Brief reference book of infectious diseases. Infectious and parasitic diseases Infectious diseases clinic doctor's reference book

Susceptibility to infectious diseases depends on many factors: age, past and concomitant diseases, nutrition, vaccination. It changes during pregnancy and may depend on your emotional state. All these factors influence immunity– a person’s ability to resist infections. The infectious process is an interaction between a macro- and a microorganism. With normal immunity, the penetration of the pathogen is prevented by a number of protective barriers; when the strength of at least one of them decreases, a person’s susceptibility to infections increases.

In recent years, causative agents of previously unknown infectious diseases have been discovered that humans have come into contact with as a result of environmental changes and population migration. In addition, it has become known that microbes are the cause of some diseases that were previously considered non-infectious. For example, a certain type of bacteria (Helicobacter pylori) plays a role in the development of gastric ulcers. Currently, there are many hypotheses about the role of viruses in the formation of benign and malignant tumors.

Prevention of infections.

Preventing infections is as important as fighting them. After all, even simply washing your hands on time after visiting the restroom or upon returning from the street can save you from a number of intestinal infectious diseases. For example, the same typhoid fever. Of course, you can use disinfectants for “risk surfaces”. But in any case, this does not provide a 100% guarantee for a sufficiently long period. It is also worth paying attention to the fact that the source of infections can be anything, from the railings on the stairs and the buttons in the elevator, to the banknotes that we respect so much, which have passed through many hands. To prevent ordinary vegetables from becoming a source of dangerous microbes or even helminths, they should be washed especially thoroughly. In some cases, even a weak solution of potassium permanganate.

Infectious and parasitic diseases include
Intestinal infections
Tuberculosis
Some bacterial zoonoses
Other bacterial diseases
Infections that are predominantly sexually transmitted
Other diseases caused by spirochetes
Other diseases caused by chlamydia
Rickettsial diseases
Viral infections of the central nervous system
Arthropod-borne viral fevers and viral hemorrhagic fevers
Viral infections characterized by lesions of the skin and mucous membranes
Viral hepatitis
Human immunodeficiency virus disease [HIV]
BOther viral diseases
Mycoses
Protozoan diseases
Helminthiasis
Pediculosis, acariasis and other infestations
Consequences of infectious and parasitic diseases
Bacterial, viral and other infectious agents
Other infectious diseases

Educational literature for medical students

N.D.Yushchuk, Yu.Ya.Vengerov

and pharmaceutical education in Russian universities as a textbook for medical students

Moscow "Medicine"

UDC 616.9-022(075.8) BBK 55.14

REVIEWER:

A.K.Takmalaev - Doctor of Medical Sciences, Professor, Head of the Department of Infectious Diseases of the Peoples' Friendship University of Russia.

Yushchuk N.D., Vengerov Yu.Ya.

Yu98 Infectious diseases: Textbook. - M.: Medicine, 2003. - 544 p.: ill.: l. ill. - (Educational literature. For students of medical universities.) ISBN 5-225-04659-2

The textbook was prepared by a team of authors taking into account modern advances in infectology and the relevance of individual nosoforms in accordance with the program on infectious diseases for medical faculties of medical universities. It can be used as a textbook on infectious diseases for sanitary and hygienic faculties of medical universities and training courses in tropical medicine.

For medical students.

Preface........................................................ ...........................................
Introduction........................................................ ........................................................
GENERAL ISSUES IN INFECTIOUS PATHOLOGY
1. Classification of infectious diseases. Infectious pro
process and infectious disease.................................................... ............
2. Main features of infectious diseases...................................
3. Diagnostics................................................... ........................................
4. Treatment........................................................ ........................................................
5. Emergency conditions in the clinic of infectious diseases. . . .
SPECIAL ISSUES IN INFECTIOUS PATHOLOGY
6. Bacterioses................................................... ...........................................
Sadylonellosis......................................................... ........................
6.1.D) Typhoid.................................................... ....................
6.p£ Paratyphoid A, B............................................... ....................
6.1.37""Salmonellosis............................................ .......................
6.2. Dysentery (shigellosis)................................................... ..............
6.3. Escherichiosis......................................................... ...............................
6.4. Food poisoning.................................................................. ...
6.5. Cholera................................................. ......................................
6.6. Yersiniosis......................................................... ...........................
6.6.G7>Pseudotuberculosis.................................................. .............
■£.6.2. Yersiniosis......................................................... ....................
6.6.37 Plague................................................... ........................................
6.7. Klebsiellosis......................................................... ...........................
6.8. Pseudomonas infection......................................................... .......
6.9. Campylobacteriosis......................................................... ...............
6L<1 Листериоз................................................................................
6'11."Brucellosis............................................ ....................................
(T.IZ Tularemia................................................... ...................................
6.13.hAnthrax.................................................... ........................
6.14. Streptococcal infections...................................................................
6.14.1. Scarlet fever................................................. ...............
6.14.2. Erysipelas................................................ ............................
6.14.3. Angina................................................. ........................
6.15. Pneumococcal infections...................................................................
6.16. Staphylococcal infections.........................................................
£D7. Meningococcal infection...................................................................
6.18. Diphtheria................................................. ...............................
6.19. Whooping cough and parawhooping cough.................................................... ........
6.20. Hemophilus influenza infection....................................................
6.21. Legionnaires' disease ..................................................... ...........................

6.22. Spirochetoses......................................................... ........................
6.22.1. Epidemic relapsing fever (lice-borne). . . .
6.22.2. Endemic relapsing fever (tick-borne
recurrent borreliosis).........................................................
6.22.3. Leptospirosis................................................. ..........
6.22.4. Ixodid tick-borne borreliosis (Lyme-bor-
reliosis, Lyme disease)...................................................
6.22.5. Sodoku................................................... ......................
6.22.6. Streptobacillosis......................................................... ....
6.23. Clostridia .................................................... ......................
6.23.1. Tetanus (tetanus)................................................... ..
"у£6.23.2"Botulism............................................. ........................
6.24. Benign lymphoreticulosis (felinosis, bo
the pain of cat scratches)...................................
6.25. Sepsis................................................. ....................................
7. Eikketsioses.................................................... ......................................
<С2Л^Эпидемйческий сыпной тиф. Болезнь Брилла................
7.2. Endemic (flea) typhus....................................
7.3. Tsutsugamushi fever.................................................... .......
7.4. Marseilles fever................................................... .......
7.5. Tick-borne typhus of Northern Asia....................................
7.6. Rocky Mountain Spotted Fever.................................................
7.7. Australian tick-borne rickettsiosis....................................
7.8. Vesicular rickettsiosis................................................................. ...
7.9. Q fever (coxiellosis)................................................. ....
7.10. Ehrlichiosis......................................................... ............................
8. Chlamydia...................................................... ......................................
B.PORNITOSIS................................................... ....................................
9. Mycoplasmosis................................................... ...................................
9.1. Mycoplasma pneumonia - infection....................................
10. Viral infections.................................................... ........................
- (10.1. Viral hepatitis................................................... ...............
10.1.1. Hepatitis A................................................ ...................
10.1.2. Hepatitis E................................................... ...................
10.1.3. Hepatitis B................................................ ...................
10.1.4. Hepatitis D .................................................... ................
10.1.5. Hepatitis C................................................... ...................
10.1.6. Hepatitis G ..................................................... ................
10.1.7. Diagnostics and differential diagnosis 288
10.1.8. Treatment................................................. ....................
10.1.9. Forecast................................................. ....................
10.1.10. Prevention........................................................ .........
10.2. HIV infection............................................... ......................
10.3. Acute respiratory diseases...................................................
10.3.1. Flu................................................. ......................
10.3.2. Acute respiratory viral infections. . .
10.3.2.1. Adenoviral infection......................
10.3.2.2. Parainfluenza................................................
10.3.2.3. Respiratory syncytial infection
tion................................................... ..........
10.3.2.4. Coronavirus infection......................

	10.3.2.5. Rhinovirus infection......................
	10.3.2.6. Reovirus infection........................
	10.3.2.7. Diagnostics and differential
	diagnostics..............................................
	10.3.2.8. Treatment................................................. ....
	10.3.3. Severe acute respiratory syndrome. . . .
10.4. Enteroviral infections................................................................... .
	10.4.1. Enterovirus infections Coxsackie - ECHO
	10.4.2. Polio................................................. ..........
10.5. Herpetic infections......................................................... .....
	10.5.1. Herpetic infection (herpes simplex). . . .
	10.5.2. Chicken pox................................................ ..........
	10.5.3. Shingles.........................................................
	10.5.4. Infectious mononucleosis (Epstein-
	Barr virus mononucleosis)...................................
	10.5.5. Cytomegalovirus infection.........................
10.6. Measles................................................. .........................................
10.7. Rubella................................................. ...............................
IGL&. Mumps (mumps infection)............
[O^Viral diarrhea.................................................... ......................
	10.9.1. Rotavirus infection.........................................................
	10.9.2. Norwalk virus infection....................................
10.10. Foot and mouth disease......................................................... ......................................
10.11. Natural spa................................................... ...............
10.12. Cowpox................................................ ...........................
10.13. Monkeypox................................................................ ...........................
10.14. Phlebotomy fever................................................... .....
10.15. Hemorrhagic fevers....................................................................
	10.15.1. Yellow fever................................................ ...
	10.15^-Dengue fever.................................................. ..........
Balantidiasis........................................................ ...........................
J2.3. Malaria........................................................ ................................
12.4. Leishmaniases......................................................... ......................
12.5. Toxoplasmosis......................................................... ........................

12.9.1. American trypanosomiasis (Chagas disease) 475

12.9.2. African trypanosomiasis (sleeping sickness). . 476

13. Actinomycosis................................................... ...................................................
14. Mycoses .................................................... ........................................................
14.1. Aspergillosis........................................................ ...........................
14.2. Histoplasmosis......................................................... ........................
14.3. Candidiasis................................................. ...............................
14.4. Coccidioidosis......................................................... ......................
15. Helminthiasis................................................... ...........................................
15.1. Nematodes......................................................... ...........................
15.1.1. Filariasis......................................................... .............
15.1.2. Ascariasis......................................................... ...............
15.1.3. Toxocariasis......................................................... ...............
15.1.4. Trichocephalosis......................................................... ..........
15.1.5. Enterobiasis......................................................... ...............
15.1.6. Ankylostomiasis......................................................... ....
15.1.7. Strongyloidiasis......................................................... ........
15.1.8. Trichinosis................................................. .............
15.2. Trematodes......................................................... ........................
15.2.1. Schistosomiasis......................................................... ..........
15.2.2. Opisthorchiasis......................................................... ...............
15.2.3. Fascioliasis......................................................... ...............
15.3. Cestodoses......................................................... ............................
15.3.1. Teniarinhoz......................................................... .............
15.3.2. Teniasis......................................................... ........................
15.3.3. Cysticercosis......................................................... .............
15.3.4. Diphyllobothriasis......................................................... ......
15.3.5. Echinococcosis (hydatid).................................................
15.3.6. Alveococcosis......................................................... ..........
Application................................................. .........................................
Bibliography................................................ ...............................
Subject index................................................ ...........................

Abbreviations frequently found in the text

anti-HBcAg - antibodies against HBcAg anti-HBeAg - antibodies against HBeAg anti-HBsAg - antibodies against HBsAg

	Antibodies against hepatitis C virus
	Antibodies against hepatitis D virus
	Antibodies against hepatitis E virus
	Aspartate aminotransferase
HAV (HAV) - hepatitis A virus
HBV - hepatitis B virus
HCV (HCV) - hepatitis C virus
BTD (HDV) - hepatitis D virus
HEV (HEV) - hepatitis E virus
	Human herpes virus
	AIDS virus
	Herpes simplex virus
	Epstein-Barr virus
	Hepatitis A
	Hepatitis B
	Hepatitis C
	Hepatitis D
	Hepatitis E
	Hepatitis G
	Delayed hypersensitivity
	Blood-brain barrier
	Disseminated intravascular clotting
	Artificial ventilation
	Histological activity index
	Infectious-toxic shock
	Immunofluorescence
	Linked immunosorbent assay
	Creatine phosphokinase
	Fluorescent antibody method
	Macrocytic-phagocytic system
	Acute renal failure
	Acute respiratory viral infection
	Circulating blood volume
	Fibrin degradation products
	Polymerase chain reaction
	Hepatic encephalopathy
	Agglutination reaction
	Hemagglutination aggregate reaction
	Leptospira agglutination and lysis reaction
	Hemagglutination reaction
	Immunofluorescence reaction
	Coagglutination reaction
	Neutralization reaction
	Indirect hemagglutination reaction

PHA - passive hemagglutination inhibition reaction

	Reticuloendothelial system
	Acquired immunodeficiency syndrome
	Toxic shock syndrome
	Ultrasonography
	Ultraviolet irradiation
	Organophosphorus compounds
	Chronic active hepatitis
	Chronic hepatitis
	Chronic persistent hepatitis
	Chronic renal failure
	Cytomegalovirus
CMV - cytomegalovirus infection
	central nervous system
	Electroencephalography
HBcAg - cow antigen of hepatitis B virus
	Antigen “e” (infectivity) of hepatitis B virus
	Hepatitis B virus surface antigen
	Varicella-zoster virus

Preface

In connection with the adoption in 2002 of a new program on infectious diseases for medical faculties of medical institutes, the further development of infectology as a scientific discipline, the emergence and spread of new infectious diseases, changes in the structure of morbidity, the development and implementation of new diagnostic methods and treatment of infectious diseases, an urgent need arose to publish a new textbook “Infectious Diseases”, which reflects the requirements of the new program and the achievements of science and practice in the field of infectious diseases.

This textbook was prepared by the authors with the active participation of the scientific and teaching staff of the Department of Infectious Diseases with the course of epidemiology of the Moscow State Medical and Dental University. The general part outlines the main features of infectious diseases, methods of their diagnosis and treatment, including emergency conditions, which helps avoid repetition when describing individual nosological forms.

The material is arranged according to the etiological classification of infectious diseases. The volume of material corresponds to the role of each nosological form in human pathology. The description of diseases that are not included in the program (highlighted in font), but play a significant role in infectious pathology, allows the textbook to be used as a manual for students of a course in tropical medicine, as well as for the training of residents and the specialization of doctors in infectious diseases.

»
RABIES Rabies is an acute viral disease characterized by damage to the nervous system with the development of severe encephalitis. Clinical diagnosis Incubation period The incubation period lasts from 12 to 90 days (rarely up to 1 year). The precursor stage lasts 2-3 days. General malaise, headache. The first symptoms of mental disorders: fear, anxiety, depression, insomnia, irritability. Low-grade fever. In the area of ​​the bite there is a burning sensation, itching, hyperesthesia, the scar swells and turns red. The excitement stage lasts 2-3 days. Hydrophobia, aerophobia, auditory and visual hallucinations, hypersalivation. Attacks of clouding of consciousness, aggressiveness, violent psychomotor agitation. Fever, respiratory and cardiovascular disorders. The stage of paralysis lasts 18-20 hours. Consciousness is clear, lethargy, salivation, hyperthermia, paralysis of the muscles of the tongue, face, limbs, respiratory muscles and heart. Laboratory diagnostics 1. Virusoscopic method. Detection of Babes-Negri bodies in ammonium horn cells (used for post-mortem diagnosis). 2. Virological method. Isolation of the virus from the saliva of patients, a suspension of brain tissue or the submandibular salivary glands of the deceased by infecting mice (intracerebral) or hamsters (intraperitoneal), as well as in tissue culture. 3. Immunofluorescent method. Sections of brain tissue treated with a specific luminescent serum are examined to detect the Ag of the rabies virus. Measures regarding patients and contact persons Hospitalization. Required. Contact insulation. Not produced. Animals that have bitten are monitored for 10 days. Rabid and suspected rabid animals are destroyed and their brains are sent for laboratory testing. Specific prevention 1. Dry rabies vaccines such as Fermi and CAV are used for active immunization for conditional and unconditional indications. Indications for vaccinations, the dose of the vaccine and the duration of the immunization course are determined by doctors who have received special training. 2. Rabies immunoglobulin from horse serum is used to create immediate passive immunity. Nonspecific prevention Prevention of roaming in dogs and cats, preventive immunization of domestic animals, thorough primary treatment of bite wounds. BOTULISM Botulism is a food poisoning caused by botulinum bacillus toxin, which occurs with damage to the central nervous system. Clinical diagnosis Incubation period from 2 hours to 8-10 days (usually 6-24 hours). The onset is often sudden with symptoms of general weakness, headache, dizziness, dry mouth. Visual impairment (diplopia, blurred vision near), further impairment progresses - dilated pupils, ptosis of the eyelids, paralysis of accommodation, strobism, nystagmus. Paralysis of the soft palate (nasal sound, choking). Paralysis of the muscles of the larynx (hoarseness, aphonia) and the muscles of the pharynx (impaired swallowing). Impaired articulation, paresis of facial and masticatory muscles, neck, upper limb, and respiratory muscles. Consciousness is preserved. Tachycardia, hypotension, muffled heart sounds. Laboratory diagnostics The material for research can be vomit, gastric lavage (50-100 ml), feces, urine (5-60 ml), blood (5-10 ml). The research is being carried out in two directions: 1. Detection of botulinum toxin and determination of its type in a neutralization experiment on white mice. 2. Isolation of the pathogen using special methods for cultivating anaerobes. Preliminary answer (based on the results of the bioassay) in 4-6 hours. The final one is on the 6-8th day. Measures regarding patients and contact persons Hospitalization. Mandatory, early. Contact insulation. In the outbreak, all persons who consumed an infected product together with sick people are placed under medical observation for 12 days. These individuals are given specific prophylaxis (see below). Conditions of discharge. Clinical recovery. Admission to the team. After clinical recovery. Clinical examination: Long-term asthenia requires restriction of physical activity and observation for several months. According to indications - observation by a neurologist. Specific prevention 1. Antibotulinum therapeutic and prophylactic antitoxic serums of types A, B, C, E are used to prevent botulism for persons who consumed an infected product at the same time as patients. 2. Botulinum polyanatoxin types A, B, C, E are used to immunize persons who have contact with botulinum toxin (laboratory technicians, experimenters) and the population in disadvantaged areas. Nonspecific prevention Compliance with food processing technology that excludes the possibility of accumulation of botulinum toxins in them. TYPHUS AND PARATYPHUS Typhoid fever and paratyphoid fever are acute infectious diseases characterized by bacteremia, fever, intoxication, damage to the lymphatic system of the small intestine, roseola rashes on the skin, enlargement of the liver and spleen. Clinical diagnosis Incubation period 1 to 3 weeks (average 2 weeks). The onset is often gradual. Weakness, fatigue, adynamia. Headache. Fever. Increasing intoxication. Sleep disturbance, anorexia. Constipation, flatulence. In the initial period, symptoms are revealed: lethargy, bradycardia, pulse dilation, muffled heart sounds, dry rales in the lungs; the tongue is covered with a grayish-brown coating and thickened, the edges and tip of the tongue are clean, catarrhal tonsillitis, enlarged liver and spleen. By the beginning of the 2nd week, symptoms reach their maximum development: intoxication intensifies (impaired consciousness, delirium), elements of a roseolous-papular rash appear on the skin of the upper abdomen and lower chest. Bradycardia, pulse dichroism, blood pressure decreases, heart sounds are muffled. The tongue is dry, covered with a dense dirty-brown or brown coating. Severe flatulence, often constipation, less often diarrhea. Rumbling and soreness in the right iliac region. There is leukopenia in the blood, protein in the urine. Complications: bleeding, perforation With paratyphoid A in the initial period, the following are noted: fever, facial hyperemia, conjunctivitis, scleritis, catarrhal phenomena, herpes. Exanthema is polymorphic and appears earlier. With paratyphoid B, a shortening of the disease period is noted; in the initial period, toxicosis and gastrointestinal disorders are more pronounced, typhoid-like and septic forms are possible. With paratyphoid C, typhus-like, septic and gastrointestinal forms occur. Laboratory diagnostics 1. Bacteriological method0. From the first days of the disease, at the height of the fever (during a relapse), 5-10 ml of blood is inoculated into bile (selenite) broth (50-100 ml) in order to isolate a blood culture. To isolate the pathogen, you can examine stool, urine, roseola scrapings, and bone marrow punctate. The material is inoculated on enrichment media or directly on dense differential diagnostic media. Cultures of blood, urine, feces, and scrapings from roseola can be repeated every 5-7 days. Sputum, pus, abdominal exudate, and cerebrospinal fluid (for special indications) can be subjected to bacteriological examination to isolate the causative agent of typhoid fever and paratyphoid fever. 2. Serological method. From the 5-7th day of illness, with an interval of 5-7 days, a blood test is carried out in order to detect AT and increase their titer in RA and RPHA separately with O-, H- and Vi-diagnosticums. 3. To identify typhoparatyphoid bacterial carriage, a bacteriological examination of bile and feces is carried out (after giving a saline laxative). An indirect indication of bacterial carriage can be the detection of Vi antibodies. Measures regarding patients and contact persons Hospitalization. Required. Leaving the patient at home is permitted with the permission of the epidemiologist. Contact insulation. Not carried out. Medical observation is established for 21 days from the moment of hospitalization of the patient (daily thermometry, one-time bacteriological examination of stool and blood test in the RPGA). Triple phaging is carried out. When the pathogen is isolated from feces, a repeat examination of the feces, as well as urine and bile, is carried out to determine the nature of carriage. If the RPGA result is positive (titer above 1:40), a one-time background examination of stool, urine and bile is performed. Employees of food enterprises and persons equated to them, with a positive result of bacteriological and serological tests, are considered as chronic carriers and are not allowed to work. Their further observation and examination are carried out in the same way as convalescents (see below). Conditions of discharge. Clinical recovery and three times the result of a back-test of stool and urine (on the 5th, 10 and 15th day of normal temperature) and a single back-test of bile (on 12-14 days of normal temperature). Persons who have not received antibiotics are discharged no earlier than the 14th day of normal temperature. Admission to the team. Convalescents of typhoid and paratyphoid fever (except for workers of food enterprises and persons equivalent to them) are allowed into the team without additional examination. Convalescents - workers of food enterprises and persons equivalent to them - are not allowed to work in their specialty for a month, by the end of which their feces and urine are examined five times. If these individuals continue to excrete the pathogen, they are transferred to another job. 3 months after clinical recovery, their stool and urine are examined five times with an interval of 1-2 days and bile once. If the result of the background examination is negative (one month after recovery), these persons are allowed to work in their specialty with a monthly background examination of stool and urine in the next two months and a single examination of bile and a RPGA with cysteine ​​- by the end of the 3rd month. A single isolation of the pathogen after 3 months after recovery leads to the removal of these individuals from work with a change in profession. Students of schools and boarding schools are allowed into the team, and if carriers are detected, they are removed from duty in the catering unit and canteen. Preschool children who carry bacteria are not allowed into the team and are sent to the hospital for examination and follow-up treatment. Medical examination: All those who have had typhoid fever and paratyphoid fever (except for workers of food enterprises and persons equivalent to them) are observed for 3 months. In the first 2 months, medical examination and thermometry are carried out weekly, in the 3rd month - once every 2 weeks. Bacterial examination of stool and urine is carried out monthly, bile examination is carried out after 3 months simultaneously with the placement of RPGA with cysteine. If the result is negative, they are removed from the register; if the result is positive, they are given further treatment and removed from duties in the catering department and canteen. Employees of food enterprises and persons equivalent to them are examined quarterly (stool and urine - once) for 2 years, and then 2 times a year until the end of their working career. At the end of the 2nd year, they are given RPHA with cysteine ​​and, if the result is positive, they undergo a five-fold examination of feces and urine and a single examination of bile. Specific prevention Immunization against this infection is regarded only as an additional means in the system of a complex of anti-epidemic measures. Vaccinations in modern conditions of relatively low incidence of typhoid fever cannot have a significant impact on the course of the epidemic process. Vaccinations, both routinely and according to epidemiological indications, are carried out taking into account the level of communal improvement of populated areas. Nonspecific prevention General sanitary measures (improving the quality of water supply, sanitary cleaning of populated areas, sewerage, fly control, etc.). VIRAL HEPATITIS Viral hepatitis is a group of etiologically heterogeneous diseases accompanied by predominant damage to the liver - an increase in its size and impaired functional ability, as well as symptoms of intoxication expressed to varying degrees. Clinical diagnosis Incubation period Viral hepatitis A is transmitted by the fecal-oral route, the disease is acute, cyclical, characterized by short-term symptoms of intoxication, transient liver disorders, and a benign course. The incubation period is from 10 to 45 days. Viral hepatitis B is transmitted parenterally and is characterized by a slow progression of the disease, a long course, and the possibility of developing chronic hepatitis and liver cirrhosis. The incubation period is from 6 weeks to 6 months. Viral hepatitis C is transmitted exclusively by the parenteral route, clinically it occurs like hepatitis B, only severe forms are less common, but more often a chronic process is formed that results in cirrhosis of the liver. The incubation period ranges from several days to 26 weeks. Viral hepatitis delta is transmitted parenterally, occurs as a coinfection (simultaneously with hepatitis B) or as a superinfection (layered on chronic hepatitis B, on carriage of the hepatitis B virus). Viral hepatitis E is transmitted by the fecal-oral route, clinically proceeds as hepatitis A, but more often produces severe forms, including fulminant forms with a fatal outcome, especially in pregnant women. The incubation period is from 10 to 40 days. Pre-icteric period with signs of syndromes: flu-like (fever, chills, headache, weakness), dyspeptic (anorexia, nausea, vomiting, abdominal pain, diarrhea, fever), arthralgic (pain in joints, muscles), asthenovegetative (weakness, sleep disturbances , headache, irritability), catarrhal. At the end of the period, the urine darkens, the feces become discolored, and the liver enlarges. Jaundice period. Increased jaundice and general weakness. Pain in the liver area, itchy skin. Sometimes the spleen is enlarged. Bradycardia, decreased blood pressure. Prekoma. Sharp increasing weakness, adynamia, persistent vomiting, anorexia, worsening sleep, tachycardia, shrinkage of the liver and increasing jaundice. Dizziness, tremor. Hemorrhages. Coma. Prolonged excitement is replaced by a lack of response to stimuli. The pupils are dilated, tendon reflexes are absent. Reduction in liver size. Post-icteric period. Slow decrease in liver size, liver function tests are pathologically altered. The period of convalescence. The size of the liver is normalized, its functional state is restored, and asthenovegetative syndrome may be observed. Laboratory diagnostics 1. Methods of immuno- and serodiagnostics. During the incubation period, pre-icteric and all subsequent phases of hepatitis B, the serum is examined for the presence of the surface antigen of the hepatitis B virus (HBsAg), as well as the internal antigen of the hepatitis B virus (anti-HBc). During the incubation and prodromal periods and at the beginning of the acute stage of the disease, HBsAg is detected in the serum. From the end of the prodromal period, in the acute period, in the period of convalescence, anti-HBs and anti-HBc antibodies are detected, the latter with greater consistency and in higher titers. To detect antigen and antibodies to viruses A, B, C, delta, radioimmunological and immunological methods are used using commercial test systems. For hepatitis A, blood serum is examined for the presence of anti-HA antibodies of the IgM class. During the period of convalescence, IgG antibodies appear and persist for many years. 2. In the preicteric period and during all periods of the disease, the level of activity of alanine and aspartate aminotransferases (ALAT and AST) is determined in the blood. With hepatitis, aminotransferase activity increases (normal range is 0.1-0.68 mmol/l/h). 3. From the end of the pre-icteric period, the content of bilirubin in blood serum taken on an empty stomach is determined: total (normal 3.4-20.5 µmol/l), the ratio between bound (direct) and free (indirect) is normal 1:4; They put thymol (norm 0-4 turbidity units) and sublimate (norm 1.6-2.2 ml of mercuric) tests. In patients with hepatitis, the bilirubin content increases (mainly due to the bound fraction), the thymol test indicator increases, and the sublimate test decreases. 4. At the beginning of the icteric period, bile pigments are found in the urine, which are normally absent. 5. The severity of the disease can be judged by a decrease in the level of beta-lipoproteins (normally 30-35%), prothrombin index (normally 93-100%), changes in the content of serum protein fractions. Measures regarding patients and contact persons Hospitalization. Required. Those suspected of the disease are placed in diagnostic wards; isolation at home is allowed for 1-3 days for laboratory examination. Contact insulation. Not carried out. Medical surveillance of contacts with patients with viral hepatitis A is established for 35 days. During this period, transfer of contacts to other groups and child care institutions is prohibited. Admission of new children, as well as admission of contact children into healthy groups, is allowed with the permission of the epidemiologist, subject to timely administration of immunoglobulin. Conditions of discharge. Good general condition, absence of jaundice, liver shrinkage or a tendency to shrink, normalization of bilirubin levels and other indicators. The activity of aminotransferases should not exceed the norm by more than 2-3 times. Detection of HBsAg in convalescents is not a contraindication to discharge. Admission to the team. Hepatitis A convalescents are considered disabled for 2-4 weeks, depending on the severity of the disease, condition at discharge and the presence of concomitant diseases. They are freed from heavy physical activity for 3-6 months. Hepatitis B convalescents can return to work no earlier than after 4-5 weeks. The period of release from heavy physical activity should be 6-12 months, and if indicated, longer. Clinical examination: All convalescents are examined after 1 month by the attending physician of the hospital. Children convalescent with hepatitis A are examined in the clinic after 3 and 6 months and, in the absence of residual effects, are removed from the register. Children who have had hepatitis B are called to the hospital for examination also after 9 and 12 months. Adult convalescents of hepatitis A in the presence of residual effects are examined in the clinic after 3 months and can be removed from the register. Adults who have had hepatitis B are examined in the clinic after 3, 6, 9 and 12 months. All convalescents (adults and children) with residual effects are observed in the hospital monthly until complete recovery. According to indications - re-hospitalization Specific prevention Identification and monitoring of carriers of the viral hepatitis B antigen. Identified carriers of the B antigen are registered in the centers of the State Sanitary and Epidemiological Surveillance. Dispensary observation and registration of carriers should be concentrated in the office of infectious diseases. Accounting is carried out during the entire period of antigen detection. Clinical and biochemical examination of HBsAg carriers should be carried out immediately after detection of the antigen, after 3 months and then 2 times a year during the entire period of detection of HBsAg. Of the biochemical indicators, it is recommended to study in dynamics: bilirubin content, protein sediment samples (sublimate, thymol), transamine activity (AlAT, AST). Preference should be given to determining the activity of AST, since this enzyme reflects the presence of minimal inflammation in the liver. In addition to conventional methods, ultrasound examination of the liver structure (echohepatography) is recommended. If HBsAg is detected again 3 and 6 months after its initial appearance, as well as in the presence of minimal clinical and biochemical changes, a diagnosis of “chronic viral hepatitis” is made and hospitalization in an infectious diseases hospital is required to clarify the depth of liver damage. The mode and nature of work depend on the severity of the pathological process in the liver. Healthy carriers are deregistered if they test negative for HBsAg five times within a year at intervals of 2-3 months. For the prevention of hepatitis A, immunoglobulin is used for epidemic indications. The drug is administered within 7-10 days from the onset of the disease to children from 1 to 14 years of age, as well as to pregnant women who have contact with the sick person in the family or institution. In preschool institutions, with incomplete isolation of groups, immunoglobulin should be administered to children of the entire institution. Nonspecific prevention Disinfection: control over water supply, sanitary condition and maintenance of food facilities and children's institutions; sanitary cleaning of populated areas, sanitary and epidemiological regime in health care facilities, prevention of parenteral infection. FLU Flu is an acute infectious disease characterized by symptoms of specific intoxication, catarrh of the upper respiratory tract, and a tendency to epidemic and pandemic spread. Clinical diagnosis Incubation period 1-2 days. The beginning is acute. General intoxication (fever, weakness, adynamia, sweating, muscle pain, headache, pain in the eyeballs, lacrimation, photophobia). Dry cough, sore throat, sore throat, hoarseness, nasal congestion, nosebleeds. Skin hyperemia, hyperemia and granularity of the pharynx, scleritis. Bradycardia, decreased blood pressure, muffled heart sounds. In the blood - neutropenia, monocytosis. Laboratory diagnostics 1. Virological method. From the first days of the disease, swabs from the mucous membrane of the throat and nose are examined in order to isolate the virus (in developing chicken embryos). 2. Immunofluorescent method. From the first days of illness, fingerprint smears from the mucous membrane of the inferior nasal concha, treated with a specific luminescent serum, are examined in order to detect influenza virus antigens. 3. Serological method. Paired sera are examined in the hemagglutination reaction (HRT) and RSC in order to detect antibodies and increase their titer. Measures regarding patients and contact persons Hospitalization. According to clinical indications. Contact insulation. In preschool groups, medical observation is carried out and contacts are separated from other groups for up to 7 days. Conditions of discharge. After clinical recovery, no earlier than 7 days from the onset of the disease. Admission to the team. After clinical recovery, no earlier than 10 days from the onset of the disease. Medical examination: Convalescent children are given a gentle regime for at least 2 weeks after clinical recovery. Specific prevention 1. Live influenza vaccine for intranasal use is vaccinated according to epidemic indications in persons over 16 years of age. Vaccinations with monovaccine or divaccine are carried out three times with an interval of 2-3 weeks. 2. Live influenza vaccine for children is vaccinated according to epidemic indications in children 3-15 years old. Vaccinations with monovaccine or divaccine are carried out three times with an interval of 25-30 days. 3. Live influenza vaccine for oral administration is vaccinated according to epidemic indications in children and adults. Mono- or divaccine is administered three times with an interval of 10-15 days, for the purpose of emergency prevention - twice within 2 days. 4. Anti-influenza donor immunoglobulin is used to prevent influenza in epidemic foci. Nonspecific prevention Limiting sick people from visiting pharmacies and clinics, and healthy people, especially children, from visiting entertainment events: wearing masks, using oxolinic ointment, ventilation, ultraviolet radiation and disinfection of premises. DYSENTERY Dysentery is an infectious disease of the gastrointestinal tract caused by microbes of the genus Shigella, which primarily affects the mucous membrane of the large intestine, manifested by colitis syndrome. Clinical diagnosis Incubation period 1-7, usually 2-3 days. The main symptoms of dysentery are general intoxication (fever, loss of appetite, vomiting, headache). Neurotoxicosis according to the meningoencephalic variant (loss of consciousness, convulsions, symptoms of meningism). Colitic syndrome (cramping abdominal pain, tenesmus, rumbling and splashing along the large intestine, spasmodic sigmoid colon, scanty stool with mucus, streaks of blood, sometimes pus, in the form of “rectal spitting”, pliability, gaping of the anus or prolapse of the rectum). In mild forms, the temperature is subfebrile, intoxication is mild, colitis is moderate, stools are up to 5-8 times a day, there are no blood impurities. In the moderate form of hyperthermia, symptoms of general intoxication and colitic syndrome are expressed, stool up to 10-12 times a day. In severe forms, neurotoxicosis is pronounced, hyperthermia, colitic syndrome, stool in the form of “rectal spitting” more than 12-15 times a day. Laboratory diagnostics 1. Bacteriological method. From the first days of the disease, a three-fold examination of feces is carried out (the first before the start of etiotropic therapy) in order to isolate the pathogen and identify it. The medium for primary sowing is Ploskirev's medium. For the study, portions with an admixture of mucus are selected immediately after natural bowel movements. If it is impossible to culture the material at the site of collection, it is placed in test tubes with a preservative (glycerol mixture) and stored for no more than 12 hours at 2-6 (C. 2. Serological method. From the end of the 1st week, the passive hemagglutination reaction (RPHA) is examined paired sera to detect antibodies and their titer. 3. Coprocytological examination is carried out from the first days of the disease. Detection of mucus, neutrophilic leukocytes, erythrocytes, and intestinal epithelial cells in a smear from feces allows one to judge the intensity of the inflammatory process and its localization. 4. In the later stages of the disease For diagnostic purposes, sigmoidoscopy can be used. Measures for patients and contact persons Hospitalization. According to clinical and epidemiological indications. Contact insulation. Not carried out. Medical observation is established for 7 days to identify recurrent diseases in the outbreak. In addition, employees of food enterprises and persons equated to them, children and staff of preschool institutions (if repeated cases of the disease appear there), organized preschoolers from apartment outbreaks are subject to a one-time stool examination in the first 3 days of observation. Bacteria carriers are hospitalized to clarify the diagnosis. If diseases appear simultaneously in several groups of a preschool institution, all contact children, group staff, catering workers and all other service personnel are examined bacteriologically. The frequency of examination is determined by the epidemiologist. Conditions of discharge. Not earlier than 3 days, after clinical recovery, normalization of stool and temperature; negative result of a single control stool examination carried out no earlier than 2 days after the end of etiotropic therapy. Employees of food enterprises and persons equated to them who have suffered bacteriologically confirmed dysentery, and organized preschool children are discharged after suffering from dysentery after a single bacterial examination. If the results of the bacterial examination in the hospital are positive, treatment is continued before discharge. A positive result of a bacterial examination after a repeated course of etiotropic therapy determines the need to establish dispensary observation for such persons. Admission to the team. It is carried out without additional examination. Children from orphanages and boarding schools are not allowed to work in the catering unit and canteen for 1 month (those who have suffered an exacerbation of chronic dysentery - for 6 months). Preschoolers who have suffered an exacerbation of chronic dysentery are admitted to the team after 5 days of medical observation, with good general condition, normal stool and temperature, and a negative result of a single background examination. If bacterial excretion continues, organized preschoolers are not allowed into the group. Employees of food enterprises and persons equated to them, with bacterial excretion for more than 3 months, are considered as suffering from a chronic form of dysentery and are transferred to work not related to food. Clinical examination: Organized preschoolers are observed for a month with a one-time stool examination at the end of the period of illness. For 3 months with monthly background examination and examination by a doctor, the following are observed: - persons suffering from chronic dysentery, confirmed by the isolation of the pathogen; - bacteria carriers that secrete the pathogen for a long time; - persons suffering from unstable stool for a long time; - employees of food enterprises and persons equivalent to them. Workers of food enterprises and persons equated to them, suffering from chronic dysentery, are observed for 6 months with monthly background examination. After this period, in the case of complete clinical recovery, these persons can be allowed to work in the specialty. Specific prevention. A polyvalent specific bacteriophage with an acid-resistant coating is used during the period of seasonal rise in morbidity for preventive purposes in preschool institutions that are unfavorable in terms of morbidity. Nonspecific prevention Sanitary supervision of water supply, sewerage, collection and disposal of sewage; sanitary control at food industry and public catering enterprises, sanitary education. DIPHTHERIA Diphtheria is an acute infectious disease caused by the diphtheria bacillus, characterized by an inflammatory process with the formation of a fibrinous film at the site of introduction of the pathogen and symptoms of general intoxication. Clinical diagnosis Incubation period from 2 to 10 days (usually 7 days). Diphtheria of the oropharynx. Catarrhal. Weakness, moderate pain when swallowing, low-grade fever. Congestive hyperemia and swelling of the tonsils, lymphadenitis. Islanded. Moderate fever and intoxication. Enlargement and swelling of the tonsils with islands of fibrinous films. Enlarged, painful lymph nodes. Membranous. The beginning is acute. Fever, intoxication. Enlargement and swelling of the tonsils. Congestive mild hyperemia of the mucous membrane. The deposits are continuous, dense, whitish, and after removing them - erosion. Enlarged and painful lymph nodes. Common. Spread of films beyond the tonsils, fever, severe intoxication, decreased blood pressure, muffled heart sounds. Toxic. General intoxication, fever. Swelling of the cervical tissue (subtoxic - one-sided near the lymph nodes, grade I - up to the middle of the neck, grade II - up to the collarbone, grade III - below the collarbone). Significant enlargement and swelling of the tonsils and surrounding tissues. Breathing problems. Plaques of a dirty gray color, spreading to the mucous membranes of the soft and hard palate. Putrid smell. Damage to the cardiovascular system. Paresis and paralysis. Triad: vomiting, abdominal pain, galloping heart rate. Diphtheria of the larynx. The beginning is gradual. Moderate intoxication. Laryngeal stenosis (stage I – hoarseness, rough “barking” cough; stage II – noisy breathing, aphonia, retraction of pliable places, participation of auxiliary muscles in the act of breathing; stage III – hypoxia, anxiety, drowsiness, cyanosis). Diphtheria of the nose. Mild intoxication, bloody discharge from the nose, films and erosions on the nasal mucosa. Laboratory diagnostics 1. Bacteriological method. In the first 3 days of the patient’s illness or hospital stay, material taken from the lesion is examined (mucus from the throat and nose, swab from the conjunctiva, from the vagina, wound discharge, pus from the ear, etc.) in order to isolate the pathogen. The material from the pharynx is taken no earlier than 2 hours after eating. Media for primary inoculation: blood tellurite agar, quinosol medium, Lefler's medium. Approximate accelerated methods: a) microscopy of material from a swab; b) the material is collected with a swab previously moistened with serum and a solution of potassium tellurite. The tampon is placed in a thermostat and after 4-6 hours, based on the color change and based on the microscopy of the smear from the tampon, an answer is given. 2. Serological methods. a) study of blood serum in the RPGA in order to detect antibacterial antibodies and increase their titer; b) determination of the antitoxin titer in the blood serum using the Jensen method in the first days of the disease (before the administration of antitoxic serum). A titer of 0.03 IU/ml and below is in favor of diphtheria, a titer of 0.5 IU/ml and above is against diphtheria. 3. In order to identify groups subject to revaccination, RPGA with diphtheria erythrocyte antigen diagnosticum is performed. Measures regarding patients and contact persons Hospitalization. Mandatory for sick and suspicious persons, as well as carriers of toxigenic microbes. Carriers of atoxigenic microbes are not hospitalized and are not removed from the team. Contact insulation. Stops after isolation of the patient or carrier of toxigenic microbes, final disinfection and a single negative result of a bacterial examination of the mucus of the throat and nose. Medical observation of contacts is carried out within 7 days from the moment of hospitalization of the patient or carrier. Conditions of discharge. Isolation of patients and carriers of toxigenic microbes is stopped after clinical recovery and a negative result of a double bacterial examination of the mucus of the throat and nose, carried out with an interval of 1 day, 3 days after the end of treatment. Admission to the team. Diphtheria convalescents are allowed into the team without additional examination. Convalescent carriers of toxigenic microbes with repeated and long-term seeding continue treatment in the hospital. They can be admitted to the immune team no earlier than 60 days from the date of clinical recovery, subject to constant medical supervision until the carrier state ceases. Medical surveillance is established for the team where a carrier of the toxigenic bacillus is admitted in order to identify persons with diseases of the nasopharynx, their treatment and examination; Only properly vaccinated children are accepted again. Medical examination: Carriers of toxigenic microbes are subject to medical observation and biological examination until two negative results are obtained. Carriers of atoxigenic microbes with pathological processes in the nasopharynx are subject to treatment. Specific prevention 1. Children under 3 years of age who have not had whooping cough are vaccinated with DPT vaccine. 2. The DPT vaccine is used to vaccinate children from 3 months to 6 years of age who have had whooping cough, who have not previously been vaccinated with the DTP vaccine, and who have contraindications to vaccination with the DPT vaccine (a gentle method of immunization). 3. Children and adolescents from 6 to 17 years of age, as well as adults, are vaccinated with ADS-M toxoid. Nonspecific prevention Measures to combat bacterial carriage (detection, isolation, treatment). MEASLES Measles is an acute infectious viral disease characterized by fever, intoxication, catarrh of the upper respiratory tract and mucous membranes of the eyes, and the gradual development of a maculopapular rash. Clinical diagnosis Incubation period 9-17 days (with seroprophylaxis - 21 days). The initial catarrhal period lasts on average 3-4 days: fever, general malaise, lethargy, weakness, decreased appetite, sleep disturbance, headache, runny nose, scleritis, conjunctivitis, dry cough. From the 2-3rd day - a decrease in temperature, worsening runny nose, rough cough, enanthema, Belsky-Filatov-Koplik spots. Period of rash: increased intoxication, exanthema - spots and papules, prone to merging, on an unchanged skin background, characterized by stages (1st day - behind the ears, face, neck and partially chest; 2nd day - torso and proximal limbs; 3rd day – for the entire skin of the extremities). From the 4th day the rash fades in the same order, pigmentation, and occasionally peeling. Complications: croup, pneumonia, damage to the digestive tract, otitis media, meningoencephalitis. Mitigated measles (in children who received immunoglobulin): low-grade fever, mild catarrhal symptoms, Belsky-Filatov-Koplik spots and no stages of rash, the rash is not abundant, small. There are no complications observed. Laboratory diagnostics 1. Virological method. From the first days of illness, swabs from the nasopharynx or blood are examined in order to isolate the virus in tissue culture. 2. Serological method. Paired sera are examined in the RSC or RTGA in order to detect antibodies and increase their titer. 3. Immunofluorescent method. At the end of the prodromal period and during the period of rash, fingerprint smears from the nasal mucosa, treated with a special luminescent serum, are examined in order to isolate measles virus antigens. Measures regarding patients and contact persons Hospitalization. According to clinical and epidemiological indications (from closed children's institutions, dormitories). Contact insulation. Children who have not been vaccinated against measles and have not had measles are separated for 17 days from the moment of contact, and those who received immunoglobulin are separated for 21 days. Once the exact day of contact is established, separation begins on the 8th day. Preschoolers vaccinated with live measles vaccine are subject to medical observation for 17 days from the date of contact. Conditions of discharge. Clinical recovery, but not earlier than the 4th day, and in the presence of complications (pneumonia) - no earlier than the 10th day after the onset of the rash. Admission to the team. After clinical recovery. Medical examination: Not carried out. Specific prevention 1. Children aged 12 months are vaccinated with live measles vaccine. Those who have not had measles are revaccinated before school at the age of 6-7 years. In outbreaks, for the purpose of emergency prevention of measles, all children over 12 months can be vaccinated only up to the 5th day from the moment of contact. 2. Immunoglobulin is used as emergency prophylaxis for children who have not had measles and have not been vaccinated; contact with a patient with measles - with contraindications to vaccination. 3. To assess the intensity of vaccine immunity, serological studies are carried out. Contingent: children timely and correctly vaccinated against measles, separately for each age group; in communities where no cases of measles were recorded over the past year. Based on the results of examining children 4-5 years old, one can judge the quality of vaccinations given 1-2 years ago, and schoolchildren can judge the strength of vaccine immunity in the long term after immunization or after re-vaccination. The criterion for measles protection is the identification in each study group of no more than 10% of seronegative individuals (with titers of specific antibodies less than 1:10 in the RPGA). If more than 10% of seronegative students are identified in a group of students and it is impossible to expand the serological examination of all students of a given school (vocational school, technical school), with the exception of those who have already been vaccinated. Nonspecific prevention: Early isolation of the patient. RUBELLA Rubella is an acute infectious viral disease characterized by minor catarrhal symptoms in the upper respiratory tract, enlarged occipital and other groups of lymph nodes and a small-spotted rash. Clinical diagnosis Incubation period 15-21 days. Weakness, malaise, moderate headache, sometimes pain in muscles and joints. The temperature is often subfebrile, minor catarrhal symptoms, conjunctivitis. Enlargement and tenderness of the posterior cervical and occipital lymph nodes. A small-spotted rash first on the face and neck, then throughout the body. There is no pigmentation. Complications: arthritis, encephalitis. Laboratory diagnostics Serological method. Paired sera are examined in the RPGA in order to detect antibodies and increase their titer. Measures regarding patients and contact persons Hospitalization. Not required. Contact insulation. Women in the first 3 months of pregnancy are isolated from the patient for 10 days from the onset of the disease. Conditions of discharge. Isolation of the patient at home stops 4 days after the appearance of the rash. Medical examination: Not carried out. Specific prevention Under development. Nonspecific prevention Isolation of patients from the team. MALARIA Malaria is an infectious disease that lasts a long time, characterized by periodic attacks of fever, enlargement of the liver and spleen, and progressive anemia. Clinical diagnosis The incubation period for three-day malaria is 10-20 days, for four-day malaria - 15-20 days, for tropical - 8-15 days. The beginning is acute. Stunning chills for 1.5-2 hours. With three-day malaria, attacks last 6-8 hours every other day, with four-day malaria - 12-24 hours every other day, with tropical malaria - the attack is prolonged. There is an enlargement of the liver and spleen. Mild icterus. Herpetic rashes. Laboratory diagnostics Microscopic method. In blood smears or in a “thick drop” stained according to Romanovsky-Giemsa, malaria plasmodia are detected (blue cytoplasm, bright red nucleus, intraerythrocytic location). Measures regarding patients and contact persons Hospitalization. For tropical malaria - mandatory, immediate; in other cases – mandatory during the epidemic period. Contact insulation. Not carried out. Conditions of discharge. Clinical recovery, but earlier than 2 days after the disappearance of plasmodium in the blood. Admission to the team. After clinical and parasitological recovery. Clinical examination: Carried out throughout the year. Specific prevention has not been developed. Nonspecific prevention Destruction of larvae and mosquitoes that carry malaria, use of repellents. MENINGOCOCCAL INFECTION Meningococcal infection is an acute infectious disease caused by the meningococcus Neisseria meningitidis, characterized by clinical manifestations varying in severity and nature: from mild nasopharyngitis and carriage to generalized forms - purulent meningitis and meningococcemia. Clinical diagnosis Incubation period from 1 to 10 days (usually 5-7 days). Acute nasopharyngitis. Increased temperature, moderate intoxication, nasopharyngitis. Meningitis. The onset is acute or sudden. Occasionally prodrome in the form of nasopharyngitis. Fever, agitation, headache, vomiting, general hyperesthesia, meningeal symptoms, bulging and tension of the large fontanel. Pose: on the side, with legs bent and head thrown back. Delirium, agitation, impaired consciousness, convulsions, tremor. Tendon reflexes are animated, then decrease. Meningoencephalitis. Pathological reflexes, paresis, paralysis. Meningococcemia. Acute onset, fever, pallor. Rashes on the skin of the abdomen, buttocks, thighs from small hemorrhagic “star-shaped” elements to large hemorrhagic elements with necrosis in the center on all skin covers. Clinical picture of infectious-toxic shock, Waters-Friderichsen syndrome: decrease in temperature to normal levels, drop in blood pressure, thready pulse, shortness of breath, acrocyanosis, general cyanosis, oligoanuria, impaired consciousness, coma, vomiting “coffee grounds”, DIC syndrome. Laboratory diagnostics 1. Microscopic method. From the first days of the disease, gram(–), bean-shaped, intracellularly located diplococci are found in smears from cerebrospinal fluid sediment, from hemorrhagic rash elements, and less often from blood. 2. Bacteriological method. From the first days of the disease, cerebrospinal fluid, blood, nasopharyngeal mucus, and material from hemorrhagic rash elements are inoculated onto serum or ascites agar with ristomycin in order to isolate meningococci. 3. Serological method. Paired sera are examined in the RPGA in order to detect antibodies and increase their titer on days 5-7 of illness and over time. 4. Immunodiagnostic method. Detection of meningococcal antigen in the blood or cerebrospinal fluid in the reaction of counter immunoelectroosmophoresis (VIEF). 5. Other methods. When examining the cerebrospinal fluid, an increase in pressure is detected (the norm is 130-180 mm water column, or 40-60 drops per minute), cytosis is determined (the number of cells in 1 mm, the norm is up to 8-10), a cytogram (norm: lymphocytes 80 -85%), protein (norm 0.22-0.33 g/l), sugar content (norm 0.2-0.3 g/l or 2.8-3.9 mmol/l) and chlorides (norm 120-130 mmol/l, or 7-7.5 g/l). With meningitis: increased pressure, neutrophil cytosis up to 10,000 per 1 mm, increased protein, decreased sugar and chlorides. When examining peripheral blood, hyperleukocytosis with a sharp shift to the left is revealed. Measures regarding patients and contact persons Hospitalization. Mandatory for patients with the generalized form. Hospitalization of patients with nasopharyngitis is carried out according to clinical and epidemiological indications. Carriers of meningococcus are not subject to hospitalization. Contact insulation. It is carried out until a single negative result is obtained from the examination of mucus from the nasopharynx. Contacts of meningococcal carriers are not isolated. In groups that are hotbeds of infection, medical observation is established for 10 days. Conditions of discharge. After clinical recovery and a negative result of a single bacterial examination of mucus from the nasopharynx, carried out no earlier than 3 days after the end of etiotropic therapy. Admission to the team. Convalescents are admitted to the children's group after receiving a negative result from a single bacterial examination of mucus from the nasopharynx, carried out no earlier than 5 days after discharge from the hospital. Carriers of meningococcus are allowed into the team after treatment and a negative result of a bacterial examination of mucus from the nasopharynx, carried out no earlier than 3 days after the end of sanitation. Clinical examination: Those who have had meningitis without residual effects are observed for 2 years with examination by a neuropsychiatrist in the 1st year of observation 4 times and in the 2nd year – 1-2 times. In the presence of residual effects - active treatment and observation for at least 3-5 years. Specific prevention Chemical polysaccharide meningococcal vaccine is vaccinated for prophylactic purposes and in foci of infection - for the purpose of emergency prevention for children over 5 years of age and adults. Nonspecific prevention General measures are the same as for other airborne infections. Children under 5 years of age who are in contact with the generalized form can use immunoglobulin. MUMPS INFECTION Mumps infection (mumps, behind the ear) is an acute infectious viral disease characterized by damage to the glandular organs and the central nervous system. Clinical diagnosis Incubation period 11-21 days (average 18-20 days). Glandular form. The onset is acute, sometimes with a prodrome (malaise, muscle pain, headache, sleep and appetite disturbances). Increased temperature, enlargement and soreness of the salivary glands (submandibular, sublingual, more often parotid). Inflammatory changes in the area of ​​the excretory ducts of the glands. Orchitis, pancreatitis, etc. Nervous form. The beginning is acute. Fever, severe headache, vomiting, meningeal syndrome, focal lesions of the brain and cranial nerves. Laboratory diagnostics 1. Virological method. From the 1st-5th day of illness, saliva, blood, and less often cerebrospinal fluid are examined in order to isolate the virus in developing chicken embryos. 2. Serological method. Paired sera are examined in the RTGA (with an interval of 7-14 days) in order to detect antibodies and increase their titer. 3. Other methods. In the nervous form: in the first days, a study of the cerebrospinal fluid reveals an increase in protein up to 2.5%, lymphocytic cytosis in the range of 300-700 cells per 1 mm. When the pancreas is damaged, an increase in blood diastase activity is detected (normally 32-64 units). Measures regarding patients and contact persons Hospitalization. According to clinical and epidemiological indications. Contact insulation. Children under 10 years of age who have not had mumps are separated 21 days from the moment of contact. When establishing the exact day of contact, separation begins on the 11th day. If repeated cases of the disease appear in a children's institution, separation is not carried out. Conditions of discharge. Clinical recovery, no earlier than 9 days from the onset of the disease. In the case of the nervous form - no earlier than 21 days from the onset of the disease; in the case of the development of pancreatitis - a control determination of blood diastase activity. Admission to the team. After clinical recovery. Clinical examination: For those who have suffered from the nervous form, observation is carried out for 2 years with an examination by a neuropsychiatrist in the 1st year 4 times, in the 2nd year – 1-2 times. According to indications - examination by an ophthalmologist and otolaryngologist. Specific prevention. Children aged 15-18 months are vaccinated with a live anti-mumps vaccine. Nonspecific prevention Isolation of patients. SALMONELLOSIS Salmonellosis is an acute infectious disease caused by microbes of the genus Salmonella, occurring mainly with damage to the gastrointestinal tract, less often in the form of generalized forms. Clinical diagnosis The incubation period for the alimentary route of infection is 12-24 hours, for the contact route it is 3-7 days. Gastrointestinal form. Gastritis, enteritis, gastroenteritis. The beginning is acute. Fever, epigastric pain, nausea, vomiting. Intoxication (headache, weakness, weakness, anorexia). The stool is loose, watery, foul-smelling, undigested, dark green in color. Exicosis. Enterocolitis, gastroenterocolitis, colitis. The beginning is acute. Fever, intoxication, nausea, persistent vomiting. epigastric pain. Enlarged liver and spleen. Spasm and soreness of the large intestine. There may be tenesmus. The stool is liquid with an admixture of mucus, blood, dark green in color, in the form of “swamp mud”. Long-term severe toxicosis, less often exicosis, persistent intestinal dysfunction. Typhoid-like form. The beginning is acute. Fever, intoxication. The skin is pale, dry. Cyanosis. Muffled heart sounds, bradycardia. A densely coated and thickened tongue, flatulence, infrequent but persistent vomiting, enlarged liver and spleen. Roseolous or roseolopapular rash. The stool is enteric or normal. Septic form. Develops in newborns and weakened children. Fever with large daily ranges. The clinic depends on the location of the purulent focus. Pneumonia, purulent meningitis, nephritis, hepatitis, arthritis, enterocolitis. Hospital-acquired salmonellosis, especially in young children, usually has a more severe and prolonged course, accompanied by significant intoxication and symptoms of gastroenterocolitis. Toxicodystrophic conditions may develop. In children over 3 years of age and adults, hospital-acquired salmonellosis can be mild. Laboratory diagnostics 1. Bacteriological method. From the first days of the disease, a three-fold examination of stool is carried out (the first before the start of etiotropic therapy) in order to isolate the pathogen. Vomit, gastric lavage, food debris, and if a generalized infection is suspected - blood (in the first days of illness), urine (from the end of the 2nd week), cerebrospinal fluid, sputum can also serve as material for research. The primary culture media are selenite (bile broth) or one of the differential diagnostic media for enterobacteria. 2. Serological method. Paired sera are examined in the RA and RPGA (with an interval of 7-10 days) in order to detect antibodies and increase their titer. 3. Coprocytoscopy and sigmoidoscopy allow one to judge the nature and localization of the inflammatory process in the intestine. Measures regarding patients and contact persons Hospitalization. According to clinical and epidemiological indications. Contact insulation. Not carried out. Medical surveillance is established for 7 days to identify recurrent diseases in the outbreak. Employees of food enterprises and persons equated to them, children attending nurseries, kindergartens, as well as orphanages and boarding schools are subject to a one-time stool examination without removal from work or removal from the team. If a disease appears simultaneously in several groups of a preschool institution, all children, group staff, food service workers and all other personnel are examined bacteriologically. The frequency of examination is determined by the epidemiologist. In case of nosocomial salmonellosis: - the patient is isolated; - in case of a group disease (outbreak), it is possible to temporarily organize a special department on site; - after the patient is removed, hospitalization of new patients in this ward is stopped for 7 days; - contacts remain in the ward and are subjected to a one-time background examination and further clinical observation; - if 3 or more cases of the disease occur in different wards or when Salmonella is cultured from swabs or air in different rooms, the department is closed and a biological examination of all children, mothers and staff is carried out. Such a department is opened after a set of anti-epidemic measures has been carried out with the permission of the Center for State Sanitary and Epidemiological Supervision. Conditions of discharge. Not earlier than 3 days after clinical recovery, normal temperature and stool; a negative result of a single stool examination carried out no earlier than 2 days after the end of etiotropic therapy. Employees of food enterprises and persons equivalent to them, children under 2 years of age and children attending preschool institutions are discharged under these conditions after a double negative stool test. Admission to the team. After clinical recovery, with the exception of workers of food enterprises and persons equivalent to them, and children of nurseries and orphanages. These persons are not allowed into the team for 15 days after discharge from the hospital (they undergo three bowel examinations with an interval of 1-2 days). If the pathogen is isolated, the observation period is extended for another 15 days, etc. Chronic carriers of Salmonella are not allowed in nurseries and children's homes, and workers in food enterprises and persons equivalent to them are transferred to work not related to food. Bacteria-carrying schoolchildren (including those from boarding schools) are not allowed to be on duty in the catering department and canteen. Clinical examination: Workers of food enterprises and persons equivalent to them, children under 2 years of age and organized preschoolers are observed for 3 months with monthly examination of feces. Specific prevention Polyvalent Salmonella bacteriophage is used for prophylactic purposes according to epidemiological indications to all persons who have interacted with patients or salmonella excretors. Nonspecific prevention Sanitary and veterinary supervision over the slaughter of livestock and poultry. Compliance with the rules of storage and preparation of food products. Deratization. ANTHRAX Anthrax (anthrax, malignant carbuncle) is an acute infectious disease belonging to the group of zoonoses, characterized by severe intoxication, fever, occurring in the form of cutaneous and visceral forms. Clinical diagnosis Incubation period from several hours to 8 days (on average 2-3 days). Skin form. With the carbunculous variety, at the site of the entrance gate of infection there is a spot, papule, vesicle, pustule, ulcer, necrosis, regional lymphadenitis. From the 2nd day of illness - intoxication with a rise in temperature to 39-40 (C, cardiovascular disorders. The duration of intoxication is 5-6 days, the local process is 2-4 weeks. Edematous, bullous, erysepeloid varieties of the skin form are possible. Pulmonary form. After a short incubation period (up to 1 day), a sudden rise in temperature to high numbers, runny nose, lacrimation, photophobia, chest pain, cough, intoxication, headache, vomiting, increasing cardiovascular failure. Death. Gastrointestinal form. Intoxication. Acute abdominal pain, bloody vomiting with bile, bloody diarrhea, intestinal paresis, inflammation of the peritoneum, effusion, perforation of the intestinal wall, peritonitis. Death in 2-4 days. Septic form. Generalization of the process occurs quickly without previous local phenomena. There are abundant hemorrhages on the skin, the lungs and intestines are affected. Meningeal syndrome. Death occurs on the first day. Laboratory diagnostics 1. Microscopic method. Smears prepared from the contents of vesicles or carbuncles and Gram-stained are examined for the presence of capsules. 2. Immunofluorescent method. Examine smears prepared from the above materials and treated with a specific luminescent serum. 3. Bacteriological method. The material is examined (see above) and inoculated on solid (MPA) and liquid (MPB) media in order to isolate the pathogen. For the same purpose, a bioassay is performed by intraperitoneal infection of white mice. The material for research can also be blood, sputum, feces, and cadaveric material. 4. Allergic method. From the first days of illness, a skin allergy test with anthraxin is performed. 5. Detection of pathogen antigen and antibodies to it by ELISA. Measures regarding patients and contact persons Hospitalization. Mandatory, immediate - to the infectious diseases department or separate wards. Separate medical staff are allocated for care. All secretions are disinfected. Contact insulation. Not carried out. Persons who have been in contact with sick animals or have been in close contact with a sick person are placed under medical surveillance for 8 days. They are given emergency prophylaxis with anti-anthrax immunoglobulin and antibiotics. Conditions of discharge. In the skin form - after epithelization and scarring of ulcers at the site of the fallen scab, in other forms - after clinical recovery. Admission to the team. After clinical recovery. Clinical examination: Not carried out Specific prophylaxis 1. Routine vaccinations for people with anthrax live dry vaccine STI are carried out according to professional indications using the cutaneous and subcutaneous method. 2. Anti-anthrax immunoglobulin and antibiotics are used for emergency prevention of the disease in persons who have had direct contact with infected material, within no more than 5 days after consuming infected food or after skin contact. Nonspecific prevention Reduction and elimination of morbidity among domestic animals. Destruction of food products and disinfection of raw materials obtained from sick animals. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Acquired immunodeficiency syndrome (AIDS) is a viral, slow-acting infection caused by the human immunodeficiency retrovirus, transmitted sexually, parenterally and vertically, characterized by specific predominant damage to helper T-lymphocytes, leading to the development of a secondary immunodeficiency state. Clinical diagnosis Incubation period from 2-4 weeks to 5 years. In the acute febrile phase, “mononucleosis” syndrome: sore throat, fever, lymphadenopathy, hepatosplenomegaly; flu-like syndrome; asthenic serous meningitis or meningoencephalitis; transient exanthemas. In the asymptomatic phase, seroconversion occurs (antiviral antibodies in the serum). Persistent generalized lymphadenopathy: enlargement of the cervical, occipital, postauricular, elbow and other groups of lymph nodes; vegetative-vascular disorders; an imbalance appears in the immune system. PreAIDS – weight loss up to 10%; fungal, viral, bacterial lesions of the skin and mucous membranes; exacerbation of chronic foci of infection: sweating, prolonged diarrhea, fever, signs of immunodeficiency. AIDS - weight loss of more than 10%, hairy leukoplakia, pulmonary tuberculosis, persistent bacterial, fungal, viral, protozoal lesions of the skin and internal organs, localized Kaposi's sarcoma. Generalization of all infections, disseminated Kaposi's sarcoma, damage to the nervous system, AIDS-marker diseases. Laboratory diagnostics 1. Serological method. Numerous diagnostic test systems are produced for detecting antibodies to HIV antigens using enzyme immunoassay. A primary positive result requires mandatory confirmation using the immunoblotting technique. 2. Immunoinduction. Using a set of poly- and monoclonal antibodies, both complexes and individual antigenic determinants of HIV can be detected in the blood of patients and HIV-infected people. 3. Virological research. HIV isolation is carried out only in specialized centers. 4. Genetic methods. Nucleotide sequences of the virus can be detected in DNA from the blood cells of patients and HIV-infected people. Measures regarding patients and contact persons Hospitalization. Issues of isolation and hospitalization of AIDS patients and HIV-infected people are resolved collectively by epidemiologists, clinicians, and AIDS center staff. Contact insulation. Not carried out. Contacts from foci of HIV infection are monitored at the AIDS center and infectious diseases department for 1 year, with blood testing for HIV using the ELISA method carried out once a quarter. Admission to the team. Admission to the team of AIDS patients and HIV-infected people will be decided collectively by epidemiologists, clinicians, and AIDS center staff. Clinical examination: Conducted at the AIDS center, terms are not regulated. Specific prevention has not been developed. Nonspecific prevention Prevention of sexual transmission of HIV infection: - use of condoms during sexual intercourse. Parenteral route of infection: - disinfection and sterilization of medical instruments, widespread use of single-use medical instruments. Personal prevention measures: - work in overalls, use gloves. If your hands are contaminated with blood (blood serum), you must pinch the skin with a cotton ball soaked in a disinfectant (chloramine, bleach, alcohol), and then wash your hands with soap. Tick-borne typhus Tick-borne typhus (North Asian rickettsiosis) is an acute infectious disease with a benign course, characterized by the presence of a primary affect, fever and skin rashes. Clinical diagnosis Incubation period 4-9 days. The beginning is acute. Fever, headache, insomnia. Inflammatory reaction at the site of a tick bite and regional lymphadenitis. Polymorphic roseolous-papular rash with a characteristic localization on the skin of the trunk, buttocks, extensor surface of the extremities, sometimes on the face, palms and soles with subsequent pigmentation. Bradycardia. Arteriovenous hypotension. Children have a milder course of the disease. Laboratory diagnostics 1. Bacteriological method. From the first days of the disease, the pathogen is isolated from the blood by infecting developing chicken embryos. 2. Serological method. From the 2nd week of the disease, paired sera are examined in RA, RPHA or RSK with rickettsial antigen in order to detect antibodies and increase their titer. Measures regarding patients and contact persons Hospitalization. According to clinical indications. Contact insulation. Not carried out. Conditions of discharge. Clinical recovery no earlier than 10 days from the onset of the disease. Admission to the team. After clinical recovery. Clinical examination: It is recommended to limit physical activity for 3-6 months. Specific prevention has not been developed. Nonspecific prevention Deratization and disinsection in epidemic foci. Wearing protective clothing and inspecting clothing and body surfaces to detect and remove ticks. The removed ticks are destroyed, the bite site is treated with solutions of iodine, lapis or alcohol. CHOLERA Cholera is an acute intestinal infection caused by Vibrio cholerae, characterized by gastroenteritis with rapid dehydration due to loss of fluid and electrolytes through vomit and feces. Clinical diagnosis Incubation period from several hours to 5 days. Light form. Weight loss – 3-5%. Moderate thirst and dry mucous membranes. Mild short-term diarrhea. Exicosis I degree. Moderate form. Loss of body weight – 5-8%. Hemodynamic disorders (tachycardia, hypotension, cyanosis, cold extremities). Thirst, oliguria. The stool is frequent, plentiful, quickly loses its fecal character (a type of rice water), an admixture of mucus, and blood. Rumbling intestines, flatulence. Vomit. Exicosis degree II. Severe form (algid). Weight loss more than 8-12%. Severe hemodynamic disorders (fall in blood pressure, weak pulse, muffled heart sounds, cyanosis, cold extremities, anuria). Sharpened facial features, dry sclera, aphonia. Hypothermia. Frequent vomiting and diarrhea. Cramps. Exicosis III-IV degree. Laboratory diagnostics 1. Bacteriological method (carried out in OI laboratories). From the first days of illness, repeated examinations of stool and vomit are carried out in order to isolate the pathogen. Media for primary sowing: 1% peptone water with potassium tellurite, alkaline agar. The preliminary answer is in 12-16 hours, the final answer is in 24-36 hours. 2. Serological method. Paired sera are examined in RA and RPGA in order to detect antibodies and increase their titer. Measures regarding patients and contact persons Hospitalization. Strictly mandatory for patients and vibration carriers. Contact insulation. In exceptional cases, when the infection is widespread, a quarantine is established on the territory of the outbreak with the isolation of those in contact with patients, vibrio carriers, those who died from cholera and contaminated environmental objects, as well as those leaving the quarantine territory. These persons are subject to medical observation for 5 days with three-time (during 24 hours) bacterial examination of stool. Vibrio carriers and patients with acute gastrointestinal diseases are identified and hospitalized. The medical staff of the hospital and observatory are transferred to a barracks position. Conditions of discharge. Clinical recovery, negative results of three stool tests (for 3 consecutive days) and a single bile test (portions B and C), carried out no earlier than 24-36 hours after antibiotic treatment. Employees of food enterprises and persons equated to them, as well as those suffering from diseases of the liver and biliary tract, are examined for 5 days (five-fold examination of stool and one-time examination of bile) with preliminary administration of a laxative before the first examination. Admission to the team. Persons who have suffered from cholera and vibrio carriers are allowed into the team immediately after discharge from the hospital. Children are admitted no earlier than 15 days after discharge and five daily stool examinations. Medical examination: Persons who have suffered from cholera and vibrio carriers are observed throughout the year. A background examination (with preliminary administration of a laxative) is carried out: in the 1st month, once every 10 days, in the next 5 months - once a month, then once every 3 months. In case of long-term vibrio carriage with damage to the liver and biliary tract - inpatient treatment. Persons who are in a cholera outbreak and have suffered acute gastrointestinal diseases are observed for 3 months with monthly background checks for pathogenic intestinal flora, including Vibrio cholerae. When eliminating an outbreak, employees of food enterprises and persons equivalent to them, medical workers and organized preschool children who were in the outbreak of cholera are subjected to testing for vibrio carriage 1 time during the 1st month, then once in April-May. Employees of food enterprises and persons equivalent to them, when hired for a year after the elimination of the outbreak, are examined three times daily for vibrio carriage. Specific prevention 1. Cholera vaccine is used for subcutaneous preventive vaccinations for children and adults. 2. Cholerogen toxin is vaccinated for adults and children from 7 years of age. Nonspecific prevention Sanitary supervision of water supply, sewerage, collection and disposal of sewage; sanitary control at food industry and public catering enterprises, sanitary education. PLAGUE Plague is an acute infectious disease characterized by a severe form of general intoxication, specific damage to the lymph nodes, lungs and other organs. Clinical diagnosis Incubation period from several hours to 10 days (usually 3-6 days). The onset is sudden. High temperature, intoxication, impaired consciousness, delirium. Damage to the cardiovascular system. Toxic shortness of breath. Enlarged liver and spleen. In the bubonic form - lymphadenitis, suppuration and opening of the bubo. In the cutaneous bubonic form - a pustule, sharp pain, then an ulcer. In the pulmonary form - severe intoxication, high constant fever, previously progressive decline in cardiovascular activity, respiratory failure, cough, sputum with blood. In the septic form - severe sepsis with severe hemorrhagic syndrome. Laboratory diagnostics 1. Bacterioscopic method (carried out in the laboratories of the General Public Inspectorate). From the first days of the disease, smears from sputum, punctate buboes (less often mucus from the throat), stained with Gram and methylene blue, are examined in order to detect the pathogen. 2. Bacteriological method (carried out in OI laboratories). From the first days of the disease, sputum, bubo punctates, blood, and mucus from the throat are examined in order to detect the pathogen. Medium for primary inoculation: Hotinger agar or special media. Laboratory animals are infected with the same material. 3. Serological method. From the end of the 1st week, blood serum is examined in RA and RPHA and antigen neutralization reactions in order to detect AT. 4. Immunodiagnostic method. From the first days of the disease, blood serum and pathological material are examined in the passive hemagglutination inhibition reaction (RPHA) and the antibody neutralization reaction (RNAT) in order to detect the antigen. 5. Detection of pathogen antigen and antibodies to it by ELISA. Measures regarding patients and contact persons Hospitalization. Mandatory, urgent, with isolation in a room with pre-disinfection, deratization and disinfestation. The medical staff works in full anti-plague suit. All patient secretions are disinfected. Contact insulation. All persons who have been in contact with the patient or with contaminated objects are subject to strict isolation for 6 days with daily temperature measurements three times. Persons with a fever are transferred to an isolation ward for a final diagnosis. Medical personnel serving patients are subject to careful medical supervision with double temperature measurements. Conditions of discharge. Complete clinical recovery (for the bubonic form - no earlier than 4 weeks, for the pulmonary form - no earlier than 6 weeks from the date of clinical recovery) and a negative result of a three-fold bacterial examination (bubo punctate, throat smears and sputum). Admission to the team. After clinical recovery and three-fold background examination. Clinical examination: Conducted for 3 months. Specific prevention. Adults and children from 2 years of age are vaccinated with live dry plague vaccine according to epidemic indications. Nonspecific prevention Prevention of the introduction of the disease from abroad and the occurrence of the disease in people in enzootic areas.

Construction of an infectious diseases hospital (department). Infectious diseases hospitals (departments) are located, whenever possible, on the outskirts of populated areas, away from main highways and water sources. When building a hospital, the required minimum land area for 1 bed is taken into account - 200 m2.

The number of beds in a hospital depends on the population of the city, region (200-500 or more beds); the same applies to infectious diseases departments in district, city and regional hospitals (20-40 beds in rural areas and 40-100 beds in cities and large settlements). They are guided by the following calculation: 1.4 beds per 1000 population.

An infectious diseases hospital should have the following units: admission department (emergency room); departments for hospitalization of patients; boxed departments or separate boxes for accommodating patients with diseases of unknown etiology, mixed infections; department (wards) for providing care to patients with conditions requiring emergency intervention; catering unit; laundry; X-ray department (office); laboratory; pharmacy; disinfection department (chamber); economic and technical service; administrative and managerial apparatus.

In the case where the infectious diseases department is part of a district, city or regional hospital, a number of services (food department, pharmacy, administrative, laboratory, x-ray room) may be shared. The laundry and disinfection chamber should serve only the infectious diseases department.

Reception department (rest). In the emergency department (rest room), incoming patients are received; establishing a diagnosis; taking material for research; sanitary treatment of patients; filling out documentation for applicants; triage of patients; transportation of patients to departments; processing of patients' belongings; transport processing; emergency information from sanitary and epidemiological institutions about incoming patients; providing emergency care to patients; issuing certificates about the condition of patients.

Large hospitals admit patients 24 hours a day. If there are few patients admitted at night, they are seen by the hospital doctors on duty.

In cases where infectious diseases departments are part of a district, city or regional hospital, patients are admitted in a separate emergency room or separate examination boxes of the hospital emergency room.

Arrangement of the reception department (rest room)) should ensure the flow principle of working with patients, when they do not come into contact with each other at all stages of reception, processing and transportation.

Each examination box must have a separate entrance and exit, an examination room, a sanitary unit, a washbasin for staff, chairs, a couch, a medical cabinet with a set of instruments and medications, a thermostat and a sterilizer, disinfectant solutions and equipment, bottles and Petri dishes with media, and the necessary documentation , stretchers, clothes for incoming patients, bags for personal clothing of patients.

The reception department should have a rest room for doctors on duty, a shower for staff, a room for clean linen, sets of clothes for working with conventional infections, a telephone and a help desk. The number of observation boxes depends on the scale of the hospital, but there should be at least four of them: for patients with intestinal, droplet infections (except scarlet fever), as well as for patients with scarlet fever, etc. Near the emergency department, it is necessary to equip an area for sanitizing the vehicles used to deliver patients.

The procedure for working in the emergency department is as follows: upon a signal from the doctor who has established the diagnosis of an infectious disease, the patient is transported by a disinfection station machine to the infectious diseases hospital (department). Upon arrival at the emergency department, the medical worker accompanying the patient gives a referral to the doctor on duty, who indicates in which box the patient can be admitted. A doctor, sister and nanny enter this box and put on gowns, headscarves, caps and, if necessary, masks. The nanny and sister undress the patient; the doctor conducts a survey and examination, decides on the diagnosis, prescribes the necessary studies and treatment, the type of treatment of the patient’s body, the procedure for transportation, and also indicates which department (section), box or ward the patient should be taken to. When distributing patients, the doctor takes into account: nosological forms of diseases and their severity, age, gender of patients, duration of the disease, the presence of homogeneous complications and contact with other infectious patients.

In cases where the patient was not delivered by special transport, which, of course, should be an exception, the doctor indicates the method of handling the transport. The treatment is carried out immediately on the site by a nurse and a nanny or a disinfectant. Special transport is processed by a worker at the disinfection station. After the patient has undergone sanitary treatment, he is put on hospital clothes and, accompanied by a nurse, is sent to the department (box).

For personal clothing, a receipt is filled out, one copy of which is given to the patient (attached to the medical history), and the other is placed in a clothes bag, which is immediately transferred to the disinfection chamber. In cases where patients are admitted at night (and the chamber operates only during the day), a powdered disinfectant in the amount of 20-25 g per set is poured into bags with clothes of patients with typhoid and paratyphoid fever (it is necessary to use preparations that do not cause discoloration of clothes).

Depending on the clinical manifestations of the disease, in patients prescribed by a doctor, blood is taken from a vein for culture in bile or sugar broth, a smear from the mucous membranes of the throat and nose (for diphtheria bacillus or other flora), feces (for typhoid-paratyphoid diseases, dysentery) and etc.

If necessary, patients are provided with emergency care - intubation, recovery from shock, collapse, stopping bleeding, administration of the first doses of therapeutic serums.

In the reception department, they fill out a medical history and an application for a catering unit and keep the following documents: a register of admitted patients, a register of patients being consulted, emergency notifications (summary), a register of persons who communicated with patients with childhood droplet infections (according to data from preschool children's institutions), a journal for recording the collection of material for research and a duty log. This log and medical history are filled out by a doctor who checks the report sent to the regional sanitary-epidemiological institution. When patients with typhus, botulism, salmonellosis and some other infections are admitted, they are reported by telephone to the sanitary-epidemiological station.

After completing the examination and reception, the staff takes off their gowns, caps, and masks in the box. After receiving the patient, the room is wet treated; the brushes and washcloths used to wash the patient are boiled. The patient's secretions, rinsing waters, in the absence of a chlorinating installation, are collected in containers, filled with a disinfectant solution (bleach-lime milk) or covered with bleach (liquid materials) and after a certain exposure (2 hours) drained into the sewer. The instruments used when receiving the patient are sanitized, and gowns, caps, headscarves and masks are disinfected. Stretchers or strollers on which patients were transported are also subject to treatment.

If necessary, the doctor on duty calls a senior doctor or the necessary specialists for a consultation. If the doctor still has doubts and the question of the diagnosis is not resolved, the patient is sent to a separate room. The same applies to patients with mixed infections who were in contact with other patients.

Infectious diseases department. Infectious diseases departments serve for hospitalization, examination and treatment of infectious patients. The number of departments in an infectious diseases hospital can vary - from 3-4 to 10-16 or more. The average number of beds in each of them is 40-60. In departments for hospitalization of young children, as well as for adult patients with some types of infections, the number of beds may be smaller. The approximate staff of the department is as follows: head of the department - 1; residents - 2; senior nurse - 1; nurses on duty - 5-6; sister-hostess - 1; nurses - 5-6; barmaids - 2.

Departments can be located in separate buildings (pavilion type) or in one building; in this case, they must have their own entrance and exit to the hospital courtyard.

Each department consists of wards (with 2-4 beds each), a pantry, a room for doctors, a manipulation room, and a sanitary unit.

When placing patients, it is necessary to adhere to the following recommendations: the room volume allocated per patient should be 18-20 m3, the floor area should be 7-8 m2, the distance between beds should be 1 m. The temperature in the wards should be maintained at least 16-18 ° C, humidity - about 60%; regularly ventilate the room using transoms, vents, central supply or combined ventilation.

The pantry should have a separate passage to the yard for delivering food and removing food scraps. If the departments are located in a multi-story building, food is delivered using special elevators. A stove is installed in the pantry to heat food, boil dishes, and supply cold and hot water; There should be: a tank for soaking dishes, a tank for leftover food, racks for drying dishes, tables for serving food and cutting bread, various utensils, as well as the necessary equipment.

The sanitary unit of the department is equipped with a bathtub, a shower unit, and washbasins for washing patients in the department. The toilet consists of separate cabins, the number of which depends on the number of beds in the department (1 point for 12-20 people). A sanitary checkpoint will also be provided for medical personnel.

The department maintains the following documentation: medical histories, a patient registration register, a register of blood transfusions and its components, a register of nosocomial infections, and medication prescription cards.

The medical history includes passport data, the patient’s complaints upon admission, medical history, life history, epidemiological history, objective research data, preliminary diagnosis, diaries indicating the necessary studies, therapy and epicrisis. The results of various laboratory tests are pasted into the medical history on a separate sheet (a chart of the medical history is given in the appendix).

To ensure the correct sorting of incoming patients, separate hospitalization of patients with mixed infections, unknown diseases or unknown contacts, boxed departments, boxes are required, the number of beds in which should be 25% of the total number of beds in the hospital (in old hospitals 15-20% is allowed). The best option are boxes built according to the scheme proposed by the domestic engineer E.F. Meltzer.

A hospital's food service unit is usually located in a separate building, and the best way to deliver food to the departments is through underground tunnels; There are special elevators in the buildings. In other conditions, food is delivered to the departments by barmaids.

The laundry is built and equipped in such a way as to ensure the flow of laundry in only one direction: a room for receiving and sorting laundry, then a room for boiling and washing. Subsequently, the laundry goes to the dryer, after the dryer to the ironing room and, finally, to the delivery room.

In the disinfection department of the hospital, steam or paraformalin disinfection chambers are installed, each of which is equipped in such a way as to ensure a direct flow of things arriving for processing: on the one hand, a room for receiving, sorting and loading the chamber, on the other, for unloading the chamber, placing and issuing of things. The cameras operate according to a certain mode, depending on the shape of the pathogens and the type of clothing.