Infectious diseases. Rabies, Botulism, Brucellosis, Typhoid fever, Chicken pox, Viral hepatitis, Hemorrhagic fevers, Influenza, Dysentery

In the course of an infectious disease, successively changing periods are distinguished: latent (incubation), onset of the disease (prodromal); active manifestation of the disease; recovery.
The first period is the time from the moment the microbe enters the body until the first signs of the disease appear (latent period). The duration of this period is different - from several hours to several weeks and even months. During this period, not only the reproduction of microbes takes place in the body, but also the restructuring of defense mechanisms.
After the first (hidden, incubation) period, the second one develops - prodromal, in which the first symptoms of the disease are detected. More often during this period there is still no specific manifestation of a particular infectious disease.
The third period is called the period of active manifestations of the disease, in which the characteristic symptoms of this infectious disease are fully manifested. In this period, one can distinguish the initial stage, the height of the disease and the subsidence of all pathological manifestations.
The fourth period - recovery - is characterized by the restoration of normal functions in the body.
Table 13
The duration of the incubation period of infectious diseases

More on the topic COURSE OF INFECTIOUS DISEASES:

1. PREVENTION AND VACCINATION (REDUCING THE PREVALENCE OF INFECTIOUS DISEASES INCLUDING HIV)

Each acute infectious disease proceeds cyclically with a change of periods.

I - incubation, or incubation period.

II - prodromal period (stage of precursors).

III - the period of peak, or development, of the disease.

IV - the period of convalescence (recovery).

The incubation period is the time from the moment the infection enters the body until the first symptoms of the disease appear. The duration of this period varies widely - from several hours (influenza, botulism) to several months (rabies, viral hepatitis B) and even years (with slow infections). For many infectious diseases, the average incubation period is 1–3 weeks. The duration of this stage depends on a number of factors. First of all, on the virulence and the number of pathogens that have entered the body. The greater the virulence and the number of pathogens, the shorter the incubation period. Also important is the state of the human body, its immunity, protection factors and susceptibility to this infectious disease. During the incubation period, bacteria multiply intensively in the tropic organ. There are no symptoms of the disease yet, but the pathogen is already circulating in the bloodstream, characteristic metabolic and immunological disorders are observed.

Prodromal period - the appearance of the first clinical symptoms and signs of an infectious disease (fever, general weakness, malaise, headache, chilling, weakness). Children during this period do not sleep well, refuse to eat, are lethargic, do not want to play, participate in games. All of these symptoms are found in many diseases. Therefore, it is extremely difficult to make a diagnosis in the prodromal period. There may also be manifestations uncharacteristic of this infection, for example, an unstable stool with viral hepatitis, influenza, a measles-like rash with chicken pox. Symptoms of the precursor period develop in response to the circulation of toxins in the blood as the first non-specific reaction of the body to the introduction of the pathogen. The intensity and duration of the prodromal period depend on the causative agent of the disease, on the severity of clinical symptoms, and on the rate of development of inflammatory processes. Most often, this period lasts for 1-4 days, but can be reduced to several hours or increased to 5-10 days. It may be absent altogether in hypertoxic forms of infectious diseases.

Height period. The maximum severity of general (non-specific) signs and the appearance of symptoms typical of this disease (icteric staining of the skin, mucous membranes and sclera, skin rashes, instability of the stool and tenesmus, etc.), which develop in a certain sequence, are characteristic. The period of development of the disease also has a different duration - from several days (influenza, measles) to several weeks (typhoid fever, brucellosis, viral hepatitis). Sometimes during the peak period, three phases can be distinguished: rise, peak and extinction. In the growth phase, the restructuring of the immune response to infection continues, which is expressed in the production of specific antibodies to this pathogen. Then they begin to freely circulate in the blood of a sick person - the end of the stage of peak and the beginning of the extinction of the process.

The period of convalescence (recovery) is the gradual extinction of all signs of the manifestation of the disease, the restoration of the structure and functions of the affected organs and systems. After the disease, there may be residual effects (the so-called post-infectious asthenia), expressed in weakness, fatigue, sweating, headache, dizziness and other symptoms. In children during the period of convalescence, a special sensitivity to both reinfection and superinfection is formed, which leads to various complications.

Symptoms and course. The incubation period lasts from 15 to 55 days, but can sometimes be delayed up to six months or more.

The disease has three periods.
1. Prodromal (the period of precursors) - lasts 1-3 days. Accompanied by an increase in temperature to 37.2-37.3 ° C, depression, poor sleep, insomnia, anxiety of the patient. Pain at the bite site is felt, even if the wound has healed.
2. Stage of excitation - lasts from 4 to 7 days. It is expressed in a sharply increased sensitivity to the slightest irritation of the sense organs: bright light, various sounds, noise cause cramps in the muscles of the limbs. Patients become aggressive, violent, hallucinations, delirium, a sense of fear appear,
3. Stage of paralysis: eye muscles, lower extremities; severe paralytic respiratory disorders cause death. The total duration of the disease is 5-8 days, occasionally 10-12 days.

Recognition. Of great importance is the presence of a bite or contact with the saliva of rabid animals on damaged skin. One of the most important signs of a human disease is rabies with spasms of the pharyngeal muscles only at the sight of water and food, which makes it impossible to drink even a glass of water. No less indicative symptom of aerophobia - muscle cramps that occur at the slightest movement of air. Increased salivation is also characteristic, in some patients a slushy stream of saliva constantly flows from the corner of the mouth.

Laboratory confirmation of the diagnosis is usually not required, but it is possible, including using the recently developed method for detecting the rabies virus antigen in prints from the surface of the eye.

Treatment. There are no effective methods, which makes it problematic in most cases to save the patient's life. We have to limit ourselves to purely symptomatic means to alleviate the painful condition. Motor excitation is removed with sedatives (sedatives), convulsions are eliminated with curare-like drugs. Respiratory disorders are compensated by tracheotomy and connecting the patient to an artificial respiration apparatus.

Prevention. The fight against rabies among dogs, the destruction of stray. People bitten by animals known to be sick or suspicious of rabies should immediately wash the wound with warm boiled water (with or without soap), then treat it with 70% alcohol or iodine alcohol tincture, and contact a medical facility as soon as possible to get vaccinated. It consists in the introduction of anti-rabies serum or anti-rabies immunoglobulin deep into the wound and into the soft tissues around it. You need to know that vaccinations are effective only if they are made no later than 14 days from the moment of a bite or saliva by a rabid animal and were carried out according to strictly established rules with a highly immune vaccine.

Usually, the toxin accumulates in products such as canned food, salted fish, sausage, ham, mushrooms, cooked in violation of technology, especially at home.
The formation of botulinum toxin is impossible at a temperature of storage of food and canned food below +18 gr. Celsius.

Symptoms and course. The incubation period lasts from 2-3 hours to 1-2 days. The initial signs are general weakness, a slight headache. Vomiting and diarrhea are not always, more often - persistent constipation, not amenable to the action of enemas and laxatives. With botulism, the nervous system is affected (visual impairment, swallowing, voice change). The patient sees all objects as if in a fog, double vision appears, the pupils are dilated, and one is wider than the other. Often there is strabismus, ptosis - drooping of the upper eyelid of one of the eyes. Sometimes there is a lack of accommodation - the reaction of the pupils to light. The patient experiences dryness in the mouth, his voice is weak, his speech is slurred.

Body temperature is normal or slightly elevated (37.2-37.3°C), consciousness is preserved. With increased intoxication associated with the germination of spores in the patient's intestines, eye symptoms increase, swallowing disorders occur (paralysis of the soft palate). The heart sounds become muffled, the pulse, initially slow, begins to accelerate, blood pressure drops. Death can occur with symptoms of respiratory paralysis.

Recognition. It is carried out on the basis of anamnesis - the relationship of the disease with the use of a certain food product and the development of similar phenomena in persons who used the same product. In the early stages of the disease, it is necessary to distinguish between botulism and poisoning with poisonous mushrooms, methyl alcohol, atropine. A differential diagnosis should be made with the bulbar form of poliomyelitis - according to eye symptoms and temperature data (poliomyelitis gives a significant increase in temperature). The diagnosis is confirmed by the detection of exotoxins in the blood and urine.

Treatment. First aid - saline laxative (for example, magnesia sulfate), peach or other vegetable oil to bind toxins, gastric lavage with warm 5% sodium bicarbonate solution (baking soda). And most importantly - the urgent introduction of anti-botulinum serum. Therefore, all patients are subject to immediate hospitalization. In cases where a biological test can determine the type of bacterial toxin, a special monoreceptor antitoxic serum is used, the action of which is directed against one specific type of exotoxin (eg type A or E). If this cannot be established, a polyvalent one is used - a mixture of sera A, B and E.

Careful patient care is required, according to indications, respiratory equipment is used, and measures are taken to maintain the physiological functions of the body. In case of swallowing disorders, artificial nutrition is carried out through a probe or nutritional enemas. Of the medications, chloramphenicol has an auxiliary effect (0.5 g 4-5 times a day for 5-6 days, as well as adenosine triphosphoric acid (intramuscularly 1 ml of 1% solution once a day) in the first 5 days of treatment. monitor the regularity of the chair.

Prevention. Strict sanitary supervision of the food industry (catching fish - its drying, smoking, canning, slaughtering and meat processing).

Compliance with sanitary and hygienic requirements is also mandatory for home canning. Remember that the spores of the anaerobic microbe botulism live in the soil, but multiply and release poison in conditions where there is no oxygen. The danger is represented by canned mushrooms that are not sufficiently cleaned from the ground, where 1 spores can be stored, canned meat and fish from swollen cans. Products with signs of their poor quality are strictly prohibited: they have the smell of spicy cheese or rancid butter.

Symptoms and course. The incubation period is about 14 days. The body reacts to the infection with an increase in a number of lymph glands, liver and spleen. In its course, brucellosis can be acute (lasts 2 months), subacute (from 2 to 4-5 months) and chronic, including those with relapses and generalization of infection (bacteremia) - lasts up to 2 years, sometimes longer.

The onset of the disease is manifested by general malaise, loss of appetite, poor sleep. Patients complain of pain in the joints, lower back, muscles. Body temperature gradually (3-7 days) rises to 39°C, further undulating. Sweat is profuse, moisture of the skin, especially of the palms, is observed even when the temperature drops to normal.

After 20-30 days from the onset of the disease, the patients feel worse, they have increased pain, mainly in large joints - the knee, then the hip, ankle, shoulder, less often the elbow. The size and shape of the joint changes, its outlines are smoothed out, the soft tissues surrounding it become inflamed and swell. The skin around the joint is glossy, may acquire a pink tint, sometimes roseolo-popular rashes of a different nature are noted.

In the future, without appropriate treatment, numerous disorders in the musculoskeletal system (joints, bones, muscles) progress, which is caused by the spread of infection (bacteremia). Pathological symptoms from the nervous system increase, patients become irritable, capricious, even tearful. They suffer from neuralgic pain, sciatica, sciatica. Some have genital lesions. In men, brucellosis can be complicated by orchitis, epididymitis. In women, adnexitis, endometritis, mastitis, spontaneous miscarriages are possible. On the part of the blood - anemia, leukopenia with lymphocytosis, monocytosis, increased ESR.

Recognition. A carefully collected history helps, taking into account the epizootic situation and the specific circumstances of infection, laboratory tests (peripheral blood picture, serological and allergic reactions). Special bacteriological studies confirm the diagnosis. The disease must be distinguished from typhoid fever, sepsis, infectious mononucleosis, and rheumatic fever. In all cases, it is necessary to keep in mind the complications typical of brucellosis, for example, orchitis.

Treatment. The most effective means are antibiotics. Tetracycline 1 inside 4-5 times a day, 0.3 g with night breaks for adults. The course of treatment at these doses is up to 2 days of normalization of temperature. Then the dose is reduced to 0.3 g 3 times a day for 10-12 days. Given the duration of the course of treatment with tetracycline, as a result of which allergic reactions can occur, a number of side effects and even complications caused by the activation of Candida yeast-like fungi, antifungal agents (nystatin), desensitizing drugs (diphenhydramine, suprastip), vitamins are prescribed at the same time. Patients are prescribed a transfusion of single-group blood or plasma. Vaccine therapy is carried out, which stimulates the body's immunity to the pathogen and helps to overcome the infection. The course consists of 8 intravenous injections of a therapeutic vaccine with a 3-4 day interval. Before starting the course, the degree of sensitivity of the patient to the vaccine is tested, observing for 6 hours the reaction to the first test injection, which should be moderately pronounced; in case of a shock reaction, vaccine therapy should not be carried out.

In the stage of attenuation of acute inflammatory phenomena, physiotherapy exercises are prescribed, applications on the joints of paraffin in a warm form. With persistent remission - resort treatment, taking into account the existing contraindications.

Prevention. Combines a number of veterinary and health care activities.

In farms, animals with brucellosis must be isolated. Their slaughter with subsequent processing of meat for canned food should be accompanied by autoclaving. Meat can also be eaten after it has been boiled in small pieces for 3 hours or salted and kept in brine for at least 70 days. Milk from cows and goats in areas where there are cases of diseases of large and small livestock can only be consumed after boiling. All dairy products (yogurt, cottage cheese, kefir, cream, butter) should be prepared from pasteurized milk. Cheese made from sheep's milk is aged for 70 days.

To prevent occupational infections when caring for sick animals, all precautions must be observed (wear rubber boots, gloves, special gowns, aprons). The aborted fetus of an animal is buried in a pit to a depth of 2 m, covered with lime, and the room is disinfected. In the fight against the spread of brucellosis, vaccination among animals with special vaccines plays an important role. Human immunization is of limited importance among other preventive measures.

The only source of infection is a sick person and a carrier. Typhoid fever sticks are carried directly by dirty hands, flies, sewage. Dangerous outbreaks associated with the use of infected foods (milk, cold meat dishes, etc.).

Symptoms and course. The incubation period lasts from 1 to 3 weeks. In typical cases, the onset of the disease is gradual. Patients report weakness, fatigue, moderate headache. In the following days, these phenomena intensify, body temperature begins to rise to 39-40 ° C, appetite decreases or disappears, sleep is disturbed (drowsiness during the day and insomnia at night). There is a delay in stool, the phenomenon of flatulence. By the 7-9th day of illness, a characteristic rash appears on the skin of the upper abdomen and lower chest, usually on the anterolateral surface, which is small red spots with clear edges, 23 mm in diameter, rising above the level of the skin (roseola). Fading roseolas may be replaced by new ones. A peculiar lethargy of patients, pallor of the face, slowing of the pulse and a decrease in blood pressure are characteristic. Dispersed dry rales are auscultated over the lungs - a manifestation of specific bronchitis. The tongue is dry, cracked, covered with a dirty-brown or brown coating, the edges and tip of the tongue are free from plaque, with imprints of teeth. There is a rough rumbling of the caecum and pain in the right iliac region, the liver and spleen are enlarged on palpation. The number of leukocytes in the peripheral blood, especially neutrophils and eosinophils, decreases.

ESR remains normal or rises to 15-20 mm/h. By the 4th week, the condition of the patients gradually improves, the body temperature drops, the headache disappears, and appetite appears. Terrible complications of typhoid fever are intestinal perforation and intestinal bleeding.

In recognition disease, timely detection of the main symptoms is of great importance: high body temperature lasting more than a week, headache, adynamia - decreased motor activity, loss of strength, sleep disturbance, appetite, characteristic rash, sensitivity to palpation in the right iliac region of the abdomen, enlarged liver and spleen. From laboratory tests, to clarify the diagnosis, bacteriological (immunofluorescent method) blood cultures on Rappoport's medium or bile broth are used; serological studies - Vidal reaction, etc.

Treatment. The main antimicrobial drug is chloramphenicol. Assign 0.50.75 g, 4 times a day for 10-12 days to normal temperature. 5% glucose solution, isotonic sodium chloride solution (500-1000 mg) are injected intravenously. In severe cases - corticosteroids (prednisolone at a dose of 30-40 ml per day). Freemen must observe strict bed rest for a minimum of 7-10 days.

Prevention. Sanitary supervision of food enterprises, water supply, sewerage. Early detection of patients and their isolation. Disinfection of the premises, linen, dishes that boil after use, fight against flies. Dispensary observation of patients with typhoid fever. Specific vaccination with a vaccine (TAVTe).

Symptoms and course. The incubation period lasts an average of 13-17 days. The disease begins with a rapid rise in temperature and the appearance of a rash in various parts of the body. At the beginning, these are pink spots 2-4 mm in size, which turn into papules within a few hours, then into vesicles - vesicles filled with transparent contents and surrounded by a halo of hyperemia. In place of bursting vesicles, dark red and brown crusts form, which fall off in 2-3 weeks. The polymorphism of the rash is characteristic: on a separate area of ​​​​the skin, spots, vesicles, papules and crusts can be found simultaneously. Enanthems appear on the mucous membranes of the respiratory tract (pharynx, larynx, trachea). These are bubbles that quickly turn into a sore with a yellowish-gray bottom, surrounded by a red rim. The duration of the febrile period is 2-5 days. The course of the disease is benign, but severe forms and complications can occur: encephalitis, myocarditis, pneumonia, false croup, various forms of pyoderma, etc.

Recognition is made on the basis of the typical cyclical development of the elements of the rash. Laboratory tests can detect the virus using a light microscope or immunofluorescent method.

Treatment. There is no specific and etiotropic treatment. It is recommended to observe bed rest, monitor the cleanliness of linen and hands. Lubricate the elements of the rash with 5% potassium permanganate solution or 1% brilliant green solution. In severe forms, immunoglobulin is administered. With purulent complications (abscesses, bullous streptoderma, etc.), antibiotics (penicillin, tetracycline, etc.) are prescribed.

Prevention. Isolation of the patient at home. Toddler and preschool children who have been in contact with the patient are not allowed in childcare facilities until 21 days. Weakened children who have not had chicken pox are given immunoglobulin (3 ml intramuscularly).

With viral hepatitis A, the source of infection is patients at the end of the incubation and preicteric period, since at this time the pathogen is excreted in the feces and transmitted through food, water, household items if hygiene rules are not followed, contact with the patient.

With viral hepatitis B, the source of infection is patients in the acute stage, as well as carriers of the hepatitis B antigen. The main route of infection is parenteral (through the blood) using non-sterile syringes, needles, dental, surgical, gynecological and other instruments. Infection is possible through transfusion of blood and its derivatives.

Symptoms and course. The incubation period for viral hepatitis A ranges from 7 to 50 days, for viral hepatitis B - from 50 to 180 days.

The disease proceeds cyclically and is characterized by the presence of periods
- preicteric,
- icteric,
- post-icteric, passing into the recovery period.

The preicteric period of viral hepatitis A in half of the patients proceeds in the form of a flu-like variant, characterized by an increase in body temperature to 38-39 ° C, chills, headache, aching pain in the joints and muscles, sore throat, etc. In the dyspeptic variant, pain and heaviness in the epigastric region, loss of appetite, nausea, vomiting, and sometimes frequent stools come to the fore. With the asthenovegetative variant, the temperature remains normal, weakness, headache, irritability, dizziness, impaired performance and sleep are noted. For the preicteric period of viral hepatitis B, the most characteristic are aching pains in large joints, bones, muscles, especially at night, sometimes swelling of the joints and redness of the skin. At the end of the preicteric period, the urine becomes dark, and the feces become discolored. The clinical picture of the icteric period of viral hepatitis A and viral hepatitis B is very similar: icterus of the sclera, mucous membranes of the oropharynx, and then the skin. The intensity of jaundice (icterus) increases throughout the week. Body temperature is normal. Weakness, drowsiness, loss of appetite, aching pain in the right hypochondrium, some patients have skin itching. The liver is enlarged, compacted and somewhat painful on palpation, there is an increase in the spleen. Leukopenia, neutropenia, relative lymphocytosis and monocytosis are found in the peripheral blood. ESR 2-4 mm/h. In the blood, the content of total bilirubin is increased, mainly due to direct (bound). The duration of the icteric period of viral hepatitis A is 7-15 days, and that of viral hepatitis B is about a month.

A formidable complication is an increase in liver failure, manifested by impaired memory, increased general weakness, dizziness, agitation, increased vomiting, increased intensity of icteric coloration of the skin, a decrease in the size of the liver, the appearance of hemorrhagic syndrome (bleeding of blood vessels), ascites, fever, neutrophilic leukocytosis, an increase in the content of total bilirubin and other indicators. A common end result of liver failure is the development of hepatic encephalopathy. With a favorable course of the disease, after jaundice, a period of recovery begins with the rapid disappearance of clinical and biochemical manifestations of hepatitis.

Recognition. Based on clinical and epidemiological data. The diagnosis of viral hepatitis A is established taking into account the stay in the infectious focus 15-40 days before the disease, a short pre-icteric period, more often according to the influenza-like variant, the rapid development of jaundice, a short icteric period. The diagnosis of viral hepatitis B is established if at least 1.5-2 months before the onset of jaundice, the patient received blood, plasma transfusions, there were surgical interventions, numerous injections. Laboratory tests confirm the diagnosis.

Treatment. There is no etiotropic therapy. The basis of treatment is the regimen and proper nutrition. The diet should be complete and high-calorie, fried foods, smoked meats, pork, lamb, chocolate, spices are excluded from the diet, alcohol is absolutely prohibited. It is recommended to drink plenty of water up to 2-3 liters per day, as well as a complex of vitamins.

In severe cases, intensive infusion therapy is carried out (intravenous 5% glucose solution, gemodez, etc.). Corticosteroids are indicated if there is a threat or development of liver failure.

Prevention. Given the fecal-oral mechanism of transmission of viral hepatitis A, it is necessary to control nutrition, water supply, and personal hygiene. For the prevention of viral hepatitis B, careful monitoring of donors, high-quality sterilization of needles and other instruments for parenteral procedures.

3 types of the disease have been described:
1) hemorrhagic fever with renal syndrome (hemorrhagic nephrosonephritis);
2) Crimean hemorrhagic fever;
3) Omsk hemorrhagic fever.

Hemorrhagic fever with renal syndrome. The incubation period is 13-15 days. The disease usually begins acutely: severe headache, insomnia, pain in the muscles and eyes, sometimes blurred vision. The temperature rises to 39-40°C and lasts for 7-9 days. The patient is initially agitated, then lethargic, apathetic, sometimes delusional. The face, neck, upper chest and back are brightly hyperemic, there is reddening of the mucous membranes and vasodilatation of the sclera. By the 3rd-4th day of illness, the condition worsens, intoxication increases, repeated vomiting is observed. On the skin of the shoulder girdle and in the armpits, a hemorrhagic rash appears in the form of single or multiple small hemorrhages. These phenomena increase every day, bleeding is noted, most often nasal. The borders of the heart do not change, the tones are muffled, sometimes there is an arrhythmia and, less often, there is a sudden pericardial rub (hemorrhage). Blood pressure remains normal or decreases. Shortness of breath, congestion in the lungs. The tongue is dry, thickened, densely coated with a gray-brown coating. The abdomen is painful (retroperitoneal hemorrhages), the liver and spleen increase inconstantly. Renal syndrome is especially typical: sharp pains in the abdomen and lower back when tapping. Decrease in the amount of urine or its complete absence. Urine becomes cloudy due to the presence of blood and high protein content. In the future, recovery gradually occurs: pain subsides, vomiting stops, diuresis increases - the volume of urine excreted. For a long time there is weakness, instability of the cardiovascular system.

Crimean hemorrhagic fever. Body temperature in 1 day reaches 39-40 ° C and lasts an average of 7-9 days. The patient is agitated, the skin of the face and neck is red. Sharp reddening of the conjunctiva of the eyes. The pulse is slowed down, blood pressure is lowered. Respiration is speeded up, in the lungs there are often dry scattered rales. The tongue is dry, covered with a thick gray-brown coating, urination is free. In the absence of complications after a decrease in body temperature, a gradual recovery occurs.

Omsk hemorrhagic fever according to the clinical picture, it resembles the Crimean one, but is more benign, with a short incubation period (2-4 days). Features are the undulating nature of the temperature curve and frequent damage to the respiratory system.

Recognition hemorrhagic fevers is based on a characteristic clinical symptom complex, blood and urine tests, taking into account epidemiological data.

Treatment. Bed rest, careful patient care, a dairy-vegetarian diet. Pathogenetic means of therapy are corticosteroid drugs. To reduce toxicosis, intravenous solutions of sodium chloride or glucose (5%) are administered up to 1 liter. In acute renal failure, peritoneal dialysis is performed.

Prevention. Food storage areas are protected from rodents. Repellents are used. Patients are isolated and hospitalized, an epidemiological survey of the focus of infection and monitoring of the population are carried out. In the premises where the patients are located, current and final disinfection is carried out.

Symptoms and course. The incubation period lasts 12-48 hours. The typical flu has an acute onset, often with chills or chills. Body temperature in 1 day reaches a maximum (38-40°C). Clinical manifestations consist of a syndrome of general toxicosis (fever, weakness, sweating, muscle pain, severe headache and eyeballs, lacrimation, photophobia) and signs of damage to the respiratory organs (dry cough, sore throat, rawness behind the sternum, hoarse voice, nasal congestion). During the examination, a decrease in blood pressure, muffled heart sounds are noted. Diffuse lesions of the upper respiratory tract (rhinitis, pharyngitis, tracheitis, larepgit) are detected. Peripheral blood is characterized by leukopenia, neutropenia, monocytosis. ESR in uncomplicated cases is not increased. Frequent complications of influenza are pneumonia, frontal sinusitis, sinusitis, otitis media, etc.

Recognition during influenza epidemics is not difficult and is based on clinical and epidemiological data. During inter-epidemic times, influenza is rare and the diagnosis can be made using laboratory methods - the detection of the pathogen in the mucus of the throat and nose using fluorescent antibodies. Serological methods are used for retrospective diagnosis.

Treatment. Patients with uncomplicated influenza are treated at home, placed in a separate room or isolated from others with a screen. During the febrile period - bed rest and heat (hot water bottles to the legs, plenty of hot drinks). Prescribe multivitamins. Pathogenetic and symptomatic drugs are widely used: antihistamines (pipolfen, suprastin, diphenhydramine), with a runny nose, a 2-5% solution of ephedrine, naphthyzine, galazolin, sanorip, 0.25% oxolinic ointment, etc. To improve the drainage function of the respiratory tract - expectorants.

Prevention. Vaccination is used. Can be used for the prevention of influenza A rimantadine or amaptadine 0.1-0.2 g / day. The sick are allocated separate dishes, which are disinfected with boiling water. Caregivers are advised to wear a gauze bandage (of 4 layers of gauze).

Symptoms and course. The incubation period lasts from 1 to 7 days (usually 2-3 days). The disease begins acutely with an increase in body temperature, chills, feelings of heat, fatigue, loss of appetite. Then there are pains in the abdomen, at first dull, spilled over the entire abdomen, later they become more acute, cramping. By location - the lower abdomen, more often on the left, less often on the right. The pain usually gets worse before a bowel movement. There are also peculiar tenesmus (drawing pains in the rectum during defecation and within 5-15 minutes after it), false urges to the bottom appear. On palpation of the abdomen, spasm and soreness of the colon are noted, more pronounced in the region of the sigmoid colon, which is palpated in the form of a thick tourniquet. The stool is speeded up, the stools are initially fecal in nature, then an admixture of mucus and blood appears in them, and then only a small amount of mucus with streaks of blood is released. The duration of the disease ranges from 1-2 to 8-9 days.

Recognition. Produced on the basis of epidemiological history data, clinical manifestations: general intoxication, frequent stools mixed with blood mucus and accompanied by tenesmus, cramping pain in the abdomen (left iliac region). Of great importance is the method of sigmoidoscopy, which reveals signs of inflammation of the mucous membrane of the distal colon. Isolation of dysenteric microbes during bacteriological examination of feces is an unconditional confirmation of the diagnosis.

Treatment. Patients with dysentery can be treated both in an infectious disease hospital and at home. Of the antibiotics, tetracycline (0.2-0.3 g 4 times a day) or chloramphenicol (0.5 g 4 times a day for 6 days) have recently been used. However, the resistance of microbes to them has increased significantly, and the effectiveness has decreased. Nitrofuran preparations (furazolidone, furadonin, etc.) are also used, 0.1 g 4 times a day for 5-7 days. A complex of vitamins is shown. In severe forms, detoxification therapy is carried out.

Prevention. Early detection and treatment of patients, sanitary control of water supply sources, food enterprises, measures to combat flies, personal hygiene.

Symptoms and course. According to the location, diphtheria of the pharynx, larynx, nose is distinguished, rarely - the eyes, ear, skin, genitals, wounds. At the site of the localization of the microbe, a hard-to-remove grayish-white plaque in the form of films is formed, which is coughed up (with damage to the larynx and bronchi) as a cast from the organs. The incubation period is 2-10 days (usually 3-5). Currently, pharyngeal diphtheria predominates (98%). Catarrhal diphtheria of the pharynx is not always recognized: the general condition of patients with it almost does not change. There is moderate weakness, pain when swallowing, subfebrile body temperature. Swelling of the tonsils and swollen lymph nodes are minor. This form may end in recovery or go into more typical forms.

The island type of diphtheria of the pharynx is also characterized by a mild course, a slight fever. There are single or multiple areas of fibrinous films on the tonsils. Lymph nodes are moderately enlarged.

For membranous diphtheria of the pharynx, a relatively acute onset, an increase in body temperature, and more pronounced symptoms of general intoxication are characteristic. The tonsils are edematous, on their surface there are solid dense whitish films with a pearly tint - fibrinous deposits. They are removed with difficulty, after which bleeding erosions remain on the surface of the tonsils. Regional lymph nodes are enlarged and somewhat tender. Without specific therapy, the process can progress and become more severe forms (common and toxic). At the same time, plaque has a tendency to spread beyond the tonsils to the arches, tongue, side and rear walls of the pharynx.

Severe toxic cases of throat diphtheria begin rapidly with an increase in body temperature to 39-40 ° C and severe symptoms of general intoxication. The cervical submandibular glands swell with swelling of the subcutaneous tissue. With toxic diphtheria, 1 stenosis and swelling reaches the middle of the neck, with II degree - up to the collarbone, with III - below the collarbone. Sometimes the swelling spreads to the face. Characterized by pale skin, blue lips, tachycardia, lowering blood pressure.

With the defeat of the nasal mucosa, bloody discharge is noted. In severe lesions of the larynx - shortness of breath, in young children in the form of stenotic breathing with stretching of the epigastric region and intercostal spaces. The voice becomes hoarse (aphonia), a barking cough appears (a picture of diphtheria croup). With diphtheria of the eyes, swelling of the eyelids of a more or less dense consistency, copious discharge of pus on the conjunctiva of the eyelids, and greyish-yellow plaques that are difficult to separate are noted. With diphtheria of the entrance to the vagina - swelling, redness, ulcers covered with a dirty greenish coating, purulent discharge.

Complications: myocarditis, damage to the nervous system, usually manifested in the form of paralysis. Paralysis of the soft palate, limbs, vocal cords, neck and respiratory muscles are more common. A fatal outcome may occur due to respiratory paralysis, asphyxia (suffocation) with croup.

Recognition. To confirm the diagnosis, it is necessary to isolate a toxigenic diphtheria bacillus from a patient.

Treatment. The main method of specific therapy is the immediate administration of antitoxic antidiphtheria serum, which is administered fractionally. For toxic diphtheria and croup, corticosteroids are administered. Detoxification therapy, vitamin therapy, oxygen treatment are carried out. Sometimes croup requires urgent surgery (intubation or tracheotomy) to avoid death from asphyxia.

Prevention. The basis of prevention is immunization. Use adsorbed pertussis-diphtheria-tetanus vaccine (DPT) and DTP.

Symptoms and course. Extremely varied. Signs of damage to various organs and systems are revealed in one sequence or another. Most often, yersiniosis begins with acute gastroenteritis. In the future, the disease can proceed either as an acute intestinal infection or generalized - i.e. distributed throughout the body. All forms are characterized by common signs: acute onset, fever, intoxication, abdominal pain, upset stool, rash, joint pain, liver enlargement, a tendency to exacerbations and relapses. Taking into account the duration, acute (up to 3 months), protracted (from 3 to 6 months) and chronic (more than 6 months) course of the disease are distinguished.

The incubation period is 1-2 days, can reach 10 days. The most constantly manifested symptoms of intestinal damage in the form of gastroenteritis, gastroenterocolitis, mesenteric lymphadenitis, enterocolitis, terminal ileitis, acute appendicitis. Pain in the abdomen of a constant or cramping nature, of various localization, nausea, vomiting, loose stools with mucus and pus, sometimes with blood from 2 to 15 times a day. Symptoms of general intoxication are manifested in the following: high temperature, in severe cases - toxicosis, dehydration and a decrease in body temperature. At the onset of the disease, a punctate or small-spotted rash on the trunk and limbs, liver damage, and meningeal syndrome may appear. In a later period - mono or polyarthritis, erythema nodosum, myocarditis, conjunctivitis, iritis. These manifestations are regarded as an allergic reaction. In the peripheral blood, neutrophilic leukocytosis and elevated ESR are observed. The disease lasts from a week to several months.

Recognition. Bacteriological examination of feces, serological reactions in paired sera.

Treatment. In the absence of concomitant diseases, in cases of mild and erased course of yersiniosis, patients can be treated at home by an infectious disease doctor. It is based on pathogenetic and etiotropic therapy aimed at detoxification, restoration of water and electrolyte losses, normal blood composition, suppression of the pathogen. Medications - chloramphenicol at the rate of 2.0 g per day for 12 days, from other drugs - tetracycline, gentamicin, rondomycin, doxycyclip and others in the usual daily dosages.

Prevention. Compliance with sanitary rules at catering establishments, cooking technology and shelf life of food products (vegetables, fruits, etc.). Timely detection of patients and carriers of yersiniosis, disinfection of premises.

Symptoms and course. The duration of the incubation period is 5-20 days. Signs are formed gradually, reaching a maximum by the end of the first, beginning of the second week. There is a slight malaise in the first 2-3 days of illness, accompanied by a slight increase in temperature and mild changes in the lymph nodes and pharynx. At the height of the disease, fever, inflammation in the pharynx, enlargement of the spleen, liver and posterior lymph nodes are observed.

The duration of the temperature reaction is from 1-2 days to 3 weeks - the longer the period, the higher the rise in temperature. Characterized by temperature fluctuations during the day at 1-2°C. The enlargement of the lymph nodes is most distinct and constant in the cervical group, along the posterior edge of the sternocleidomastoid muscle. They may be in the form of a chain or a package. In diameter, individual nodes reach 2-3 cm. There is no swelling of the cervical tissue. The nodes are not soldered to each other, they are mobile.

Nasopharyngitis can be manifested as a sharp difficulty in breathing and copious mucous discharge, as well as mild nasal congestion, perspiration and mucous discharge on the back of the throat. "Spear-shaped" plaque, hanging from the nasopharynx, is usually combined with massive overlays on the tonsils, loose-curdled consistency of white-yellow color. All patients have hepato-lienal syndrome (damage to the liver and spleen). Often the disease can occur with jaundice. Various rashes on the skin are possible: the rash is different and persists for several days. In some cases, conjunctivitis and lesions of the mucous membranes may prevail over the rest of the symptoms.

Recognition. It is possible only with a comprehensive accounting of clinical and laboratory data. Usually, an increase in lymphocytes (at least 15% compared with the age norm) and the appearance of "atypical" mononuclear cells in the blood are noted in the blood formula. Conduct serological studies to identify heterophile antibodies to erythrocytes of various animals.

Treatment. There is no specific therapy, therefore, symptomatic therapy is used in practice. In the period of fever - antipyretic drugs and plenty of fluids. With difficulty in nasal breathing - vasoconstrictor drugs (ephedrine, galazolin, etc.). Apply desensitizing drugs. It is recommended to gargle with warm solutions of furacilin, sodium bicarbonate. Nutrition of patients with a successful course does not require special restrictions. Prevention has not been developed.

Symptoms and course. The incubation period lasts 2-14 days (usually 5-7 days). The catarrhal period is manifested by general malaise, slight cough, runny nose, subfebrile temperature.

Gradually, the cough intensifies, the children become irritable, capricious. At the end of 2 weeks of illness, a period of spasmodic cough begins. The attack is accompanied by a series of coughing shocks, followed by a deep whistling breath (reprise), followed by a series of short convulsive shocks. The number of such cycles ranges from 2 to 15. The attack is pumped up by the release of viscous vitreous sputum, sometimes vomiting is noted at the end of it. During an attack, the child is excited, the veins of the neck are dilated, the tongue protrudes from the mouth, the frenulum of the tongue is often injured, respiratory arrest may occur, followed by asphyxia.

The number of attacks is from 5 to 50 per day. The period of convulsive cough lasts 34 weeks, then the attacks become less frequent and finally disappear, although the "normal cough" continues for 2-3 weeks.

In adults, the disease proceeds without bouts of convulsive coughing, manifested by prolonged bronchitis with a persistent cough.

Body temperature remains normal. General health is satisfactory.

Erased forms of whooping cough can be observed in children who have been vaccinated.

Complications: laryngitis with stenosis of the larynx (false croup), bronchitis, bronchitis, bronchopneumonia, lung atelectasis, rarely encephalopathy.

Recognition. It is possible only when analyzing clinical and laboratory data. The main method is the isolation of the pathogen. At 1 week of the disease, positive results can be obtained in 95% of patients, at 4 - only in 50%. Serological methods are used for retrospective diagnosis.

Treatment. Patients under the age of 1 year, as well as with complications, severe forms of whooping cough are hospitalized. The rest can be treated at home. Antibiotics are used at an early age, with severe and complicated forms. It is recommended to use a specific anti-pertussis gamma globulin, which is administered intramuscularly at 3 ml daily for 3 days. During apnea, it is necessary to clear the airways of mucus by suction and to carry out artificial ventilation of the lungs.

Apply antihistamines, oxygen therapy, vitamins, inhalation with aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum. Patients should be more in the fresh air.

Prevention. For active immunization against whooping cough, adsorbed pertussis-diphtheria-tetanus vaccine (DKDS) is used. Contact children under the age of 1 year and not vaccinated are administered normal human immunoglobulin (anti-measles) 3 ml for 2 consecutive days for prophylaxis.

The causative agent belongs to the group of myxoviruses, contains RNA in its structure. The source of infection is a patient with measles during the entire catarrhal period and in the first 5 days from the moment the rash appears.

The virus is contained in microscopically small particles of mucus of the nasopharynx, respiratory tract, which are easily dispersed around the patient, especially when coughing and sneezing. The causative agent is unstable. It easily perishes under the influence of natural environmental factors, when the premises are ventilated. In this regard, the transmission of infection through third parties, care items, clothing and toys is practically not observed. Susceptibility to measles is unusually high among people who have not had it at any age, except for children of the first 6 months. (especially up to 3 months), with passive immunity received from the mother in utero and during breastfeeding. After measles, strong immunity is developed.

Symptoms and course. From the moment of infection to the onset of the disease in typical cases, it takes from 7 to 17 days.

There are three periods in the clinical picture:
- catarrhal,
- rash period
- and the period of pigmentation.

The catarrhal period lasts 5-6 days. Fever, cough, runny nose, conjunctivitis appear, there is redness and swelling of the mucous membrane of the pharynx, the cervical lymph nodes are slightly enlarged, dry rales are heard in the lungs. After 2-3 days, measles enanthema appears in the form of small pink elements on the mucous membrane of the palate. Almost simultaneously with the enanthema on the buccal mucosa, many dotted whitish areas can be detected, which are foci of degeneration, necrosis and keratinization of the epithelium under the influence of the virus. This symptom was first described by Filatov (1895) and the American physician Koplik (1890). Belsky-Filatov-Koplik spots persist until the onset of the rash, then become less and less noticeable, disappear, leaving behind the roughness of the mucous membrane (pityriasis peeling).

During the rash, catarrhal phenomena are much more pronounced, photophobia, lacrimation are noted, runny nose, cough, and bronchitis are intensified. There is a new rise in temperature to 39-40 ° C, the patient's condition worsens significantly, lethargy, drowsiness, refusal to eat, in severe cases, delirium and hallucinations are noted. The first measles maculopapular rash appears on the skin of the face, first on the forehead and behind the ears. The size of individual elements is from 2-3 to 4-5 mm. The rash gradually spreads from top to bottom within 3 days: on the first day it prevails on the skin of the face, on the 2nd day it becomes abundant on the trunk and arms, by the 3rd day it covers the entire body.

Pigmentation period (recovery). By 3-4 days from the onset of the rash, an improvement in the condition is planned. The body temperature normalizes, catarrhal phenomena decrease, the rash fades, leaving pigmentation. By the 5th day from the onset of the rash, all elements of the rash either disappear or are replaced by pigmentation. During recovery, marked asthenia, increased fatigue, irritability, drowsiness, and a decrease in resistance to the effects of bacterial flora are noted.

Treatment. Mostly at home. It is necessary to carry out the toilet of the eyes, nose, lips. Plentiful drink should provide the body's need for fluid. Food - complete, rich in vitamins, easily digestible. Symptomatic therapy includes antitussive, antipyretic, antihistamines. Antibiotics are usually not needed for uncomplicated measles. They are prescribed at the slightest suspicion of a bacterial complication. In severe condition of patients, corticosteroids are used in a short course at a dose of up to 1 mg / kg of body weight.

Prevention. Currently, the main preventive measure is active immunization (vaccination).

The disease occurs in the form of epidemic outbreaks that recur after 7-12 years. In inter-epidemic times, isolated cases are observed. The maximum number of diseases is recorded in April-June. Of particular danger is the disease for pregnant women due to intrauterine infection of the fetus. The rubella virus is released into the environment a week before the onset of the rash and within a week after the rash. Infection occurs by airborne droplets.

Symptoms and course. The incubation period is 11-24 days. The general condition suffers little, so often the first symptom that attracts attention is exanthema, a rash that resembles either measles or scarlet fever. Patients have a slight weakness, malaise, headache, sometimes pain in the muscles and joints. Body temperature often remains subfebrile, although sometimes it reaches 38-39 ° C and lasts 1-3 days. An objective examination revealed mild symptoms of catarrh of the upper respiratory tract, slight reddening of the pharynx, conjunctivitis. From the first days of the disease, generalized lymphadenopathy occurs (i.e., a general lesion of the lymphatic system). The increase and soreness of the posterior cervical and occipital lymph nodes is especially pronounced. Exanthema appears 1-3 days after the onset of the disease, first on the neck, after a few hours it spreads throughout the body, it can be itchy. There is some thickening of the rash on the extensor surface of the limbs, back, buttocks. The elements of the rash are small spots with a diameter of 2-4 mm, usually they do not merge, last 3-5 days and disappear without leaving pigmentation. In 25-30% of cases, rubella occurs without a rash, is characterized by a moderate increase in temperature and lymphadenopathy. The disease can be asymptomatic, manifesting itself only in viremia and an increase in the titer of specific antibodies in the blood.

Complications: arthritis, rubella encephalitis.

Recognition. It is carried out on the basis of a combination of clinical and laboratory data.

Virological methods are not yet widely used. From serological reactions, a neutralization reaction and RTGA are used, which are placed with paired sera taken at intervals of 10-14 days.

Treatment. In uncomplicated rubella therapy is symptomatic. In case of rubella arthritis, hingamin (delagil) is prescribed 0.25 g 2-3 times a day for 5-7 days. Diphenhydramine (0.05 g 2 times a day), butadion (0.15 g 3-4 times a day), symptomatic agents are used. With encephalitis, corticosteroid drugs are indicated.

The prognosis for rubella is favorable, with the exception of rubella encephalitis, in which the mortality rate reaches 50%.

Endemic. The source of infection in the city is sick people and dogs. In rural areas - various rodents (gerbils, hamsters). The disease occurs in some areas of Turkmenistan and Uzbekistan, Transcaucasia, and is common in Africa and Asia. Outbreaks of the disease are common from May to November - this seasonality is associated with the biology of its vectors - mosquitoes. The morbidity is especially high among persons newly arrived in the endemic focus.

There are two main clinical forms of leishmaniasis:
- internal, or visceral,
- and skin.

Internal leishmaniasis. Symptoms and course. The typical finding is a dramatically enlarged spleen, along with an enlarged liver and lymph nodes. The temperature is remitting with two or three rises during the day. The incubation period lasts from 10-20 days to several months. The disease begins gradually - with increasing weakness, intestinal upset (diarrhea). The spleen gradually increases and by the height of the disease reaches a huge size (descends into the small pelvis) and high density. The liver is also enlarged. Various types of rashes appear on the skin, mostly papular. The skin is dry, pale earthy in color. A tendency to bleeding is characteristic, cachexia (weight loss), anemia, and edema gradually develop.

Recognition. An accurate diagnosis can be made only after a puncture of the spleen or bone marrow and the presence of Leishmania in these organs.

Anthropogenic (urban type) cutaneous leishmaniasis: incubation period 3-8 months. Initially, a tubercle with a diameter of 2-3 mm appears at the site of the introduction of the pathogen. Gradually, it increases in size, the skin above it becomes brownish-red, and after 3-6 months. covered with a scaly crust. When it is removed, an ulcer is formed, which has a round shape, a smooth or wrinkled bottom, covered with a purulent coating. An infiltrate is formed around the ulcer, during the decay of which the size of the ulcer gradually increases, its edges are undermined, uneven, and the discharge is insignificant. Gradual scarring of the ulcer ends about a year after the onset of the disease. The number of ulcers is from 1-3 to 10, they are usually located on open areas of the skin accessible to mosquitoes (face, hands).

Zoonotic (rural) cutaneous leishmaniasis. The incubation period is shorter. At the site of the introduction of the pathogen, a cone-shaped tubercle with a diameter of 2-4 mm appears, which grows rapidly and after a few days reaches 1-1.5 cm in diameter, necrosis occurs in its center. After rejection of dead tissue, an ulcer opens, which expands rapidly. Single ulcers are sometimes very extensive, up to 5 cm in diameter or more. With multiple ulcers, and with this type of leishmaniasis, their number can reach several tens and hundreds, the size of each ulcer is small. They have uneven undermined edges, the bottom is covered with necrotic masses and abundant serous-purulent discharge. By the 3rd month, the bottom of the ulcer is cleared, granulations grow. The process ends after 5 months. Often observed lymphangitis, lymphadenitis. Both types of cutaneous leishmaniasis can develop a chronic tuberculoid form resembling lupus.

Diagnosis of cutaneous forms of leishmaniasis established on the basis of a characteristic clinical picture, confirmed by the detection of the pathogen in the material taken from the nodule or infiltrate.

For treatment patients with cutaneous leishmaniasis are prescribed monomycin intramuscularly at 250,000 units. 3 times a day for 10-12 days. Monomycin ointment is applied topically.

Prevention. Fight against mosquitoes - carriers of the pathogen, destruction of infected dogs and rodents. Recently, prophylactic vaccinations with live cultures of Leishmania have been used.

Symptoms and course. The incubation period lasts 14-19 days. The disease begins acutely with chills. Body temperature rises to 38-39°C and lasts 3-5 days. Characterized by significant fluctuations in temperature, accompanied by repeated chills and sweating. Expressed symptoms of general intoxication (headache, muscle and joint pain, soreness of the eyeballs, loss of appetite). Facial skin is moderately hyperemic, rash is rare. In some patients, a painful dry cough joins from 3-5 days of illness. Pulmonary lesions are clearly identified on x-ray examination in the form of focal shadows of a rounded shape. In the future, typical signs of pneumonia appear. Tongue dry, lined. There are also enlarged liver (in 50%) and spleen. Diuresis is reduced, there are no significant changes in the urine. Recovery is slow (2-4 weeks). Apathy, subfebrile temperature, decreased ability to work persist for a long time. Relapses occur in 4-20% of patients.

Treatment. Apply tetracycline 0.2-0.3 g or chloramphenicol 0.5 g every 6 hours for 8-10 days. At the same time, an intravenous infusion of a 5% glucose solution, a complex of vitamins, according to indications, oxygen therapy, blood transfusion, and cardiovascular agents are prescribed.

Recognition. The diagnosis is made on the basis of clinical and laboratory data and epidemiological history. In all patients with suspected malaria, a microscopic examination of blood (thick drop and smear) is performed. The discovery of Plasmodium is the only indisputable proof. Serological research methods (XRF, RNGA) are also used.

Meningococcus is localized mainly in the pia mater, causing purulent inflammation in them. It penetrates into the central nervous system either through the nasopharynx along the olfactory nerves, or by the hematogenous route.

Symptoms and course. The incubation period is from 2 to 10 days. Allocates localized forms when the pathogen is located in a specific organ (meningococcal carriage and acute nasopharyngitis); generalized forms with the spread of infection throughout the body (meningococcemia, meningitis, meningoencephalitis); rare forms (endocarditis, polyarthritis, pneumonia).

Acute nasopharyngitis may be the initial stage of purulent meningitis or an independent clinical manifestation. With a moderate increase in body temperature (up to 38.5 ° C), there are signs of intoxication and damage to the mucous membrane of the pharynx and nose (nasal congestion, redness and swelling of the posterior pharyngeal wall).

Meningococcemia- meningococcal sepsis begins suddenly, proceeds rapidly. Chills, headache, body temperature rises to 40 C and above. The permeability of blood vessels increases and after 5-15 hours from the onset of the disease a hemorrhagic rash appears, from small petechiae to large hemorrhages, which are often combined with necrosis of the skin, fingertips, auricles. Symptoms of meningitis (see below) are absent in this form. Arthritis, pneumonia, myocarditis, endocarditis are possible. In the blood, a pronounced neutrophilic leukocytosis with a shift to the left.

Meningitis also develops acutely. Only some patients have initial symptoms in the form of nasopharyngitis. The disease begins with chills, a rapid rise in temperature to high numbers, agitation, motor restlessness. A severe headache appears early, vomiting without previous nausea, general hyperesthesia (increased skin, auditory, visual sensitivity). By the end of 1 day of illness, meningeal symptoms arise and increase - stiff neck, Kernig's symptom - the inability to straighten the leg bent at a right angle, and Brudzinsky's symptom - flexion of the legs at the knee joints when bending the head to the chest.

There may be delirium, agitation, convulsions, tremors, in some cranial nerves are affected, in infants there may be swelling and tension of the fontanelles. In half of the patients on the 2nd-5th day of illness, an abundant herpetic rash appears, less often petechial. In the blood, neutrophilic leukocytosis, ESR increased. With proper treatment, recovery occurs on the 12-14th day from the start of therapy.

Complications: deafness due to damage to the auditory nerve and inner ear; blindness due to damage to the optic nerve or choroid; dropsy of the brain (loss of consciousness, severe shortness of breath, tachycardia, convulsions, increased blood pressure, pupillary constriction and sluggish reaction to light, extinction of meningeal syndromes).

Treatment. Of the etiotropic and pathogenetic measures, intensive penicillin therapy is the most effective. Semi-synthetic penicillins (ampicillin, oxacillin) are also effective. Carry out detoxification of the body, treatment with oxygen, vitamins. When symptoms of edema and swelling of the brain appear, dehydration therapy is carried out, which helps to remove excess fluid from the body. Corticosteroid drugs are prescribed. For convulsions - phenobarbital.

Prevention. Early detection and isolation of patients. Discharge from the hospital after the negative results of a double bacteriological examination. Work is underway to create a meningococcal vaccine.

Symptoms and course. ARI is characterized by relatively mild symptoms of general intoxication, a predominant lesion of the upper respiratory tract and a benign course. The defeat of the respiratory system manifests itself in the form of rhinitis, nasopharyngitis, pharyngitis, laryngitis, tracheolaryngitis, bronchitis, pneumonia. Some etiological agents, in addition to these manifestations, also cause a number of other symptoms: conjunctivitis and keratoconjunctivitis in adenovirus diseases, moderately pronounced signs of herpetic sore throat in enterovirus diseases, rubella-like eczema in adenovirus and enterovirus diseases, false croup syndrome in adenovirus and parainfluenza infections. The duration of the disease in the absence of pneumonia is from 2-3 to 5-8 days. With pneumonia, which is often caused by mycoplasmas, respiratory syncytial virus and adenovirus in combination with a bacterial infection, the disease lasts 3-4 weeks or more, and is difficult to treat.

Recognition. The main method is clinical. They make a diagnosis: acute respiratory disease (ARI) and give its decoding (rhinitis, nasopharyngitis, acute laryngotracheobronchitis, etc.). The etiological diagnosis is made only after laboratory confirmation.

Treatment. Antibiotics and other chemotherapy drugs are ineffective because they do not act on the virus. Antibiotics can be prescribed for acute bacterial respiratory infections. Treatment is most often done at home. During the febrile period, bed rest is recommended. Symptomatic drugs, antipyretics, etc. are prescribed.

Prevention. For specific - a vaccine is used. Remantadine can be used to prevent influenza A.

Symptoms and course. The incubation period ranges from 6 to 17 days. According to the clinical picture, typical and atypical (meningopneumonia, serous meningitis, ornithosis without lung damage) are distinguished. In addition to acute, chronic processes can develop.

pneumonic forms. They begin with symptoms of general intoxication, which are only later joined by signs of damage to the respiratory system. Chills are accompanied by an increase in body temperature above 39 ° C, there is a severe headache in the fronto-parietal region, pain in the muscles of the back and limbs; the general weakness, an adynamia accrue, appetite disappears. Some people experience vomiting and nosebleeds. On the 2nd-4th day of illness, there are signs of lung damage, expressed not very sharply. There is a dry cough, sometimes stabbing pains in the chest, there is no shortness of breath. In the future, a small amount of mucous or mucopurulent viscous sputum is released (in 15% of patients with an admixture of blood). In the initial period of the disease, pallor of the skin, bradycardia, lowering blood pressure, muffled heart sounds are noted. X-ray examination revealed damage to the lower lobes of the lungs. Residual changes in them last quite a long time. During recovery, especially after severe forms of ornithosis, the phenomena of asthenia with a sharply reduced blood pressure and vegetative-vascular disorders persist for a long time.

Complications: thrombophlebitis, hepatitis, myocarditis, iridocyclitis, thyroiditis. Recognition of ornithosis is possible on the basis of clinical data, taking into account epidemiological prerequisites.

Treatment. The most effective are antibiotics of the tetracycline group, which are 3-5 times more active than chloramphenicol. Daily doses of tetracycline range from 1.2 to 2 g. With modern methods of treatment, mortality is less than 1%. Relapses and transition to chronic processes are possible (10-15% of cases).

Prevention. Control of ornithosis among domestic birds, regulation of the number of pigeons, limiting contact with them. Specific prophylaxis has not been developed.

Symptoms and course. The incubation period lasts 10-12 days, rarely 7-8 days. The onset of the disease is acute: chills or chilling with a rapid increase in body temperature to 39-40 ° C and above. Redness of the face, conjunctiva and mucous membranes of the mouth and throat. From the 4th day of illness, simultaneously with a decrease in body temperature and some improvement in the patient, a true rash appears on the face, then on the trunk and limbs. It has the character of pale pink spots that turn into dark red papules. Bubbles appear in the center of the papules after 2-3 days. At the same time or earlier, a rash appears on the mucous membranes, where the vesicles quickly turn into erosions and ulcers, resulting in pain and difficulty in chewing, swallowing, and urinating. From the 7-8th day of illness, the patient's condition worsens even more, the body temperature reaches 39-40°C, the rash suppurates, the contents of the vesicles first become cloudy and then become purulent. Sometimes individual pustules merge, causing painful swelling of the skin. Severe condition, confused consciousness, delirium. Tachycardia, arterial hypotension, shortness of breath, fetid odor from the mouth. The liver and spleen are enlarged. A variety of secondary complications may appear. By 10-14 days, the pustules dry out, and yellowish-brown crusts form in their place. Soreness and swelling of the skin decrease, but the itching of the skin increases and becomes painful. From the end of 3 weeks, the crusts fall off, leaving whitish scars for life.

Complications: specific encephalitis, meningoencephalitis, iritis, keratitis, panophthalmitis and nonspecific pneumonia, phlegmon, abscesses, etc. With the use of antibiotics, secondary complications began to occur much less frequently.

Recognition. For emergency diagnosis, the contents of smallpox are examined for the presence of the virus using RNGA, which uses sheep erythrocytes sensitized with anti-smallpox antibodies. With positive results, the mandatory step is the isolation of the pathogen in chicken embryos or in cell culture, followed by identification of the virus. The final answer can be received in 5-7 days.

Treatment. The therapeutic efficacy of anti-small gamma globulin (3-6 ml intramuscularly) and metisazon (0.6 g 2 times a day for 4-6 days) is low. Antibiotics (oxalin, methicillin, erythromycin, tetracycline) are prescribed for the prevention and treatment of secondary purulent infection. Bed mode. Oral care (washing with 1% sodium bicarbonate solution, 0.1-0.2 g of anesthesin before meals). A 15-20% solution of sodium sulfacyl is instilled into the eyes. The elements of the rash are lubricated with a 5-10% solution of potassium permanganate. With moderate forms, mortality reaches 5-10%, with confluent - about 50%.

Prevention. The basis is smallpox vaccination. Currently, due to the eradication of smallpox, smallpox vaccination is not carried out.

The rise in incidence begins in July, reaching a maximum in September-October, is of an epidemic nature. Susceptibility is high and does not depend on age and sex.

Symptoms and course. Paratyphoid A and B, as a rule, begins gradually with an increase in signs of intoxication (fever, increasing weakness), dyspeptic symptoms (nausea, vomiting, loose stools), catarrhal symptoms (cough, runny nose), roseolous-papular rash and ulcerative lesions of the lymphatic system join intestines.

Features of clinical manifestations in paratyphoid A. The disease usually has a more acute onset than paratyphoid B, with an incubation period of 1 to 3 weeks. Accompanied by dyspeptic disorders and catarrhal symptoms, possibly redness of the face, herpes. The rash, as a rule, appears on the 4-7th day of illness, often plentiful. During the course of the disease, there are usually several waves of rashes. The temperature is remitting or hectic. The spleen is rarely enlarged. In the peripheral blood, lymphopenia, leukocytosis are often observed, eosinophils persist. Serological reactions are often negative. Greater possibility of recurrence than with paratyphoid B and typhoid fever.

Features of clinical manifestations of paratyphoid B. The incubation period is much shorter than in paratyphoid A.

The clinical course is very diverse. When the infection is transmitted through water, a gradual onset of the disease is observed, its relatively mild course.

When salmonella penetrates with food and its massive intake into the body occurs, gastrointestinal phenomena (gastroenteritis) predominate, followed by the development and spread of the process to other organs. With paratyphoid B, more often than with paratyphoid A and typhoid fever, mild and moderate forms of the disease are observed. Relapse is possible, but less common. The rash may be absent or, on the contrary, be abundant, varied, appear early (4-7 days of illness), the spleen and liver increase earlier than with typhoid fever.

Treatment. It should be comprehensive, including care, diet, etiotropic and pathogenetic agents, and, according to indications, immune and stimulating drugs. Bed rest until 6-7 days of normal temperature, from 7-8 days it is allowed to sit, and from 10-11 to walk. Easily digestible food, sparing the gastrointestinal tract.

During the period of fever, it is steamed or given in a pureed form (table No. 4a). Among drugs with a specific action, the leading place is occupied by chloramphenicol (dosage of 0.5 g 4 times a day) up to the 10th day of normal temperature. To increase the effectiveness of etiotropic therapy, mainly to prevent relapses and the formation of chronic bacterial excretion, it is recommended to carry it out in the process with agents that stimulate the body's defenses and increase specific and nonspecific resistance (typhoid-paratyphoid B vaccine).

Prevention. It comes down to general sanitary measures: improving the quality of water supply, sanitary cleaning of populated areas and sewerage, fighting flies, etc.

Dispensary observation of those who have undergone paratyphoid fever is carried out for 3 months.

Symptoms and course. The incubation period is usually 15-19 days. There is a short prodromal (initial) period, when weakness, malaise, muscle pain, headache, chilling, sleep disturbance, and appetite are noted. With the development of inflammatory changes in the salivary gland, signs of its defeat appear (dry mouth, pain in the ear area, aggravated by chewing, talking). The disease can occur in both mild and severe form.

Depending on this, the temperature can be from subfebrile numbers to 40 ° C, intoxication also depends on the severity. A characteristic manifestation of the disease is the defeat of the salivary glands, more often the parotid. The gland increases, there is pain on palpation, which is especially pronounced in front of the ear, behind the earlobe and in the area of ​​​​the mastoid process. Of great diagnostic importance is Murson's symptom - an inflammatory reaction in the area of ​​the excretory duct of the affected parotid gland. The skin over the inflamed gland is tense, shiny, swelling can spread to the neck. Enlargement of the gland usually lasts 3 days, the maximum swelling lasts 2-3 days. Against this background, various, sometimes severe complications can develop: meningitis, meningoencephalitis, orchitis, pancreatitis, labyrinthitis, arthritis, glomerulonephritis.

Treatment. Bed rest for 10 days. Compliance with a dairy-vegetarian diet, limiting white bread, fats, coarse fiber (cabbage).

With orchitis, a suspension is prescribed, prednisone for 5-7 days according to the scheme.

For meningitis, corticosteroid drugs are used, lumbar punctures are performed, and a 40% solution of Urotropin is administered intravenously. With developed acute pancreatitis, a liquid sparing diet, atropine, papaverine, cold on the stomach are prescribed, with vomiting - chlorpromazine and drugs that inhibit enzymes - Gordox, contrical trasilol.

The prognosis is favorable.

Prevention. In children's institutions, when cases of mumps are detected, quarantine is established for 21 days, active medical supervision. Children who have had contact with patients with mumps are not allowed in children's institutions from the 9th day of the incubation period to the 21st, they are given placental gamma globulin. Disinfection in the foci is not performed.

Symptoms and course. The incubation period is short - up to several hours. Chills, fever, nausea, repeated vomiting, cramping pains in the abdomen, mainly in the iliac and umbilical regions, are noted.

Frequent, loose stools, sometimes with an admixture of mucus, join. Intoxication phenomena are observed: dizziness, headache, weakness, loss of appetite.

The skin and visible mucous membranes are dry. Tongue coated, dry.

Recognition. The diagnosis of foodborne infectious poisoning is made on the basis of the clinical picture, epidemiological history and laboratory tests. Of decisive importance are the results of bacteriological examination of feces, vomit, gastric lavage.

Treatment. To remove infected products and their toxins, gastric lavage is necessary, which gives the greatest effect in the first hours of the disease. However, with nausea and vomiting, this procedure can be carried out at a later date. Washing is carried out with a 2% solution of sodium bicarbonate (baking soda) or a 0.1% solution of potassium permanganate until clean water is discharged. For the purpose of detoxification and restoration of water balance, saline solutions are used: trisol, quartasol, rehydron and others. The patient is given plenty of fluids in small doses. Medical nutrition is important. Foods that can irritate the gastrointestinal tract are excluded from the diet. Well-cooked, pureed, non-spicy food is recommended. To correct and compensate for digestive insufficiency, it is necessary to use enzymes and enzyme complexes - pepsin, pancreatin, festal, etc. (7-15 days). To restore the normal intestinal microflora, the appointment of colibacterin, lactobacterin, bificol, bifidumbacterin is indicated.

Prevention. Compliance with sanitary and hygienic rules at public catering establishments, food industry. Early detection of persons suffering from tonsillitis, pneumonia, pustular skin lesions and other infectious diseases, bacteria excretors. Veterinary control over the state of dairy farms and the health of cows (staphylococcal mastitis, pustular diseases) is important.

By the nature of the lesion are distinguished:
1) erythematous form in the form of redness and swelling of the skin;
2) hemorrhagic form with the phenomena of permeability of blood vessels and their bleeding;
3) bullous form with blisters on inflamed skin filled with serous exudate.

According to the degree of intoxication, they distinguish - light, moderate, heavy.

By multiplicity - primary, recurrent, repeated.

According to the prevalence of local manifestations - localized (nose, face, head, back, etc.), wandering (passing from one place to another) and metastatic.

Symptoms and course. The incubation period is from 3 to 5 days. The onset of the disease is acute, sudden. On the first day, the symptoms of general intoxication are more pronounced (severe headache, chills, general weakness, possible nausea, vomiting, fever up to 39-40 ° C).

erythematous form. After 6-12 hours from the onset of the disease, there is a burning sensation, bursting pain, redness (erythema) and swelling on the skin at the site of inflammation. The area affected by erysipelas is clearly separated from the healthy one by an elevated, sharply painful roller. The skin in the focus area is hot to the touch, tense. If there are small punctate hemorrhages, then they talk about the erythematous-hemorrhagic form of erysipelas. With bullous erysipelas against the background of erythema, bullous elements are formed at various times after its appearance - blisters containing a clear and transparent liquid. Later, they subside, forming dense brown crusts, which are rejected after 2-3 weeks. Erosions and trophic ulcers can form at the site of the blisters. All forms of erysipelas are accompanied by lesions of the lymphatic system - lymphadenitis, lymphangitis.

Primary erysipelas are more often localized on the face, recurrent - on the lower extremities. There are early relapses (up to 6 months) and late (over 6 months). Concomitant diseases contribute to their development. The most important are chronic inflammatory foci, diseases of the lymphatic and blood vessels of the lower extremities (phlebitis, thrombophlebitis, varicose veins); diseases with a pronounced allergic component (bronchial asthma, allergic rhinitis), skin diseases (mycoses, peripheral ulcers). Relapses also occur as a result of adverse professional factors.

Disease duration: local manifestations of erythematous erysipelas disappear by the 5th-8th day of illness, in other forms they can last more than 10-14 days. Residual manifestations of erysipelas - pigmentation, peeling, pastosity of the skin, the presence of dry dense crusts in place of bullous elements. Perhaps the development of lymphostasis, leading to elephantiasis of the limbs.

Treatment. Depends on the form of the disease, its multiplicity, the degree of intoxication, the presence of complications. Etiotropic therapy: antibiotics of the penicillin series in average daily dosages (penicillin, tetracycline, erythromycin or oleandomycin, oletetrip, etc.). Less effective drugs are sulfonamides, combined chemotherapy drugs (bactrim, septin, biseptol). The course of treatment is usually 8-10 days. With frequent persistent relapses, tseporin, oxacillin, ampicillin and methicillin are recommended. It is desirable to conduct two courses of antibiotic therapy with a change of drugs (intervals between courses of 7-10 days). With often recurrent erysipelas, corticosteroids are used at a daily dosage of 30 mg. With persistent infiltration, non-steroidal anti-inflammatory drugs are indicated - chlotazol, butadione, reopyrin, etc. It is advisable to prescribe ascorbic acid, rutin, B vitamins. Autohemotherapy gives good results.

In the acute period of the disease, the focus of inflammation is indicated by the appointment of UVI, UHF, followed by the use of ozocerite (paraffin) or naftalan. Local treatment of uncomplicated erysipelas is carried out only with its bullous form: a bulla is incised at one of the edges and dressings with a solution of rivanol, furatsilin are applied to the focus of inflammation. Subsequently, dressings with ectericin, Shostakovsky's balm, as well as manganese-vaseline dressings are prescribed. Local treatment alternates with physiotherapeutic procedures.

The prognosis is favorable.

Prevention Erysipelas in persons susceptible to this disease is difficult and requires careful treatment of concomitant diseases of the skin, peripheral vessels, as well as sanitation of foci of chronic streptococcal infection. Erysipelas does not give immunity, there is a special hypersensitivity of all those who have been ill.

Symptoms and course. The disease most often affects the skin, less often - the internal organs.

The incubation period is from 2 to 14 days.

With skin form (carbunculosis) exposed areas of the body are most susceptible to damage. The disease is severe when carbuncles are located in the head, neck, mucous membranes of the mouth and nose. There are single and multiple carbuncles. First (at the site of the entrance gate of the microbe) a reddish spot appears, itchy, similar to an insect bite. During the day, the skin noticeably thickens, the itching intensifies, often turning into a burning sensation, a vesicle develops in place of the spot - a bladder filled with serous contents, then with blood. Patients, when combing, tear off the bubble and an ulcer with a black bottom is formed. From this point on, there is a rise in temperature, headache, loss of appetite. From the moment of opening, the edges of the ulcer begin to swell, forming an inflammatory roller, edema occurs, which begins to spread rapidly. The bottom of the ulcer sinks more and more, and "daughter" vesicles with transparent contents form along the edges. This growth of the ulcer lasts 5-6 days. By the end of the first day, the ulcer reaches a size of 8-15 mm and from that moment is called anthrax carbuncle. The peculiarity of the anthrax carbuncle is the absence of pain in the necrosis zone and the characteristic three-color color: black in the center (scab), around - a narrow yellowish-purulent border, then - a wide crimson shaft. Possible damage to the lymphatic system (lymphadenitis).

With a successful course of the disease, after 5-6 days the temperature decreases, general well-being improves, swelling decreases, lymphangitis and lymphadenitis fade away, the scab is rejected, the wound heals with the formation of a scar. With an unfavorable course, secondary sepsis develops with a repeated rise in temperature, a significant deterioration in the general condition, an increase in headache, an increase in tachycardia, and the appearance of secondary pustules on the skin. There may be bloody vomiting and diarrhea. Lethal outcome is not excluded.

In intestinal form (alimentary anthrax sepsis) toxicosis develops from the first hours of the disease. There is a sharp weakness, abdominal pain, bloating, vomiting, bloody diarrhea. The patient's condition is progressively deteriorating. Secondary pustular and hemorrhagic rashes are possible on the skin. Soon anxiety, shortness of breath, cyanosis sets in. Possible meningoencephalitis. Patients die from increasing heart failure in 3-4 days from the onset of the disease.

Pulmonary form anthrax is characterized by a rapid onset: chills, a sharp increase in temperature, pain and a feeling of tightness in the chest, cough with foamy sputum, rapidly increasing phenomena of general intoxication, insufficiency of the respiratory and cardiovascular systems.

Bronchopneumonia and effusion hemorrhagic pleurisy are determined clinically and radiologically. Death occurs in 2-3 days as a result of pulmonary edema and collapse.

septic form proceeds very rapidly and ends in death.

Treatment. Regardless of the clinical form of the disease, treatment consists of pathogenetic and etiotropic therapy (the use of specific anti-anthrax globulin and penicillin and semi-synthetic antibiotics).

The prognosis for cutaneous forms of anthrax is favorable. Doubtful in septic cases, even with early treatment.

Prevention. Proper organization of veterinary supervision, vaccination of pets. In case of death of animals from anthrax, animal carcasses must be burned, and food products obtained from them must be destroyed. According to epidemic indications, people are vaccinated with the STI vaccine. Persons who have been in contact with sick animals or people are subject to active medical supervision for 2 weeks.

Symptoms and course. The incubation period usually lasts 2-7 days. The disease begins acutely. The body temperature rises, severe malaise, headache, sore throat when swallowing, chills join. A typical and constant symptom is angina: bright redness of the pharynx, swollen lymph nodes, as well as tonsils, on the surface of which plaque is often found. By the end of 1, the beginning of 2 days, characteristic exanthems appear (a bright pink or red punctate rash that thickens in places of natural skin folds). The face is bright red with a pale nasolabial triangle, but on the edges of which a small punctate rash can be distinguished. On the folds of the limbs, petechial hemorrhages are not uncommon. The rash may look like small vesicles filled with transparent contents (miliary rash). Some patients have pruritus. The rash lasts from 2 to 5 days, and then turns pale, while the body temperature decreases. In the second week, a lamellar skin lesion begins, most pronounced on the folds of the arms (small and coarse). The tongue is coated at the onset of the disease, cleared by day 2 and takes on a characteristic appearance (bright red or "crimson" tongue).

From the side of the cardiovascular system, tachycardia, moderate muffled heart sounds are observed. There is increased fragility of blood vessels. In the blood - neutrophilic leukocytosis with a shift of the nuclear formula to the left, ESR increased. Typically, an increase in the number of eosinophils by the end of 1 - the beginning of 2 weeks of illness. Lymph nodes are enlarged, painful. Perhaps an increase in the liver, spleen.

On average, the disease lasts from 5 to 10 days. It can occur in a typical and atypical form. Erased forms are characterized by mild symptoms, and toxic and hemorrhagic bleeding phenomena occur with a prominent toxicosis (poisoning) syndrome: loss of consciousness, convulsions, renal and cardiovascular failure.

Complications: lymphadenitis, otitis media, mastoiditis, nephritis, otogenic brain abscess, rheumatism, myocarditis.

Treatment. Subject to appropriate conditions - at home. Hospitalization for epidemic and clinical indications. Bed rest for 5-6 days. Antibiotic therapy is carried out with drugs of the penicillin group in average daily dosages, vitamin therapy (vitamins of groups B, C, P), detoxification (hemodez, 20% glucose solution with vitamins). The course of antibiotic treatment is 5-7 days.

Prevention. Isolation of patients. Exclusion of contact of convalescents with newly admitted to the hospital. Discharge from the hospital not earlier than the 10th day of illness. Children's institutions are allowed to visit after 23 days from the moment of illness. In the apartment where the patient is located, regular disinfection should be carried out. Quarantine is imposed for 7 days for those who did not suffer from scarlet fever after their separation from the patient.

The causative agent of the disease is a large anaerobic bacillus. This form of microorganism is capable of producing the strongest toxin (poison), causing increased secretion at neuromuscular junctions. The microorganism is widely distributed in nature, persists in the soil for many years. It is a frequent harmless inhabitant of the intestines of many domestic animals. The source of infection is animals, the transmission factor is soil.

Symptoms and course. The incubation period averages 5-14 days. The smaller it is, the more severe the disease. The disease begins with discomfort in the wound area (drawing pains, muscle twitching around the wound); possible general malaise, anxiety, irritability, loss of appetite, headache, chills, low-grade fever. Due to cramps of the masticatory muscles (trismus), it is difficult for the patient to open his mouth, sometimes even impossible.

Spasm of the swallowing muscles causes the appearance of a "sardonic smile" on the face, and also makes it difficult to swallow. These early symptoms are unique to tetanus.

Later, stiffness of the occipital muscles, long muscles of the back develops with increased pain in the back: a person is forced to lie in a typical position with his head thrown back and the lumbar part of the body raised above the bed. By the 3-4th day, there is tension in the abdominal muscles: the legs are extended, movements in them are sharply limited, the movements of the hands are somewhat freer. Due to the sharp tension of the abdominal muscles and diaphragm, breathing is superficial and rapid.

Due to the contraction of the muscles of the perineum, urination and defecation are difficult. There are general convulsions lasting from a few seconds to a minute or more of varying frequency, often provoked by external stimuli (touching the bed, etc.). The patient's face turns blue and expresses suffering. As a result of convulsions, asphyxia, paralysis of cardiac activity and respiration can occur. Consciousness throughout the illness and even during convulsions is preserved. Tetanus is usually accompanied by fever and constant sweating (in many cases from pneumonia and even sepsis). The higher the temperature, the worse the prognosis.

With a positive outcome, the clinical manifestations of the disease last 3-4 weeks or more, but usually on the 10-12th day, the state of health improves significantly. Those who have had tetanus for a long time may experience general weakness, muscle stiffness, weakness of cardiovascular activity.

Complications: pneumonia, muscle rupture, compression fracture of the spine.

Tetanus treatment is complex.
1. Surgical treatment of the wound.
2. Ensuring complete rest for the patient.
3. Neutralization of the toxin circulating in the blood.
4. Reducing or removing the convulsive syndrome.
5. Prevention and treatment of complications, especially pneumonia and sepsis.
6. Maintenance of normal blood gas composition, acid-base and water-electrolyte balances.
7. Fight against hyperthermia.
8. Maintain adequate cardiovascular activity.
9. Improving lung ventilation.
10. Proper nutrition of the patient.
11. Control over body functions, careful patient care.

A radical excision of the edges of the wound is carried out, creating a good outflow, antibiotics (benzylpenicillin, oxytetracycline) are prescribed for prophylactic purposes. The unvaccinated are given active-passive prophylaxis (APP) by introducing 20 IU of tetanus toxoid and 3000 IU of tetanus toxoid into different parts of the body. Vaccinated individuals are given only 10 units of tetanus toxoid. Recently, a specific gamma globulin obtained from donors has been used (the dose of the drug for prevention is 3 ml once intramuscularly, for treatment - 6 ml once). Adsorbed tetanus toxoid is administered intramuscularly 3 times in 0.5 ml every 3-5 days. All of these drugs serve as means of influencing the toxin circulating in the blood. Central to the intensive care of tetanus is the reduction or complete removal of tonic and tetanic seizures. For this purpose, antipsychotics (chlorpromazine, prolazil, droperidol) and tranquilizers are used. To eliminate severe seizures, muscle relaxants (tubarip, diplacin) are used. Treatment of respiratory failure is provided by well-developed methods of respiratory resuscitation.

Forecast. Mortality in tetanus is very high, the prognosis is serious.

Prevention. Routine immunization of the population with tetanus toxoid. Injury prevention at work and at home.

The source of infection is only a sick person, from whom body and head lice, having sucked on blood containing rickettsia, pass them on to a healthy person. A person becomes infected when scratching the bite sites, rubbing the excrement of lice into the skin. At the very bite of the lice, infection does not occur, since the causative agent of typhus is absent in their salivary glands. The susceptibility of people to typhus is quite high.

Symptoms and course. The incubation period lasts 12-14 days. Sometimes at the end of incubation there is a slight headache, body aches, chilling.

The body temperature rises with a slight chill and already by 2-3 days is set at high numbers (38-39 ° C), sometimes it reaches a maximum value by the end of 1 day. In the future, the fever has a constant character with a slight decrease on the 4th, 8th, 12th day of illness. A sharp headache, insomnia appear early, a breakdown quickly sets in, the patient is excited (talkative, mobile). Face red, puffy. Small hemorrhages are sometimes seen on the conjunctiva of the eyes. There is diffuse hyperemia in the pharynx, pinpoint hemorrhages may appear on the soft palate. The tongue is dry, not thickened, coated with a grayish-brown coating, sometimes protruding with difficulty. The skin is dry, hot to the touch, in the first days there is almost no sweating. There is a weakening of heart tones, increased respiration, enlargement of the liver and spleen (from 3-4 days of illness). One of the characteristic signs is typhus exanthema. The rash appears on the 4-5th day of illness. It is multiple, abundant, located mainly on the skin of the lateral surfaces of the chest and abdomen, on the fold of the arms, captures the palms and feet, never on the face. The rash occurs within 2-3 days, then gradually disappears (after 78 days), leaving pigmentation for some time. With the onset of the rash, the patient's condition worsens. Intoxication increases sharply. Excitation is replaced by oppression, lethargy. At this time, a collapse may develop: the patient is in prostration, the skin is covered with cold sweat, the pulse is frequent, the heart sounds are muffled.

Recovery is characterized by a decrease in body temperature, accelerated lysis on the 8-12th day of illness, a gradual decrease in headache, improved sleep, appetite, and restoration of the activity of internal organs.

Treatment. The most effective antibiotics of the tetracycline group, which are prescribed 0.3-0.4 g 4 times a day. You can use chloramphenicol. Antibiotics give up to 2 days of normal temperature, the duration of the course is usually 4-5 days. For detoxification, a 5% glucose solution is administered. Apply oxygen therapy. With a sharp excitation, barbiturates, chloral hydrate are indicated. Good nutrition and vitamin therapy are of great importance. An important role is played by proper patient care (complete rest, fresh air, comfortable bedding and linen, daily toilet of the skin and oral cavity).

Prevention. Early hospitalization of patients. Sanitary treatment of the hearth. Monitoring of persons who have been in contact with the patient is carried out for 25 days with daily thermometry.

The infection is transmitted to humans either directly by contact with animals (hunting), or through contaminated food and water, less often by aspiration (when processing grain and feed products, threshing bread), by blood-sucking insects (gadfly, tick, mosquito, etc.).

Symptoms and course. The incubation period is from several hours to 3-7 days. There are bubonic, pulmonary and generalized (spread throughout the body) forms. The disease begins acutely with a sudden rise in temperature to 38.5-40°C. There is a sharp headache, dizziness, pain in the muscles of the legs, back and lumbar region, loss of appetite. In severe cases, there may be vomiting, nosebleeds. Severe sweating, sleep disturbance in the form of insomnia or vice versa drowsiness are characteristic. Often there is euphoria and increased activity against the background of high temperature. There is redness and swelling of the face and conjunctiva already in the first days of the disease. Later, petechial hemorrhages appear on the oral mucosa. The tongue is covered with a grayish coating. A characteristic feature is an increase in various lymph nodes, the size of which can be from a pea to a walnut.

From the side of the cardiovascular system, bradycardia and hypotension are noted. In the blood, leukocytosis with a moderate neutrophilic shift. The liver and spleen are not enlarged in all cases. Pain in the abdomen is possible with a significant increase in mesenteric lymph nodes. The fever lasts from 6 to 30 days.

Bubonic form of tularemia. The causative agent penetrates the skin without leaving a trace; after 2-3 days of illness, regional lymphadenitis develops. Buboes are a little painful and have clear contours up to 5 cm in size. Subsequently, either softening of the bubo occurs (1-4 months), or its spontaneous opening with the release of thick creamy pus and the formation of a tularemia fistula. The axillary, inguinal, and femoral lymph nodes are most commonly affected.

Ulcerative bubonic form characterized by the presence of a primary lesion at the site of the entry gate of infection.

Oculo-bubonic form develops when the pathogen enters the mucous membranes of the eyes. The appearance of yellow follicular growths up to millet grain size on the conjunctiva is typical.

Bubo develops in the parotid or submandibular areas, the course of the disease is long.

Anginal-bubonic form occurs with a primary lesion of the mucous membrane of the tonsils, usually one. Occurs during the food route of infection.

There are forms of tularemia with a predominant lesion of internal organs. Pulmonary form - more often recorded in the autumn-winter period. The generalized form proceeds according to the type of general infection with severe toxicosis, loss of consciousness, delirium, severe headache and muscle pain.

Complications can be specific (secondary tularemia pneumonia, peritonitis, pericarditis, meningoencephalitis), as well as abscesses, gangrene caused by secondary bacterial flora.

Diagnosis is based on a skin-allergic test and serological reactions.

Treatment. Hospitalization of the patient. The leading place is given to antibacterial drugs (tetracycline, aminoglycosides, streptomycin, levomycetin), treatment is carried out up to the 5th day of normal temperature. With prolonged forms, combined antibiotic treatment with a vaccine is used, which is administered intradermally, intramuscularly at a dose of 1-15 million microbial bodies per injection at intervals of 3-5 days, the course of treatment is 6-10 sessions. Recommended vitamin therapy, repeated transfusions of donor blood. When a fluctuation of the bubo appears, surgical intervention (a wide incision to empty the bubo). Patients are discharged from the hospital after complete clinical recovery.

Prevention. Elimination of natural foci or reduction of their territories. Protection of dwellings, wells, open reservoirs, products from mouse-like rodents. Carrying out mass planned vaccination in the foci of tularemia.

Symptoms and course. Very diverse - from asymptomatic carriage to severe conditions with severe dehydration and death.

The incubation period lasts 1-6 days. The onset of the disease is acute. The first manifestations include sudden diarrhea, mainly at night or in the morning. The stool is initially watery, later it takes on the form of "rice water" without smell, an admixture of blood is possible. Then profuse vomiting joins, appearing suddenly, often erupting in a fountain. Diarrhea and vomiting are usually not accompanied by abdominal pain. With a large loss of fluid, the symptoms of damage to the gastrointestinal tract recede into the background. Violations of the activity of the main systems of the body, the severity of which is determined by the degree of dehydration, become the leading ones. 1 degree: dehydration is expressed slightly. Grade 2: weight loss by 4-6%, a decrease in the number of erythrocytes and a drop in hemoglobin levels, an acceleration of ESR. Patients complain of severe weakness, dizziness, dry mouth, thirst. Lips and fingers turn blue, hoarseness of voice appears, convulsive twitches of the calf muscles, fingers, chewing muscles are possible. Grade 3: weight loss of 7-9%, while all of the above symptoms of dehydration increase. With a drop in blood pressure, collapse is possible, body temperature drops to 35.5-36 ° C, urine output may completely stop. Blood from dehydration thickens, the concentration of potassium and chlorine in it decreases. Grade 4: fluid loss is more than 10% of body weight. Facial features are sharpened, "dark glasses" appear around the eyes. The skin is cold, clammy to the touch, cyanotic, prolonged tonic convulsions are frequent. Patients are in a state of prostration, shock develops. Heart sounds are sharply muffled, blood pressure drops sharply. The temperature drops to 34.5°C. Frequent deaths.

Complications: pneumonia, abscesses, phlegmon, erysipelas, phlebitis.

Recognition. Characteristic epidemiological anamnesis, clinical picture. Bacteriological examination of feces, vomit, gastric contents, laboratory physical and chemical blood tests, serological reactions.

Treatment. Hospitalization of all patients. The leading role is given to the fight against dehydration and the restoration of water-salt balance.

Solutions containing sodium chloride, potassium chloride, sodium bicarbonate, glucose are recommended. In severe dehydration - jet injection of fluid until the pulse returns to normal, after which the solution is continued to be injected drip. Foods containing a large amount of potassium salts (dried apricots, tomatoes, potatoes) should be included in the diet. Antibiotic therapy is carried out only in patients with 3-4 degrees of dehydration, tetracycline or chloramphenicol are used in average daily dosages. Discharge from the hospital after complete recovery in the presence of negative bacteriological tests. The prognosis for timely and adequate treatment is favorable.

Prevention. Protection and disinfection of drinking water. Active observation by a doctor of persons who have been in contact with patients for 5 days. For the purpose of specific prophylaxis, according to indications, corpuscular cholera vaccine and cholerogen toxoid are used.

Refers to especially dangerous infections. In nature, it is preserved due to periodically occurring epizootics in rodents, the main warm-blooded hosts of the plague microbe (marmots, ground squirrels, gerbils). The transmission of the pathogen from animal to animal occurs through fleas. Infection of a person is possible by contact (when skinning and cutting meat), eating contaminated food, flea bites, and airborne droplets. Human sensitivity is very high. A sick person is dangerous to others, especially patients with a pulmonary form.

Symptoms and course. The incubation period lasts 3-6 days. The disease begins acutely with a sudden onset of chills and a rapid rise in temperature to 40°C. Chills are replaced by fever, severe headache, dizziness, severe weakness, insomnia, nausea, vomiting, muscle pain. Intoxication is expressed, disturbances of consciousness are frequent, psychomotor agitation, delirium, hallucinations are not uncommon. Unsteady gait, redness of the face and conjunctiva, slurred speech are characteristic (patients resemble drunkards). Facial features are pointed, puffy, dark circles appear under the eyes, a suffering expression full of fear. The skin is dry and hot to the touch, a petechial rash is possible, extensive hemorrhages (hemorrhages) that darken on corpses. Symptoms of damage to the cardiovascular system develop rapidly: expansion of the boundaries of the heart, deafness of tones, increasing tachycardia, drop in blood pressure, arrhythmia, shortness of breath, cyanosis. The appearance of the tongue is characteristic: thickened, with cracks, crusts, covered with a thick white coating. The mucous membranes of the mouth are dry. The tonsils are often enlarged, ulcerated, with hemorrhages in the soft palate. In severe cases, vomiting of the color of "coffee grounds", frequent loose stools with an admixture of mucus, blood. In the urine, an admixture of blood and the presence of protein is possible.

There are two main clinical forms of plague:
- bubonic
- and pulmonary.

With bubonic, there is a sharp pain in the area of ​​​​the affected lymph glands (usually inguinal) even before their noticeable increase, and in children axillary and cervical. Regional lymph glands are affected at the site of a flea bite. They quickly develop hemorrhagic necrotic inflammation. The glands are soldered together, with adjacent skin and subcutaneous tissue, forming large packages (buboes). The skin is glossy, reddens, subsequently ulcerates, and the bubo opens outward. In the hemorrhagic exudate, the glands are found in a large number of plague sticks.

In the pulmonary form (primary), hemorrhagic inflammation appears with necrosis of small pulmonary foci. Then there are cutting pains in the chest, palpitations, tachycardia, shortness of breath, delirium, fear of a deep breath. The cough comes on early, with much viscous, clear, glassy mucus, which then becomes frothy, thin, rusty. The pain in the chest intensifies, breathing sharply weakens. Typical symptoms of general intoxication, rapid deterioration, development of infectious toxic shock. The prognosis is difficult, death occurs, as a rule, for 3-5 days.

Recognition. Based on clinical and epidemiological data, the final diagnosis is based on laboratory tests (bacterioscopic, bacteriological, biological, serological).

Treatment. All patients are subject to hospitalization. The basic principles of therapy are the complex use of antibacterial, pathogenetic and symptomatic therapy. The introduction of detoxifying liquids (polyglucin, reopoliglyukin, gemodez, neocompensan, plasma, glucose solution, saline solutions, etc.) is shown.

Prevention. Control of rodents, especially rats. Observation of persons working with infectious materials or suspected of being infected with plague, prevention of the importation of plague into the country from abroad.

Symptoms and course. The incubation period is 8-23 days. Most often, the disease is manifested by a sudden rise in temperature to 39-40 ° C, a sharp headache, nausea, vomiting, redness of the face, neck, upper chest, conjunctiva, and pharynx is noted. Sometimes there is loss of consciousness, convulsions. Characterized by rapidly passing weakness. The disease can occur with other manifestations.

Feverish form- benign course, fever for 3-6 days, headache, nausea, neurological symptoms are mild.

meningeal form- fever 7-10 days, symptoms of general intoxication, meningeal syndromes are expressed, lymphocytic pleocytosis in the cerebrospinal fluid, the disease lasts 3-4 weeks, the outcome is favorable.

Meningoencephalitic form- lethargy, drowsiness, delirium, psychomotor agitation, loss of orientation, hallucinations, often a severe convulsive syndrome like status epilepticus. Lethality 25%.

Polio form- accompanied by flaccid paralysis of the muscles of the neck and upper limbs with muscle atrophy by the end of 2-3 weeks.

Complications. Residual paralysis, muscle atrophy, decreased intelligence, sometimes epilepsy. Full recovery may not occur.

Recognition. Based on clinical manifestations, epidemiological data, laboratory tests (serological reactions).

Treatment. Strict bed rest. In the first three days, 6-9 ml of anti-encephalitis donor gamma globulin is administered intramuscularly. Dehydration agents. Intravenous administration of hypertonic glucose solution, sodium chloride, mannitol, furosemide, etc. Oxygen therapy. With convulsions, chlorpromazine 2.51 ml and diphenhydramine 2 ml-1%, with epileptic seizures, phenobarbital or benzonal 0.1 g 3 times. Cardiovascular and stimulant breaths.

Prevention. Anti-tick vaccination. The vaccine is administered three times subcutaneously at 3 and 5 ml with an interval of 10 days. Revaccination after 5 months.

Symptoms and course. The incubation period is 5-10 days. The disease begins with chills, high fever, headache, aching muscles, lower back, weakness, loss of appetite. After 2-3 days, dry mouth joins, photophobia, salivation, and pain during urination are possible. On the reddened mucous membrane of the oral cavity, a large number of small bubbles the size of a millet grain, filled with a cloudy yellow liquid, appear, after a day they spontaneously burst and form ulcers (aphthae). After opening the aft, the temperature, as a rule, decreases somewhat. Speech and swallowing are difficult, salivation (saliva) is increased. In most patients, vesicles - vesicles can be located on the skin: in the region of the terminal phalanges of the fingers and toes, in the interdigital folds. Accompanied by a burning sensation, crawling, itching. In most cases, the nails then fall out. Aphthae on the mucous membrane of the mouth, lips, tongue disappear after 3-5 days and heal without leaving scars. New rashes are possible, delaying recovery for several months. In children, gastroenteritis is often observed.

Distinguish skin, mucous and mucocutaneous forms of the disease. Erased forms that occur in the form of stomatitis are not uncommon.

Complications: accession of a secondary infection lead to pneumonia and sepsis.

Treatment. Hospitalization is required for at least 14 days from the onset of the disease. There is no etiotropic therapy. Particular attention is paid to careful patient care, diet (liquid food, fractional nutrition). Local treatment: solutions - 3% hydrogen peroxide; 0.1% rivanol; 0.1% potassium permanganate; 2% boric acid, chamomile infusion. Erosions are extinguished with a 2-5% solution of silver nitrate. In severe cases, the introduction of immune serum and the appointment of tetracycline or chloramphenicol are recommended.

Prevention. Veterinary supervision of animals and food products received from them, compliance with sanitary and hygienic standards by farm workers.

The main stages of an infectious disease

Infection has the most important feature, namely, contagiousness. The direct cause of the onset of the disease is the introduction into the human body of a pathogenic (pathogenic) microorganism that has a number of properties. However, one introduction of microbes into the body for the development of the disease is not enough. In order to develop infection, the person must be susceptible to the infection.
The human body is affected by both the microbial cell of the pathogen (virus, rickettsia) and toxins that are released either during the life of the microorganism (exotoxins) or as a result of its death (endotoxins).

The human body responds to the introduction of the pathogen with a complex pathophysiological and morphological reaction that determines the clinical picture of the disease. The human body in the process of an infectious disease undergoes great changes: the metabolism changes, the temperature rises, the activity of the nervous, cardiovascular, respiratory and digestive systems of the body changes, immunity is produced and formed. The organism takes part in the process of an infectious disease as a whole, which is achieved by the regulatory influence of the nervous and endocrine systems.
Of great importance for the emergence and flow infectious disease have socio-economic conditions (life, nutrition, living and working conditions, timely and sufficient medical care, and much more). Chronic malnutrition, overwork, mental trauma lower the body's resistance to diseases, contribute to their severe course, and are one of the causes leading to death in infectious diseases.
influence the course of some infectious diseases and climatic conditions. During the rainy and cold period of the year, the number of cases of infections transmitted by airborne droplets increases. The age of a person matters a lot. So, children of the first 6 months of life very rarely get measles, diphtheria, diseases caused by Coxsackie and ECHO viruses. Adults rarely get whooping cough, scarlet fever.
Most infectious diseases cyclicity is characteristic - a certain sequence of development, increase and decrease in the symptoms of the disease. There are the following periods of development of an infectious disease:
1) incubation (hidden) period;
2) the initial period (prodromal), or the period of increasing symptoms;
3) the period of the main manifestations of the disease;
4) the period of extinction of the disease (early period of convalescence);
5) recovery period (reconvalescence).
The incubation period is the period from the moment of infection to the onset of the first clinical symptoms of the disease. During this period, reproduction and accumulation in the body of pathogens and their toxins occurs. With each infectious disease, the incubation period has a certain duration, subject to only slight fluctuations.
The initial period, or the period of increasing symptoms, is characterized by the general initial manifestations of an infectious disease: malaise, often chills, fever, headache, nausea, and vomiting. The onset of an infectious disease can be acute or gradual.
The period of the main manifestations infectious diseases characterized by the appearance of the most significant symptoms of the disease.
During this period, most infectious diseases occur with elevated temperature. Body temperature in infectious patients is measured at least 2 times a day, and the results are entered in the form of a graph on a temperature sheet, where the patient's pulse rate and his blood pressure are also noted. In some cases where there are indications that infectious disease appeared, body temperature is measured every 2-3 hours.

The appearance of cases of sporadic typhus indicates the existence in people who have had epidemic typhus, a reservoir of Provacek's rickettsiae and the possibility of recurrence of the disease in them after many years (Zdrodovsky P.F., 1972). In the presence of lice in the environment of a patient with sporadic typhus, an outbreak of epidemic typhus is possible.

Q fever

Q fever- pneumorickettsiosis. It is characterized by high contagiousness, acute febrile course and the development of pneumonia. It is found in many countries, including on the territory of the USSR.

Etiology and pathogenesis. Q fever is caused by Burnett's rickettsia. It is transmitted by airborne, alimentary or contact route.

Morphological picture. In acute cases, interstitial pneumonia develops, which can sometimes take a protracted course and be fatal. At the autopsy of the dead in such cases, in addition to interstitial, foci of focal pneumonia with carnification phenomena, vasculitis, hyperplasia of the lymph nodes with the formation of numerous epithelioid and plasma cell nodules are found in them.

Diseases caused by bacteria

Diseases caused by bacteria are extremely diverse, which is determined by the peculiarity of the pathogen, the method of infection, the affinity of cells and tissues in relation to the infection, the nature of the reaction of the macroorganism to the infection, etc. The diseases described below are an illustration of the diversity of bacterial infections.

Typhoid fever

Typhoid fever- acute infectious disease from the group of intestinal; typical anthroponosis. Epidemics are possible, but at present the disease is usually sporadic and rather mild.

Etiology and pathogenesis. Called typhoid bacillus (Salmonella typhi). The source of infection is a sick person or a bacillus carrier whose secretions (feces, urine, sweat) contain microbes. Infection occurs parenterally. The incubation period is 10-14 days. Bacteria proliferate in the lower small intestine and secrete endotoxins. From the intestine, through the lymphatic pathways, they enter the group lymphatic follicles (the so-called Peyer's patches) and solitary follicles, and then to the regional lymph nodes. Having overcome the lymphatic barrier, the pathogen enters the bloodstream. Developing bacteremia, especially clearly expressed during the 1st week of the disease, when the typhoid bacillus can be isolated from the blood (hemoculture). Bacteremia is associated with generalization of the infection and the development of immunity. Starting from the 2nd week, using the agglutination reaction (Vidal reaction), antibodies to the pathogen are determined in the blood. Elimination of the pathogen is also associated with bacteremia, which, from the 2nd week of the disease, is excreted with sweat, milk (in lactating women), urine, feces, and bile. During this period, the patient is especially contagious. In the biliary tract (bile), typhoid bacteria find the most favorable conditions for existence and multiply intensively (bacteriocholia). Excreted with bile into the lumen of the small intestine, bacteria cause a hyperergic reaction in group sensitized at the first meeting (infection) and generalization of the infection (bacteremia).