurrence of disease in people in enzootic areas
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