The textbook presents modern information about the most pressing infectious diseases. The main clinical manifestations of the disease, a characteristic epidemiological history are described, diagnostically significant clinical and laboratory data are highlighted, and the possibilities of specific prevention of infection are presented. The basic principles and means of treatment are supplemented with information about patient care, taking into account the various problems of the patient for each nosological form. The manual contains basic definitions and concepts about infectious and epidemic processes, supplementing and explaining information about the given infectious diseases. To control the assimilation of the material, tests were given for all nosological forms. Tutorial intended for specialists with secondary medical education.
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The given introductory fragment of the book Current infections in the practice of nurses (D. A. Lioznov, 2012) provided by our book partner - the company liters.
MAIN INFECTIOUS DISEASES
2.1. Adenovirus infection
Adenoviral infection (pathogens are several dozen DNA-containing human adenoviruses) – acute infection, characterized by damage to lymphoid tissue, mucous membranes of the upper respiratory tract, eyes, intestines and occurring with moderate intoxication.
Source of infection– a sick person and a virus carrier.
Mechanisms of infection– aerosol (transmission routes: airborne droplets and airborne dust) and fecal-oral (transmission routes: alimentary and household contact).
Clinical picture. The incubation period is 1–2 weeks, usually 5–8 days. The clinical manifestations of the disease are varied. The following forms are distinguished adeno viral infection: rhinopharyngitis, rhinopharyngotonsillitis, rhinopharyngobronchitis, pharyngoconjunctival fever, conjunctivitis and keratoconjunctivitis, adenoviral atypical pneumonia.
Any of the clinical forms of the disease is characterized by an acute onset, increased body temperature with chills, the appearance of a moderate headache, general weakness, pain in the bones, joints, and muscles. By the 2nd – 3rd day, body temperature reaches 38 – 39 °C. However, even with high temperature the patient's condition may remain satisfactory. Insomnia, nausea, vomiting, and dizziness are rarely observed. The disease may occur with low-grade fever. The duration of the febrile period is from 4 – 6 to 14 days. From the first days of the disease, nasal congestion and profuse serous discharge appear, and later, due to the addition of bacterial flora, serous-purulent nasal discharge (rhinitis). Patients complain of a sore throat when swallowing (pharyngitis, tonsillitis), a feeling of “sand” in the eyes, lacrimation (conjunctivitis), cough (tracheitis, bronchitis).
The face is moderately hyperemic, scleritis is pronounced, the conjunctiva is hyperemic, with enlarged follicles, sometimes with a filmy coating. The mucous membranes of the nose are swollen. In the oropharynx there is moderate diffuse hyperemia, back wall pharynx with hypertrophied follicles. The tonsils are enlarged, hyperemic, with islands of whitish plaque, often filmy. Purulent plaque appears only when bacterial flora is attached. The submandibular and cervical lymph nodes are enlarged; less commonly, generalized enlargement of the lymph nodes is observed. The liver and spleen enlarge.
Some patients experience abdominal pain and loose stools.
With adenoviral keratoconjunctivitis, patients complain of pain, a sensation of a foreign body in the eyes, lacrimation, and photophobia. Blepharospasm (persistent, spastic closure of the eyelids) often occurs. The mucous membrane of the eyes is sharply hyperemic. The cornea loses its shine, becomes cloudy, and vision is impaired. Usually one eye is affected first, then the other. Recovery occurs slowly, over 1 – 2 months.
Adenoviral pneumonia is severe and develops after a period of catarrhal symptoms. Fever persists for a long time - up to 3 weeks. The patient is bothered by cough and shortness of breath. X-ray reveals small focal pneumonia.
Complications: otitis, sinusitis, tonsillitis, pneumonia caused by secondary bacterial flora, exacerbation of chronic diseases, with adenoviral pneumonia - ARF.
Clinical signs:
– acute onset of the disease;
– moderate long-lasting fever, less often – low-grade fever;
– moderate manifestations of intoxication;
– a combination of symptoms of damage to the upper respiratory tract (rhinitis), pharynx (pharyngitis), tonsils (tonsillitis, often membranous), mucous membranes of the eyes (follicular or membranous conjunctivitis);
– enlarged lymph nodes;
– enlarged liver and spleen;
– abdominal pain, loose stools.
Epidemiological history: contact with a patient with symptoms of acute respiratory disease, conjunctivitis, diarrhea, during the expected incubation period (1 - 2 weeks);
outbreaks of acute respiratory disease occurring with conjunctivitis in a family or community; consumption of raw water and thermally unprocessed foods for 1 - 2 weeks. before the onset of the disease; use of utensils, household items, including toys, by a patient with adenoviral infection; failure to comply with personal hygiene rules. Children and young people are more often affected. It is necessary to take into account the rise in incidence in the winter and spring months and the possibility of an outbreak in individual groups in the summer.
Laboratory diagnostics . The hemogram shows moderate leukopenia, ESR is within normal limits or slightly increased.
To confirm the diagnosis, PCR and MFA are used. The material for the study is nasopharyngeal swabs, eye discharge during conjunctivitis, feces, and blood. From serological methods RSK, RTGA, RN, ELISA are used.
Treatment and patient care. In most cases, treatment is carried out at home. Indications for hospitalization are severe intoxication, acute respiratory failure, as well as unfavorable premorbid background.
In the first days of illness, if the fever persists, bed rest is indicated. The room in which the patient is located is systematically ventilated, and wet cleaning is carried out regularly. If conjunctivitis is present, remove sources of bright light. The diet should be nutritious, enriched with vitamins, drinking plenty of fluids (fruit juice, tea, fruit juices, etc.) is recommended; if you have a sore throat, use liquid, semi-liquid or pureed food. It is necessary to carry out careful care of the oral cavity (rinsing with boiled water, furatsilin solution 1: 5000), eyes (rinsing with a 2% solution boric acid, instillation of 20% sodium sulfacyl solution). Causal therapy has not been developed. For the treatment of rhinitis and conjunctivitis, it is recommended to use oxolinic, tebrofen ointments, a deoxyribonuclease solution, which is instilled into the conjunctival sac and into the nasal passages. For moderate and severe forms of the disease, donor immunoglobulin is administered. Antibiotics are indicated for the development of bacterial complications.
Pathogenetic therapy includes the prescription of antipyretics, desensitizing agents, and vitamins. In severe cases of adenoviral infection, detoxification infusion therapy is performed.
To facilitate nasal breathing, vasoconstrictor drugs (naphthyzine, galazolin, ephedrine) are instilled into the nose; decrease inflammatory process in the oropharynx is facilitated by the use of pharyngosept, falimint.
Specific prevention. An adenovirus vaccine is under development.
2.2. Angina
Sore throat (caused by beta-hemolytic streptococcus serogroup A) is an acute infectious disease that occurs with intoxication syndrome, inflammatory damage to the mucous membrane and lymphoid apparatus of the pharynx - palatine tonsils and regional lymph nodes.
Source of infection– a carrier of the bacteria or a patient with manifest forms of streptococcal infection.
Mechanism of infection– aerosol, transmission route – airborne droplets.
Clinical picture. The incubation period is short, 2 – 4 days. The onset of the disease is acute, often rapid: a sore throat appears, body temperature quickly rises to 39–40 °C or more, and a headache occurs. Symptoms of damage to the pharynx progress rapidly; due to pain, swallowing of not only food, but also saliva is impaired; young children often experience abdominal pain, nausea and vomiting.
Upon examination, bright hyperemia of the mucous membrane of the oropharynx is determined. The tonsils are enlarged in size, compacted, covered with a pale yellow or greenish (purulent) coating, which, depending on the form of the tonsillitis, is found in the area of the lymphatic follicles (follicular tonsillitis), fills the lacunae and covers the surface of the tonsils (lacunar tonsillitis). The plaque can be easily removed with a spatula.
Patients with reduced reactivity may develop necrosis of the tonsils (necrotizing tonsillitis).
Mild forms of the disease are often limited to bright hyperemia of the tonsils without plaque (catarrhal tonsillitis).
Along with damage to the pharynx, an enlargement of the regional anterior cervical lymph nodes is naturally determined; their palpation is painful.
After 3–5 days, most patients experience a fading of the main symptoms, but recovery processes in the pharynx are delayed up to 2–3 weeks.
Complications: paratonsillar or retropharyngeal abscesses, cervical cellulitis, purulent inflammation middle ear (otitis) and mastoid process(mastoiditis). In some cases, after 2 - 4 weeks. after the manifestations of tonsillitis subside, a picture of immunopathological complications develops: myocarditis, acute glomerulonephritis, vasculitis, and a possible rheumatic attack.
Clinical and epidemiological diagnostics.
Clinical signs:
– acute onset of the disease, increase in body temperature to 39 – 40 °C;
– intoxication syndrome;
– sore throat;
– bright hyperemia of the mucous membrane of the oropharynx;
– tonsils are hypertrophied, with purulent deposits;
– enlargement and tenderness of the anterior cervical lymph nodes.
Epidemiological history: contact with patients with streptococcal infection (sore throat, scarlet fever, erysipelas) during incubation periods (2 - 4 days).
Laboratory diagnostics. The hemogram shows neutrophilic leukocytosis, increased ESR.
The diagnosis is confirmed by isolating a culture of beta-hemolytic streptococcus serogroup A by culture of mucus from the anterior nasal passages and oropharynx.
Treatment and care for patients. Patients with tonsillitis are hospitalized for clinical (severe course, severe concomitant pathology) or epidemiological (from organized groups) indications. Etiotropic therapy is carried out with penicillin drugs, and if they are intolerant, macrolides or cephalosporin derivatives are prescribed. It is important to carry out a full course of antibiotic therapy (7 days), despite rapid relief clinical manifestations against her background.
For the purpose of detoxification, crystalloid and colloid solutions are used.
Local treatment consists of gargling with warm antiseptic solutions(furacilin, iodinol, infusion of chamomile, sage, etc.).
Patients with tonsillitis need care. During the acute period of the disease, bed rest is indicated. Food should be high in calories, thermally and mechanically gentle. During the recovery period, you should gradually expand your motor regimen, while limiting physical activity.
Specific prevention not developed.
2.3. Rabies
Rabies (caused by an RNA virus) is an acute zoonotic infection that causes severe irreversible damage to the central nervous system and ends in death.
Sources of infection– infected wild (foxes, wolves, raccoons, skunks, vampire bats) and domestic (dogs, cats) animals.
Mechanism of infection– contact, transmission route – direct (through bites of sick animals, when infected saliva gets into fresh lesions of the mucous membranes and skin, through scratches caused by animal claws). The greatest danger comes from bites to the head, face, neck, hand, fingers, toes, and genitals.
Clinical picture. The duration of the incubation period varies significantly and ranges from 10 days to 1 year or more, but more often 30–60 days.
In the clinical course of the disease, three periods are distinguished: prodromal (depression); height (excitement); terminal (paralytic).
Initial period, which lasts 1–3 days, is mainly manifested by nonspecific symptoms: low-grade body temperature, fatigue, headache, and possible dyspeptic symptoms. Marked increased irritability, depression, unreasonable fear, sleep disturbance. Characteristic signs of this period are itching, pain or paresthesia, and sometimes inflammatory phenomena(swelling, redness) at the site of the bite.
Then comes period of excitement. Cardinal symptom rabies, which manifests itself precisely during this period of the disease, is hydrophobia (phobia of water). An attempt to swallow liquid or saliva leads to a painful spasm of the muscles of the pharynx and larynx, accompanied by a feeling of horror. As the disease progresses, one reminder of water or the sound of pouring liquid provokes an attack of hydrophobia, and then the provoking factors may be blowing a stream of air in the face (aerophobia), bright light (photophobia), or loud sound (acousticophobia).
The duration of the attacks is several seconds. Paroxysm of hydrophobia is accompanied by clouding of consciousness with the development of auditory and visual hallucinations frightening in nature. There is motor agitation and respiratory distress.
During the interictal period, the patient is conscious, adequate, and remembers what happened.
After 1–2 days, profuse salivation develops, sweating increases, and body temperature rises. The combination of difficulty swallowing and increased salivation is manifested by a characteristic symptom - “foaming at the mouth.” Disorders of the respiratory and cardiovascular systems are increasing.
The duration of the excitation period is 2–3 days, sometimes up to 6 days.
For terminal (paralytic) period The cessation of attacks of hydrophobia is characteristic. Patients are able to eat and drink, fear and anxiety disappear, but apathy, general weakness, drooling increase, and body temperature rises to 40 °C and above. Paralysis of the cranial nerves and limbs develops, and the function of the pelvic organs is disrupted.
Death occurs within 1–3 days. from the beginning of the terminal period as a result of paralysis of the heart or respiratory center.
Total duration illness lasts 3–7 days. Under conditions of intensive therapy and artificial support of the functions of vital organs, patients continue to live for several weeks.
The prognosis is always unfavorable. Mortality in the development of clinical manifestations of the disease is 100%. Isolated cases of recovery have been described (in patients who received a course of immunization).
Clinical and epidemiological diagnostics.
Clinical signs:
– hydrophobia – painful spasm of the muscles of the pharynx and larynx when trying to swallow water, at the mention of water or at the sound of pouring liquid;
– aerophobia, photophobia, acoustic phobia – painful spasm of the muscles of the pharynx and larynx in response to various stimuli (a breath of air, bright light, loud sound);
– excessive salivation;
– pain, itching, burning, hyperesthesia of the skin at the site of the bite.
Epidemiological history: bite of a wild (fox, wolf, raccoon, skunk, vampire bat) or domestic (dog, cat) animal or salivation of damaged skin and mucous membranes.
The disease is most often reported among rural residents, in children.
Laboratory diagnostics. Intravital methods for diagnosing rabies include the study of corneal prints, skin biopsies using MFA, isolation of the virus from saliva, lacrimal and cerebrospinal fluid by intracerebral infection of newborn mice, identification of the pathogen in saliva using PCR, determination of antibodies to the virus in saliva and cerebrospinal fluid.
The diagnosis is confirmed by the detection of specific inclusions (Babes-Negri bodies) during a histological examination of the brain of humans and animals killed by rabies and the detection of virus antigens in the tissue of the brain and other organs using immunofluorescence.
Treatment and care for patients. Patients with rabies are subject to hospitalization in the intensive care unit and intensive care unit of an infectious diseases hospital.
Due to the lack of etiotropic drugs for the treatment of rabies, the main treatment is symptomatic therapy aimed at reducing the patient's suffering. Sleeping pills, anticonvulsants and painkillers are used.
Carrying out activities aimed at maintaining the activity of the cardiovascular and respiratory systems can prolong the patient’s life.
The patient is placed in a separate room, isolated from external stimuli (noise, shaking, bright light, sound of flowing water, etc.). An individual nursing station is established. Medical personnel work with the patient wearing gloves and a mask. It is necessary to avoid salivation of the patient by caring personnel. Parenteral nutrition is indicated. Specific prevention. Persons involved in catching and keeping stray animals, veterinarians, hunters, foresters, slaughterhouse workers, taxidermists, and laboratory employees working with the “street” (wild, circulating in nature) rabies virus are subject to vaccination for epidemic indications.
All persons at risk of contracting rabies, after initial treatment of the wound (excessive washing with soapy water and lubrication with disinfectants - solutions of iodine, alcohol, hydrogen peroxide), are given emergency prophylaxis with an anti-rabies vaccine according to a scheme including 6 injections (0, 3, 7, 14, 30 and 90 days). If the animal that attacked a person remains healthy for 10 days. observations, immunization is stopped after the 3rd injection.
In case of salivation and any damage caused by wild animals, as well as bites dangerous location(head, face, neck, hand, fingers and toes, genitals) caused by domestic and farm animals, active immunization is combined with the administration of rabies immunoglobulin.
2.4. Brill–Zinsser disease
Brill-Zinsser disease (synonyms: recurrent, relapsing, sporadic typhus) is a relapse of epidemic typhus (pathogen: Provacek's rickettsia), occurring many years after primary disease, characterized by a relatively mild course, but clinical manifestations typical of typhus.
Clinical picture. Clinically, the disease occurs as a mild or moderate form of typhus. An indication of previous typhus fever is important for diagnosis.
The disease begins acutely with a rapid (within 1–2 days) increase in body temperature. The temperature curve is of a constant type, without incisions characteristic of typhus. Patients complain of severe headache, which is not relieved by analgesics. Excitement, anxiety, and hyperesthesia are usually observed. There is facial hyperemia and hemorrhages in the mucous membranes of the oropharynx and conjunctiva. A profuse roseola-petechial rash is characteristic. Signs of meningoencephalitis and damage to the vascular system are the same as with typhus, but less pronounced. Typhoid status rarely develops.
Complications Brill-Zinsser diseases are rare and are represented by thrombophlebitis, in isolated cases - thromboembolism.
Clinical and epidemiological diagnostics.
Clinical signs:
– rise in body temperature to 39 – 40 °C for 2 – 3 days;
– severe (excruciating) headache, anxiety;
– insomnia, hyperesthesia;
– excitement, irritability;
– hemorrhages in the mucous membranes of the oropharynx and conjunctiva;
– roseola-petechial rash;
– signs of encephalitis (smoothness of the nasolabial fold, Govorov-Godelier symptom, etc.);
– enlargement of the liver and spleen.
Epidemiological history: indication of typhus in the past.
Laboratory diagnostics. Serological diagnosis is carried out as for typhus. In Brill-Zinsser disease, specific IgG class antibodies and relatively high antibody titers in the RSK and RNGA reactions are detected in the blood already in the early stages of the disease.
Treatment and nursing as in epidemic typhus.
Prevention epidemic typhus provides prevention of Brill-Zinsser disease.
2.5. Lyme disease
Lyme disease (synonym - systemic tick-borne borreliosis) is a naturally focal transmissible infection (pathogens - Borrelia from the spirochete family), characterized by stages and polymorphism of clinical manifestations, erythema, lesions nervous system, heart, joints, tendency to chronicity.
The reservoir of Borrelia in natural foci are small and large wild animals (rodents, marsupials, deer, etc.).
Mechanism of infection– transmissible, carrier – ixodid tick.
Clinical picture. The incubation period lasts from 1 to 20 days, on average 7 to 10 days. There are three stages during the disease.
In most cases (70%), the disease begins with the appearance of erythema in the area of tick suction - first (erythemal) stage diseases. Patients note itching, pain at the site of tick suction, swelling and redness of the skin. In this case, moderate intoxication occurs - headache, general weakness, malaise, body temperature briefly rises to 38 ° C. Erythema is a cardinal sign of the disease. The area of redness of the skin around the site of tick suction gradually expands, the size of the erythema increases (“creeping”, “migratory” erythema), reaching 3–70 cm in diameter. Erythema is delimited from unaffected skin by a bright red border. In the center, the skin turns pale, and the erythema takes on the appearance of a ring (“ring” erythema). A vesicle may appear at the site of tick suction, followed by necrosis. Regional lymphadenitis is characteristic.
The erythema usually disappears within a few days (or weeks) even without treatment. In its place, skin pigmentation and peeling often persist. This completes the first stage of the disease. Some patients do not have skin erythema, which significantly complicates the diagnosis of these forms of the disease, which is usually based only on epidemiological and serological data.
Second stage associated with the dissemination of borrelia into various organs and tissues, which occurs after 2–6 weeks. from the onset of the disease. Characterized by damage to the nervous system, which manifests itself as meningitis, meningoencephalitis and syndromes of damage to the peripheral nervous system. With meningitis, patients complain of headache, photophobia, pain in the eyeballs, increased body temperature, vomiting. On examination, stiff neck muscles and decreased abdominal reflexes are detected. In the cerebrospinal fluid, signs of serous inflammation of the soft meninges are revealed - moderate lymphocytic pleocytosis, increased protein levels and normal content glucose.
Possible development of moderate symptoms encephalitis– disturbance of sleep rhythm, emotional instability, memory loss, which usually persist for 1 – 2 months. Neuritis of the cranial nerves accompanied by paresis facial muscles, numbness, tingling of the affected half of the face, drooping corner of the mouth, pain in the ear and lower jaw.
Lesions of peripheral nerves are represented by radicular sensitivity disorders, poly- and mononeuritis, and plexitis. Patients complain of pain, numbness of the skin, and discomfort in the limbs. Objectively, a decrease in tendon reflexes, muscle weakness, and muscle atrophy are determined.
At 5 - 6 weeks. From the onset of the disease, signs of heart damage appear. Patients complain of discomfort and pain in the heart area, palpitations. An increase in the size of the heart and muffled heart sounds are detected. Possible development of myocarditis and myopericarditis.
In the second stage of the disease, transient pain appears in the bones, muscles, and joints. As a result of hematogenous introduction of borrelia into the skin, secondary erythemas are formed; they are not associated with the primary affect, but have manifestations similar to it. The number of secondary erythemas may vary; they are usually small in size. The first and second stages correspond to the acute and subacute course of the disease.
Third stage develops several months or years after the onset of the disease. Late manifestations of Lyme disease are consistent with chronic infection. One of the common late manifestations of borreliosis is arthritis. Usually one or two large joints are affected (usually the knees). There is pain in the joints, their swelling, the skin over them is moderately hyperemic. Arthritis has a recurrent course, inflammation becomes chronic, and degenerative changes occur in the joints. The causative agent of Lyme disease can be isolated from joint fluid.
Late lesions of the nervous system manifested by headache, fatigue, memory loss, sleep disturbance. Symptoms of encephalomyelitis appear, mental disorders and damage to the cranial nerves develop with persistent impairment of vision, hearing, and swallowing. Polyradiculoneuritis, polyneuropathy with impaired sensitivity and movement disorders are possible.
Skin lesions at chronic illness Lyme manifests itself as widespread dermatitis. Sometimes it develops gradually, forming confluent bluish-purple spots on one of the limbs. First, spots on the skin are combined with swelling and infiltration, then the erythema disappears and pronounced atrophy of the skin occurs, it takes on the appearance of tissue paper (atrophic acrodermatitis).
Clinical and epidemiological diagnostics.
Clinical signs:
– itching, pain at the site of tick suction;
– swelling and redness of the skin at the site of tick suction;
– gradual increase in the zone of hyperemia (“creeping erythema”);
– erythema in the form of a ring;
– passing signs of damage to the nervous system – serous meningitis, polyneuritis, encephalitis with moderate manifestations;
– myocarditis;
– arthralgia, chronic arthritis;
– chronic encephalomyelitis, polyradiculoneuritis, polyneuropathy, mental disorders, damage to the cranial nerves with persistent impairment of vision, hearing, and swallowing;
– chronic skin lesions (chronic atrophic acrodermatitis, scleroderma-like disorders, skin lymphadenosis).
Epidemiological history: visits to forests, forest parks in spring and summer, indications of a tick attack during the incubation period (1 - 20 days, on average 7 - 10 days). People who work in forest areas (hunters, trappers, etc.), as well as tourists and city dwellers who pick mushrooms and berries, usually get sick.
End of introductory fragment.
Infections accompany a person throughout his life. And the very history of the development of the human population is also the history of infections that remain with us, despite the development of medicine, science and the numerous benefits of civilization. In today's rapidly changing world, borders between states are disappearing, the population is actively migrating, new types of pathogens that are resistant to modern medicines. As a result, infectious disease statistics are steadily increasing. Our expert, infectious diseases doctor, head of the 3rd department of the Regional Infectious Diseases, talks about the infectious diseases that patients most often turn to doctors for today. clinical hospital in Lvov Kashchevska Sofia Igorevna.
Has the picture of infectious diseases changed in 2019 compared to previous years?
Today we can say that yes, it has changed. The beginning of 2019 was memorable for us sharp increase number of patients with measles. This situation was a logical continuation of outbreaks of this infection over the previous 2 years, due to the low level of vaccination of the population and the lack of collective immunity to the measles virus. Fortunately, it can be said that this year the incidence of measles is beginning to decline: since January, the number of patients began to gradually decrease, and by spring we transferred our department to normal operation.
By the way, about ARI and flu season. What can children and adults expect this year?
- This season, experts predict the activity of new influenza strains. It's not about the flu H1N1“California”, to which we are “accustomed” and against which many people in our country have formed immunity through preventive vaccination and as a result of previous illness. According to forecasts, in the northern hemisphere during the new season, instead of the “familiar” influenza pathogen, three new strains will dominate: A/Briben (H1N1); A/Kansas (H3N2); B/Colorado Line B/Victoria/2/87) and B/Phuket (Line B/Yamagata). These strains were identified in the USA, and now we will “meet” them on the European continent, and this once again serves as confirmation that there are no borders for infections. Groups at increased risk for influenza include young children, adolescents, pregnant women, the elderly and patients with chronic pathology.
What other infections can be called “leaders” in terms of the frequency of patient visits to doctors in 2019?
- Rotavirus diarrhea, which is commonly called “intestinal flu,” was common. It should be noted that rotavirus is most dangerous for young children, because with this disease an acute diarrhea syndrome develops, accompanied by the loss of large amounts of fluid and salts, which literally exhausts the child. Fortunately, modern laboratory rapid tests for determining rotavirus help to quickly clarify the diagnosis and quickly provide qualified assistance. medical care even in outpatient setting, before the child is admitted to the hospital. It should also be noted that the incidence of “intestinal” flu among children increases from September, when preschool institutions and schools begin to operate at full capacity after the summer. Another common reason for calls is acute intestinal infections (AI), the causative agents of which are bacteria, among which Salmonella is the leader. Bacterial OCI is characterized by spring-summer seasonality, and epidemic outbreaks arise due to violations of hygiene rules and regulations. This year, we observed and treated such outbreaks after weddings, graduations, anniversaries, as well as in tourist groups, given the openness and popularity of our city for travelers from different countries.
It is also worth mentioning adenoviral infection, which, although considered a type of ARI, can occur throughout the whole year. As is known, young children are most susceptible to adenovirus. Adenoviral infection in them can begin under the “mask” of acute intestinal infection, with which alarmed parents of children turn to an infectious disease doctor. Therefore, in the process of a comprehensive examination of such patients, we also conduct rapid tests for the detection of adenoviruses. In contrast to bacterial acute intestinal infections, with adenoviral infection, already on the 2-3rd day of the disease, symptoms of acute respiratory infections appear in the form of redness of the oropharynx, runny nose and conjunctivitis against a background of moderate elevated temperature bodies.
Your department specializes in the treatment of acute tonsillitis. In what cases does it become necessary to hospitalize such patients in the infectious diseases department?
Acute inflammation of the tonsils (tonsillitis), or “tonsillitis,” occupies a separate “honorable” place in the clinic of infectious diseases. Symptoms of tonsillitis can be observed against the background of many infectious diseases. This is due to the role of the palatine tonsils in the formation of the body’s general and local response to infection. Despite their small size, the palatine tonsils are an important part of the peripheral immune system and an “entry gate” for viruses and bacteria. The need to consult an infectious disease specialist and an ENT specialist arises when the symptoms of tonsillitis increase when a certain infectious disease is suspected (for example, infectious mononucleosis or diphtheria), as well as the development of complications that require specialized medical care. In our institution, thanks to the presence of otolaryngologists on staff, we have the opportunity to form a multidisciplinary team for the successful diagnosis and treatment of acute tonsillitis and their complications.
You mentioned infectious mononucleosis and diphtheria. Not all parents think about these infections when a child develops a sore throat. Are there specific symptoms that suggest danger?
At the very beginning there are no specific symptoms. Therefore, if a child has inflamed tonsils, it is necessary to immediately contact a pediatrician or family doctor. These specialists always remember that tonsillitis can be one of the symptoms of diphtheria or infectious mononucleosis. In order to rule out diphtheria, the doctor will take a swab from the throat to determine the causative agent. This approach is absolutely justified today not only in children, but also in adults, given the low level of vaccination in all population groups against this dangerous infection.
Remember that diphtheria begins like a regular sore throat. Taking into account the unfavorable epidemic situation in the country and the low level of vaccination, inflammation of the tonsils requires increased vigilance. You cannot self-medicate acute tonsillitis- You should definitely consult a doctor who will first rule out diphtheria.
As for infectious mononucleosis, this disease begins as a normal acute respiratory infection with tonsillitis, then all groups of lymph nodes, the liver and spleen become enlarged. The listed symptoms are accompanied characteristic changes V clinical analysis blood. This is the test that doctors refer all patients with symptoms of tonsillitis to. Given this peculiarity of the disease, we additionally involve hematologists as consultants. By the way, infectious mononucleosis is called the “kissing disease”: its causative agent is the Epstein-Barr virus, which is transmitted by airborne droplets. Children aged 3 to 6 years who attend preschool institutions and adolescents (15-16 years old) are most often affected. Toddlers lick their own and other people's toys and pacifiers, and teenagers, communicating closely, transmit the virus to each other through kisses. Seasonality is not typical for infectious mononucleosis; we consult and successfully treat patients all year round.
What advice do you have for our readers to reduce the risk of contracting infectious diseases?
Vaccination will help protect against influenza, measles and diphtheria, and this opportunity should not be neglected. At the beginning of autumn, the entire staff of our department was vaccinated against influenza with the current seasonal vaccine. Therefore, we can calmly provide qualified assistance patients without “falling out” of the work process and without exposing our loved ones to the risk of infection with seasonal influenza viruses. As for the prevention of ARI, in addition to the well-known recommendations regarding a healthy lifestyle, at the height of the ARI season, it is advisable to avoid crowded places, after traveling on public transport, try not to touch your face with your hands, do not rub your eyes and nose, carry with you and use, if necessary, wet wipes with antiseptics, especially when traveling with children. The level of human culture and awareness plays a major role in the prevention of infectious diseases. Our level of culture and awareness does not allow us to take food with dirty hands - everyone has already learned this. But there are other ways of spreading infections. It is necessary to explain to children from an early age that you cannot drink from the same cup or bottle with someone, even if this someone is your friend; that kissing is a way of showing tenderness towards loved ones, and not demonstrating liberated behavior. All these precautions are simple, universal and good at any time of the year.
Infectious diseases account for at least 60% of the total number of registered diseases. According to WHO, infectious diseases in the 21st century will again strive to dominate the structure of general pathology, and will also be one of the main causes of death throughout the world. Infectious diseases claim more than 13 million lives every year, killing 1,500 people every hour, more than half of them are children under 5 years of age. The cause of most deaths from infectious diseases are pneumonia, tuberculosis, intestinal infections, HIV, viral hepatitis,
Advances in infectious diseases
1. Natural smallpox has been eradicated.
2. Epidemics of plague, cholera, typhoid and typhus have been curbed.
3. The incidence of polio, whooping cough, mumps, and diphtheria has decreased significantly.
Unsolved problems of infectious pathology
1. The emergence of new infections caused by previously unknown infectious agents (microorganisms) that overcome the interspecies barrier between animals and humans, appearing in an unusual geographical area.
2. The emergence of drug-resistant forms of pathogens.
3. A feature of modern infectious pathology is the dominant and ever-increasing role of viruses as etiological agents, especially newly identified infections.
4. An unfavorable situation with the diagnosis of viral intestinal infections, which is fully carried out only in a few laboratories.
5. The problem of nosocomial infections. Lack of full registration, untimely completion preventive measures contributes to the spread of nosocomial infections.
6. The lack of full registration of infectious agents leads to the fact that a number of so-called “somatic” diseases are considered non-infectious, while it has now been proven that many human diseases, previously considered non-infectious, turned out to be caused by various bacteria and viruses.
There are 3 groups of infections that a person will have to face
Firstly, these are infections that we inherited from previous centuries, including the 20th century. They only went into the shadows, threatening to return at any moment, and some of them have already returned (the so-called “recurring infections”): tuberculosis, malaria, sexually transmitted infections, etc.
Secondly, these are new, or rather, first identified infections that became known at the end of the 20th century. Among them - HIV infection, Lyme disease, ehrlichiosis, yersiniosis, legionellosis, Lasa, Ebola, Marburg viral fevers, enterotoxigenic and enterohemorrhagic escherichiosis, T-cell leukemia, campylobacteriosis, a number of viral intestinal diseases, hepatitis E, C, D, F, G, etc.
The third group consists of infections that are currently not yet known, but will certainly be diagnosed in the 21st century. This group of infections will be replenished by, among other things, many diseases that previously became non-infectious.
The importance of infectious agents in non-infectious pathology
Infection in gastroenterology. The pathogenetic role of H. pylori in the development of gastritis and peptic ulcer. With Whipple's disease in the intestinal wall and lymph nodes An infectious agent was discovered that is believed to be the cause of the development of this disease.
Infections in cardiology. The role of cardiotropic enteroviruses and the chronic form of Coxsackie virus infection in the etiology of rheumatic carditis and non-rheumatic carditis has been revealed. The risk of developing atherosclerosis is significantly increased in patients with antibodies to the hepatitis A virus.
Infection in oncology. It has been proven that etiological factors more than 80% of cases of malignant neoplasms are infectious agents (papilloma virus, herpetic group viruses, hepatitis B and C, etc.)
Infections in gynecology. Primary chronic inflammatory diseases internal organs, secondary infertility, teratogenic effect on the fetus, serious illnesses in newborns are often caused by the TORCH complex.
Infection in urology. The most common and socially significant bacterial infections of the urogenital tract include gonococcal, trichomonas, chlamydial, mycoplasma, ureaplasma and gardnerella.
Infection in neurology. Bacterial infections (meningococcal infection, tuberculosis, borreliosis, etc.) and viral (influenza, tick-borne encephalitis, etc.), as well as a group of diseases caused by prions (Kuru, Creinzfeld-Jakob disease, Hertsmann-Straussler-Scheinker syndrome, fatal familial insosmia ).
A number of infections become epidemics when an armed conflict or serious economic difficulties begin in a country. The main victims of infections are refugees. They, in turn, cross borders and spread epidemics to other countries. Military personnel participating in hostilities on the territory of other states are also a source of infection. More than 2 million people cross state borders every day, allowing epidemics to spread almost instantly. Thanks to the development of international trade, many pathogens of dangerous diseases enter other countries through imported food products.
Over the past decades, the clinical and epidemiological manifestations of many infections have changed more than in the entire previous history of observations of these diseases, which gave V.I. Pokrovsky et al. (1193) introduce such a concept as “the modern evolution of the epidemic process.”
Prospects and tasks:
1) improve the socio-economic conditions of society as a whole and children’s
healthcare in particular;
2) introduction of scientific achievements in the field of specific and nonspecific prevention;
3) it is necessary to increase the immune layer among children to 95% through full immunization; the task has been set to eliminate polio and measles;
4) development of new chemotherapeutic drugs, overcoming drug resistance of pathogens;
5) improving the early diagnosis of infectious diseases, which is complicated by their mild and mild course in recent years;
6) development and implementation of accessible methods for early rapid diagnostics for determining antigens in blood, urine, etc.;
7) carrying out anti-epidemiological measures in the outbreak.
2. EPIDEMIOLOGY OF CHILDREN'S INFECTIOUS DISEASES
TEXT: Anastasia Pivovarova
WE LOVE OURSELVES AND OUR HEALTH BECAUSE OUR BODY- the closest and most understandable thing we have. But we love diseases no less. Try complaining that you have a toothache - you will hear several stories and recipes in response. But some diseases become more popular than others, and sometimes it seems that everyone around is suffering from the same disease - from the stars to their closest neighbors. This is not like when a person is afraid and tests himself for everything, rather like an epidemic, only many fashionable diseases do not spread at the speed of the flu. When and why do diseases become popular?
A disease you can't hide from
It is not always possible to understand what people actually suffered from just a hundred years ago. They suffered from stomach pain, seizures, and died from blows and black blood, because medicine was far from today’s achievements. It was impossible to protect ourselves from diseases; even ideas about hygiene were very different from those to which we were accustomed. There was no protection against many diseases, and in such conditions the emergence of fashion can only be explained by a defense mechanism: in order not to be afraid of the disease, one had to be proud of it. In the 18th century, medicine began to develop in Europe - as far as possible. It was at this time that it became fashionable to get sick, and literature and art only fueled interest in illnesses: many wanted to be like heroines who faint from an excess of feelings.
Consumption came into fashion. Largely because
Until the end of the next century, people did not know how to treat tuberculosis, and they suffered from it a lot. And also because previously the concept of “consumption” included many diseases, not only tuberculosis itself. It was believed that consumption comes to scientists, to those suffering from unhappy love and to the grieving. It is possible to get tuberculosis romantically
it happened in the 20th century as well
with the heroines of E.M. Remarque, but after they learned to treat and prevent tuberculosis, it became associated with a low standard of living, and the romanticization ended. Now tuberculosis is still one of the leading causes of death in the world, but calling it fashionable
and no one can be interesting anymore. There is nothing mysterious left in it, and the problem of tuberculosis resistance to antibiotics is of interest to scientists, not public opinion.
It can be assumed
that “diseases of affluence” - those that appear in wealthy people - are becoming fashionable
It can be assumed that “diseases of affluence” - those that appear in wealthy people - are becoming fashionable. If earlier the poor simply could not afford to get sick (due to lack of medical care and banal hunger, people from the lower classes simply died from any more or less serious disease), then the rich could. There was a general tendency to get sick distinctive feature high society. Peasants and workers were supposed to be invariably healthy and strong because their “simple” nature was supposedly not subject to breakdown, unlike the complex and finely tuned nature of aristocrats. “How could you think of suddenly appearing in society without being sick? Such good health is befitting only the peasant generation. If you truly do not feel any ailments, then please hide such a terrible crime against fashion and customs. Please, be ashamed of such a strong build and do not shield yourself from the number of gentle and sick people of the big world,” the satirical work of Nikolai Ivanovich Strakhov, published in 1791 and recently republished, illustrates just this.
However, not all common diseases became fashionable. For example, only women suffered from hysteria - it was a mysterious disease with many symptoms, its cause was seen in the uterus, which of its own free will wandered or sent the brain in pairs. There was nothing attractive about hysteria, despite its prevalence; on the contrary, it was considered a sign of weakness. But melancholy, in which one can see signs of depression or affective disorders, was much more popular. It is enough to recall the images of Byron or re-read “Eugene Onegin” to understand: in the 19th century, in order to be considered fashionable, you had to declare yourself a melancholic.
The disease that used to be
has not been studied
There is a so-called third-year syndrome: at this time, medical students move from the basics to the study of diseases, cram dangerous symptoms and immediately find them in themselves. Approximately the same effect occurs when a person feels unwell and opens medical encyclopedia or enters symptoms into the Google search bar: there are many diseases that even a healthy person can easily detect. There are quite a few nonspecific symptoms that appear in completely different diseases: weakness, dizziness, fever, drowsiness, and so on. Finding a couple of such signs in yourself is a simple task, especially if you have trouble sleeping for a couple of nights or forget to eat lunch for a week.
The same mechanism works when a disease becomes the subject of close attention of doctors and scientists: for example, they discover a new treatment method or identify a separate diagnosis, or create a program to support patients. Information about the disease, its symptoms, risk factors appears in the information space, people learn about it and massively discover signs of the disease in themselves. This is also helped by opinion leaders, the same stars who talk about their illnesses or support charities: Against the backdrop of general interest, it is easier to collect donations. For example, a few years ago, autism spectrum disorders and the “mysterious” Asperger’s syndrome were very “popular.” After the release of the series about Sherlock, “sociopaths” appeared en masse, and at the same time, guides on how to communicate with them.
