Vimyxnu cepymi ca GuonoruunM npenapaTH, CembpxauM aHTHTeNa cpeLly MAKpOOpraHMaMUTE WAM NpOMsBeAeHH OT TAK eKSOTOKCHHK, KOKTO Ce NpHNaraT 3a NeYeHHe Ha UMGeKUNOSHO GonHI. Cepymupe morat na Geaat xereponomn (oT KUBOTHH) HAM XoMOROXKHM (OT AOSPOBOA\N). CepyMu ce wanonsear npn neveHne Ha TeTaHyC, ras0Ba rakrpeHa, Goryanzem, AMbTepHA. ZagHMKUTeNKO npeAM NpunomeHneTo wm TpAGBa fa ce HanpaBH nipoGa 3a CapwxUyaCTaHTeAHOCT OT 6bp3 THN. TEMA No 26 POL STAPHYLOCOCCUS Cradunoxoknre ca foam (+) KOKH, HaMaT MAAK M pecHH, Ha npenapat ce pasnonaraT BES. opmara Ha rposa. S. epidermidis wma Kancyna, HeBSHcKaTeNHK Ca KBM xpaHitTeAHiTe cpean 4 Ha kppeeH arap S. aureus qasa wnpoKa Gera-xemonmTwuna 30H. CragMAOKOKMTe M3ABpHKAT BHCOKA koHueHrpauwa Ha NaCl (go 15 %). B sasMcumoct oT Tosa gaan npoHsseKaaT eHaMMa KOarynaza (koarynupa nw cecupea KpeBHuA CepyN) CTabunoKoKHTe ce genaT Ha Koarynasa (+) ~S. aureus, Hin koarynaza (-) ~S. epidermidis, S. saprophyticus. OcHoshuar natorenen npeqcraauren e S. aureus. Toit nponaeerka MHOMECTBO TOKCHHN H eHSHMI? + xemonwainnn (pasrpanauyn xemorno6unal, ~ exconnarny (pasuensa enhigepmnca 1 cTaguoKoKHTe, KOMTO ro NpoMaBexNAT NPEAMIBKEAT cHiiapoma Ha nonapenara Koma. OGKHOBeHO NpM HOBOpomeHMTe), - eHTepoTOKCHHH (re3H cTadyAOKOKH, KONTO NPOMSBEMAaT eHTePOTOKCHHM, npeaMsEnKeaT ebtepoxonnri).. ~ Ev3umi, KOTO npowseexaaT S. aureus ca Koarynaza (cocHpsa cepyma) dnEpHHoAHaHH (pasrpaxga ceeaMnuTenHOTeKaHHiMA Ban KONO Be3nanKTenHOTO orHMue). + Cragunokoxnre npovssexaar cbujo GeTa-nakrawiasa Kato 90 % OT TAX Ca pesHcTeHTHH Ha neHnUsniH, S. aureus npMuMHABaT MHOXKECTSO saGonABAHHA, OOOsHauaBAHi KATO rHORHO-BHananHTeAHH MAeKYK Ha KOM, MEKH ToKaHH, KDBEOHOCHK CbAOBe, CTaBH, KOCTH, MYCKYAIM, NHKONHO-NoAOBaTa cHCTeMa, GenKA p06, mozbke. ApyrnaT THN 3aGonABAHWA ca TOKCHH-Megnipatite (cHHAPOMBT Ha NONapeHaTa KOA entepoKonutute).. S. epidermidis e Hopmane o6uraren Ha repnoTo, KOMaTa, HO NPM HapywleHa MMYHHA sara npH Tepanua ¢ KOpTMKOCTepOHAM M APYTH HMYHOCyNpeCOpH MOKe Aa NPHYMHM saGonABaHE — Hali-uecToengokapanTn (npn Hann4ne Ha npoTesH, Te. M3KycTBeHN Kaan 8 cepyeTo), yponHbexyuM (npH hanmune Ha ypoKateTep). S. saprophyticus npawninea oBnKHOBeHO ypOMKoEKYNH, S. aureus e winpoko pasnpoctpanen 8 noveara, se3qyKa M eoqata. HopManlHo MOMeM fa TO OTKPHEM B koKaTa M repnoTo Ha NoBeKa. Tleweswe. Mo-ronawata act ca PeSMCTeHTHM Ha NeHMUANKY, C HaKMOVeHME Ha neHMUMAMHasa YeTofiunauTe neHRUANHHH — OKCAYANHH. AKO CTapMMOKOKDT € PESHCTENTEH M Ha OKCAWAMMH, TOBA osnavasa, Ye TOR © pesucTeHTe Ha scH4KM GeTa-nakramM. 3a ocTakanuTe tpynn ce cnepK no ‘artuGnorpamara TEMA Ne 27 STREPTOCOCCUS PYOGENES CrpentoxoxuTe ca ronama rpyna MAKpoopraHiaMn, KORTO ce eM CnopeA BHAA Ha aHTureHuTe cu ka rpyn oF A no H m oT k so v. Streptococcus pyogenes ce skniousa 6 rpyna A Ha crpenToKoKuTe. Streptococcus pyogenes = Geva-xemon#THNHH cTpeNTOKOKN OT rpynia A Te ca Tpam (+) KoKH, noapeneHn Bbs sepiKKH. Mimar Kancyna oT xeanypoHosa KUCenHHa. BauickaTennu ca Kom xpaHHTeMHHTe CDEAM, Ha KBDBEH arap AasaT WHPOKA BeTa-KeMonHTHNHa 30H, Ochosti dbakropn Ha natoreHHocTra ca’ © Kancynara c wapasenn antaparouwTHn csoficrea © M-nporen, cnopea Kolito crpenrokoxuTe ce aenat Ha ceporunose (c pagnH4HHt m-npoTeKHH) Tol wma anrndarountin ceovicrsa n HAKOM wamoBe S. pyogenes MMaT CxOAeH m-npOTEMH ¢ anTureHi Ha raymeponuTe (aHTHTeHH OT GE6peUMTe), craBHHTe MeMGpaH H MOSbKa, KaKTO Copyeto. B peaynrar Ha CKoAcTEOTO Ha aHTHTeHHTe 2HTHTEMaTa, KONTO Ce O6pasyeaT CpeWly TOM anTHreH, aeficTeat # cpeuly COGcTBeHH aHTHTeHK Ha HOBeWKOTO TANO ~ ABTOHMYHHKa PeaKYMA Kato saGonasave Tosa e peamaT3uM, + Cipentonnsnn O - rofl nnsnpa eprpountnTe n neskounmTe. B MoBeKOTO Tamo cpeuly Hero ce o6paayear axTurena, KouTo Aokazeame “pes AST-peaKunATa. Tash peakyMA e nonomuTenHa NpM am, 200 ennHnyN ¥ Qoxa36a HanWNneTO Ha axTHBHA CTDeNTOKOKOHa HHODEKLIAR + Epmtporenen ToKcnit ~ Toh yapexaa enmoTena He KpBBOHOCHHTe cyACBe, YepHHA ApS Cepyero. S. pyogenes, KowTo ro nponasemaaT, npmunHAsar cKapnariia Pasnpocrpanenne. Oxono 15-20 % oF aeuara ca KOAOHMSHpaHN Cec S. pyogenes, Te. HeBnHarn npH WSonHpaHe Coc cHrypHOCT Toh € npHUKHHTeN Ha HHOexuMATa. EqMHcTEeHO AST-peakynATa HH Aaa CBeneHHA anh Mname cTpENTOKOKOBA MHOEKLUNA3aGonasanna, KoMTO npHMMHasa. 1. THoiHo sesnanutenin — Haii-vecro anrHna, apMHrHT, MHeKUWK Ha KOKaTa, Ha AMMGHMTE Bean, nHeBMOHMK H ApyTH. Toxcnl meannpakn saGonasaia ~ ckapnatna W epnannen (¥epBeH BATwp). CkapnaTHHaTa & AeTcKa uA eKYosHa GonecT, KORTO ce NPOREAB C NOBMWaBaHe Ha TemnepaTypata, aHrMHa (ssnanenne Ha cnmevunte) M Apxo YepseHM o6pueH (Kato ronemm neTHa) nO TANOTO. Bapmuenara e mexypuera, KouTo ce nosBAEaT; MOPOMMH € ¢ ApEBHM Men4nuM. EpHaMNeMeT CUO ce Npequseukea OT epMTporeHHitA TOXCHH, HO SxopHa BpaTa Ha HMdeKUMATa e HE YCTHATA KyxiiHa, @ HAKGKBO HapaHasaHe, NpH KOeTO ce MONyHaBAT APKO HepBeHH Naki, HaAKTHATH, C Tappan prose, HerHofinn saGonasaHina — Tosa ca aBTOMMYHHHTe YCNOMHEHHA, peBwaTHsDM. OEnvaliHo MmaTepwannre 3a MUKBOBHOAOTUUHO MacneABaHe ca TepneH ceKpeT, paHes cexper. /leveHHe: TeHMAWANH Hav aMAHONeHHUMAMH, NpH HaNMHNE Ha aneprMg —maKDONHTH, TEMA No 28 STREPTOCOCCUS PNEUMONIAE Te ca Tpam (+) Kon ¢ o6ula 3a ase KneTKM nonHsaxapngHa Kancyna. Pasnonarar ce KaTO AunnoxoKn (no agoriKw). KynTHBMpaT ce Ha KpbBeH arap M MsMcKBaT OT 5 % Ao 12 % BBrnepogeH AByoKnc. Kononnue ca anda-xemonnTH4Hi, Octoskn dbaxToph Ha narorennocrra: ‘© Kancyna, Koto 6nokupa arounrosara ‘* Ensim, Koiiro yepexqa ennrena Ha ropHnte auxaTenkn morauya © Ensim, Koro pasrpamqa MTA-antuTenaTa MHesmoKoKHTe MHOTO YecTO KONOHHSMpAT HasO>apMHKca, T.e, NpHceCTeaT Ges ma npeqwsenkaaT 3aBonaBave. OBHKHOBeHO NpHUMHABAT saGonABAHE CneA BHPYCH MHeKUMA, NPeyMOpa HW ApYTH Apeapasnonarauyn baxtopn 3a6onasanna, KoHTO npMYMHABaT: © Bpowxnr (ocoBeHo usocTpAHeTO Ha xpoHH4HH 6poHKnTh)© Mkesmonnn © Own © Menwnrar Marepuanu, Konro ce ssumar: * Hasogapenrnanen cexper © XpauKa © Auxsop * Wapyrn Tlewenne: # ammnonermyinnt coc ann Ges uHxHEHTOP © maxponura + or xetionownre Ges uinpodnn, camo moncHdnyxcaynH H NeBOHAYKCALINH. B Hnkakes caysali He Gea qa ce npnarat amunornuKosnga! Mpodwnantuna. Coujecrayea 23-sanentHa saKcuna (23 ceporuna Kancynu). Ta He Cb3qasa qocraTEHHo MOWeH HMyeH OTrOBOP, ZaujOTO NpeACTaBNABa T-HeSZBNCHM aHTHTeH H 3aTOSE He Ce MpHnara npH Meus Ao 2 ropMHN. Hanocne”bk ce NORBABaT KOHIOTHPAHM BAKCHHK, KwAeTO KANCynHUTe aHTHTeHH ca ceppsarn Hanphmep c TeTaHMveH aHaTOKCHH, KOeTO NpegcTaB/asa BaKCHHaTa 3 TeTaHyC. TasM BaKcMHa Beve aza mHoro no-mowjeH H AOGop MMyHeH OTTOBOD. MesmoxoknTe ce pasnpoctpakagat no 8b3AyWHO-Kankos Mer. TEMA No 29 MEHMHTOKOKH (NEISSERIA MENINGITIDIS), Te ca Tpaw () aunnoKonn ¢ oGue nonnaaxapngna Kancyna, He oSpaayeaT peck H cnopiL Muoro eancxarennu ca Kom xpaniTenHure cpeau, xyATHEUaT ce Ha 5 % 0 10 % Burnepopen asyoKuc axropn Ha natorennocrra: © nonwsaxapnata kancyna, Enoxnpawia barounTosata ‘© nin, npukpenauy rH Kom enMTenHHTe KneTKH Ha HasogapMHKcaBonegysa camo wosen‘t, Kato 3apazaTa MOMe Aa TpbrHe OT GonHM, o3apasABaulM HM 3qpaBH. Tipenasa ce no Bu3qywHo-Kankos NBT KaTO BXOAHa Bpara e Haz0hapHHKCET. OT 5 56 Ao 20 % oT XOPaTa ca HOCHTeRH Ha MeHMHrOKOKA 3a6onnsanna, KONTO npHMMHA! © © puHObapHHrHT — akO NPOHMKHE Npes KPbBHO-MOsDYHaTa Gapnepa ome ga npM4NHH MEHMHTOKOKOB MEHMHMMT, a BP3MOMHO € Aa NPHYMHH H CencHc (MH>EKYNA Ha KPbBTA). Kamanka (cmmnrom) Ha MeHWHEMT: BHEsaNHO CHNHO NoBHWaBaHe Ha TeMnepatypata go 40-41 Tpaayca, cHAHO maeoGonne M NospUlane, rep4ose, purMgHocT (BTEPARSaHe) Ha BpaTHHTE MyCKYAM, MerinnroKoKoBHaT MeHMHrHT MOKE Aa NpeMMHE S MeHHHTOKOKOS CencHc mHOrO Gyp30. KanHMHO TOBA ce nponsasa c xemoparmunu O6pusn (KPBEONEANEH NO KomATA), BagbauuTenno ce B3HMa KpbB 3a XEMOKYATYpa K AMKBO. CbUjecTByBa Gepsa AKarHOsa, NH KOATO AO 30 MMHYTH OpHEHTHpoBLUHO MoNeM fa Ka\Kem KOM e npMMHHTeNRT (naTeKC-arnoTHHayMOHeH TCT). Tevenne. © Bycoxn go3n neHnunaMl * Uedanocnopunn 3-ra renepauna © Xnopampennkon Ha scvukn KoHTaKTHH TpAGea fa ce Aane pudaMnnuv. TEMA No 30 TOHOKOKM (NEISSERIA GONORRHOEAE) Tosa ca Tpam (-) annnoKoKi, 6e3 Kancyna, Ho maT nuaK, KyATHBMpAT ce Ha WOKONaAOB arap C5 %- 10 % svrneponen asyoxnc. Ocnoshn dbakropm Ha naroreKHocrra: © Twa, KonTo ce NpHKpenaT KeM ennTenHiTe KneTKM Ha WHiiKaTa Ha maTkaTa, ypeTpaTa, PeKTYMa HW KOHIOHKTHBa * Anturennre Ha mnnnre ce npomexaT mHoro Gep30 8 Xoma Ha MHpeKYNATa, TaKa He He MoraT a ce o6pasysar Gnoknpaun axrurena.© Enawn, pasrpamqaus MTA-antuTenaTa Tmunnasar saGonasane camo npn NOBeK@, KOeTO € NONOBO NpeHOCMMO. MsTOUHNAM Ha 3apasa a Gonwnre of octpa u no-Hecto xpoHnsHa roHOpeR. MKyGauMOHHMAT NepHoA e OT oKONO 2-8 aH. pH pikeTe ce nponBAsa C YPeTpHT, No-eCTO € oCTpa opma H KAHHYHO HMa weRTOBEnesHNKas COMNEH exper w Gonka npn ypuHupave. pH MeHATe NO-ecTO MpEH4HO sano¥sa KATO BbSTaneHHe Ha wuiiKara wa mavivara, Mioro YecTa © xpoKMYHara GopMa, T.e. nowTH GeschmnromHo ApoTHAHE Cec cna6o Texenne. Or BonsinTe 10% or munKeTe M 60 % - 80 96 oF KeHHTe ca C XPOHKMHa opma Ha roHOpeR TIpu nunca Ha ceoespemenno nevenme mone Aa ce CTHTHe AO CrepuauTer, saujoro MHGeKYMATA ce KaNBa Harope i ce sanyweat danonnesnre 1pe61. AKo Malika, Gonka oT roHoper, pom qeTe AeTeTO ce undexTupa (nony4aBa ce KOHIOHKTHEHT, koliTo ce Hapuya GneHoper). 3aTOBa BCHKK HOBOPOAeHM Ce HaKaNBaT C AMTHGHOTMMHM KANKM MAM YHTBeHTA ~ C6HKHOBEHO TeTpayMKAMH Wau epHTPOMMLAH, Tevenne: © Uedanocnopinn 3-ra revepauwa © XuHononn © Bucenton TEMA Ne 31 CEMEVCTBO ENTEROBACTERIACEAE. ESCHERICHIA COLI Enrepo6aktepuure ce ycraHopasar e vepsara Ha YoBexa M KABOTHMTe, HO Ce OTKPHBAT 4 bs SHWHa Cpeaa. flenaT ce Ha Be ronens rpyni: © YcnosHo natoreHHn - npHunHABaT 3aGonssaHKA caMO NpK HanmuMe Ha NpeApasnonarauyn npwsunn — E. coli, Clepsiela, Enterobacter, Seracia, Proteus, Providentia, Morganella (3a cbuwosere!t! © O6niratHo natoreHH ~ npnunuagaT 226onABHNA NPM BCAKO HaBANSaHE SS sbsnpHEMUNS iguana. Jersinia pestis (4yma), Salmonella typhi (kopemex TH¢), Shigella (qusenTepu). E. coli ca Fpam (-) nppynus, uMar nium mnKpoKancynn. KyATHBHpaT ce Ha CheuMaNKM xpaHHTeRHA cpemu 3a entepoGakrepn, KaXTO M Ha KpbeeH arap (noHaKora Mma GeTa-xemonnsa). ‘axropn Ha natorenoctra:E. coli e npegcrasuten Ha HopManHata MuKPodnopa & CTOMaUIHO-\peBHHA TpaKT, HO 6 2aBMcHMOCT OT avTurenHaTa cH cTpykrypa Te MoraT a NpHNMHAT pasnHuiM saGonABaHMA. Onpenenenn K- (Ha kancynwe) w O-akTarenm (Ha annononHzaxapanre) sauuTasat GakTepnuTe oT gelicteKeTo Ha Komnnemenra w Gnokupat darountosata. Onpenenenn F-antarenn (Ha nite) npuxpensr E. coli Koi Ypoennrensitre kneTki M 8 pe3yntaT Ha Tosa MOraT 8 NPHNHKAT yPOMHGEKUMA. E, coli Ki nprexasa Kancyna, cKonHa C emGpwoHanHuTe HeBpokanHH memGpaHn (OBSKEKHTe Ha Hesponnte Ha em6pHona) m 6 pesynTaT TOsM WAM MOME a NPHYMHH MEHAHTHT npH HOBOPOAEHOTO. 3a6onnsanna, KouTO npHMMHASaT: © E. coli © Hopmanen o6uraTen Ha cTOMAWHO-WpeBHHA TpaKT. PasnH4HK NpHMMKM moraT Ba Aowenat Ao NpomeHH 8 KOnMYECTBeHKA CocTaB Ha E. coli. HaManaBaHeTo HM ce O3HAvaBa KATO ucGaxmepuosa. O6uKHoseHo BOAM AO YeenMuaBaHe KOAMYECTSOTO Ha TROMTe B CTOMaLIHO- NpesHuA Tpakr. KaTO yCnoBHO naToreHHM muKpoopraHWaMu E. coli ca NpMYMHUTenK Ha MHOKeCTBO BETPeGOMHHMHH HHDEKWAH (paHEBM MHOEKUMM, NHEEMOHKH, YPORHbEKUNH, CeNcHe ¥ ApyrH). WasuH GonHMYaTa Te NPMUMHABAT yPOMHAEKYNH, MEHHHrUTH NPM HOBOPOAeHH H exTepoKonnTH. E. coli, Konto npwuniasaT eHTepoKonuTK cnagar KeM 4 OcHOBHH pyr © ExTeponatorennn E.coli ~ npaumHaBaT cneunpvurn O-aHTHreHi, KOeTO Mm Wasa BeaMOMHOCT Aa Ce Npwxpenar M yepeaAT AMrasMuaTa Ha ToHKMTe Yepea. PesynTaroT e OGunHa AMapnA Boneaysar Hosopoqenn # aeua Ao 5 roaHHH. # ExTepotorcureHHn E.coli ~ nponssemnat cneynduueH eHTepoTOKCHK, KOFTO BOAH AO OBUAHA ‘Avapue, nogoGHa Ha Ta3H npn xonepara. © EnTepounsasvaHn E.coli ~ npvunHaBat saGonssaHe, Hepasnuunmo or GakTepnannaTa Avaentepia © Entepoxemoparnunn E.coli ~ xemoparuveH KOnMT, Morar aa ce esemar ScaKaksn maTepnan — ypvia, P2SAMYHM CEKPETH, AMKBOP, KPBB H Hali-BeNe deuec. Npx muxpoSuorormunoTo HscneasaHe O6M4aliHo ce Ha0nMpa E.coli. saToBa Ypes ceponorMHa PeaKuna TepcHm cneyMduunn O-aHTHreHH, xapaKTepHit 3a eHTeponarorenHute E.coli (npH Aeua ao 5 roan). Mlevenne, Morar a ce wsnon3eaT ScHMKM rpynn aHTAMUKPOGHK CpeAcTsa, HO 3aqbMKUTeNKO cep na6opatopvo onpenenave Ha vyscraTenHocrra. TEMA Ne 32 POD SALMONELLAToli npunaanenu wan etepoGakTepuuTe. OGxBaula nogsMKKu GakTepHn, Fpam (-) nepuTpuxtt He o6pasyea couymicxa Kancyna, a MAkpoKancya, KORTO @ MOWeH dpakTOp Ha NaTOreHHOCTTA Megnunicko suavenne ~ oGanrarHo natoreHHn ca 3a 4OBeKa Ca MHOMECTBO ABN M AOWALHH >enBOTHH, NPHUKHABaT 3 rpynn saGonABAHHA: 1. Tudonaparann — Kopemer TH, npu4nHeH oT S. typhi napatd A, B mC 2. Canmowenku racrpostrepita (xpaHtTenHn TOKCHKOMHOeKYAK) ~ NPHYKHABAT Ce OT canMoHEnH rpynn BHC. 3. Cencne 8 MHAMBHAN C MMyHEH AeMYNT — BCHUKM naTOreHKN canMoHEnH cnageT KUM eAMH eAMHCTBeH BAS. enterica w npeacTasnaBaT CepoTunose, pasnuvasaulu ce no O- M H- AY. @axropn Ha narorennoctra. OctHoses daxTop € mnkpoKancynHng AF, KoFiTO Gnoknpa darounTosaTa W 8 pesynrar Ha Tosa S. typhi npexnensa sue darounTure axropy Ha wHBasHATa, NognomaraT npHKpeNAHETO K HaBAHSaHETO Ha CanMoHENHTe B eHTepoUNTUTe, Canmonenute ca ycToFiuHeH Bee BBHUHa Chega KaTO 8 xpaHMTeNHM NpoRYETH (Meco, puba, Riya) MoraT a ce pasmHomasar u Aa ce HaTpynar. Mp YMMpaHeTO MM Ce OTAENA rONAMO KONHNECTEO EHAOTOKCKH, Koliro @ of cbilectaeHo aHaueHne 3a xpahuTenHitTe TOKCHKOAMOEKUIN, Kamnwana kaprana Ha Kopemnua tHe. MaToNHMUK Ha ZapazaTa ca camo Gon M sapazoHocHTenn. 30% or npeGoneaysannte acrasar xpoHMuHh sapasoHOcHTenH AO KpaR Ha KUBOTA cH. MeTAT Ha MpesaBaHe e exano-opanen, Karo npeHocHTen ca MyxH, MPBCHH PUe, SaMBpCeHA Bona H ApyTH. BxoaNa spara Ha MHbeKKHNTe € nurasmuaTa Ha TBHKHTE Yepsa, OTKBAETO Te Hasnvsar 6 Opraninama Ha YoBeKa npes AnmbHaTa CHCTeMma, CTHTaT AO KPBBTa MYpes HeA AO HEPHHA ApOG, cnesKaTa, aumaunrte euann. Tosn eran cesnama ¢ mupsara cegmnua Ha Gonectra, np KoATO TewnepaTypate ce oKausa ao 39 ~ 40°C w octasa Taka Ao Kpan Ha 3aGonasanero (40 ann). Mwa ommaaHanocr, rnasoGonve, Gonkn 8 Kopema. Or sTopata ceAMHYa HaTaTEK Sanovea SanrBrnABAHe Ha CosHaHMeTO M cneynoMHeH ‘o6pHe no Kopema, Kakro M Aapina. ToBa Cuenaga c pasMHOMaBaHeTO Ha GakTepMHTe 8 ¥epHKA ADOE cneakata 4 BTOPHAHOTO HM pasnpocrpaHeHHe B YenKA opraHnsDM. Mpes YepHNA Apo Te nonagaT ‘oTHOBO B Yepsara C *bUKaTa, KORTO BOAM AO HeKPORa M NeDDopAUIMA Ha Yepsara, KAMHYHO TpeTaTa ceamnua Ha 2a60naeaHeTo ce xapakTepusnpa ¢ ycnomNeHiA. YeTBEpTaTa ceAMHYa e CeAMnuaTa Ha BbaCTaHOBABAHE, ako OYenee Xpaninrensn ToKcKoMMibexuwn. Pesepsoep Ha Sapasara ca -MBOTHITe, JapaznEaHeTO ce v3eDpUIBa pes xpatiava. Aliuara ce sapasngaT mexaHMHO OT CaNMOHENH, HAMMpAAK Ce 8 aHyCa Ha MTMUMTe, TpomemauTenHoro Mm CexpaneHie Ha cTaliHa TeMMneparypa BoaK Ao HaBAMaaHeTO Ha CanMoHenATe HaBurpe 8 AlUETO M ako TO He e TepmM4HO OBpaGoTeHO, Mome Ma HacTenH SapasRBaHe. Mowe Coil Aa ce sapasvm Hc meco H mnAKo. CanwoHennTe, npHuNHABaLin xpaHHTeNHH TOKCHKONMDEKUKM He Apownksat npes anrasnyara Ha Yepsara. Te ocTasaT 8 KneTKHTe, pasMHOMaBaT ce M OTAENAT eHAOTOKCHHM, KaKTO MH HANMUKUAT eHAOTOKCHH 8 xpaHaTa. To npemcrasnasa ocHosHaTa NpH¥HHa 3a Auapnara. Miny6aunonHat nepnon e 8 ~ 48 vaca chem KOHCyMayMATa Ha 2apazeHaTa xpana. Moasasa ce nospeuiaHe, BonkH, AMapns, nosnuena Temnepatypa. AMapuaTa e Ges cays 4 KPBS. UNbeKUWATa ecamoorpannuasauia ce. Npn nexiTe H cpeaHOTeMKH Cnyvan TpABBa Aa npeMMHe B pamKuTe Ha 2-5 Aun, He ce npenopeusa akTuGnoTH4Ho AeNeHHe. EaMHcTBeHO TpAGBa a Ce sbacTaHOBAT BoRaTa enextponiate. Mpw TemKnTe cny¥an, KaKTO M NOM KOPEMAHA TH HMaMe H3GOP Ha CAMO OKOND S aHTUGHOTHKa: XOHONOHA,6HCeNTOR, xnopapeHHKON, aMIMMUANK, YebANOCROPAHH TpeTa reHepaLira) TIpw Kopemen tH npea mpsara ceAMMUa MoXe Aa Ce BIeMe KPRE 3a XEMOKYATYPA TEMA Ne 33 POL] SHIGELLA - Sh. sonne, Sh. disinteriae, Sh, flexner, Sh. boyd Te npnanrmear ocrpm nipexunosHn saGonseahwa. Xapaxtepusnpar ce c eHTepoKonnTeH cimapom (anapna c npmmech Ha Crys M KpBE M MaMeHeHnA 8 qeGenoTo wepsd). Te ca Tpam (-) npRAnUM. He o6pasysar Kancyan, Hamar pec ca HenomSHxHHN. CpaskirTenHO no-Mmanko ycTo#MMBN ca OT canmovenute so6 sbhulla cpena. Npnuniasat 2aGonasaHeTo Gakrepanua auzeHTepnA. Or anaeHreDAR Goneaysa camo YoseKeT, Kato npemaBaHeTO € C MPYCHM PLU, MYRK, NPM NOW GHTOBH ycnOBHA Npeaasateto crasa no KONTaKTHO-GuTOS MoT M pAAKO NO BogeH. TonAMO sHaYeHHe HMaT 3ApaBHTE 3apaaokochTenn. Mexannamer Ha npeqasane e ekanHo-opanen Ochosnn daxtopH Ha natoreHHocrra. WnratoKcHs ~ npowseeMna ce camo oF Sh. disenteriae, KoaTo npwunnaga xnaceckaTa GakTepHanla ANSeHTepMA - MHOTO NO-TedKa OT AUSEHTEPHNTE, NPHYAHEHH OT ocratanute supose. Wnraroxcuirer yapemaa UHC, EsOpeunre, Te Kato Gnokupa GenTeunua cHHTeS H Taka y6usa knevknTe. @axropy Ha aaxesnara W MHBasMATa 4 MHBasMATa, NO3BONABALIA Ha WrenMTe ga HaBnasaT B KNeTKATE Ha 4pesnara nurasmua Ma rh yHMWomaT ~ OGpaayear ce A3BH. UnranogoGun ToKcHHn ~ yspexnar knerKnre. Enjgotoxenn, Wuky6auvonHuaT nepvog e 1-7 AHH, cneg KoeTo ce nosMulasa TemnepatypaTa, noaBABaT ce Gonkn 8 Kopema h avapma, /leveHneTo @ aHTMOMOTHNHO, KaTO ce anonseaT CblIWTe AHTHONCTHUM, KaKTO NH canmowenute. TEMA Ne 34 POD VIBRIO CHOLERAE Te npwunasat xonepa ~ ocTpo HNpeKUWMOSHO saGonABANe, MpOTHYaWIO ¢ MHTOKCHKAYHA Guava anapna, Bonewa Ao AexnapaTauvA. Mma TeHAeHUMA Kom NaHAeMMMHO pasnpocrpaHeHne (7 TaHjemnn). Npeaasa ce no bexanto-opanes met ¢ xpaHa n Boga. Tepsute 6 naHgemun ca NpHYKHeHH0t Vibrio cholera 6Hotun xonepa, a 7-mara — or 6vorun eltor. Fant (-) NPLNMYH C enKa HaBHOKA H ema pecia. Te ca cHnHo nogsmKHM, crporM aepoGu KaTO npeANOUNTaT ankanHO pH. MskniownTeNHo HeBsickaTentn Ca KbM xpaHuTenkHTe Cpenw. Morar Aa ce paaMHoMasar @ OSuKHOBeHA ankana 8o7a, KOeTO Fi NaBH mHoro YCTORUNEH Ebs BRHUIMa Cpena. Bos Boga MoraT Ma Ce sanasAT 6-7 meceUa, @ xpatia ~ 8 npoabamenne Ha 6-7 AHN. Asara Guotuna (cholera w eltor) cnanar Kom xonepHM BHEPHOHH ¢ O: - AT, a oT O2 - Ors xonepnute BHEPHOHH HE npHNMHABaT Xonepa. TocnegHHTe cay¥an Ha xonepa ca npMYMHeHM oT BHOPHOHM ¢ Oss ~ AT. Or xonepa Goneayea camo YoseKeT. 3apasnsaHeTo e nO deKanHo-opanet mexannsm 4pes sapazena Boga H xpaHa. CTOMAUIHHAT COK y6HBa XONepHHTe BHOPHOHH. 3apasABAHETO HacTenea NpH normDulaHeTO MM 8 FONAMO KOAHYECTBO MAM HMA NpeXPAHEake, KOTO TM 3auyMTABA OT K-Ta Ha CToMaWHWMA COK; npH HapyWieni Ha CeKpeUMATa Ha CTOMAWHUA COK BUGpMOHVTe ce NpvKpenAT KOM KNETKUTe Ha TRHKONPeBHaTa AMTaBYa M npoNBsEKAaT exSOTOKCHH, BOAEUI AO CeKPeUWA Ha BORA W eneKTpONHTA M GnoKHpaHe Ha NpveMa Ha eneKTpOAWTH B wnevauTe. B peayaTar Hacrenéa O6WNHa AYapMA Ao 20 ~ 30 nuTpa AHesHO. CuepTTa Moke aa HaCTNW B pesyntat Ha HapyWeNMe BBs BOAHO-eneKTPONATHOTO PasHOBeCHe. OCHOBHOTO AeYeHHE © BANBaHE Ha ‘TeuHOCTH H enexTponNTH. Moret fa ce n3nONSBaT TeTpAUNKANH, xiopambennKon, EpATDOMMUMH, TEMA No 35 POD HAEMOPHILUS INFLUENZAE Tosa ca fpam (-) npesnus. Te He oBpaayear pec cropw. BaucKaTeNHH ca KM xpaHTenHATe cpeaM iu He ca ycToluMeH SsbB BDHWHa Cpega, NpMTexaBaT KaNcyna (caMO NaTOreHHMTe NpeACTasMTeNn, ocraliannte sngose ca npeactasitenn Wa HopManwata MuKPodnopa Ha YCTHaTa KyXiAHa). Paxropn Ha narorennocrra. Manu, KonTo Mmar aaxesnBun csoficrsa npM 3-TH THN ~ Kancynara, KORTO Coulo MpuKpena m Groxnpa daroumTosera, fs, KOTO pastpanna 1gA - AT. 3aGonasaHne, KowTO TpHUHABaT KancynHiTe warMoBe ~ EPOHKNT, TPaxeHT, NApHHTHT, pMHOApMHTHT, NHEBMOKMA, CHHYSHTT, MeHMNTHT, PRAKO MOMe H OcTeOMMenHT. OcBeH Ye MOKE Aa NpHYKHM MEpEHYHO sa6onasaHe (nM Manan geua), MHoro NecT nphuntirTen e H Ha BTOPHYK BaKTepMannn HNdexyAn. Crea rpnn coulecrByea BAKCHHG, KORTO He © B MMyHUSAYMOHHMA KaneHAAp (KANCYAHHA NonMBaxapHA, cBLpSaH C NpoTeMHA Ha Austepniiuna anaroKcns, 3a fa Gee n0-BHCOKO HMyHOreHeH). Tlevenve. B mHoro ronan % oT caywauTe aMMHONeHMUMAMHHTe HE ca eOUKACHH, 3aTOBA ce NPenopE4sa ayrnomefinul, Makponut (fnapHTpo- M aauTpOMHUNK) H HHebACHeKYEyuNs- coe Hee ROAXOAA. Gr uowmy ( TEMA No 36 POD] CORYNEBACTERIUM DIPHTERIAETosa ca Tpam (+) nppukn ~ npas un neKo uaEuTH, ¢ yAeGeneHN Kpaluya, KONTO ce pasnonarat Abe MeTaxpomaTH4Hn Tenya. CneuvanHo ce OUseTABaT C O4seTABAHETO NO Halicep KaTO Ce BHAT KATO TApHUKK. MeTaxpomaTHuHiTe TemKa ca CMH M YMTONnasMaTa e HEATO-Kagnea. Mpenapara ot kaminunn marepnann. Andtepwiinnte GaxTepnn ce pasnonarat nog, Bren, ,cbulecTBysaT Mi KopHneGaKTepMM, KOMTO ca Hopman” OGTatenn Ha nasohapmMNKca mM Hasaq ce nogpernaT yenopeao. Muxpooprannsmute npnuniasar 2a6onaeaHero andrepHA, KATO OCHOBeH dakTop Ha aTOTeHHOCTTA e ANOTEpHIIHUAT eXSOTOKCHH, KOMTO € mHOrO chaHa OTPOBA YBPEKAa HaAGEGpeUNTe, Mospka, CopYeTO H Ha Hero ce AbMKaT OCHOBHHTE KAMHMUHM cHIANTOMH MPH ANOTEpHR. Comectayaar anbrepniinn Gakrepnn, KOTO He npowssexaaT TOXCHHN. Te He npHNitaear Audtepna, 8 camo dapnrar, Bes BxoaHaTa epata Ha HHOeKYMATA TOKCHHET NpEAMSBHKBa OHOPMAHE Ha Hanenu. Mpx o6paGoreave Ha TOKcHHa ¢ MOpMaNHH H TONANHa NonyYaBame ANTEpHEH aHATOKCHH (S23 ToKcHuno pelicrsve, Ho npemMaBHKsa OGpaayaaHe Ha aHTHTeNa Cpeluy Hero; Tol e AMyHOreHeH). Apye @axtop © axruren, Kott Gnokupa arousrozara - WaTouHMK Ha 2apazata e GondusT osek. Mpeqasa ce no sb3qyHO-Kankos Mor. BakTepHHTe HasnH3aT 8 AMTaBHYaTa Ha repnOTO, HOCa, conenunre, kegeTo m ocrasar, Te He npoMMKear No-HasbTpe, Monywaea ce sbananeHne, chopmapane Ha $yGpnnosHn Hamenn, KONTO Morar ja NoKPHAT enHrMOTACa M fa NpeAMaBHKaT SaRyLNAGAHe Avdrepwara ce xapanrepysmpa c Horo cHAMa MMTOKcHKayHA (8 OpraHH3Ma HaBansa AudTepniinnaT ToKcnH, Koliro yeperna LINC, copaesnia myckya HaAGeGpeynre). Baxcunara e andtepvex anaroxcnn. Mpnnara ce 2-3-4 mecey Ha 24 meceua, 6-7 ron, 4 11-12 rog. Nlevenne. 3aqpmuuTento, seqnara aHaTuTOKcHHeH Cepym cneA npoGa 3a CBpEXYySCTEHTeNHOCT OT 6Bp3 un, ‘TEMA Ne 37 PO] MYCOBACTERIUM Npeactasnten e Mycobacterium tuberculosis. Mycobacterium ca Tpam (+) npp4nun, Henoasmann 4 HecnopooBpasysauyn. Npniaanentat Kom Poa Mycobacterium a cemelictao Mycobacteriaceae. Npegcrasnagat TRHKM, npasH MAM M3BHTH Tppunun. He oBpasysar cnopu w Kancynn. OyseTReat ce TpyAHO no Tpam nopazM ronAMoTO KoAMYECTEO runway 8 KneTeNHaTa cTeHa. Te ca ao 60 % oT cectasa Ha KneTeuHaTa CTeHa. JaTOBa Tm HapHuame KucenniHo ycroviunen GaxTepnn. Tosa ca 6asHo pactRuiM MAKpOOpraHi3mn, LlenaT ce Ha 18 ~ 20 Haca, KOeTO BOAH AO KyATHBHpAHe OT 3.0 6 ceqMnun. Ochosin pakropy Ha naToreHHocTra ca: © Kopawaasiaonerpakrop, KofiTo uM nomara ja He ce yMHOKaBAT BbB daroumTHTe. NpnTeMaeaT pyr auTurenn coc cpuyoro aelicrane.B oKonnara cpeaa ca MHoro ycToliunsi. 3anaaBaT BPaMOMHOCTTA Aa NPHNWHAT 3a60nABAHE AO 4 — 5 meceya. B xpanurenuuTe npoaykru ce aanazeat HaKONKO meceua. TyGeprynosata ce npwunHasa oF M. tuberculosis u oT M. bovis. Ta e npn KpasuTe. BakeH npoGnem e TyGepxynosara 6 Bera. Mo nmTeparypHin qaHHM 1/3 OT xopara ca 3apazeHH c TyGepkyno3a: Vstownmk a sapasara e Goannar c orkpnra Gopma Ha TyGepkynosa unw roseaaTa (emBp porat AoGuTDK), Mpenaea ce no sy3qyWHO-KaNKOB MMT Wan anMmeHTapHO (4pes xpata). TyGepKynosara THnH4Ha xPOHHMHa PEUNANBHDAWIA HHdeEKLUNA, Tropamsnara TyGepKynosa ce xapaktepusupa c Temneparypa, oTnanHanocr, oTCnabBaHe, HOUHO wanotRBaHe, Kawanya. OGnKHOBeHO sacAra Genna apo6 c oBpasysaHe Ha orHMue. pn zacraHe Ha pernonanen nnmpen Besen ce OGpasysa rmepsHYeH KOMMNEKC. Ha TOBA HBO HMA HAKOAKO W3KOAa. AKO NoseKer e ¢ Ao6pa HMyHHa sauyTa, OrHMUleTO KANUMOMUMpA H Ce NPHKMO4BA AOTYK, HO B Hero OcTaeaT kB TyBepKynOsHH BakrepHi, AKO YoBeKET HAMA QO6pa MMyHHa 2auiNTa, MOMe Aa ce passe GponxoagenuT, orHMu\Ha NHEBMOHHA, nneBpuT, a ako Ce ZacerHe KPBBOHOCEH cba — MuAMApHA TyGepkynosa, Tosa e peuMANBHpaua uAdeKYMA. Vina npucrenK M saTHxeaKUR. HaKpaR ce cTura Ao OGpaayeane Ha ronemm KabepHn (KyxHHM) 8 Gena apo6, KoMTO duGpoaMpaT M ce YHMUJOKABA YeNHAT p06, Gonkuat ywupa. Mocneanara basa © duGpoKaBepHOsHa TyGepKyno3a. TyGepkynOsaTa WOME Aa BacerHe KocTHTe, cTaBHTe m Ge6peunTe. Tosa ce cay¥sa npn MmpEHuHa, HO wma M nocTMEpsHNHa TYGepKynose — TOBA moMKe Aa Ce CAYYM MDH AaKTHBMpAHETO Ha naTeHTHATa HHbEKUMA. Umynnreret np tyGepkynosate e€ KneTBYHO MeaMMpaH H ce goKasea c npoba 2a cepeuyecrenTennocr or 3a6aseH Tun ~ npoGa Ha manry. BakcuHata npn TyGepKynosara e MBA HM Ce chara seawara cnen paxqanero. Ha 7 v4 18 roanun ce npaaH npoGara 3a matiTy, 3a Aa ce ycraHoan aan ima RoctaTeuo Hanperiar MmyHuTer, Tipu Hea ce Bkapsa BbTpeKOMHO TyGepKYAMH BBB sapHaHTa Ha PPD (npeuncTeH npoTeHHos Aepusar). Peaxynara ce orwnTa cneg 72 waca, Karo ce MsMepea AVaMeTSPET Ha MHduaTpaTa (npaBH ce Ha pekava, npurucka ce orcrpaHH H ce Mamepsa camo TeEpaaTa WacT). CroMiHOCTH nog 5 mm HanaraT NoctasaHe Ha HoBa BaKcMla. CrofiHocT Haq 15 mm roBopaT 3a aKTHBHa TyGepKynOsHa UNdeKLUE. CroviHocta merkqy 5. 15 mm noKasear, Ye scH4Ko e Hapen, 3a TyGepKyno3ara ce Hanonseay cneuwanHn AHTHMMKpOGHH cpeactea M TOBA ca M3OHHasHT, eTaHGyTON, PHdaMNHKMH, xMHOROHH, OGHKHOBEHO komOnvaunara e 3 3a He no-manko or 69 meceya. TEMA No 38 POD BACILLUS 8. ANTHRACIS Npnumsasa ocoGeHo onachara wkcbeKuna aktpaKc. To e Fpam (+) npesMua. Pasnonara ce BBs BEpHKKH C 06ua nonunentuqna Kancyna. Np HanHaMe Ha KACROPOA NPM Temneparypa OT 14 ~ 42°C, KoraTo yenosvara He ca GnaronpuaTHn (Hea xpanitTenHn SeulecTBa), OBpaaysaT cnopA, KowTO He AedopMupaT kneranre, Tosa ca aepoSHu cnopooBpasysauiy MuKpoOpranuamAchosen daxrop Ha natoreHHocrra e KancynaTa, KoATO GnoKMpa arouMTO3aTa MH aHTpaKCHAA exzoToKcun. 3a6onasaHeTo aHTpaKc e xapakTepHo 3a NoBeKa M eapHTe MKHEOTHM. TIpH HenocpemcTseH KONTAKT ¢ Gomki wKHBOTHM HMM TeXHH NpOAYKTH (KONA, Meco, KO3KHA) ce pazeHBa KOMHaTa GopMa Ha avpanca, NpH normujaHe Ha 3apaseHo meco ce passa YpeBHa Gopwa. XapakTepwaupa ce C XemoanTaMeH eHTepoTOKCHH, Tpw BAMWBAHe Ha AHTPAKCHH CNOpH ce pazsHsa GenogposHa hopma Ha armpanc, KoRTO e Hali-paaKa. KoxHaTa Gopma Ha aHTpaKca 3anowGa Coc Sa4epEABAHE CBC CMHKABO- YepseHo-vepen usnT. OGpasysa ce mexypue m 8382. Toba e CenposoneHo ¢ nosmWasaHe Ha Temneparypara m0 41° Cw Tema niTOKcHKaye. CarpprHoctra e or 5— 20% 6e3 nevenne Benogpobrara opma Ha akTpakca npeacTasnasa XemopaTH4Ha NHeBMOHMA. CMmepTHoCTTa NpH Genogpobnara dopma e 100 %. 3aToBa np comHeHMe ce npasH npodAaKTHKA C NeHMUKAMHH 4 TeTpayvKAMAN, SleveHneTo TpAGBa Aa 3anouHe BbIMOMHO Hal-paHO C MacHpaHa TpOllHa AHTHGHOTHYHA ‘Tepana u ce npwnara npoTHBoaHTpaKceH cepym. ‘TEMA No 39 PO CLOSTRIDIUM C. TETANI; C. BOTULINUM Knocrpnanre ca Tpam (+) npeunus. OGpasysar cnopy, Kouro gedopmnpat KneTKaTa, Te. cnopata € no-ronama or Gaktepnannata kneTka. Te ca o6nKratHM aHaepoGu. Ceulectaysa camo pH avigepoGuu ycnosu. Nox C. tetani cnopata e pasnonoxeHa TepMnHanHo. Ochosen dbaxtop Ha natoreHHocTTa e O6pasyBaHeTO Ha CHIEN eKSOTOKCHH, KOITTO Ce en Ha Be 4acTA — Teraniocnasmink (ocHosHaTa 4act, KoaTO Aelicréa) m TeTaHONHSMH. TOSH TOKCMH e HYBCTEHTETEH KM Tonnmia w ce pasrpankaa OT KCeNOTO pH 8 CTOMaWHMA Cok. Caupaea ce c npecuHanTHuaTa MeMBpala 8 Hespomyckynnie cunanch H BnoKpa ocsoGomqasaneTo Ha MHXnGHTOpM Ha NPoBeXaHETO. Tipw npornvane Ha mmnync npe3 qaneH chHanc ce oTAeMA ayeTHAXOANH, KOliTO axTHBHpa MYCKYMHOTO BnaKHO 3a CoKPauleHNe. Hopmanko crea 3BeCTHO BPeMe ce OTAENR eHSHM, KOMITO paarpakae AueTHAXOAMHa, 3a Ae MOKE MYCKYAHOTO BaKHO Aa ce OTnycHe. TeTaHyc cnasmuHeT EnoKnpa eHavma, KoliTo paarpaxkna ayeTHnxonnna, B pesynTaT npH TeTaHyc HMaMe HenpeKDcHaTa aKTHBayMA Ha MychynHoTO CekpamleHne. Myckyar e HenpeKecHaTo CoKpATeH M CBMT. VistouHnk Ha 3apazata ca TpesonachuTe KMBOTHH, Karo 30 — 40 % or xopaTa cBuO Kmar TeTaHnuHh Gayman. Ortam Te nonagat 8 okonHaTa Cena n cnopoopasysar. Cnopn uMa He camo 8 Rowsara, HOM NO ApexnTe, npaxa no npegmerure. Teranyc SvsHHKBa, KoraTO 8 paHiaTa (rpAGBA Ma e ABAGOKa pasKDCHO-KOHTYSH ¢ OBpasyeaHe Ha MKOGOse) nonaaHaT cnopH Ypes noweaTa Man npaxa, HanwsieTo Ha AMOG BOAM AO ChaqaBaHe Ha aHaepoBHa arMochepa M npespoulake Ha CnopuTe Bs BererarHBHn KneTRH, Te nponsBeXKAaT TOKCHH, KOlITO NPOHHKBa B NOBeKa M Tam AelicTBa HNO KPBEH nor ce npeHaca 0 canancuTe.Teranyc Mowe a ce passue npu yGoxnaHe, nonyYaBaHe Ha paHn 8 peayntaT Ha KaTacTpda, MynHara pava Ha HOBOPOReHOTO, pM pakgaHe unk KpMMMHaneH aGOpT. Mome M oTeDTPe Np Nepdopauna Ha Yepsara VinkySaunonnnaT nepnog e or 4 HM go meceyn. 3ano¥Ba coc CoKpauiasane (ropy) Ha AbsKaTeAHHTe MycKynH, NOCHE ce 3acAraT MMMMYECKHTe. MapasBT Ha AHYETO e T.Hap. ,cmeWeH nay”. Cnea rosa ce nonyyasa repy Ha excTeHsopHHTe mycKynn. Cweptra HacTonga nw napannsa Ha yckyanTe Ha napHhKca H aMadparmara. Viaynurrerer e anrvroxcnien. BakcnnaTa npencrasnasa TeTaHieH aHaToKcHH. Mpnnara ce KaTO MOMGHHHpaHH BaKCHHH ANprepHA — TeTaHyC ~ KOKMOW. [lo MMyHIBaLMOHeH KaneHAap TaaH BaKcHHa Ce punara Wa 2, 3, 4, 24 meceua, 6 - 7, 11 ~ 12, 16 ~ 17, 25, 35 roqnun 4 cneg rosa npes 10 romuHu Tlevenneto ce pas ¢ XMMepHMYHEH xeMONOMeH M xeTepanOMeH cePYM cneA npoba 3a ceppxuyacrantenkocr. TEMA No 40 C. BOTULINUM. AaepoGen cnopoo6pazyeauy mukpoopraHiaem. OcHoseH dakTop Ha naToreHHocrra e HeroBueT waoToKciH. Toit npemcrasnaga Hai-cnnwara wasectHa aocera oTposa. TepmocTa6uneH e, 7.€. npA rorsene He ce paspyuasa. YeroruNe e Ha KuCenOTO pH B CTOMAUIHHA COX. Ochosen mexanwsue Ha Aelicrsne. Bnonipa ocaoBomqaBaHero Ha alleTHmonvla @ chHancHTe, KoeTO 8OAM AO Nunca Ha MyCKyAHO CeKpauyeHve — Bana napanusa. Morar aa Goneaysar xopata m KHBOTHMTe, KOETO Ce NPHYMHABA B PeSysTAT Ha KOHCyMAUIAR Ha aapazeHe xpana. Ecrectsenata cpena 3 oGurasaHe e noveara M oTTam nonaAaT 8 nnoposeTe, SeneHNYUMTe, MecoTO H pHBaTa M aKO He Ce KOHCepsHpa AOGpe, NonagHanuTe cnopn ce pasmHomasaT B aHaepobuara atwocdepa M npoayuMpat exsoroKcuHn. Xopata ce sapasasaT 4pes KOHCyMayNA Ha 3apazeHn KOHCepen. Npes YpestiaTa AMraBHUE TOKCHHET Nonaga & KDBBTA M AOCTHTA CHHaNciTe, KeAeTO Aelictsa. Vaxy6auvonnmar nepHog e or S aca mo 8 AeHoHOWMA. 32no¥ea noeMWaBaHe Ha Temmeparypara, Gonky & KopeMa, noBpDUlaHe, ‘maso6onHe, Nony\aBa Ce Napanv3a Ha ONHMTE MYCKYAN C ABOTHO BHMpAHe, PasUIMPeHMe Ha 3eHMUKTe, HapyweHO doKycuPaHe, akyMomaUMA, chanaHe Ha wnenaunte, rpy6 moraine rac. BonwiTe sarusaT oT napanvza 4 cnupake Ha cepmeuHara AeliHocT. Mlevenueto @ coc cneunduuHn aHrHTena, Hali-uecto cpewy A, B, E cepoTunosere Ha GotynMHosHA ToKCHH, POs TREPONEMA T. PALLIDUM Tpam (-) nppanun ¢ mHoro mambk HanpeveH pasmep. Morat wa ce Ha6mgasaT camo CoC cneypanen maxpockon Ha Tomo 3pHTenHo none. Te ca H3BHTH MuKpoopraHnamut c 10 ~ 14 npasnannWaBHBKH. BaBHO PaCTALy MUKPOOPraHHSM e, KAKTO MUKOBAKTepHHTe, C MHOFO ABNTO TeHEpAUMOHHO speme, He ce KyATHBHpaT 6 XpaHHTeNHH CpeaM. NoAARpaHETO Ha WaMOBETE © CAMO 8 TECTACH Ha 3aliun. Npvunnaga saGonasanero cu*bunuc, or KoeTO Gonepyea camo YoseKr. Mpemasa ce no KoEBEH M ‘no noNOB Mer, KakTO M OT Malika Ha MeTe. MHKyGauMOHHMAT epHOA e OT 2 - 3 ceAMAUM. Ha mactoro Ha npoHMiKsane ce noneasa A38a (Hapnua ce ulcus durum ~ 38a C TeBPAO ABHO) Permonanen anmdagenit (seananenve Ha nnmdHnre Bpsan). Crea 3-4 ceamnun assata sapactsa Mc Toba NPHKnlovBa MBpBHAT CraaHli Ha cHunHca. BropMaT cranni sano¥sa cep 1 ceammya win 2 ~ 3 meceua ¢ nonsata Ha OGpwe M YepseHH nBMKH MO URNOTO TANO, AMMOHMTe BRINK ce noAysaT TeHepannaupaHo Kato Toba CbcToAHHe npoaEnKasa 4 ~ 12 ceamMyM, cneA KoeTO npemnHasa. Chen 4 FORMHN 3anovsa TpeTHAT cTaqHii. MuTepsameT MeMKAY BTOPHA H TPETHA cTaAKi Mowe Aa 6vae AO 10 FOAMHM. B TpeTUAT nepHon SONHNAT BeYe He e 3apa3eH, 32 pasnnka OT MBpEHA H ETOpHA. XapakrepHanpa ce c yepemaane Ha surpeWHuTe opraHn. Caeg 10 ~ 30 roquin e HersepTHRT cTaanii Ha cHduanca, np Kolito ce yapemaa HepsHara cucTema. Awarnosa. Ceponoruuno okassane Ha aHTuTena 6 cepyma Ha GonHuTe. Alewenne. Uedbanocnopunn 3-ra renepauua (OBLIA XAPAKTEPHCTKA HA BAPYCHTE Bupycure ca Ha rpaknuaTa MexKay MMBaTa M_HemMBaTa MaTepHA. 3pennTe eMpycHH UacTAMUM, Hapevenn BHDHOHM, ca WHEPTHH 8 OKOAHATA Cpena, Te CAMO NpeMMHaBaT Npes HEA H Ca cnOCOGHH Aa sapazneat \KvEH KneTkH. B >KNBaTa KeTHA BHPYCET e cnocoGeH fa Ce PasMHOK M Aa OGpazysa HOBM BMpYCHM HacTHUM. BHMOHUTE ca WarpageHN OT HyKNeHHoBa KHCenKMa ([JHK HAH PHK), 306KONeHa oT Genres o6818Ka, KoRTO ce Hapiua HyKneoKancHA, Tip axon smpycn uma sTopa o6uska, KoATO € nMnonporennosa. Toit Karo BuPyCHTE ce PaSMHOMaBaT CAMO B KMBK KAETKH, METOAUTE 3a KYATHEMPAHE Ha BMPYCH Ca No-HEOGUYaliHH. Te Morar Aa ce KyATHBHpar Ha ONHTHH MHBOTHH (HOBOPOAEHH, Ha KOKOUIM EMGPHOHM, HAM KneTEUHK KynTYDH). B KAETRUHHTE KYATYDH BUPYCHTE NPEANsBUKBAT CneuMdHYeH UMTONATHYEH ebexr. ‘TEMA No 42 CEM. PICORNAVARIDAE POLIOVIRUSES 1, 2, 3 Tukoprasmpycute ca Hait-manknTe BMpycu. Te ca PHK - BMpyCh M Ca CpaBHHTenHO YCTOMMNBH 0 ObHUlHa cpeaa. EAnK OT SamHUTE poRoBe 8 TOBA ceMeicraO ca EHTepOBNpYCHTe, KONTO BkALOUBETNonmosupycre 1, 2 4 3. MonMosupycute npHunuasar sa6onRBaHeTo NonuoMuUenum. Toit € ocrpo WneKyNOsHO 3a6onRBaHe, XapakTepHsHPAWlO Ce C BEINANMTENHM HIMEHEHHA 8 CHBOTO BeUECTBO Ha Tpe6HayHnA MosBK, BANA NapanHaa, ABNKAUIa Ce Ha yepeMqaHe Ha HespoHUTe (Mlapaniza osHavasa ANNA Ha BBSMOMHOCT 3a ABWKEHNE. MloNHOMMENHTHHTE BUYCH YepeX~AaT HEBPOHHTe, KETO BOAN AO anna Ha Cokpawenne). Npenasa ce no deKanko-onaneH Met M camo B KDaR Ha HHKYOAUMOHHMA NepHOA Gonknar Mowe ga npeaane 3a6onrBaHeTo NO BL3;yUIHO-KaNKOB Mbt. Bonemysa CAMO YOBEKET M O6nkHOBeHO 2apasnBaHeTo € pes xpala. BMDYCBT nonama & ODraHHaMa W Ce DasMHOMAKA 8 ENKTeNa Ha ToHKUTe Yepsa, CnMBHUNTe H cTTaM nonaga 8 xppsTa. MHOTO pRaKO OT KDBBTa BHpyCET AOCTATa Abnratenunre HeBpoHH Ha Tp»GHANHKA MOSRK H TH yaperaa. MHKYEAUMOHNKAT NepnoR e 7 — 35 AH, Kato ® Kpan GonHHAT oTAeNA spyca pes repnenn ceKpeTH (T.€. NO SBsAyWHO-KaNKOS MT) Mm YpEs Seunca. pes heynca supycor ce orgens 3a owe 2-7 ceaMMUM. ZaGonRBaHeTo sanowsa ¢ NOBMWABAHe Hat, nosppuiane 1 Nona Ha napanusi. OBuKHOBeHO Ha 100 sapazenn ce saGonnea camo 1. Ceuectaysa qo6pa npodunakruxa kaTo Mma aga BHAA BaKCHHK: © Xia BaKcnla — npunara ce Kato 2 Kanki Ha e3HKa, © YOura Bakchka — Ta € c NOAKOMHO MH MyCKyAHO NPHNOMeHHE. MpobreM e, ve y6uTaTa BaKCHHa aba 70 ~ 80 % ebextusHocr, Te. TA € NO-HeedexTHSHa OT MiBATa, B MOMEHTA TA NpHCRCTEA S viKy6auvoHHi kaneHmap, KaTO AONpeqM 3 ~ 4 romUHM ce NpMara Camo ‘KMBaTa BAKCHHA, TEMA No 43 INFLUENZA VIRUS Bupycet € npwynHuten Ha rpuna. TpunHuTe BHpycH ca PHK — Bupycu c 8 cermeHTa PHK. Hykneoxancngpr e noxpHt c agoeH aunnpen col. Cope Benrexa, Kolito yuaacrsa & HykneoKancnga, TDHnHTe BUDYCH ce AeNRT Ha A, Bu C, 8 CnopeA aNTHTEHITe Ha AOHKUR nANHeH CoH (xeMArAyTHKHA 4 Heypawmnngasa) pHniiTe supyCH THN A Ce AenaT Ha noATHNOSe. XemarnytuHnieT onpeaena NpMKpenAHeTO Ha rpunkuTe BYpyCH KM KNeTKMTe (enMTeNa) Ha HOCOrMBTKATA WM HABAM3HETO MM B TAX. Mpv yoseKa Aocera cewiecteysat rpunHn BMipyc c 3 xemarnyTHHMHa: H, —H3. Moasata Ha rpuneH BupyC ¢ HOB Xemarnyrninn HC BREMOMHOCTH 38 NpeAaBaHe OT YOBEK Ha NOBEK BORN AO naHAeMA. Heypamunugasata oGesnevasa n3an3aHero Ha rpHnHnTe BMpycH OT KneTKaTa. [pv YoBeKa Mma QBe eypemnnaaan: Ny No XapanTepha ocoBeHocr Ha rpHnkuTe BYpYCH € TAXHaTa TONAMA HSMeHYHBOCT, AbMKaulIa Ce Ha MyTauHH Ha reHUTe 3a XemarnyTHHHH W HeypaMMHnaasa. Tosa BoqH AO NoREaTa Ha rpHNHM BHpyCH C anki wameHeHna. TonemuTe aHTAreHHi H3MeHeHHMA He XeMarnyTMHiHa M HeypamuAnaasaTa ce aEmKar Ha npekapexqane Ha renure (PHK e &-cermeHTHa) MemAy YOBEWIKH H IKMBOTHHCKM SMpycH OT THN ApH ycnosuara Ha KOMRGEKYUR, Tpumsm © ocrpo unbexyHosHO saGonasaHe, xapaKTepHsHpaujo ce ¢ BUCOKa TeMnepaTypa, rmapoGonwe, CHNHH MycKyniiA GonkH, BBsNANeHNE Ha TOPHITE ANKATENHH METMUIA M MHOTO CHAHOapazena unToKcuKauMA, Mpenasa ce No Be3qyuHO-Kanko8 mT. MHKY6AUNOHHMAT NepHOA e 1 ~ 2 RHM. Moro wecro ce cpewat YCnOwHeHK — GPOHKHTH, NHeBMOHHM, MOMe fla Ce CTATHE HO MHOKapAMT. Jlewenne. AnruGvoTHuM He ce npinarar, camo ako wma GakTepMania cyxa MHOeKUHR. CneundxuHA ApotHsorpiniin cpeacrsa ca Pemaxrannn, Tamnday 4 Apyru. Mpogaaktaka, 'snonsear ce yGutm BaxcnHn KaTO © wlionysak, KoliTo npeacrasaasa camo nunonpoTenHoBata OGBHBKA Ha rpHNHMA BHpYC, T.e. Camo XeMarnyTuHnna W HeypaMMHngagata; © Baxcurpiin — rpiniuat eupyc @ paspazaH HanonosMHa C Uen HaManRBaHe Ha GenTeYHOTO comppnxanne ‘TEMA No 44 PETPOBMPYCH (CEM. RETROVIRIDAE) HIV~1,2 Petposupycute ca PHK ~ eipycu. Te mmat cheunanen eHsHm, HapeHen OBpatia ThaHcKPHNTasa, kolo Wa 6a3ara Ha PHK cunTesMpa QHK. HIV-supycrte nputexasat aunonpoTentosa o6BMBKa C avturenH, KoWTO pasnosHasaT camo KneTKH, HoCeMH Lifl4-moneKynara. Tosa ca TxennepuTe 1 maxpoparare, Hasniaaiikn 8 tax, HIN-supycure cuiTesnpar JHK, maeHTHiia Ha caoaTa PHK, pea obpatnara TpanckpHnrasa, KoRTO ce BMbKBa 8 reHoMa Ha KneTKaTa M ocTasa HeaxrTHoHa. Tosa NOAOMeHMe ChoTseTCT8a Ha BTOPUA NepHOA OT HIV-MHbeKuATa, HapeveH AameHmen nepuod. Tor mome Aa npoatnxs 5 ~15 roqunn. Takusa Gon ce osHauaBaT Kato ceponosumusHu. Paanvwnn, Bce oule HENSACHEHH akTOpH, BOAAT 0 aKTHBHDaHE Ha BAPYCA. Toft ce pasMHOMasa 4 nanycraiinn Txennepnte, rm yaMwomasa. Tosh crannit ot HIV-wmieKunaTa ce xapakrepHanpa C HOUWHK H3nOTABaHMR, HaManABaHe Ha TeNeCHOTO Tern, reHepannaupaHo YeennuaBaHe Ha NAMOHATE eeann mM ApyrH. Tlocneawnat craanii m craamaT wa CNH (Chwapom Ha npHqoGwTa vMyHHa HegoctaresHoct), KofiTo ce xapakTepwanpa ¢ OnoprionMcTH4HH MbeKUMM (nDMWAHEHM OF MUKPOoprannamm, KOHTO ca 8 OxONHaTa Cpema H HOPMaNHO W306UIO He BpeAAT Ha sapaBeTO) - ryGeprynosin Gaxrepnn, xepnec, reGx, YecTo ce cpeuaT H Heonnasmn ( HanpHMep capKoma Ha Kanoww), HiIV-supycue ce orkpusar 8 Kpesta, cnepmara, nMKBOpa, ypuHaTa, MaiunHOTO M”AKO. NpeqaBar ce OCHOBHO NO KPBEEH H NONOB MET, eBEHTYANHO NPM PaxAaHeTO, AKO TO € NO-TPaaMaTHYHO. Mewenne, 3acera Hama. VisnonseaT ce HykneosMAHA UNM HeHyKNeOsMAHH aHanosM Ha OBpaTHara TpaHcxpuinrasa, Baxcnna, Bce ouje Hama. Hali-Necro ToBa ce AbmKM, Toit KATO OGpaTHaTa TpaHcKpHTTasa AonycKa MHOrO rpewnn.Amarnozara ce nocraes upe3 enaiiza, 1.¢, qokaasaHe Ha cneuMOnunn akTHTena 8 cepyma, ‘TEMA Ne 45 XEPNECHM BPYCH (CEM. HERPESVIRIDAE) Xepnechure supycn npuTemasar apoiHosepwkna AK u aMnugHa obMBKa. JlenAT ce Ha TPH Noacemelicrsa: anda-, Gera- u rama-herpesvirinae. Mepaoro noacemelicteo akniovea xepneKc cmnneKc Bupyc 4 xepnec Bapvuena socrep supyc. XepneKc cHmnneKc sHpYCHTe NPHNKHRBAT NaGHaNeH (Kepnec cumnnexc Tun 1) u renuTanex (xepnec cunnnexe Tun 2) xepnec. XepnechiTe Bupycn moraT Aa NpMaHKAT TOKKH KEPETO-KOMIOHKTHBHTH Ht eHUEdaNuTH NPM HOBOPOAeHH, aKO ca POAeHH OT GonHa maliKa C renntanex xepnec. Mopsinara xepnecha uadexuvia OGuKHOBeHO € 1 —5 ropMHM, CneA KOeTO XepnecHHTe BApYCH octasar 8 raranute Ha Nepento-mosb4HHTe Hepsi H Np Npeapasnonarauin ycnOBMA Ce H3ABABAT KATO ‘faGnanen wan reHnTaneH xepnec. Bapmuena socrep sMpyc npmsuKAea eapuYena KaTO MupBHAHa HNdeKYAR. Non eDapactHH, Ape6onenyeann oT sapnyena, BMpycHTe moraT Aa Ce aKTHBHpAT OTHOBO M Aa NpeASBHKAT BapMUEN aocrep. Bapuyenama e geTcxa unbeKumosHa Gonect ¢ wHKyBauMoKeH nepnoa 10 — 21 AHH. XapakTepuanpa ce c nonsata Ha cheynduyen obpme. OGpmBHUTe EAM NpeMMHABaT NDEs HAKONKO cTagva: maxyna (nerHo}, nanyna (menka), sesukyna (mexyp4e), nyctyna (rHomHO mexypye), Kpycra ( Kopnuka). Np sapmuenara OGpHBHHTe eqMHMWH Ca Ha pasnn¥eH CTaAMil M Ce NOABABAT KaKTO NO TANOTO, Taka W no BcHHKH AnrasMuA (8 HOCA, yCTaTa, reHHTanHHTe) MNO OKOCMeHaTa HaCT Ha cmaBara. 3aGonasanero € npMAPYIKEHO c BHCOKa TeMMepaTypa, KATO TA 32BNCH OT GpoR Ha OGPMEHHTE eAMHMBM (Gpon Ha menue). Nevewne. Hama nevenne. Bapnyenara npemnnasa cama. floGpe e aa ce cnasea aera ~ 6e3 Meco, woxonag, Aliya, 7.2. aneprasmpauyn xpanu Mpn sapmuena soctep ce noRsaBa OBpHB 8 MACTOTO, KbAeTO MNepeupaT MHTepKocranHHTe Hepen, Broxaa ce o6pue ¢ ApebHit MexypeTa Ha NepseNa OcHOBa M MHOO CANHa Bonka, Kom stopoTo noacemelicrao cnana yToMerano aupyc, KoliTo e npoGneM 3a BpeMeHHHTe MEH, Tol Karo BoAM Ao yapemAaHHA Ha Nnofa. TpeTOTO noACEMelIcTEO BKnIONEA eOUIaTIHEap Bupyca, KOHITO e pwunnnren Ha HNbeKKHOIHATA MOHOHYKNEOZA H AUMOM Ha BpAuT. TEMA Ne 46 XENATTHI BMPYCH,Bupychnre xenaTuTH ca ocrpu saGonaBaHus, xapakrepHsHpaulM ce ¢ yaPeNAAHKA Ha YepHUA Ap06 Mt nossa Ha xenTeHHUA Xenamum A ce npnvnnasa oF nvkopHa supyc. YcTOWUNG @ eRe EBHUIMara cpena W 3aTORa sa6onmpanero ce npensa no eKanHo-opanen h KOHTAKTHO-GHTOB Mor. Boneaysa camo 4oBeKST. Bupycer ce vamvuea ¢ deuce oKono 3 cemMMUM npeAN WBATeHMYaTa. Tlph xenaTAT A ce yspemaaT HnevunTe Ha epuna ap06, Kato oKoNO 2/3 oT sepaseHnTe npeKapsar xenatHT A GeacHtanroMHo. B Apeankrepwsnun nepHon (nkTep — xXonTeHMua) ce Habniogasa OTMagHanocr, GesaneTuTHe, BonKH 8 Mopemiata o6nacr, nosnwasaHe Ha TeMmepatypara. C nonea Ha wATeHMUaTa YPHHATa NOTMHAGA, @ vanpaxnenuata crasaT GesyseTm. YeraHosAea ce yeenMuasaHe Ha YepHMA gpo5. AnarHozara ce ocTasR upes ceponorn4Ho WacneAgaHe. CneYnbyEHO ReYeNHE HAMA, OCHOSHO Ce NpHnara AMETa 1 cpeactaa, evajelicrsaum sepxy YepHia ApOS. CoujecTBysa BaxcHHa 3a xenaTHT A, Konto e yBura. Xenamum E e PHK—supyc. Bonenyea camo YoBexeT. MexaHnamer Ha 3apaaneane 4 KAMHMUHaTa kaptuna ca CxOAHH C Te3K NpH xenaTHT A. Xenamum B ce npvunnasa or JHK-snpyc, KoRTO @ MHorO ycrOMune ERE BLHUIHATA cpefa H 2QUPIKE BKMOUNTENHO Ha AESHHdEKUNOSHH CpencTRa. Boneaysa camo YoBeKr. BupyceT ce npeaasa NO NoAOB H KpbBEH MPT, KAKTO M TpacnAayeHTapHo (oT maliKaTa Ha Noga). Habnn3a 6 KneTKHTE Ha Neplita p06 H rH npomeHA no Takes HaYHH, He Ce aKTHBHDa aBTOMMYHHA peaKunA, myHHMTe KAETKM Ha oprannsma cunTaT KneTKMTe Ha YepHMA QpO6 3a Hyman, Mo Ta3H NpHYKHa npH 20 % oT saBonennTe MOWe Aa Ce CTHTHE Ao YCOKHEHUA 8 pesynTaT Ha XPOHNYHO HOCHTeNCTBO (KPO H KApUAHOM). Ceusectaysa pexomGnnanTHa sakcHHa, KORTO BnH3a 6 MMyHKJaYMOHKHA KaneHAap. Xenamum D e PHK-supyc. Mexannaniet Ha npegasane Ha 2apazaTa e KaTO NpH XenaTHT B. BusnpHeMunen Ko TOM Bupyc ca CAMO HocHTenmTe Ha XenaTHT B. Xenamum C e PHK-supyc. MsTOUHNK Ha sapazaTa ca camo GONHMAT YoBeK M 3apazoHOCHTeNRT. Mpeaasa ce kakto npn xenatar D. KAMHMNHaTa KapTHHa @ CKOHa ¢ TasM NpM xenaTHT Bu ce XapakTepnsupa C ToBa, Ye MecTO XenaTHTEr Ce VSRBABA HaNpaso C YCOMMEHMATA ~ xPOHMYEH xenaTHT, Umpoza M Kapuniom. Pasnikara memay xenatwr CM xenatwr B e camo 6 ToBa, ve xenatur C xponnynpa 8 30-70% or cayanTe, KOeTO e MaKMOUHTeNHO BHCOK NpoUeHT.