Professional Documents
Culture Documents
11. The pathognostic (main) symptoms of typhoid fever in the climax of the
disease. Typhoid disease turns into the climax of the disease at the end of the first
week. The appearance of the patients is very typical in this period • The skin is
pale.
• Patient is apathethic.
• Intoxication is increased.
• Temperature is constant and most typical syndrome of typhoid fever and
paratyphoid. The phase of climax is near two weeks. The phase of decrease of the
temperature is near one week. • Chills and diaphoreses are seen in patients even in
the absence of antimicrobial therapy.
• Either constipation or diarrhea may occur.
• Respiratory symptoms, including cough and sore throat may be prominent.
Examination of the chest may reveal moist rales-
The abdomen is tender, especially in the lower quadrants. Abdominal distention is
common, and peristalsis is often hypoactive. The sensation of displacing air - and
fluidfilled loops of bowel on palpating of the abdomen is considered to be
characteristic
- Rose spots, 2-4 mm erythematous, maculopapular lesions that blanch on pressure,
appear on the upper abdomen or on the lateral surface of the body
13.PECULIARITIES OF PARATYPHI A
Paratyphi A is also having similar properties as salmonella typhi
Source of infection –sick person or carrier
Mechanism of transmission –fecal oral
14.PERCULIARITIES OF PARATYPHI B
Paratyphi B
Source of infection –(humans and cattle)
Mechanism of transmission –fecal oral
Paratyphoid B incubation period is 5-10 days.
• The onset of the disease is acute, with expressive chill, myalgia and weakness
• At the initial period of the disease the intoxication may be combined with symptoms
of acute gastroenteritis
• The temperature is not prolonged. Status typhosus is absent in majority of the
patients. The symptoms of intoxication disappears very quickly
• The rash is polymorphic, plenty. It appears at the earlier period. In some cases the
course of paratyphoid B may be severe with septic manifestations
15 SIGNS OF POSSIBLE RELAPSE OF TYPHOID FEVER
Relapse, a recurrence of the manifestation of typhoid fever after initial clinical
response,It s occur in patients who have not received antimicrobial therapy,Some
possible signs include
-Subfebrile temperature
• Increasing of pulse rate
• Presence of rash Rashes appear as rose spots which is 2-4 mm and is erythematous
and maculopapular lesions that blanch on pressure
• Hepato-Splenomegaly
• Aneozynophylia
Supportive Therapy
• Bed rest and liquid diet during the fever period
• Adequate hydration
• Dietary Supplements with Ascorbic acid and vitamins
• Probiotics to prevent intestinal dysbiosis
** Prevention
• TAB Vaccine (Typhoid-paratyphoid A and B Vaccine) – 5-7years immunity
• Vi capsular polysaccharide Vaccine against the capsular (Vi) antigen **
Epidemiology
• Source of infection: contaminated food (poultry, eggs, beef, etc),
contaminated water, contact with infected animals or their fecal matter, sick
people or carriers
• Mode of transmission: Unhygienic cooking environments and persons,
improperly cooked foods
• Vectors of the infection: Flies, cockroaches, rats
• Mechanism of transmission: Fecal-oral route
• Mode of occurrence: Occur as separate sporadic cases and as outbreaks
• Incubation period is 12-72 hours but can be longer
● Susceptibility of a person depends on the premorbid state of the
macroorganism and the quantity and variety (serotypes) of Salmonella present.
● Seasonality; mostly summer
•
** NB:
Salmonella can remain viable in water for 11-120 days, in the sea water – 15-27
days, in soil – 1-9 months , in sausage products – 60-130 days, in the eggs,
vegetables and fruits till 2,5 months. **
Epidemiology
• Source of food poisoning: contaminated food (poultry, sausages, eggs, beef,
vegetables, canned foods, milk, etc), water or soil, contact with infected
animals or their fecal matter, sick people or carriers
• Mode of transmission: Unhygienic cooking environments and persons,
improperly cooked foods
• Mechanism of transmission: Fecal-oral route
• Mode of occurrence: Occur as outbreaks with an explosive character of illness
affecting a mass of people that fall ill over a short period of time (e.g. After
visiting a restaurant); and may also occur as separate sporadic cases
• Incubation period: A few hours
• Susceptibility of a person to this group of diseases is very high, sometimes up
to about 90-100%.
• Seasonality: Toxic food-borne infections may occur during the whole the year,
but occur more especially in summer.
** NB:
There are 2 types of Bacterial toxins: Exotoxins & Endotoxins
• Exotoxins are the toxic products of bacteria which are actively secreted into
environment.
Some exotoxin-releasing bacteria are Clostridium species, Enterobacter,
Proteus, etc. There are 2 types of Enterotoxins (Exotoxins) of bacteria:
thermolabile and thermostable. They increase the secretion of the fluids and
salts into the stomach and intestine and damage the membranes of the
epithelial cells. Majority of enterotoxins are thermolabile.
• Endotoxins are toxic substances which are liberated only during the lysis of
microbial cells.
Some endotoxin-releasing bacteria are Salmonella. **
Septic form:
Sepsis develops when there is a sharp decrease in the immune system function of the
patient and it is characterized by symptoms such as
• Acute onset from hectic or prolonged fever, chills and sweating, after an
Incubation period of about 5-10 days
• Pallor, rash may appear on the skin (petechiae or large hemorrhages).
• Purulent metastases in different organs and tissues
• Presence of septic focus may cause complicatioms such as meningitis,
pneumonia, osteomyelitis, pyelonephritis, enterocolitis, etc
• Hepatosplenomegaly sometimes with the development of jaundice
• Toxic-dystrophic syndrome (dystrophic changes to parenchyma of organs e.g.
liver)
• The influence of intoxication on the central nervous system leads to irritation,
violations of sleep, and sometimes delirium.
** NB:
According to the WHO classification, patients with cholera may be divided into
three groups by their degree of dehydration:
The first degree of dehydration (Mild) - Patients who have loss of fluid
volume equal to 5 % of their body weight.
• The second degree of dehydration (Moderate) - Patients who have loss of
fluid volume equal to 6-9 % of their body weight.
• The third degree of dehydration (Severe) - Patients who have loss of fluid
volume over 10% of their body weight. This dehydration is dangerous for life if
the reanimation measures are not done. **
35. Classification of cholera.
Cholera is an acute anthroponosic infectious disease caused by eating food or
drinking water contaminated by Vibrio bacteria species, that leads to severe watery
diarrhea and vomiting, which can result in dehydration and even death if untreated.
Classification
According to degree of dehydration:
1. WHO classification - patients with cholera may be divided into three groups
by their degree of dehydration:
• The first degree of dehydration (Mild) - Patients who have loss of fluid
volume equal to 5 % of their body weight.
• The second degree of dehydration (Moderate) - Patients who have loss of
fluid volume equal to 6-9 % of their body weight.
• The third degree of dehydration (Severe) - Patients who have loss of fluid
volume over 10% of their body weight. This dehydration is dangerous for life
if the reanimation measures are not done.
** NB:
Complications: collapse, renal failure, cardiac failure,, pneumonia, abscess,
phlegmon **
• start IV fluids immediately. If the patient can drink, give ORS by mouth while
the IV drip is set up. Ringer’s lactate IV fluid is preferred. If not available,
use normal saline or dextrose solution.
Measure the amount of IV fluids delivered to compensate the amount of fluid lost
from di Primary rehydration: IV fluids i.e %of weight loss given in litres in 2 hours.
Secondary rehydration: daily rehydration
● IV: Trisol, Acesolum, Lactasol, Quartasol under control of sodium and
potassium
● In first and second stage, oral rehydration with standard salt solutions: oralyte,
rehydron. First degree give 30ml/kg, second degree give 60-70ml/kg
● IV Lactated ringer solution 10-20ml/kg/hour
• ORS 500-1000ml arrhea and vomitus.
****
Asymptomatic Infection
More than 50% of EV infections are asymptomatic or result only in Nonspecific
febrile illness. Young age is associated with higher frequency of symptomatic
infection.
Encephalitis
Frank encephalitis is an unusual manifestation of enterovirus infection.
Echovirus 9 is the most common etiologic agent.
Clinical manifestations include lethargy, drowsiness, and personality change to
seizures, paresis, and coma. Children with focal encephalitis present with partial
motor seizures, hemichorea, and acute cerebellar ataxia
Rashes
Certain coxsackieviruses, echoviruses,.Rashes are usually nonpruritic, do not
desquamate, and occur on the face, neck, chest, and extremities. They are sometimes
maculopapular but occasionally hemorrhagic, petechial, or vesicular. Fever is
common. Aseptic meningitis may develop simultaneously.
Ocular Infections
Outbreaks of acute hemorrhagic conjunctivitis are typically due to Echovirus 70 or
Coxsackie virus.Presentation is characterized by a sudden onset of severe eye pain
and associated photophobia. Subconjunctival hemorrhages are frequently present.
Systemic symptoms, including fever, are rare.
Herpangina.
This is an enanthematous (mucous membrane) disease that presents with painful
vesicles of the oral mucosa along with fever and sore throat, The onset is sudden,
with high temperatures [39.4-40°C]. The oropharyngeal lesions usually erupt around
the time of first fever.The duration of illness is 3 to 6 days.
Hand-foot-and-mouth Disease.
This common clinical syndrome manifests as a vesicular skin rash on the hands and
feet along with vesicles in the oral cavity. Mainly caused by Coxsackie virus and
echovirus.
Fever could also be present. The oral vesicles usually are located on the buccal
mucosa and tongue and are only mildly painful. The exanthem involves vesicles on
the palms, soles, and the interdigital surfaces of the hands and feet.
Heart Infections
In myopericarditis, Coxscakie virus B5 the most common causative agent.
The usual presentation is fever, fatigue, and dyspnea on exertion, but more fulminant
symptoms, including heart failure or dysrhythmia, can occur.
Respiratory infections
These infections may result from enteroviruses. Symptoms include fever, coryza,
pharyngitis, and, in some infants and children, vomiting and diarrhea. Bronchitis
and interstitial pneumonia occasionally occur in adults and children. The course is
usually mild but can be severe as evidenced by the 2014 enterovirus D68
outbreak.
Symptoms may vary based on clinical form of enterovirus infection but main
symptoms include
! A Latent period lasts 2-10 days
! Acute beginning from toxic syndrome (high body temperature 39-40 degree,
headache, malaise, fatigue, repeated vomiting, decreased apetite), abdominal
pain and catarrhal syndrome
! Hyperemia of overhead half of trunk, skin, neck and face
! Injection of sclera vessels
! Hyperemia, gaininess of soft palate, and back pharyngeal wall
! Neck catarrhal lymphadenitis, or polyadenitis, may be hepatosplenomegaly
******* (NOT MAIN!!)
CLINICAL FORMS
Asymptomatic Infection
More than 50% of EV infections are asymptomatic or result only in Nonspecific
febrile illness. Young age is associated with higher frequency of symptomatic
infection.
Aspetic Meningitis
Mainly caused by Enteroviruses of group B coxsackievirus and echovirus
The clinical course typically involves an initial episode of nonspecific fevers in
conjunction with CNS symptoms.Symptoms may also include headache, malaise,
nausea, and vomiting.,photophobia. Physical examination typically demonstrates
generalized muscle stiffness or spasm.
Encephalitis
Frank encephalitis is an unusual manifestation of enterovirus infection.
Echovirus 9 is the most common etiologic agent.
Clinical manifestations include lethargy, drowsiness, and personality change to
seizures, paresis, and coma. Children with focal encephalitis present with partial
motor seizures, hemichorea, and acute cerebellar ataxia
Rashes
Certain coxsackieviruses, echoviruses,.Rashes are usually nonpruritic, do not
desquamate, and occur on the face, neck, chest, and extremities. They are sometimes
maculopapular but occasionally hemorrhagic, petechial, or vesicular. Fever is
common. Aseptic meningitis may develop simultaneously.
Ocular Infections
Outbreaks of acute hemorrhagic conjunctivitis are typically due to Echovirus 70 or
Coxsackie virus.Presentation is characterized by a sudden onset of severe eye pain
and associated photophobia. Subconjunctival hemorrhages are frequently present.
Systemic symptoms, including fever, are rare.
Herpangina.
This is an enanthematous (mucous membrane) disease that presents with painful
vesicles of the oral mucosa along with fever and sore throat, The onset is sudden,
with high temperatures [39.4-40°C]. The oropharyngeal lesions usually erupt around
the time of first fever.The duration of illness is 3 to 6 days.
Hand-foot-and-mouth Disease.
This common clinical syndrome manifests as a vesicular skin rash on the hands and
feet along with vesicles in the oral cavity. Mainly caused by Coxsackie virus and
echovirus. Fever could also be present. The oral vesicles usually are located on the
buccal mucosa and tongue and are only mildly painful. The exanthem involves
vesicles on the palms, soles, and the interdigital surfaces of the hands and feet.
Heart Infections
In myopericarditis, Coxscakie virus B5 the most common causative agent.
The usual presentation is fever, fatigue, and dyspnea on exertion, but more fulminant
symptoms, including heart failure or dysrhythmia, can occur.
Respiratory infections
These infections may result from enteroviruses. Symptoms include fever, coryza,
pharyngitis, and, in some infants and children, vomiting and diarrhea. Bronchitis
and interstitial pneumonia occasionally occur in adults and children. The course is
usually mild but can be severe as evidenced by the 2014 enterovirus D68
outbreak.
*** Pandy's test (or Pandy's reaction) is done on the CSF (cerebrospinal fluid) to
detect the elevated levels of proteins (mainly globulins).
PRINCIPLE OF THERAPY
There is no specific treatment for non-polio enterovirus infection. People with
mild illness caused by non-polio enterovirus infection typically only need to treat
their symptoms. This includes drinking enough water to stay hydrated and taking
over-thecounter cold medications as needed. Most people recover completely,
Hence , recommendations are
! Bed regimen in acute period
! Control of fever
! NSAIDs for pain relieve (ibuprofen, paracetamol ), or opiate analgesics
( morphine) in clinical forms with severe pain
! Physiotherapy (in case of epidemic myalgia or paralytic form)
! Mechanical ventilation may be required if respiratory muscles are affected
in paralytic form
! Patients with weakness or paralysis of the bladder may be treated with
cholinergic agents, the sound of running water, or catheterization.
! Cold compresses may be used, along with antihistamine/decongestant eye drops
in case of enteroviral infection presenting as acute hemorrhagic conjuctivitis
( ***mainly caused by Echo or Coxsackie virus )
! topical anesthetics, and saline rinses may be used in enteroviral infection
presenting as Herpangina and hand-foot-and-mouth disease
***** Herpangina.
This is an enanthematous (mucous membrane) disease that presents with painful
vesicles of the oral mucosa along with fever and sore throat, The onset is sudden,
with high temperatures [39.4-40°C]. The oropharyngeal lesions usually erupt around
the time of first fever.The duration of illness is 3 to 6 days.
Epidemiology
! Source- Sick patients, patients in period of convalescence and carriers.
! Mechanism of transmission: fecal-oral
! Ways of transmission: water (Shigella .flexneri), food stuffs (Shigella
.sonnei), dishes, dirty hands, flies ! Epidemic features:
- season: summer & fall
- age: affects younger children more
! Incubation period 2-5 days
*** Shigella dysenteriae causes the most serious form of bacillary dysentery
CLINICAL CLASSIFICATION
Duration
! Acute; up to 1 and a half months
! Subacute: up to 3months
! Chronic: more than 3 months
Clinical variants:
! Colitic variant
! Gastroenterocolitic variant
! Gastroenteric variant
Clinical form:
! Typical: with dominant toxicosis
! with dominant local inflammation
! mixed
Depending on severity:
! Mild form: acute diarrhea 5-8 times per day with mucus and blood. Mild
abdominal pain, normal temperature. Loss of appetite, could be vomiting
! Moderate form: acute onset of diarrhea, symptoms of toxicosis, temperature 38-
39 degrees, anorexia, crampy abdominal pain, stool 10-15 times per day with
mucus and blood. Pain during palpation of left inguinal region
! Severe form: vomiting with or without food, stool more than 15 times per day
with mucus and blood. General condition sharply worsened. Sopor, loss of
consciousness, cramps. Severe toxicosis, weight loss and dehydration.
According to Pathology:
! Acute catarrhal inflammation
! Fibrinous Necrotic
! Ulcerous and folliclic-ulcerous
! Stage of formation of scars
PECULIARITIES
With dominance of toxicosis:
! Toxicosis is the first sign (loss of appetite, headache, fatigue, vomiting,
hallucinations, unconsciousness, seizures, febrile temperature 39-40 degrees
! Colitis is secondary: abdominal pain, tenesmus, false urge to defecate, sigmoid
colon is tender, spastic, anus is open in severe cases. Feces in the form of spit of
mucus and blood (rectal spit), enlargement of number of defecation With dominance
of local inflammation:
! Sudden onset of high grade fever
! Abdominal cramping
! Abdominal pain
! Tenesmus
! Large volume of mucus, cylindrical epithelial cells diarrhea
! Fecal incontinence, small volume, mucous diarrhea with frank blood
According to severity
! Mild form: acute diarrhea 5-8 times per day with mucus and blood. Mild
abdominal pain, normal temperature. Loss of appetite, could be vomiting
! Moderate form: acute onset of diarrhea, symptoms of toxicosis, temperature 38-
39 degrees, anorexia, crampy abdominal pain, stool 10-15 times per day with
mucus and blood. Pain during palpation of left inguinal region
! Severe form: vomiting with or without food, stool more than 15 times per day
with mucus and blood. General condition sharply worsened. Sopor, loss of
consciousness, cramps. Severe toxicosis, weight loss and dehydration.
** Mild form doesn’t require etiological treatment, but adequate hydration should is
key, moderate to severe may require antibiotics eg. ciprofloxacin or azithromycin.
DON’T USE ANTIDIARRHEALS Like loperamide.
TREATMENT
In mild cases, treatment with antibiotics may not be indicated however adequate
hydration is vital.
In more severe cases:
! Antibiotic therapy- Ciprofloxacin, Ceftriaxone, Azithromycin
! Probiotics: collibacterin, bifidumbacterin
! Rehydration: trisol, quartasol, saline
! Spasmolytics: no shpa. Spasmolgon
CLINICAL CLASSIFICATION
● Asymptomatic infection: (cyst passers/carriers)
● Symptomatic infection (Intestinal Amebiasis & Extraintestinal )
- Intestinal Amoebiasis: Acute dysentery, Chronic non-dysentry, colitis,-
Symptoms present over a period of 1-2 weeks, Diarrhea with cramping,
abdominal pain, watery or bloody diarrhea and weight loss or anorexia. Stool
looks like raspberry jelly. Fever
- Extraintestinal Amoebiasis: liver, skin, lung, pleura and brain
Hepatic amebiasis: abdominal pain, weight loss,
Amebic liver abscess: fever, right upper quadrant pain, weight loss, hepatomegaly,
jaundice, weight loss. Could be associated GI symptoms such as nausea, vomiting,
abdominal distention, diarrhea and constipation
Rupture of amebic hepatic abscess: pleuropulmonary amebiasis: liver abscess
rupture, cough, pleuritic chest pain, dyspnea, necrotic sputum. amebic peritonitis
or amebic pericarditis can also occur due to rupture of liver
Cerebral amebiasis: mental status changes and focal neurological deficits.
Amoebic colitis
! Symptoms present over a period of 1-2 weekks
! Diarrhea with cramping, abdominal pain, watery or bloody diarrhea and weight
loss or anorexia. Stool looks like raspberry jelly.
! Fever
Chronic amoebic colitis
! Recurrent episodes of bloody diarrhea and vague abdominal discomfort, plus
fatigue, weight loss and occasional fever.
LABORATORY DIAGNOSIS
! Microscopic identification of cysts and trophozoites in the stool is the common
method for diagnosing E. histolytica
! Stool or liver abscess aspirate culture, , E. histolytica trophozoites can also be
identified in biopsy samples
! Stool antigen test with monoclonal antibodies
! Serum anti-amoebic antibody: PCR and DNA probes for E.histolytica
! CT with contrast: amebic liver abscess
58.The treatment principles of amoebiasis patients.
TREATMENT
Both symptomatic intestinal infection and extra intestinal disease as well as
Asymptomatic patients infected with E. histolytica should be treated with
antiamoebic drugs, to prevent spread of infection and latent infection
Epidemiology
! It has a Worldwide distribution (prevalent throughout the world increasing in
areas with poor sanitation)
! Source of infection: zoonosis: beavers, dogs, cats, rodents
! Mechanism of transmission: fecal oral
! Way of transmission: water-borne, food-borne
! Incubation period 1- 2 weeks
CLINICAL SIGNS
! Diarrhea, abdominal distention, abdominal cramps, flatulence. Malodorous,
greasy stools.
! Malaise, weakness, low grade fever, anorexia
! Nausea, vomiting
! CNS symptoms: irritability, sleep disorder, mental depression, neurasthenia
61.Diagnostics of giardiasis.
Definition
Giardiasis is a diarrheal disease caused by the microscopic parasite Giardia
duodenalis (or“Giardia” for short). Once a person or animal has been infected with
Giardia, the parasite lives in the intestines and is passed in stool (poop). Once
outside the body, Giardia can sometimes survive for weeks or even months spread
by:
• Swallowing unsafe food or water contaminated with Giardia germs
• Having close contact with someone who has giardiasis, particularly in childcare
settings
• Traveling within areas that have poor sanitation
• Exposure to poop through sexual contact from someone who is sick or recently sick
with Giardia
DIAGNOSIS
•Atleast 3 stool samples in 2 days for culture: ova and parasites should be seen.
• Fresh stool+ iodine or methylene blue examination for cysts on wet mount
• Stool antigen test with immunofluorescent antibody assay or ELISA test,
PCR( especially used for identification of subjects during a pandemic )
It’s treated with antibiotics which have anti parasitic effects (nitroimidazole drugs)
• Metronidazole: (contraindicated in first trimester of pregnancy )250mg
• Tinidazole 2g orally once
• Nitazoxanide 20mg/ml orally
•Albendazole
Epidiemology
Balantidium coli occurs worldwide. Because pigs are the primary reservoir, human
infections occur more frequently in areas where pigs are raised and sanitation is
inadequate.
● Source of infection: pork excrement(zoonosis)
● Mechanism of transmission: fecal oral
●
• Probiotics
• Vitamins
• Antibiotics: Tetracycline, metronidazole, iodoquinol,• Enzymes: pancreatin,
gordoux• Enema
Management
Avoid ingestion of material contaminated with animal feces
Treatment of infected pigs
Prevention of contaminated food
The most important candidates for vaccination are those with chronic lung and
cardiac disease, pregnant women in any trimester, residents of chronic care facilities,
health-care workers, immunosuppressed patients, and those with diabetes and renal
dysfunction. Influenza vaccine is contraindicated in those who are highly allergic to
eggs and which would result in anaphylaxis.
Epidemiology
They are facultative intra cellular parasites
Complications
Decreased pulmonary function, abscess formation(in lungs or extra
pulmonary site ) ,pulmonary fibrosis , fulminant respiratory failure ,
death
Diagnostic
Definitive method – Isolation of organism in respiratory secretions (sputum , lung
fluid , pleural fluid )
Treatment:
● Levofloxacin 750mg IV daily 7-14days
● Ciprofloxacin 400mg IV tid 7-10d
● Moxifloxacin 400mg orally or IV once per day for 7-10 days
● Azithromycin 500mg orally or IV once per day for 7 days
Herpes simplex is a viral disease caused by both herpes simplex virus 1 (HSV-1) and
herpes simplex virus 2
Source of infection
Humans (Sick persons , Carriers )
Clinical Manifestations
Herpes simplex 1
1) Acute Herpetic Gingivostomatitis – occurs in children aged 6months – 5 years ,
may occasionally be in adult
It last 5-7 days and symptoms subside in 2 weeks , viral shedding may continue for 3
weeks Symptoms include
• Abrupt onset
• High temperature (39-40c)
• Anorexia
• Gingivitis
• Vesicular lesions
• Tender regional lymphadenopathy
• Perioral skin involvement due to contamination with infected saliva
2) In adult it causes pharyngitis and tonsillitis more often than gingivostomatitis
Symptoms
• Fever , malaise , headache, sore throat
• The vesicles rupture and forms ulcerative lesions with grayish exudates on the
tonsils and posterior pharynx
3) Conjunctivitis - unilateral follicular conjunctivitis with regional adenopathy
and/or a blepharitis with vesicles on the lid margin. Photophobia, chemosis,
excessive tearing, and edema of the eyelids may be present.
4) Herpes labialis – which is the manifestation of recurrent HSV-1 infection
Symptoms
• Prodromal symptoms (Pain , burning and tingling at the site) followed by
• Development of erythematous papules that turns into tiny, thin walled vesicles ,
then they become pustular and ulcerate
5) Skin infections ( herpetic whitlow, herpes gladiatorum , eczema herpeticum )
6) Herpes encephalitis (fever , headache , focal signs , altered level of
consciousness)
Herpes simplex 2
Primary general herpes can be caused by both
Symptoms
• Constitutional symptoms like fever , headache, malaise, myalgia (prominent in the
first 3-4 days)
• Local symptoms like pain, itching , dysuria , vaginal and urethral discharge
• Tender lymphadenopathy
• In females – herpetic vesicles appear on the external genitalia , labia majora, labia
minora, vaginal vestibule , introitus, in most areas the vesicles rupture and form
ulcer , the vaginal mucosa is inflamed and edematous
• In males – the herpetic vesicles will appear in the glans penis , shaft of penis and
sometimes scrotum , thighs , in dry areas the lesions will become pustule and
encrust
Perinatal infections
Definition- Herpes zoster is viral infection that occurs with reactivation of the
varicellazoster virus that has remained dormant within dorsal root ganglia, often for
decades after the patient’s initial exposure to the virus in the form of varicella
(chickenpox),
Definition- Herpes zoster is viral infection that occurs with reactivation of the
varicellazoster virus that has remained dormant within dorsal root ganglia, often for
decades after the patient’s initial exposure to the virus in the form of varicella
(chickenpox),
- Before the rash appears there is itching , paresthesia, hyperesthesia, burning pain in
affected dermatone 2 or 4 days
- After 2 days , a characteristic rash appears , painful papules on red base
- Later Rash becomes vesicular developing on an erythematous base
- The Vesicles are clear initially but eventually they become cloudy or darkened with
blood , fever and malaise continues, the vesicles rupture, crust within 7-10 days and
involute
- Rash typically appear unilaterally( either on the left or right side of the body or
face), stopping abruptly at the midline of the limit of sensory coverage of the
involved dermatome, mostly thoracic and lumbar dermatone are affected
- some people can develop post herpetic Neuralgia ( is persistent or recurring pain
lasting 30 or more days after the acute infection or after all lesions have crusted. It is
the most frequent complication of herpes zoster,symptoms are a deep burning or
aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains.
Tzanck smear: scraping from base of fresh vesicular lesion after rupture may be
smeared, fixed with ethanol or methanol and stained with Giemsa or Wright
preparation.
Rapid diagnosis using histological appearance
Histological appearance - The presence of multinucleated giant cells and epithelial
cells containing eosinophilic inclusion bodies indicates infection with HSV or
varicella-zoster virus.
• PCR – to detect HSV(herpes simplex virus) DNA , in HSV encephalitis , PCR with
CSF is a sensitive rapid diagnostic technique,
it can also be used to detect asymptomatic viral shedding
• Direct fluorescent antibody – Cells scrapes from ulcer base can be stained with
direct fluorescent antibody and it is used to distinguish HSV-1 from HSV-2 , tissue
culture cells can also be stained
• Brain biopsy in Herpes encephalitis
In chicken pox the rash crust by the 7th day, in herpes zoster they crust by the
14th day In chicken pox rash is itchy , in herpes zoster rash is painful
Desintoxication therapy
● Antihepatic drugs: acyclovir, valaciclovir, famaciclovir
A number of nucleoside derivatives interfere with the synthesis of HSV DNA. Some
of these (trifluorothymidine, vidarabine) are useful in and licensed for the topical
treatment of herpes keratitis.
● Immune stimulators: interferon, amizone
● Symptomatic therapy: NSAID (paracetamol, ibuprofen) for pain, sitz bath, topical
lidocain
CMV in immuno-compromised persons (for instance, people who have had organ
transplants or who have HIV) with increased risk for difficult eye infections
(CMV retinitis), gastrointestinal CMV, encephalitis, CMV pneumonia.
93. Laboratory diagnosis of infectious mononucleosis.
Criteria
CBC – Lymphocytosis
Peripheral blood smear – presence of at least 10% atypical lymphocytes on smear(a
type of mononuclear cells – big monocytes with deformed big nucleus and widened
cytoplasm ) Positive serological test for EBV
Evaluation
a) CBC – Leukocytosis , lymphocytosis , monocytosis , increased ESR
b) Liver function test – mild increases in the serum transaminases
c) Peripheral blood smear – atypical lymphocytes
d) Heterophile Antibody test (Monospot test ) –
A titre of 1:40 or greater is considered a positive result
The heterophile antibody is an immunoglobulin M (IgM) antibody produced by
infected B lymphocytes. In the heterophile test, human blood is first absorbed
by a guinea pig kidney. Then, it is tested for agglutination activity that is
directed against horse, sheep, or cow erythrocytes.
it may be negative early in the course (first week ) of EBV infectious mononucleosis
so negative test can be repeated within the first 6 weeks
It is less useful in children younger than 2 years
e) Serology – igM and igG antibodies against the viral capsid antigen (VCA) of
Ebstein Barr virus is useful in confirming diagnosis of EBV and
differentiating acute and/or recent infection from previous infection
The EBV IgM viral capsid antigen titre decrease after 3-6 months
EBV IgG viral capsid antigen(VCA) antibodies rises later than the IGM viral capsid
antigen (VCA) antibodies and remains elevated for life
Based on location
a) Diphtheria of tonsils (&pharynx)
b) Diphtheria of larynx
c) Diphtheria of nasopharynx
d) Diphtheria of anterior part of nose
e) Rarely of the eyes , ears, genitals , umblicus , wounds, lips , cheeks , combined
diphtheria
Clinical onset – low grade fever , cough , hoarseness, sore throat , intensity of
intoxication depends on the square of affection ( localized , spread , toxic form )
● Gray adherent membranous exudate on tonsils in localized form
● Localized can be ( catarrhal,island, membranous), in island the thigh grey
membrane covers part of the tonsils , in membranous it covers all tonsils
● In the spread form it extends to the soft palate , cheeks,
Tongues
● Not easily seperated and exudates bleed when removed
● Hyperemia of throat with cyanotic(blue) tint and edema of the mucus
membrane in places not covered by the thick grey membrane
● Regional lymph nodes are enlarged and tender
( lymphadenopathy)
In toxic form - you see bull neck( due to neck subcutaneous tissue
edema And the grey membranous exudates also extends outside the
tonsils
Hypertoxic form
Sudden onset, severe intoxication (temp > 40c, seizures , nausea , vomiting ,
unconsciousness )
Hemorrhagic form
Hemorrhages, membranous educates are soaked with blood
A stenosis stage.
Stenotic breathing ( narrowing of airways – inspiratory Dyspnea with an
elongated inspiration ) Noisy respiration
Participation of auxiliary muscles in respiration
Aphonia develops then later inspiratory stridor.
Signs of hypoxia ; peripheral then general cyanosis , tachycardia , anxiety ,
retractions )
An asphyxia stage.
• In the struggle with stenosis the child exhausts, the respiratory muscles get
tired. The child becomes calm, sleepy, he inditfferently lies in bed.
• The respiration is accelerated, but it is superficial, the retractions are already
not so visible. • The lips, tip of the nose and nails become blue, the face turns pale,
sweat quite often appears on the forehead. • The extremities are cold,
• the pulse is very rapid, thready, sometimes paradoxical (abasement of the pulse
wave during the inhalation).
• From time to time there are attacks of acute dyspnea – the child jumps up,
rushes because of air-deficiency, the eyes express fright, the face becomes cyanotic;
sometimes such attacks result in the immediate death;
• in other cases the child dies after a more or less continuous agony with the
symptoms of exhaustion of respiratory and circulation centers.
Cardiac toxicity
Cardiac complications may arise during the first 10 days of illness or may be delayed
until 2-3 weeks after onset, following improvement in the pharyngeal phase of the
disease Cardiac involvement is thought to be responsible for 50-60% of deaths
associated with diphtheria:
The first sign of toxin- induced myocardiopathy is
- tachycardia disproportionate to the degree of fever
- Various dysarthymias like first- degree, second-degree, or third-degree AV
blocks ;ventricular tachycardia
- congestive heart failure which is a consequence of myocardial
inflammation( progressive
Dyspnea , reduced heart sounds, systolic murmur )
- Echocardiography may reveal dilated or hypertrophic cardiomyopathy;
Neurological toxicity
. Demyelination of nervous tissue
There will be Frank paralysis which involves the muscles of the palate and the
hypopharynx, beginning as early as the first 10 days of illness;
Difficulty swallowing and nasal speech are often the first indications of neurologic
impairment;
Cranial nerve deficit – Oculomotor ,ciliary paralysis (blurred vision ) , facial ,
pharyngeal dysfunction
involvement of the anterior horn cells of the spinal cord may be seen as late as 3
months after initial disease, Diffuse, usually bilateral, motor function deficits with
progression of weakness either from proximal-to-distal regions or, more commonly,
from distal-toproximal regions;
Involvement of the phrenic nerve may cause diaphragmatic paralysis at any time
between the first and seventh weeks of illness;
Recovery from neurologic damage usually is complete in patients who survive.
. Airway obstruction by the diphtheritic: membrane and peripharyngeal edema
combine to pose a risk of death in patients with diphtheria
The two major sites of infection are the respiratory mucosa and skin.
The initial symptoms of respiratory diphtheria include sore throat, malaise, and low-
grade fever. The characteristic clinical presentation is the presence of a grayish-white,
fibrinous and firmly adherent pseudomembrane that forms within the first few days
and spans over the tonsils, the pharynx, or the larynx.
LAB DIAGNOSIS:
a) Swabs from the nose, throat or suspected lesions are cultured onto blood and
tellurite agar, Löffler medium, hoyle, Mueller or tinsdale medium.
*(Tellurite inhibits growth of some normal flora and allows the Corynebacterium sp.
to grow as black or grey colonies)
c) PCR assay- for detection of the toxin gene (PCR positives must be confirmed by
the phenotypic Elek test)
d) Serology
Simanovsky-Plaut Diphtheria
Vincent tonsillitis
Leading severe pain in Fibrinous inflammation in throat, toxic
symptoms mouth and gums, syndrome
foul smelling breath
Throat changes Grey-white pseudo Cyanotic, hyperemic, edema
membrane on gums
that can ulcerate
and
cause bad taste in
mouth
Character of Grey-white pseudo Grey or white yellow membranes can
tonsillar membrane on spread outside the tonsils. They are dense,
exudates tonsils that can hard to remove and bleed when removed.
ulcerate and After removal, they reappear and cannot
become necrotic. be separated
Easily removable
Lymphadenitis Cervical Regional
lymphadenopathy
Toxic sign Absent or minor Proportional to surface of inflammation.
(mild, moderate and severe)
Subcutaneous Absent Typical for toxic forms (bull neck sign)
fat edema
Changes on the Absent Coated
tongue
Symptoms of respiratory diphtheria include sore throat, malaise, and low-grade fever.
The characteristic clinical presentation is the presence of a grayish-white, fibrinous
and firmly adherent pseudomembrane that forms within the first few days and spans
over the tonsils, the pharynx, or the larynx.
Cutaneous diphtheria commonly occurs on exposed limbs, particularly the legs.
TREATMENT:
● Immediate Hospitalization
● Bed regimen (localized forms - 10 days, toxic forms - not less than 35-45 days)
● Specific treatment- antitoxic antidiphtherial Serum (from 30-50 thousand IU in
localized forms and 100-120 thousand IU in toxic forms by Bezredka method)
● Glucocorticoids (In toxic forms and croup)
● Antibiotics (penicillin, tetracycline, erythromycin)
● Strychninum (in toxic forms)
● In case of croup - inhalations, broncholitics, diuretics, glucocorticoids, antibiotics,
antihistamine, lytic admixture
● under the indications - intubation, tracheotomy.
Peculiarities:
● Incubation period 8-12 days
● Prodromal period: high fever lasting 4-7 days. Malaise, anorexia. Cough, coryza
and conjunctivitis. Koplick spots inside the cheek opposite second molar
● Period of exanthema: Erythematous Maculopapular rash that becomes confluent
begins on the face and then proceeds to trunk , extremities, palms and soles. Lasts
about 5 days.
● Desquamation and brown staining which spares palms and soles
● Generalized lymphadenopathy, mild hepatomegaly and appendicitis may occur due
to generalized involvement of lymphoid tissues.
The most common symptoms of mumps that may be seen in both adults and
children are: • Discomfort in the salivary glands (in the front of the neck) or the
parotid glands. These glands may become swollen and tender.
• Other symptoms include fever, muscle aches, headache, loss of appetite,
difficulty chewing. Peculiarities:
● Incubation period 14-21 days
● Fever lasts about a week and usually subsides before parotitis. , headache, malaise,
anorexia, abdominal pain.
● Within 24 hours patients complain of ear pain near ear lobe which is aggravated by
chewing movement of jaw.
● Enlargement of parotid gland, initially unilateral then bilateral. Edema over parotid
gland typically occurs with non discrete borders, pain with pressure and obscured
angle of mandible.
● Involvement of other salivary glands: submaxillary glands and sublingual glands.
Orifices of ducts may be erythematous and edematous
Classification:
● Primary localized forms o Meningococcal carrier state
o Acute nasopharyngitis
● Hematogenic generalized forms
o Meningococcemia: typical acute meningococcal sepsis,
chronic o Meningitis o Meningoencephalitis
● Mixed forms (meningococcemia and meningitis)
● Rare forms: endocarditis, arthritis, irideocyclitis, pneumonia
● Complicalions: sepsis, DIC syndrome, toxic shock, brain edema
● Meningitis: Neck rigidity, positive brudzinski and kerning sign. Hemorrhagic rash
(ptechia, ecchymoses and purpura) on the body.
Severe diffuse or pulsatory headache worse at night, also increases with changing of
body position, sharp sounds and bright light.
Fountain like Vomiting without nausea and no connection with food. Hyperthermia,
hyperkinesia, photophobia, hyperalgesia and hpersomia. Assymetry of reflexes
or hyporeflexia, patients lay with extended head and bent knees. Pathological
reflexes. Tachycardia, tachypnea and arrhythmia. Tongue is dry and covered
with dirty brownish coat. Loss of consciousness.
• Meningoencephalitis
It is rare form of meningococcal infection. In this case the symptoms of encephalitis
predominate, but meningeal syndrome is weakly expressed. Meningococcal
encephalitis is characterized by rapid onset and impetuous cramps, paresises
and paralyses. Prognosis is unfavorable. The mortality is high and recovery is
incomplete even in modern conditions.
Complications:
● Meningococcal arthritis: Can occur within the first few days of treatment, or when
patient appears to be improving from meningitis or sepsis. Severe arthralgia with
few signs of joint inflammation. Occurs mostly on wrists, elbow and ankle joints
● Pericarditis is a late complication: fever, dyspnea, substernal chest pain or cardiac
tamponade ● Myocarditis
● Cranial nerve palsies, radiculitis, hemiplegia ,seizures, ophthalmic complications,
hydrocephalus, arachnoiditis.
112.Diagnostics of meningococcal infection.
Symptoms include:
Fever and chills, Fatigue, Vomiting
Severe aches or pain in the muscles, joints, chest or
abdomen Rapid breathing Diarrhea.
In the later stages, a dark purple rash
Treatment:
● Etiological treatment: benzylpenicillin 200.000-300,000 IU/kg/d, or ampicillin (or
metycillin) 200-300mg/kg/day, Chloramphenicol: 50-100mg/kg/ day, tetracycline
25mg/kg if patient resistant to other antibiotics
● Oxygen therapy
● Symptomatic therapy: antipyretics, anti-convulsants as needed
Stages
● I degree (catarrhal)- labored inspiration, retraction of intercostal spaces, barking
cough
● II degree (stenosis): Noisy respiration (whistling sound), inspiratory dyspnea with
elongated inspiration (inspiratory stridor). Participation of auxillary muscles
(intercostal, scalene, sternocleidomastoid muscles)
● III degree (asphyxia): acute oxygen insufficiency, sleepiness, cyanosis. Extremities
are cold, thread paradoxical pulse. Cramps.
Emergency Aid:
● Treat underlying cause: In case of diphtheria, give antitoxin
● Mechanical removal of blockage, suction of membranes and mucous
● Give anti-edematic drugs (euphillin)
● Oxygen
● Intubation or tracheotomy as required in severe cases
Stage:
● I degree (compensated stenosis): hoarse voice, rough barking cough, compensated
hyperventilation of lungs pO2 normal
● II degree (Subcompensated stenosis): dyspnea, moist skin, pallor, perioral cyanosis.
Mild participation of auxillary muscles. Hypoventilation of lungs, tachycardia. pO2
normal. ● III degree (Decompensated stenosis)- inspiratory dyspnea, breathing with
all auxiliary muscles. Acrocyanosis, hypotonia, hypotension, superficial breathing.
pO2 decreased pCO2 starts to increase
● IV degree (asphyxia): coma, cyanosis of whole body, superficial and labored
breating. Hypotonia, hypotension, bradycardia, aphonia. pCo2 increases severely.
Emergency Aid:
● Cool humidified oxygen. Helium-oxygen mixture to reduce work of breathing in
severe respiratory distress
● Dexamethasone 0.15-0.6mg/kg orally. Max 10mg
● Intubation if airway severely compromised
Clinical signs:
● CNS: breathlessness, difficult inspiration or expiration. Restlessness, anxious. In
terminal stages: coma
● Skin: first acrocyanosis then total cyanosis
● Respiratory system:apnea, bradypnea, tachypnea, shallow breathing. Irregular
breathing, dyspnea
● Cardiovascular system: Tachycardia, hypotension
Emergency Care:
● Clean oral cavity
● Provide oxygen
● Artificial ventilation with ambu bag,
● If further inadequacy of breathing:0.5ml of 0.1% atropine and intubation
SECTION 2
01.The classification of viral hepatitis.
Viral hepatitis is an infection that causes liver inflammation and damage.
Degree of severity:
• Mild, moderate, severe, very severe
02.The main pathogenic syndromes of viral hepatitis.
Epidemiology
• Fecal-oral mechanism of transmission
Watery route
Alimentary route
Contact way (dirty hands, towels, dishes etc)
• Source of infection
Patients in the incubation, prodromal period and climax of the disease
• Susceptibility
Children after the first year of life, teenagers, young people up to 35 years, patients
with immunosuppression.
• Factors
Contaminated Water, infected food products and household items.
Clinic presentation
● Onset of fever, poor apetite, nausea, pain in the Right Upper Quadrant
● Within few days Jaundice, dark urine, clay coloured stools
● Usually mild and self limiting.
04. Clinical and epidemiological features of hepatitis E.
Definition: Hepatitis E is a liver disease caused by infection with a virus known as
hepatitis E virus (HEV).
Epidemiology:
Source of infection: sick people
Mechanism of transmission: fecal oral
Incubation period: 2-6 weeks
Susceptibility : high
Factors of transmission: water, food.
Clinic:
Onset of fever, poor apetite, nausea, pain in RUQ
Within few days Jaundice, dark urine, clay coloured stools
Usually mild and self limiting
Definition: Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the most
common causes of acute hepatitis in humans worldwide. Most HAV and HEV
infections are acquired through contaminated water and food. Symptoms include:
Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain, Jaundice.
● CBC: leukopenia with neutropenia.
● Biochemical: increased AST,ALT, ALP
● Serological diagnoses IgM Anti-HAV for hepatitis A, IgM Anti-HEV for recent
infection.
If IgG anti-HAV, it’s for vaccinated patients
Definition: Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the most
common causes of acute hepatitis in humans worldwide. Most HAV and HEV
infections are acquired through contaminated water and food. Symptoms include:
Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain, Jaundice.
● Bed rest
● Supportive and symptomatic therapy
● Adequate nutrition: diet low fat, carbohydrates.
● Desintoxication therapy: glucose, rheosorbilact, isotonic solution
● Sorbents
● Ferments: mezim, contrical
● Lactulose
● Postexposure therapy
● Prednisolone 1-3mg/kg
● Lactulose 10-30g PO 2-4 times daily
● Rifaximin 550mg PO twice daily or Canamycin
● Stop diuretic therapy
● Correct electrolyte imbalance
● Diet: high glucose, low protein
Definition: Hepatitis D, also known as the hepatitis delta virus, is an infection that
causes the liver to become inflamed. This swelling can impair liver function and
cause long-term liver problems, including liver scarring and cancer. The condition is
caused by the hepatitis D virus (HDV
Epidemiology
● Source of infection: sick people with hepatitis B
● Mechanism of transmission: contact
● Mode of transmission: Sexual, blood transfusion, drug users, barber shops,
stomatologists,
tattoo. Hepatitis B can stay on tools for long, not killed by normal anesthetic
Clinical
● Co-infection with hepatitis D: Identical features of hepatitis B. Can lead to fatal
hepatic necrosis
● Hepatitis D Superinfection: Worsens patient’s general condition. Severe signs of
Hepatitis B
Antiviral medications
● Entecavir
● Tenofovir
● Lamivudine
● Adefovir
● Telbivudine
Antiviral medications
● Pegylated Interferon
● Ribavirin
● Protease inhibitors (simeprevir, paritaprevir, glecaprevir, grazoprevir)
Definition: HIV (human immunodeficiency virus) is a virus that attacks the body’s
immune system. If HIV is not treated, it can lead to AIDS (acquired
immunodeficiency syndrome. Epidemiological data: HIV is spread primarily by
unprotected sex (including anal and oral sex), contaminated blood transfusions,
hypodermic needles, and from mother to
child during pregnancy, delivery, or breastfeeding.[13] Some bodily fluids, such as
saliva, sweat and tears, do not transmit the virus. South Africa, Nigeria, India, South
East Asia, Carribbean Sea, Eastern Europe
Epidemiology
● Source of infection: sick people and carriers
● Mechanism of transmission: contact
● Ways of transmission: Sexual contact, iv drug abusers, infection of medical
personell.
Risk group
● Homosexuals unprotected sex
● Multi sexual partners (prostitutes), unprotected sex
● IV drug abusers
● Infected mothers to child
● Viral Hepatitis B, C, D
● Recipients of blood transfusion or organs
Definition: HIV (human immunodeficiency virus) is a virus that attacks the body’s
immune system. If HIV is not treated, it can lead to AIDS (acquired
immunodeficiency syndrome. Epidemiological data: HIV is spread primarily by
unprotected sex (including anal and oral sex), contaminated blood transfusions,
hypodermic needles, and from mother to child during pregnancy, delivery, or
breastfeeding.[13] Some bodily fluids, such as saliva, sweat and tears, do not
transmit the virus. South Africa, Nigeria, India, South East Asia, Carribbean Sea,
Eastern Europe
● Stage 2: Weight loss less than 10%, minimum defeat of skin and mucous
(seborrhea dermatitis, mycotic defeat of nails, recurrent ulcers of mucous of oral
cavity, angular cheilitis i.e, inflammation of one or both corners of the mouth ).
Episodes of herpes zoster, recurrent episodes of upper respiratory tract (bacterial
sinusitis), Level of functional ability 2 (WHO: performance status 2): symptomatic
course, normal level of daily activity
● Stage 3: weight loss > 10%, hyperthermia more than 1 month, pneumocyst
pneumonia, cerebral toxoplasmosis, extrapulmonary criptococosis,
cryptosporidiosis with diarrhea more than 1 month. Cytomegalovirus infection with
defect of any organs except liver, spleen and lymph nodes. Level of functional
ability 3 (Performance status 3): patient lay in bed less than 50% of daily time
Definition: HIV (human immunodeficiency virus) is a virus that attacks the body’s
immune system. If HIV is not treated, it can lead to AIDS (acquired
immunodeficiency syndrome. Epidemiological data: HIV is spread primarily by
unprotected sex (including anal and oral sex), contaminated blood transfusions,
hypodermic needles, and from mother to child during pregnancy, delivery, or
breastfeeding.[13] Some bodily fluids, such as saliva, sweat and tears, do not
transmit the virus. South Africa, Nigeria, India, South East Asia, Carribbean Sea,
Eastern Europe Clinical data:
● prolonged fever more than 1 month
● generalized lymphadenopathy: more than 3 lymph nodes enlarged in different
anatomical groups of lymph nodes ● Diarrhea more than 1 month
● weight loss more than 10%
● opportunistic infection,
● Wasting syndrome (cachexia)
High susceptibility
● Cyclical occurrence of coldness followed by rigor and then fever and sweating
lasting 4-6 hours every 2 days in P.vivax and P.ovale infections, while every 3 days
for P.malariae, P.falciparum can have recurrent fever every 36-48 hours or less.
● Shivering, arthralgia
● Anemia and jaundice. because of the loss of red blood cells, hemoglobinuria
● Retinal damage
● Convulsions
● P.falciparum causes severe malaria: coma, splenomegaly, severe headache, cerebral
ischemia, hepatomegaly, hypoglycemia and hemoglobinuria with renal failure.
● Chronic malaria P.vivax, P.ovale
Chief symptoms Flu like symptoms, weakness, Flu smptoms, headache, back or
malaise calf pain, jaundice
Viral hepatitis is liver inflammation due to a viral infection. The most common
causes of viral hepatitis are the five unrelated hepatotropic viruses hepatitis A, B,
C, D, and E.
33.Complications of malaria.
Malaria; An infectious disease caused by protozoan parasites from the Plasmodium
family that can be transmitted by the bite of the Anopheles.
● Plasmodium falciparum: Cerebral Malaria (seizures and coma), acute renal failure,
non cardiogenic pulmonary edema, tropical splenomegaly
● Plasmodium Vivax: late splenic rupture (2-3 months after initial infection)
● Plasmodium Malariae: immune complex glomerulonephritis
● In pregnant women it can lead to still birth, infant mortality, low birth weight
35.Prevention of malaria.
Malaria; An infectious disease caused by protozoan parasites from the Plasmodium
family that can be transmitted by the bite of the Anopheles.
Eradication of mosquito is the primary aim.
● Avoid mosquito bites
● Sleep in rooms properly screened with gauze over windows and doors
● Spray room with insecticides before entering
● Wear long sleeve shirts
● Use mosquito repellant cream
● Clean environment by getting rid of mosquito breeding sites
● Take antimalarial drugs when prescribed by doctor
The incubation period is highly variable, usually 2-4 weeks, can be 1 week to 2
months or longer.
● Complaints: weakness, headache, pain in joints, chills, dry mucous membranes and
poor appetite, dry coated tongue. Dizziness, confusion
● Slurred speech
● Nausea, vomiting, diarrhea
● Hectic fever
● Skin is pale, moist or icteric in severe cases. Cold clammy skin.
● Rashes of different types, mostly hemorrhagic. Others can be present too. Localized
anywhere on the body
● Tachycardia, hypotension. Systolic murmur at apex. Heart is enlarged
● Dyspnea, tachypnea
● Hepatosplenomegaly
● Low urine output
● Loss of consciousness
Epidemic typhus occurs in Central and South America, Africa, northern China, and
certain regions of the Himalayas. Outbreaks may occur when conditions arise that
favor the propagation and transmission of lice. Brill-Zinsser disease develops in
approximately 15% of people with a history of primary epidemic typhus.
● Abrupt onset of high fever,chills, headache, myalgia, malaise. Fever worsens and
quickly becomes unremitting. Fever on days 3-4, 8-9, 12-13.
● Giddiness, backache, anorexia, nausea.
● Face is edematous, flushed. Eyes are brilliant with injected sclera (rabbits eyes) ●
Symptom of Rosenberg: Ptechial enanthema on basis of uvula 2-3rd day of disease.
May be on transitive folds of conjunctiva from third-fourth day (symptom of Kjary-
Acuyne) ● Govorov-Godeljae symptom: tremor of tongue declining to side.
● Rash: maculopapular/ petechial rash on 4-7 day on chest then axilla, trunk and
spread peripherally. Never on face. Disappears with decreasing temperature
● Rigors, myalgia, malaise
● CNS symptom: mental dullness to coma, stupor, sensitivity to light and delirium
● Regional and generalized lymphadenopathy. Mild hepatosplenomegaly
Leptospirosis generally presents after contact with urine of infected animals. with
cough, jaundice, chest pain, lymphadenopathy, hepatosplenomegaly and is diagnosed
by PCR.
Epidemic typhus caused by Rickettsia prowazekii occurs after being bitten by a tick
or louse, can only be transferred human to human: presented by high fever, cough,
rash, muscles and joint pain. Sometimes liver and spleen can be enlarged. Eyes look
like Rabbits eye. Enanthema on uvula, tremor of tongue. Diagnosed by serology
Lyme borreliosis also known as Lyme disease, is an infectious disease caused by the
Borrelia bacterium which is spread by ticks.
1. To treat the Erythrema migrans: we give doxycycline 100mg PO bid 10-15 days,
Amoxicillin 500mg P0 tid, Cefuroxime: 500mg bid. If allergy to above give
Azithromycin 500mg single dose, erythromycin 500mg qid, clarithromycin.
2. AV block, CNS: IV antibiotics ceftriaxone 2g IV once/day 14 days.
Benzylpenicillin IV or IM 2.4g every 4-6hours. Cefotaxime 2g tid.
3. To treat Arthritis: antibiotic + NSAID, diclofenac 50mg tid, ibuprofen 300-400mg
tid (max 2400mg). Recurrent arthritis: antibiotics + arthroscopic synovectomy +
intraarticular injection.
57.Classification of erysipelas.
Erysipelas is an infection of the upper layers of the skin (superficial). The most
common cause is group A streptococcal bacteria, especially Streptococcus
pyogenes. Erysipelas results in a fiery red rash with raised edges that can easily
be distinguished from the skin around it. Classification:
1. According to etiology: Streptococcal Group A, Streptococcal group B,
staphylococcus, 2. According to clinical form(ie. The character of local changes ) :
Erysipelas erythematosum, erysipelas vasiculosum, erysipelas haemorrhagicum,
erysipelas abscedens, erysipelas gangrenosum
3. According to complication: abscess, gangrene, thrombophlebitis, bacteremia,
streptococcal toxic shock syndrome
58.Clinic of erysipelas erythematous form.
Erysipelas is a human infectious disease infectious disease of streptococcal
etiology with acute and chronic forms and is characterized by intoxication
syndrome and local changes looking like circumscribed locus of serous
hemorrhagic inflammation of skin . Clinical signs of the erythematous form is :
• It has an acute onset
• Intoxication syndrome (High fever, shaking, chills, fatigue, headache, vomiting
• Early signs of the disease before the local changes include:
1. Regional lymphadenitis and lymphangitis
2. Burning pain in erysipelas Can occur on skin of face that starts 5-6 hours before the
local inflammatory focus forms
• Local process is characterized by sharply circumscribed hyperemia with peripheral
inflammatory wall, edge painfulness , and local temperature reactions (erythematous
forms ) • Local process is associated with lymphatic edema of various degree.
• Re-infection causes lymphadenitis
59.Treatment of primary erysipelas.
3. Local treatment
• Don’t touch erythematous forms
• Emulsions ,Ointments and antiseptic solutions are meant only for bullous forms
4. Ambulatory monitoring:
• finishing treatment
• Sanitation of the chronic focuses of infection
• Relapse prophylaxis: bicillin once a month for 6 months after disease
1. Penicillin G: 0.6-1.2 million U IM bid for 10 days
2. Dicloxacillin 125-500mg PO qid for 10days
3. Nafcillin 1-2g IV qid for 7 days
3. Local treatment
• Don’t touch erythematous forms
• Emulsions ,Ointments and antiseptic solutions are meant only for bullous forms
4. Ambulatory monitoring:
• finishing treatment
• Sanitation of the chronic focuses of infection
• Relapse prophylaxis: bicillin once a month for 6 months after disease
• Icteric syndrome: called weils disease, usually severe. Fever, renal failure, jaundice,
hemorrhage and respiratory distress. May involve heart, CNS and muscles. It
present with vascular collapse, thrombocytopenia , hemorrhage,
• Hemorrhagic syndrome
• Asthenovegetative syndrome
• Intoxication syndrome
• Hepatomegaly
• Pneumonia syndrome
• Meningeal syndrome
• Biologic: using guinea pigs, inject infected material. If they die, it confirms
diagnosis
Mild disease — For outpatients with mild disease, we favor treatment with
doxycycline (adults: 100 mg orally twice daily for 7 days; children: 2 mg/kg per day
in two equally divided doses [not to exceed 200 mg daily] for 7 days) or azithromycin
(adults: 500 mg orally once daily for three days; children: 10 mg/kg orally on day 1
[maximum dose 500 mg/day] followed by 5 mg/kg/day orally once daily on
subsequent days [maximum dose 250 mg/day]).
For pregnant women, we favor treatment with either azithromycin (500 mg orally
once daily for three days) or amoxicillin (25 to 50 mg/kg in three equally
divided doses [maximum 500 mg/dose] for seven days). Azithromycin is
preferred over amoxicillin if the differential diagnosis includes rickettsial
infection.
For hospitalized adults with severe disease, we favor treatment with penicillin (1.5
million units intravenously [IV] every six hours), doxycycline (100 mg IV
twice daily), ceftriaxone (1 to 2 g IV once daily), or cefotaxime (1 g IV every
six hours). The duration of treatment in severe disease is usually seven days.
For hospitalized children with severe disease, we favor treatment with penicillin
(250,000 to 400,000 units/kg IV per day in four to six divided doses [maximum dose
6 to 12 million units daily]), doxycycline (4 mg/kg IV per day in two equally divided
doses [maximum dose 200 mg/day]), ceftriaxone (80 to 100 mg/kg IV once daily
[maximum dose 2 g daily]), or cefotaxime (100 to 150 mg/kg IV per day in three to
four equally divided doses). For children who cannot tolerate the above agents,
azithromycin is an acceptable alternative agent (10 mg/kg IV on day 1 [maximum
dose 500 mg/day], followed by 5 mg/kg/day IV once daily on subsequent days
[maximum dose 250 mg/day]). The duration of treatment in severe disease is usually
seven days.
• Tetracycline antibiotics may cause permanent tooth discoloration for children <8
years if used repeatedly. However, doxycycline binds less readily to calcium than
other tetracyclines and may be used for ≤21 days in children of all ages
• Glucocorticoids in severe forms
71.Classification of tetanus.
o Generalised: trismus (lock jaw), repeated painful spasms any part of the body.
Restlessness, irritability, dysphagia. Opisthotonus: spasm of muscles causing
backward arching of head, neck and spine. Seizures can be seen and respiratory
failure o o Grade 1(mild): mild trismus (lock jaw), general spasticity, little or no
dysphagia ▪ Grade 2 (moderate): moderate trismus and generalized spasticity,
mild dysphagia and fleeting spasms. Moderate respiratory embarrassment
▪ Grade 3a(severe): severe trismus and generalized spasticity. Severe dysphagia and
respiratory difficulties. Severe and prolonged spasms
▪ (both spontaneous and on stimulation
• Grade 3b: same as 3a with autonomic dysfunction o
Localised: muscle spasms on one extremity or one body
region
o Cephalic: due to head injury or middle ear infection: cranial nerve palsies which
progress to generalized tetanus o Neonatal: associated with umbilical stump infection
in neonates born to mothers who have not been immunized. o Maternal: tetanus
during pregnancy and 6 weeks after.
• At first, there's a tingling, prickling, or itching feeling around the bite area. A
person also might have flu-like symptoms such as a fever, headache, muscle aches,
loss of appetite, nausea, and tiredness.
• After a few days, neurological symptoms develop, including:
• irritability or aggressiveness
• excessive movements or agitation
• confusion, bizarre or strange thoughts, or hallucinations
• muscle spasms and unusual postures
• seizures (convulsions)
• weakness or paralysis (when a person cannot move some part of the body)
• extreme sensitivity to bright lights, sounds, or touch
• Classic encephalitic (furious) rabies: hydrophobia and hyperexcitability
• Paralytic (dumb) rabies: flaccid muscle paralysis
• Non-classic atypical rabies (bite of bat): neuropathic pain, focal brainstem sign and
myoclonus
79.Prevention of rabies.
• regular antirabies vaccinations for all pets and domestic animals
• bans or restrictions on the import of animals from some countries
• widespread vaccinations of humans in some areas
• educational information and awareness
• If bitten by animal: animal should be caged and monitered for 10 days to see if
signs of rabies appear.
• If animal with rabies attack you, step outside their visual acuity
• Vaccinate animals and humans with rabies vaccine
• Post exposure prophylaxis with rabies vaccine
• This phase lasts for three to seven days and is characterised by the onset of renal
failure and proteinuria. Diuretic phase :
• This is characterized by diuresis of three to six litres per day, which can last for a
couple of days up to weeks. Convalescent phase :
• This is normally when recovery occurs and symptoms begin to improve. This
syndrome can also be fatal. In some cases, it has been known to cause permanent
renal failure.
• Around 15% progress from the acute phase to the toxic phase which usually begins
on 3rd day
▪ On 3rd day: jaundice, hemorrhagic rash on skin, hepatosplenomegaly
▪ 5th day: pale face with cyanotic tint, delirium. Nausea and vomiting. Dark brown
or black emesis. Ptechia and ecchymoses on trunk and extremities. Nasal and gum
bleeding • followed by death in 50% of cases within 10-14 days.
• Staining ulcer exudates with giemsa stain or methylene blue for microscopic
investigation
• Ulcer, blood or CSF culture on sheep blood or peptone agar
• Serological: ELISA
-tissue biopsy to check for cutaneous anthrax
-Chest x-ray or CT scan
89.Epidemiology of plague.
Plague is a disease caused by Yersinia pestis usually found in small mammals and
their fleas
Source of infection: zoonosis (rodent and fleas)
Epidemiology: it occurs in various countries such as Africa, Asia , south America and
the USA
-it is gram negative , non motile, non spore forming bacillus
- it is resistant to freezing temperatures
-human plague occurs from bite of an infected flea
-outbreaks are cyclical corresponding to rodent reservoirs and arthropod vector
correspondents
-Vectors are rodents, carnivorous mammals(cats,foxes,dogs), patient with pneumonic
plague
Symptoms include:
• Malaise and headache usually severe with mental dullness. -Backache.
• Fever with moderate rigor or repeated shivering
• Tachycardia and tachypnea
• Skin is hot and dry, face bloated, eyes injected and hearing dull
• Tongue is swollen and coated with creamy fur.
• Burning in throat or stomach with nausea and vomiting
• Constipation
• Enlarged lymph nodes
• The affected gland is hard and tender.
• Buboes (inflammatory swelling of lymphatic glands) the size of walnut or egg
appear in inguinal glands, axillary region, or cervical • Leukocytosis, increase in
polymorph nuclear leucocytes
94.Treatment of plague.
Plague is a disease caused by Yersinia pestis usually found in small mammals and
their fleas
• Convalescence: softening e.g. Bubo after 2-3 weeks. First hyperemia of skin then
buboes break and drain, the pus is thick, white and no smell.
99.Treatment of tularemia.
Tularemia is a rare infectious disease caused by Francisella tularensis.Also known as
rabbit fever or deer fly fever, it typically attacks the skin, eyes, lymph nodes and
lungs. The disease mainly affects rabbits, hares, and rodents, such as muskrats and
squirrels.
• Pain in epigastric region of abdomen, umbilical or right iliac area, less often in right
hypochondrium and left iliac area
-fever
-nausea
-vomiting
-bloody diarrhea
• In the form of mesenteric lymphadenitis, terminal ileitis, acute appendicitis
• Enlarged, painful and grumbling cecum and mesenteric lymph nodes
.
102.Clinical features of pseudotuberculosis.
Yersinia pseudotuberculosis is a, gram-negative bacillus bacterium that causes Far
East scarlet-like fever in humans, who occasionally get infected zoonotically, most
often through the food-borne route.
Clinical features:
• catarrhal syndrome: Pharyngeal and tonsilar erythema without the exudates,
erythema of the soft palate, conjunctivitis, coryza • intoxication syndrome: fever,
headache
• Abdominal syndrome; tenderness during the palpation of abdomen, may be acute
appendicitis
• Dyspepsia: nausea, vomiting, liquid feces.
• Rashes: maculopapulous (like in scarlet fever), may be erythematosus or even
erythema nodosum may developed. rash appears on face and intensifies periorbitally
and neck
• Arthritis of knees , elbows, foot and hand small joints .
• Presence of “strawberry” tongue.
***Source of infection-wild and home animals (rats, dogs, foxes, cats and other);
• Way of transmitting – alimentary;
• Susceptible organism – children (not infants), adults.
Pathogenetic treatment:
! detoxification therapy: oral to all patient and in case of mild dehydration, or
parenteral: Rheosorbilact, 0.9% NaCl, 5% glucose (moderate and severe
dehydration);
! Sorbents: enterosgel 0.5-1 g/kg, polysorb (Silix) 100-200 mg/kg per day in 3
doses for 5-7 days
! antihistamines: claritin, cetirizin, suprastin, pipolphen 1-3 mg/kg per day,
! corticosteroids 1-3 mg/kg with a short course (in severe cases, in case of
myocarditis),
! Normalisation of the intestinal flora: linex, bifi-form, acidophilus 1-2 caps 2-3
times per day not less than 2 wks;
! antipyretics: paracetamol 10 mg/kg not more than 5 times per day,
! NSAIDs in case of arthritis, carditis, nodular erythema (ibuprofen 20 mg/kg
per day, aspirin 50-75 mg/kg per day, voltaren 2-3 mg/kg per day,
indomethacin 2-3 mg/kg per day (in average doses).
SECTION 3
01. Epidemic process and its components.
Epidemiology is the study of frequency, distribution and determinants of health
related events.
Epidermic process -The continuous chain of successive transmission of infection
(patientcarrier), manifested by symptomatic or asymptomatic forms of disease.
Components
● Infectious agent
● transmission factors
● Susceptible individual ( without immunity)
06. Sick person and the carrier and their epidemiological value.
Sick person is the primary source from which the infection spreads and is the most
dangerous source of infection because he or she releases a great quantity of the
pathogenic microorganisms.
A carrier is a person with infection who is capable of transmitting the pathogen to
others Carriers release pathogenic agents into the environment in a smaller quantity
than patients with clinically manifest diseases, but they are danger to community too
since they actively associate with healthy people and spread the infection.
Carriers commonly transmit disease because they do not realize they are infected, and
consequently take no special precautions to prevent transmission. Symptomatic
persons who are aware of their illness, on the other hand, may be less likely to
transmit infection because they are either too sick to be out and about, take
precautions to reduce transmission, or receive treatment that limits the disease.
Methods
● Intermediate-level disinfectants- the kill vegetative bacteria most viruses and fungi
but not resistant bacterial spores
● High-level disinfectants process destroy vegetative bacteria, myocobacteria, fungi
and enveloped and non enveloped virus but not necessarily bacterial spores
METHODS
Chemical and Physical Method
● Chemical
- Alcohol
- Chlorine and chlorine compounds
- Formaldehyde
- Glutaraldehyde
- Hydrogen peroxide
-Iodophors
- Halogen
- Peracetic acid
- Peracetic acid and hydrogen peroxide
Physical method
● Boiling at 100°C for 15 minutes, which kills vegetative bacteria.
● Pasteurizing at 63°C for 30 minutes or 72°C for 15 seconds, which kills food
pathogens. ● Using nonionizing radiation such as ultraviolet (UV) light. UV rays
are long wavelength and low energy.
12. Sterilization and its stages, control of quality.
Sterilization refers to any process that removes, kills, or deactivates all forms of life
(in particular referring to microorganisms such as fungi, bacteria, spores, unicellular
eukaryotic organisms such as Plasmodium, etc.) and other biological agents.
Stages:
Pre-Vacuum, Rising Temperature, Sterilizing and Vacuum-Drying
Methods
Heating in an autoclave (steam sterilization)
Exposure of microorganisms to saturated steam under pressure in an autoclave
achieves their destruction by the irreversible denaturation of enzymes and structural
proteins. The recommendations for sterilization in an autoclave are 15 minutes at
121-124 °C.
Filtration - Sterilization by filtration is employed mainly for thermolabile solutions.
These may be sterilized by passage through sterile bacteria-retaining filters, e.g.
membrane filters.
Exposure to ionizing radiation
Sterilization of certain active ingredients, drug products, and medical devices in their
final container or package may be achieved by exposure to ionizing radiation in the
form of gamma radiation from a suitable radioisotopic source such as 60Co (cobalt
60) or of electrons energized by a suitable electron accelerator.
Aqueous solutions in glass containers usually reach thermal equilibrium within 10
minutes for volumes up to 100 mL and 20 minutes for volumes up to 1000 mL.
Dry-heat sterilization
In dry-heat processes, the primary lethal process is considered to be oxidation of cell
constituents. Dry-heat sterilization requires a higher temperature than moist heat and
a longer exposure time. Preparations to be sterilized by dry heat are filled in units that
are either sealed or temporarily closed for sterilization. The entire content of each
container is maintained in the oven for the time . Temperature 160 , 170 , 180 degrees
for 180mins , 60mins and 30mims respectively..
Gas sterilization (with ethylene oxide)
The active agent of the gas sterilization process can be ethylene oxide or another
highly volatile substance. The highly flammable and potentially explosive nature of
such agents is a disadvantage unless they are mixed with suitable inert gases to
reduce their highly toxic properties and the possibility of toxic residues remaining in
treated materials.
When given in the liquid state or in tablets, the vaccine should be taken together with
water.
• The main measures to control skin infections include isolation and treatment of
the source of infection, killing diseased animals, homeless dogs and cats,
improving sanitation and living conditions of population, personal hygiene,
control of traumatism, and specific prophylaxis
subtypes
● Subtype 1 - typical intestinal infection ( agent stays in the GIT) shigellosis,
cholera, echerichiosis.
● Subtype 2 - Toxic infection ( intensive reproduction of the agent out of the
organism ) food poisoning , botulism and staphylococcal toxicosis
● Subtype 3 - intestinal infection with spreading of the agent beyond the
intestine ( amebiasis , ascaridiasis, echinococcosis)
● Subtype 4 - intestinal infection with penetration of the agent into blood with
additional outlet of the agent in the environment with the urine, secretions
( typhoid fever, brucellosis, leptospirosis)
This group includes diseases whose causative agents parasitize on the respiratory
mucosa and are liberated into the environment with droplets of sputum during
sneezing, cough, loud talks, or noisy respiration. People get infected when the
microbes contained in sputum get on the mucosa of the upper airways. If the
causative agent is unstable in the environment, a person can only be infected by lose
contact with the sick or carrier. Pathogenic microorganisms causing some diseases
can persist for a period of time in an enclosure where the sick is present. Infected
particles of sputum or mucus can dry and be suspended in the air. Some diseases of
this group can spread through contaminated linen, underwear, utensils, toys, etc. It is
important to timely reveal the sick and carriers, and also to break the mechanism of
infection transmission: control of overcrowding, proper ventilation and isolation of
enclosures, using UV-lamps, wearing masks, respirators, disinfection, and the like.
The diseases of this group are transmitted by blood-sucking insects, such as fleas,
mosquitoes, ticks, etc., which bite people and introduce the pathogenic agent into the
blood. Control of blood infections includes altering natural conditions, improvement
of soils, draining swamps, destroying sites where the insects multiply, disinsection
measures against mosquitoes, ticks, etc., detoxication of sources of infection by their
isolation and treatment, carrying out preventive measures. If the source of infection
are rodents, measures to control them are taken. Active immunization is also
effective.
18.Epidemiological features of infections of external coverings.
The diseases of this group occur as a result of contamination of the skin or mucosa
with the pathogenic microorganisms. They can remain at the portal of infection
(tetanus, dermatomycoses), or affect the skin, enter the body and be carried to various
organs and tissues with the circulating blood (erysipelas, anthrax).
The transmitting factors can include bed linen, clothes, plates and dishes and other
utensils, that can be contaminated with mucus, pus or scales. Pathogenic
microorganisms causing venereal diseases, rabies, AIDS, and some other diseases are
transmitted without the agency of the environmental objects.
In 2016, people age 13 to 24 accounted for 21 percent of the people diagnosed with
HIV. About 80 percent of the diagnoses in this age group (or 6,776 cases) occurred in
people between 20 and 24 years old.
As of 2018, approximately 37.9 million people are infected with HIV globally.[3]
There were about 770,000 deaths from AIDS in 2018
Source
• By having sex. You may become infected if you have vaginal, anal or oral sex
with an infected partner whose blood, semen or vaginal secretions enter your
body. ...
• By sharing needles. ...
• From blood transfusions. ...
• During pregnancy or delivery or through breast-feeding.
Ways of transmission occurs mainly through blood, semen, vaginal fluids, and breast
milk.
Mеchanism of transmission – contact
PREVENTION OF HIV
You can use strategies such as
• Abstinence (not having sex)
• Use condoms
• Avoid multiple sex partners/ Limit your sex partners
• Get tested. Be sure you and your partner are tested for HIV and other STIs
• Never reuse or "share" needles, syringes, water, or drug preparation equipment.
Only use needles and syringes that you got from a reliable source (such as
drugstores or needle exchange programs).
• You may also be able to take advantage of HIV prevention medicines such as
preexposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
• Don't douche. Douching removes some of the normal bacteria in the vagina
that protects you from infection. This may increase your risk of getting HIV
and other STIs.
• Be monogamous. Having sex with just one partner can lower your risk for HIV
and other STIs.
20. The sanitary protection of the territory from delivery and spreading of
infections that may have international importance.
Seasonality – summer-autumn.
1-st week:
The beginning is gradual
Complains: headache, tiredness, sleeplessness, anorexia, constipation or
diarrhea Long fever 39-40 °С (intermittent fevers)
Paleness of skin
«typhoid» tongue
Duguet's angina
Bradycardia, dicrotism of pulse,
hypotonia Symptoms of bronchitis
meteorism, positive Padalka's symptom
2nd week:
Typhoid rash – typhoid maculopapular rash(roseola elevata), some elements,
localized on the anterior abdominal wall and lateral walls («vest»), new elements can
appear , sometimes is present longer than fever.
Hepato-splenomegalia.
Status typhosus.
Serologic reactions.
Antiepidemic measures:
Examination on typhoid fever and paratyphoids all patients with fever, which last
more than
5 days (once on hemoculture, and if fever continue more than 10 days
Examination of all persons, who are working at the industries dealing with food, for
detection of bacteriocarriers
the incubation period), is between two and six weeks and the average incubation
period is 28 days. The illness is usually contracted in early childhood.
Hepatitis A infection causes no clinical signs and symptoms. It does not have a
chronic stage, is not progressive, and does not cause permanent liver damage.
Following infection, the immune system makes antibodies against HAV that confer.
Prevention: Hepatitis A vaccine , also Hepatitis A can be prevented by vaccination,
good hygiene and sanitation.
Infective agent : Sh. Dysenteriae, Sh. Flexneri, Sh. Boydii, Sh. Sonnei
Ways of transmission – water (more often Sh. flexneri), food staffs (Sh. sonnei),
dishes, dirty hands, flies.
Seasonal - summer-autumn.
Immunity - type-specific
Etiologic diagnostic:
Detection of the agent from the feces, vomiting mass, lavage fluid
Serologic reactions (presence of antibodies to the causative agent and increasing the
titer in dynamic)
Polymerase chain reaction (PCR) – detection of shigella DNA in feces and scraping
of the rectum mucous.
Antiepidemic measures
Medical supervision after contact persons (7 days)
Bacteriological investigation of stool (decree group only)
Serological investigation
Disinfection – current, final
Prophylaxis of Cholera
Prophylaxis
● Plan immunisation (3,4,5 months with DTaP , revaccinion in 18months , then 6, 11,
14,
18years and adults every 10years )
● In focus - 7 days medical observation after contact with sick person
● Bacteriological examination
● Sanitation of detected carriers
● Final disinfection
● Revaccination
Salmonellae are widely dispersed in nature, being found in the in the gastrointestinal
tracts of domesticated and wild mammals, reptiles, birds, and insects. May present
clinically as gastroenteritis, enteric fever, a bacteremic syndrome, or focal disease.
An asymptomatic carrier state may also occur.
Clinical manifestations
1) Localized (gastrointestinal) forms of Salmonellosis: a) Gastritic
variant; b) Gastroenteritic variant;
c) Gastroenterocolitic variant.
2) Generalized forms:
a) Typhus-like form;
b) Septic form (septicopyemia).
3) Carrier state:
a) Acute carriers;
b) Chronic carriers;
c) Transitory carriers.
nausea and vomiting, myalgia and headache , diarrhoea with loose stool swamp like
with bad smell.
Prophylaxis
Veterinary-surveillance upon animals and production of meat and dairy industry,
laboratory control of food stuffs. It is necessary to reveal carriers on milk farms, in
foods, children’s and medical establishments. The maintenance of the rules of
personal hygiene and rules of food’s cooking plays an important role in prophylaxis
of Salmonellosis.
Types С and D are associated with animal botulism, especially in cattle, ducks and
chickens. Botulism is an acute neurologic disorder that causes potentially life-
threatening neuroparalysis due to a neurotoxin.
Ways of transmission -
1) botulism food poisoning results from eating food that contains preformed
toxin; 2) wound botulism occurs when toxin is produced by C. botulinum
organisms contaminating traumatic wounds;
3) infant botulism is due to toxin production by C. botulinum within the
gastrointestinal tract of infants.
Signs
Dysphagia , diplopia, dysphonia, dry tongue , horizontal nystagmus, blepharoptosis.
Prophylaxis
The observance of the sanitary and hygienic rules at processing, transportion, keeping
and preparing of the food-stuffs experts possibility of accumulation of botulotoxin. It
is necessary to perform the strict control under sterilization and keeping preserved
food-stuffs. Cook meats, mushrooms and vegetables properly .
Serotypes - A, B, C, D, X, Y, Z
Source of infection- Carrier and sick people ( patients with meningococcal
nasopharyngitis and generalized form of infection)
Symptoms
Fever, headache, vomiting, rigidity of neck, positive kernic sign, starlike hemorrhagic
rash on thighs buttocks and trunk . Seizures.
Source of infection- sick person with acute or chronic form, healthy carrier.
Symptoms
Jaundice, fever, fatigue, loss of appetite with nausea and vomiting, joint pain and
abdominal pain.
Prophylaxis
Use of disposable medical instruments, thorough sterilisation of non-expendable
instruments.
Clinical and laboratory examination of blood and organ donors.
Specific prophylaxis - vaccination against B hepatitis HB-Vax, Ingerix-B
Symptoms
Prolonged fever, prolonged diarrhoea, generalized lymphadenopathy, weight
loss( >10%), opportunistic infections, kaposi sarcoma
Diagnostic Criteria: epidemiological data , clinical signs and laboratory data ( IFA,
immunobloting)
Etiology - plasmodium
Types of plasmodium
Pl. malariae
Pl. falciparum
Pl. ovale
Pl. vivax
Pl. knowlesi
Susceptibility – high
Symptoms
Attack of fever - (chills-hot-sweat), Hepatosplenomegaly, hémolytique
anemia(jaundice ), tachycardia, hypotonia , myalgia , diarrhoea, vomiting, loss of
appetite, cyanosis, herpes.
Prophylaxis
● Sanitarian patrolling of the state from delivery (quarantine infection
contamination) ● Mandatory registration
● Sterilization of toolkit
● At detection of sick or carrier – parasitoscopy examination of all family members
● Ant mosquito measures (melioration, usage of insecticides, repellents)
● Drug prophilaxis - primachinum 0,027gm/day for 14days
Clinical forms
Skin Bubonic , Primary pulmonary, secondary pulmonary, intestinal , primary septic,
secondary septic.
Complications
Infectious toxic shock , meningitis, adeno phlegmon
Symptoms
Fever
Severe intoxication
Severe hemorrhagic inflammation of lymphatic nodes , lungs and other organs
through Sepsis .
Anti-epidemic measures:
• prevention the import of infection from abroad;
• making of natural cells of plague healthy;
• urgent prophylaxis in the case of exposure of patient with a plague.
immunization of people :
● Vaccinations of population of certain territories;
● Urgent 6-daily prophylaxis by streptomycine tetracycline on suspicion of possible
infection.
Etiology – filoviridae
Source - mice/rat (which are excreting the virus with urine, stool and saliva)
The contamination of the person descends by air - dust, nutritional and contact
pathes (routes). The transplacental transmission of a virus from the pregnant woman
is possible.
Symptoms
Fever (39-40degrees)
Decreased visual equity( mist before eyes)
Sharp headache
Back ache and pain in muscles of extremities
Photophobia
Nausea and vomiting
Paleness nasolabial triangle, hyperemia of a face, necks, upper half of trunk.
The palpebral fissures are narrowed down, scleratis.
A mucosa of an oral cavity and pharynx are bright red with
haemorrhages. The Kerning’s signs, Brudzinsky sign can be
determined and stiff neck. Fever 7-9 days is prolonged.
Delirium
On 3-5th day of illness on a neck, lateral areas of a thoracic cell, in axillaries fossas,
above clavicles occurs petechial eruption.
Then there are nasal, intestinal, pulmonary bleedings.
Cardiac sounds are dull; the initial tachycardia is replaced by a bradycardia,
hypotonia. Dryness of tongue, abdominal pain without definite localization, patients
enlarged a liver and spleen and the icterus are possible.
Prophylaxis
Inactivated cultural, cerebral vaccines and recombinant of a vaccine
Carry out a disinfestation in the natural locuses, puttings, and also collect of tongs
with animal and poultries. For a disinfestation will use gexachloran.
Medical observation in the focus for 10 days and Conduct mandatory final
disinfection with 3 % Chloraminum solution and chlorofos. For contact persons or
one who was bitten by tongs in endemial districts enter a specific immunoglobulin
i.m. in doses 5-7.5 ml for adult, 2.5-3.5 ml - for children.
Borrelia burgdorferi organism. The tick is small, and the bite is often not
Diagnosis Criteria
Based on clinical signs especially (erythema migrans rash) and serological testing
(ELISA test and western blot).
Prophylaxis
Doxycycline (200 mg for adults or 4.4 mg/kg for children of any age weighing less
than 45 kg).
Clinic: itching in anal areas more prominent at night which leads to restlessness and
difficulty in sleeping. At night, the female worm moves to anus and deposit its eggs
and dies.
Treatment:
! Good hand hygiene and wash perianal areas well. Wash clothes and bed linen well.
! Can also give one dose of pyrantel pamoate one dose repeated in 2 weeks.
! Petroleum jelly is given to relieve itching
Clinical signs:
! patient may have signs of pneumonitis with cough and low grade fever during
the migration of larvae through the liver and lungs. Can be accompanied by
wheezing and eosinophilia
! In heavy worm burdens, adult worms migrate in intestine resulting in intestinal
blockage which lead to vomiting, abdominal pain
!
Diagnoses:
! adult worms may be expelled through anus, mouth or nose
! Eggs seen on microscopic stool exam
38.Complications of ascariasis.
Volvulus
Intussuception
Hepatic abscess
Acute cholangitis
Peritonitis
Biliary colic
Acute cholecystitis
Acute pancreatitis
Upper GI bleeding
Pathogenesis
! Ingestion of worms: adult worms live in small intestine, attached firmly
to the mucous membrane of the gut lining and feed on blood and tissue !
Adult females deposit their eggs in the gut and are passed out in feces !
They survive in light sandy loam soil feeding on bacteria.
! After one week, they become infective and move to position for suitable host to
pass
! They enter organism by ingestion
! Enter blood vessels and are carried to heart, lungs and trachea
Clinic
.Larva penetration into skin leads to pruritus.
.Adult work in intestine may cause intestinal necrosis and blood loss:abdominal pain,
diarrhea, nausea, vomiting.
.Chronic infection can lead to iron deficiency anemia.
. Mental and physical growth is retarded in children and growing youth in
ancylostomiasis .Unchecked ancylostomiasis infection may lead to fatty
degeneration of heart, liver and kidneys, ending in death.
Complications
Iron deficiency anemia, caused by loss of blood.
Nutritional deficiencies. ( malnutrition)
Intestinal ulcers
Severe protein loss with fluid buildup in the abdomen (ascites)
*Bonus Diagnostics of ancylostomiasis.
• Microscopic exam of stool deposits reveals ova
• Because hookworm species cannot be differentiated on the basis of their eggs, it
is necessary to culture larvae or to recover adult worms for morphologic study
Clinical pictures
-Initial skin penetration causes little reaction, repeated infections lead to
hypersensitive reactions. This leads to Larva currens: rapidly progressing urticarial
attack.
• Migration of larva to the lungs may stimulate an immune response resulting in
cough, wheezing and fever
• Ulceration of intestines, can lead to malabsorption, GI bleeding and eosinophilia
• Hyperinfection syndrome: parasite and host reach an equilibrium where neither host
nor parasite suffers adverse reactions. It leads to the infection proliferation with
immense numbers of larvae migrating to every tissue in the body especially the
lungs (pneumonitis), brain damage and respiratory failure
-Skin phase: Dermatitis; An itchy, red rash that occurs where the larva entered the
skin, creeping eruption may also occur.
-Respiratory phase: Löffler's syndrome (pneumonitis + Asma)
-Abdominal phase: Infection may be asymptomatic(light infection) • Symptoms
resemble gastric ulcer; (stomachache, bloating, and heartburn, hunger pain • Chronic
intermittent diarrhea may be with yellow mucus. Constipation, Nausea and loss of
appetite
Complication ;
-Gastric ulcer resulting from damaged mucosa by the worms
-Intestinal obstruction occur In severe cases, edema may result in obstruction of the
intestinal tract, as well as loss of peristaltic contractions.
-Immunosuppression
-Disseminated strongyloidosis- tissue damage
-Pneumonitis, brain damage
-Respiratory failure
42.Diagnostics of strongyloidosis
Complications
myocarditis
pneumonia
meningoencephalitis
hepatitis
nephritis
systemic
vasculitis
thrombophlebitis
thrombocytopeni
a
EPIDEMIOLOGY
● Infection occurs when filarial parasites are transmitted to humans through
mosquitoes.
● Lymphatic filariasis is transmitted by different types of mosquitoes for example
by the Culex mosquito, Anopheles, and Aedes,
● Lymphatic filariasis is spread from person to person by mosquitoes.
● humans are definitive hosts.
• It is endemic in many tropical & subtropical countries like Africa, Asia,
Western Pacific and parts of America.
Clinical picture
• Fever
• Inguinal or axillary lymphadenopathy
• Testicular and/or inguinal pain
• Skin exfoliation
• Limb or genital swelling
• dry and paroxysmal nocturnal cough;
• wheezing
• Dyspnea
Complications
• chronic lymphedema,
• hydrocele,
• skin pigmentation,
• renal impairment (eg chyluria. )
47. Etiological therapy of nematodosis
Nematode(round worm) infections need to be identified and treated accordingly.
Antihelminthic:
- Albendazole
- Mebendazole
- Pirantel,
- Vermox,
Complications;
Systemic cysticercosis.
Cyst rupture (hydatid cyst rupture rare )
Vitamin B-12 deficiency.
Obstruction of the appendix or pancreatic or bile ducts (rare)
Intestinal obstruction (rare)
Cholangitis (rare)
Cholecystitis (rare)
Pancreatitis.
* Prevention
Make sure you cook meat thoroughly
Freezing to 5 degrees for 4days
Epidemiology:
- It is found throughout the world and is most common in countries where pork is
eaten.
Eastern Europe, Russia, Eastern Africa. Latin AMerica
-Source of infection: Zoonosis (pigs)
-Mechanism of transmission: Oral (eating undercooked pork)
Life cycle;
Eggs or gravid proglottids are passed with feces; the eggs can survive for days to
months in the environment.
pigs (T. solium) become infected by ingesting vegetation contaminated with eggs
or gravid proglottids
In the animal’s intestine, the oncospheres hatch The number and invade the
intestinal wall, and migrate to the striated muscles, where they develop into
cysticerci. (A cysticercus can survive for several years in the animal.)
Humans become infected by ingesting raw or undercooked infected meat. In the
human intestine, the cysticercus develops over 2 months into an adult tapeworm,
which can survive for years.
The adult tapeworms attach to the small intestine by their scolex and reside in
the small intestine (Length of adult worms is usually 5 m or less for T. saginata
(however it may reach up to 25 m) and 2 to 7 m for T. solium)
The adults produce proglottids which mature, become gravid, detach from the
tapeworm, and migrate to the anus or are passed in the stool (approximately 6 per
day).
Complications
Tapeworm can be lodged in appendix (Appendicitis), bile
duct (cholecystitis), pancreatic duct (pancreatitis)
- Cyst in the muscles can cause lumps under the skin ( which can be tender).
-Myositis with fever and eosinophilia and muscular pseudohypertrophy. This can
later progress to atrophy and fibrosis
Complications
brain edema,
hydrocephalus
chronic meningitis
vasculitis paralysis
partial blindness
seizures, coma, and
death.
Pork tape worm infection (taeniasis) is an intestinal infection with adult tapeworms
that follows ingestion of contaminated pork.
Diagnosis
Microscopic examination of stool for ova and proglottids
CT and/or MRI and serologic testing for patients with central nervous system
symptoms.
Cysticercosis
Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm
Taenia solium. Diagnosis
Biopsy of infected tissue, microscopic examination
ELISA: Antibodies to cyticerci
CT or MRI of head
CSF exam: pleocytosis, elevated protein levels and depressed glucose levels
55. Epidemiology and life cycle of echinococcosis
Echinococcosis is a parasitic disease that occurs in two main forms in humans:
cystic echinococcosis (also known as hydatidosis) and alveolar echinococcosis,
caused by the tapeworms Echinococcus granulosus and Echinococcus multilocularis,
respectively.
Epidemiology
• Cystic echinococcosis is globally distributed in most pastoral and rangeland
areas of the world, with highly endemic areas in the eastern part of the
Mediterranean region, northern Africa, southern and eastern Europe, at the
southern tip of South America, in Central Asia, Siberia and western China.
Humans are infected through ingestion of parasite eggs in contaminated food,
water or soil, or after direct contact with animal hosts( dogs)
Life cycle
-The adult Echinococcus granulosus resides in the bowel of its definite host.
-Gravid proglottids release eggs that are passed in the feces.
-These eggs are then ingested by a suitable intermediate host, including sheep,
goat, swine, cattle, horses and camels. The eggs then hatch in the bowels and
release oncospheres that penetrate the intestinal wall.
These oncospheres then migrate through the circulatory system to various organs of
the host.
-At the organ site, the oncosphere develops into a hydatid cyst. This cyst enlarges
gradually, producing protoscolices and daughter cysts that fill the cyst interior.
-These cyst-containing organs are then ingested by the definite host, causing
infection. After ingestion, the protoscolices evaginate, producing protoscolexes.
-The scolexes of the organisms attach to the intestine of the definite host and develop
into adults in 32-80 days.
The life cycle then continues in humans:
(Humans can become infected if they ingest substances infected with Echinococcus
eggs. -The eggs then release oncospheres in the small intestine.)
Clinical picture
Human infection with E. granulosus leads to the development of one or more
hydatid cysts located most often in the liver and lungs
-Abdominal pain, nausea and vomiting are commonly seen when hydatids occur in
the liver. - If the lung is affected, clinical signs include chronic cough, chest pain and
shortness of breath.
-Other signs depend on the location of the hydatid cysts and the pressure exerted on
the surrounding tissues. Non-specific signs include anorexia, weight loss and
weakness.
Life cycle
Immature eggs are passed in feces.
The eggs mature (approximately 18 to 20 days) and yield oncospheres which
develop into a coracidia
After ingestion by a suitable freshwater the coracidia develop into procercoid
larvae...
Following ingestion of the copepod by a suitable second intermediate host,
The procercoid larvae are released from the crustacean and migrate into the fish flesh
where they develop into a plerocercoid larvae (sparganum)
The plerocercoid larvae are the infective stage for humans. Because humans do
not generally eat undercooked minnows and similar small freshwater fish, these do
not represent an important source of infection. Nevertheless, these small second
intermediate hosts can be eaten by larger predator species, e.g., trout, perch, walleyed
pike
In this case, the sparganum can migrate to the musculature of the larger predator fish
and humans can acquire the disease by eating these later intermediate infected host
fish raw or undercooked
After ingestion of the infected fish, the plerocercoid develop into immature adults
and then into mature adult tapeworms which will reside in the small intestine. The
adults of D. latum attach to the intestinal mucosa by means of the two bilateral groves
(bothria) of their scolex Eggs appear in the feces 5 to 6 weeks after infection.
Clinical picture
Fish tapeworm infections rarely present noticeable symptoms. Tapeworms are most
often discovered when people notice eggs or segments of the tapeworm in stool.
Complications
-anemia, specifically pernicious anemia caused by vitamin B-12 deficiency
-intestinal blockage
-gallbladder disease
60 Diagnostics of diphyllobothriasis.
Proglottids may also be seen in fecal samples usually in a chain of segments from a
few centimeters to about 0.5 meters in length.
Clinical presentation:
a) Most infections are asymptomatic.
b) Mild infections may cause dyspepsia, abdominal pain, diarrhoea or constipation.
c)Longer-term infections may cause more severe symptoms and may lead to
hepatomegaly and malnutrition.
Epidemiology:
• acquired by eating infected raw or undercooked fish (fecal-oral)
Pathogenesis:
● Eggs are ingested by snail and undergo development (sporocyst to rediae to
cercariae). ● Cerciae are released from snails and penetrate fresh water fish
encysting as metacercariae in muscles or under scales
● Humans become infected after eating raw or undercooked fish
● Metacercariae excyst in the duodenum and ascend through the ampulla of vater
and into the biliary ducts where they attach to the mucosa and mature. Adult flukes
grow up to: 5 to 10 mm (O. viverrini) 7 to 12mm (O. felineus).
63.Diagnostics of opisthorchiasis.
Opisthorchiasis is a parasitic disease caused by species in the genus Opisthorchis
(Opisthorchis viverrini and Opisthorchis felineus) acquired by eating infected raw or
undercooked fish.
(The Kato technique is a laboratory method for preparing human stool samples prior
to searching for parasite eggs.)
Tapeworm infections are all acquired by ingesting worm cysts or eggs. The most
common infections result from undercooked fish (Diphyllobothrium latum), beef
(Taenia saginata), and pork (Taenia solium). Other tapeworms can be spread person-
to-person (Hymenolepsis nana) or with contamination of food by feces from infected
dogs (Echinococcusspecies). Mature worms reside in the gut, releasing large numbers
of eggs, but usually causing little disease.
Most common syndrome of Tenia solium it causes is cysticercosis ( infection with
parasite cysts, most often in the brain, following ingestion of food contaminated with
parasite eggs from pig feces.)
Trematodiases, also known as trematode infections, are a group of diseases caused by
the parasite trematodes. Symptoms can range from mild to severe depending on the
species, number and location of trematodes in the infected organism.
Mostly causes flukes
Etiological Treatment
● Praziquantel : 75mg/kg.day orally three doses per day for 2 days
● Albendazole 10mg/kg/day for 7 days
• Mebendazole
• Triclabendazole