Carefully! severe bronchitis is life-threatening! Clinical signs. The disease is acute

Sometimes, feeling very unwell, we come to the clinic or call a doctor at home, and he, having carefully asked about the symptoms, makes us an incomprehensible diagnosis - acute respiratory infections. What it is is unclear. This article is devoted to a detailed explanation of this issue.

Acute respiratory infection, or ARI

If a person has a cold, he starts coughing, itching and sore throat, the temperature rises, this means that his respiratory organs are affected by an acute respiratory infection, respectively, he is sick with an acute respiratory disease, abbreviated as ARI. This concept includes a fairly large range of diseases caused by a wide range of different bacteria and viruses: streptococci, meningococci, staphylococci, influenza viruses A, B and C, parainfluenza viruses, adenoviruses, enteroviruses, etc.

All these countless harmful microorganisms, getting inside the human body, can cause acute respiratory infections. What it is - it will become even more clear after reading the list of the most common symptoms of acute respiratory infections (acute respiratory viral diseases).

Symptoms of an acute respiratory infection

4. Rotavirus infection (intestinal or has a fairly long incubation period - up to six days. The onset of the disease is acute: vomiting, diarrhea, fever. Most often observed in children.

5. Respiratory syncytial infection is characterized by the occurrence of bronchitis and pneumonia, i.e. damage to the lower respiratory tract. At the very beginning of the disease, a person feels a general malaise, runny nose, headache. The most characteristic symptom is attacks of excruciating dry cough.

6. Coronavirus infection is most severe in children. It affects the upper respiratory tract. The main symptoms: inflammation of the larynx, runny nose, sometimes lymph nodes may increase. The temperature may be in the region of subfebrile values.

ARI has a synonym - ARI, or acute respiratory infection. In the common people, ARI is usually denoted by the more familiar word "cold". Also, in connection with the cold and flu, you can often hear the abbreviation SARS.

ARI and SARS - what's the difference?

Many people think that ARI and SARS are identical concepts. But it is not so. Now we will try to explain to you what the difference is.

The fact is that the term ARI refers to the entire wide group of acute respiratory diseases caused by any microbes - bacteria or viruses. But ARVI is a narrower and more precise concept, which determines that the disease is precisely of a viral nature. Here they are - ARI and SARS. We hope you understand the difference.

The need for a more accurate diagnosis arises in some cases due to the fact that the treatment of diseases of viral or bacterial origin may be fundamentally different, but not always.

In the process of developing an acute respiratory viral infection, a bacterial factor can also join it. That is, for example, at first a person is struck by the influenza virus, and after a few days the situation is further complicated by bronchitis or pneumonia.

Difficulties with diagnosis

Due to the similarity of various acute respiratory infections to each other, the doctor can sometimes make a mistake and make an incorrect diagnosis. Especially often there is confusion with influenza and acute respiratory infections of a different etiology: parainfluenza, adenovirus, rhinovirus and respiratory syncytial infection.

Meanwhile, it is very important to identify the flu at an early stage of the disease in order to prescribe the right drugs and prevent the development of complications. In order to help the doctor, the patient must identify as accurately as possible all the symptoms he has. It should be remembered that the flu is rarely associated with a cold, while most other acute respiratory infections (especially of a bacterial nature) begin after hypothermia, just like a cold.

Another important note about influenza (ARI): you can get sick with it most often only during the epidemic, while other ARIs have year-round activity. There are other differences between influenza and other acute respiratory diseases.

Attention - flu!

This disease always has a very acute onset. In just a couple of hours, a person from a healthy person turns into an absolutely sick person. The temperature quickly rises to the highest values ​​\u200b\u200b(usually above 38.5 degrees), symptoms such as:

• headache;
• pain in the muscles of the arms and legs, cramps;
• pain in the eyeballs;
• severe chills;
• complete weakness and weakness.

For other acute respiratory infections, it is characteristic just a gradual increase in disease processes, reaching a peak on the second or third day of illness. If you feel unwell and are trying to determine what you have: the flu or an acute respiratory disease (we already know what kind of "sores" these are), remember what you just read, and if all the signs indicate that you have the flu , then immediately go to bed and call a doctor at home.

How does an acute respiratory infection occur?

The germs that cause colds and flu are transmitted primarily through airborne droplets. Let's look at the OR. What is it, how does it affect the body of a healthy person?

When talking, and especially when coughing and sneezing, a sick person, unwittingly, releases a huge amount of viruses and bacteria into the environment. Moreover, the patient becomes dangerous for others not only in the acute phase of the disease, but also in its erased form, when he considers himself only a little sick - he goes to work, freely communicates with others, "generously" sharing the disease with all citizens who meet on his way.

ARI pathogens can live not only in the air, but also on various objects: on dishes, clothes, on door handles, etc. That is why during periods of epidemics it is recommended not only to refrain from visiting public places, but also to wash your hands more often with soap and water .

In order for a person to become infected, it is enough for microbes to get on the mucous membrane of the nasopharynx and oral cavity. From there, they quickly and freely enter the respiratory tract and begin to multiply rapidly, releasing toxins into the blood. Therefore, with acute respiratory infections, intoxication of the human body always occurs to one degree or another.

Treatment of acute respiratory infections

It is good if a medicine for acute respiratory infections is prescribed by a qualified therapist, who has precisely established which infection caused the disease. In this case, the treatment will go most successfully and quickly. But many of our compatriots simply love to be treated on their own, without wasting time visiting a clinic or calling a doctor. We want to say right away that if you, who are reading these lines now, belong to this category, then we do not urge you to take the information presented in this chapter as a guide to action. We do not give recommendations here on how to treat ARI. This is only an introductory general overview, which can in no way replace the advice and appointment of a doctor.

General principles of treatment, remedies for acute respiratory infections:

2. If the temperature exceeds 38.5 degrees, then this is an indication for taking any antipyretic drug. Here is a partial list of such drugs:

• "Paracetamol";
• "Aspirin";
• "Efferalgan";
• "Ibuprofen";
• "Nurofen";
• "Panadol";
• "Anapirin";
• "Tylenol";
• "Calpol";
• "Ibusan";
• "Fervex" and many other similar drugs.

An important addition: antipyretic drugs are intended primarily for symptomatic and complex therapy. They reduce the temperature, soothe the pain, but they cannot completely cure the underlying disease. Therefore, timely medical diagnosis and the appointment of treatment by a doctor are so important.

3. Since acute respiratory diseases are almost always accompanied by severe intoxication of the body, the patient needs to drink more. Of the drinks most suitable for the sick are:

• weak warm tea with a slice of lemon;
• fruit drink made from cranberries;
• mineral water (better if it is without gas);
• juices (preferably natural freshly squeezed, not from packages).

4. Respiratory diseases are cured much more effectively and quickly if a person, at the first signs of the disease, starts taking vitamins such as ascorbic acid (vitamin C) and rutin (vitamin P). Both components are included in the excellent Ascorutin vitamin complex.

5. In some cases, doctors consider it necessary to prescribe antihistamines.

6. With active inflammatory processes in the bronchi, lungs and larynx with the formation of sputum, broncho-secretolytic drugs are prescribed:

• "Bronholitin";
• "Ambroxol";
• "ACC";
• "Bromhexine";
• "Ambrobene";
• marshmallow root syrup;
• "Ambrohexal";
• "Bronchicum";
• "Gedelix";
• "Lazolvan";
• "Mukodin";
• "Mukosol";
• "Tussin" and others.

7. In ARVI, antiviral drugs are indicated. These include the following drugs for acute respiratory infections of viral etiology:

• "Interferon";
• "Kagocel";
• "Amixin";
• "Grippferon";
• "Arbidol";
• "Rimantadine" and others.

8. If the course of acute respiratory infections is complicated by a severe bacterial infection, the doctor may prescribe antibiotics.

• "Sanorin";
• "Xymelin";
• "Tizin";
• "Nazol";
• "Rinostop";
• "Nazivin" and others.

10. The following lozenges and sprays are used to treat inflammation in the throat:

• "Geksoral";
• Strepsils;
• "Kameton";
• "Faringosept";
• "Ambassador";
• "Ingalipt" and others.

About antibiotics

We consider it useful to remind you that antibiotics for acute respiratory infections, as, indeed, for any other ailments, should not be prescribed to yourself! These are powerful drugs that can defeat the infection where other drugs can be completely powerless. But at the same time, they have a lot of side effects and contraindications. Taking advantage of the fact that today many potent drugs can be purchased at a pharmacy without a prescription, people begin to take powerful pills in order to get better as soon as possible and in some cases get the exact opposite effect.

For example, at the initial stage of influenza, taking antibiotics is not only useless (money thrown away), but even harmful. This group of drugs has no effect on viruses, they are designed to fight other microorganisms (bacteria and fungi). Once in the body of a flu patient, antibiotics destroy the beneficial bacterial microflora, thereby weakening the patient's immune system, which is already in a state of exhaustion, because the body has to use all its forces and reserves to fight dangerous viruses.

If you have signs of acute respiratory infections, do not rush to resort to antibiotics without good reason and without a doctor's prescription! Here are some side effects that one of the most powerful and popular antibiotics of the latest generation today, Sumamed, which belongs to the group of macrolides, can cause:

• dysbacteriosis (violation of the natural microflora in the intestine);
• candidiasis and other fungal infections;
• various allergic reactions;
• arthralgia (joint pain):
• many other annoyances.

When the child got sick

And now a little introductory consultation for parents. ARI is especially difficult in children. Here, as a rule, there is a high temperature, and a wild pain in the throat, and a runny nose. The child is suffering a lot, how to help him as soon as possible? Of course, first of all, you need to call a doctor and give the baby the medicines that he will prescribe. You also need to do the following:

• In order to avoid congestion in the lungs, it is necessary to put a small patient on the bed several times a day, tucking pillows under his back so that the baby can sit comfortably. The baby must be carried in his arms, pressing him to himself so that his body is in an upright position.
• When sick, children often refuse to eat. You don’t need to force them to eat, it’s better to give your child more tasty drink in the form of warm cranberry juice.
• The child's room should be cleaned daily (wet). It is recommended to throw a terry towel over the heating battery, which must be moistened periodically - this will help humidify the air. Remember that the germs that cause respiratory illness are most comfortable in dry air.
• The room must be ventilated several times a day, as a small patient needs clean fresh air. At this time (5-10 minutes) it is best to transfer the child to another room.

Errors in the treatment of ARI

If ARI is not properly treated, complications will not keep you waiting. Here are some common mistakes people who catch a cold often make:

1. Until the last, as long as there is at least some strength, they try to stand on their feet, go to work, women take care of the house, run to shops, etc., and meanwhile the disease develops. It is necessary to protect not only yourself, but also those around you (for example, your colleagues), because they are also at risk of getting sick if there is an infected person next to them.

2. They do not trust the doctor's recommendations, do not drink the drugs that he prescribed. It often happens that the doctor considers it necessary that the patient undergoes a full course of antibiotic treatment, but after drinking one or two tablets and feeling better, he stops taking the drug and thus does not allow the medicine to cope with a bacterial infection that can quietly turn into a chronic one. form.

3. Antipyretics are taken without special need. Remember that by raising the temperature, the body fights the infection, and if the thermometer shows no more than 38.5 degrees, then you do not need to stuff yourself with pills.

Folk recipes

How to treat ARI with folk methods? Well, there are a lot of recipes here! Here are just a few of them:

1. Various teas (with honey, with linden, with raspberries) help to quickly bring down the temperature. It is recommended that after giving the patient such antipyretic tea to drink, wrap him warmer and let him sweat properly. After the fever subsides, and sweating stops, you need to change the bed and underwear of the sick person and let the person sleep.

2. If a cold occurs in a mild form without an increase in temperature, then you can do foot baths with mustard before going to bed. In simple terms, soar legs. Important note: you can’t do this even at a low subfebrile temperature - hot water can cause it to rise further.

3. From inflammation of the tonsils, gargling with warm decoctions of herbs such as sage, chamomile and calendula helps very well.

4. In the room where a sick person lies, it is good to put fresh pine branches into the water. Pine needles release useful phytoncides that have the ability to destroy microbes.

5. Everyone knows how strong the antiviral effect is onions. You can give the patient to drink onion milk with honey. To prepare it, milk is poured into a small ladle, and an onion cut into several parts is placed there. The drug needs to be boiled for several minutes (3-5 will be enough). Then the milk is poured into a cup, a spoonful of honey is put there, and all this is given to the patient to drink. Such milk has anti-inflammatory, antipyretic, sedative properties, helps to fall asleep.

Let's talk about prevention

Prevention of acute respiratory infections is quite simple and, in principle, has long been known to everyone. But the carelessness inherent in the human race and hope for a chance often make us ignore the elementary rules of behavior in the season of epidemiological danger and pay for our carelessness with illness and suffering. We advise you to carefully read about preventive measures to prevent acute respiratory diseases. Here they are:

1. It is necessary to take care of strengthening your body ahead of time! No cold takes a person with strong immunity. For this you need:

• engage in recreational sports (running, skiing, skating, swimming, etc.);
• harden, for example, douse yourself with cool water in the morning;
• make sure that all vitamins are present in the diet in sufficient quantities, ascorbic acid is especially important - it is not synthesized in our body and can only be ingested with food.

2. During an epidemic of acute respiratory infections, it is recommended to lubricate the nasal mucosa with oxolinic ointment before going outside.

3. When the flu is rampant, do not tempt fate - refrain from visiting crowded places.

Conclusion

Now you know a lot about acute respiratory infections - what it is, how to be treated, how to avoid infection, and more. We have tried to convey rather complex and extensive information in a simple and concise form that is most understandable to most people. We hope that our article was useful to our readers. We wish you to always stay healthy, let diseases bypass you!

Rabies, a viral disease with severe damage to the central nervous system. It is transmitted mainly by the bite of sick animals (dog, cat, wolf, rat), whose saliva containing the virus enters the wound. Spreading then through the lymphatic tracts and partially through the circulatory system, the virus reaches the salivary glands and nerve cells of the cerebral cortex, ammon horn, bulbar centers, affecting them, causing severe irreversible damage.

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

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

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

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

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

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

Botulism. A disease caused by food contaminated with botulinum bacterium. The causative agent - anaerobe is widely distributed in nature, can be in the soil in the form of spores for a long time. It gets from the soil, from the intestines of farm animals, as well as some freshwater fish to various food products - vegetables, fruits, grains, meat, etc. Without access to oxygen, for example, when canning food, botulism bacteria begin to multiply and release a toxin, which is the strongest bacterial poison. It is not destroyed by intestinal juice, and some of its types (type E toxin) even enhance their effect.

Usually, the toxin accumulates in products such as canned food, salted fish, sausage, ham, mushrooms, cooked in violation of technology, especially at home.

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

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

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

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

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

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

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

Brucellosis. An infectious disease caused by Brucella, a small pathogenic bacterium. A person becomes infected from domestic animals (cows, sheep, goats, pigs) when caring for them (veterinarians, milkmaids, etc.) or when eating infected products - milk, little aged cheese, poorly cooked or fried meat. The causative agent, penetrating the body through the digestive tract, cracks, scratches and other damage to the skin or mucous membrane, then spreads through the lymphatic tract and blood vessels, which makes any organ accessible to this disease. Granulomas form in the mesenchymal and connective tissue. At the site of attachment of the tendon muscles, formations of a cartilaginous consistency (fibrositis) appear the size of a lentil and larger. They cause pain in the joints, bones, muscles. The consequences of brucellosis can become persistent and irreversible, causing temporary or permanent disability.

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

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

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

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

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

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

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

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

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

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

Typhoid fever. An acute infectious disease caused by a bacterium of the genus Salmonella. The pathogen can persist in soil and water for up to 1-5 months. Killed by heating and the action of conventional disinfectants.

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

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

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

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

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

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

Chicken pox. Acute viral disease mainly in children from 6 months. up to 7 years old. In adults, the disease is less common. The source of infection is a sick person, representing a danger from the end of the incubation period until the crusts fall off. The causative agent belongs to the group of herpes viruses and is spread by airborne droplets.

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

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

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

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

Viral hepatitis. Infectious diseases occurring with general intoxication and predominant liver damage. The term "viral hepatitis" combines two main nosological forms - viral hepatitis A (infectious hepatitis) and viral hepatitis B (serum hepatitis). In addition, a group of viral hepatitis "neither A nor B" has been identified. The pathogens are quite stable in the external environment.

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

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

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

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

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

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

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

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

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

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

hemorrhagic fevers. Acute infectious diseases of a viral nature, characterized by toxicosis, fever and hemorrhagic syndrome - the outflow of blood from the vessels (bleeding, hemorrhage). The causative agents belong to the group of arboviruses, the reservoir of which is mainly mouse-like rodents and ixodid ticks. Infection occurs when a tick bites, when people come into contact with rodents or objects contaminated with their secretions, through the air (hemorrhagic fever with renal syndrome). Hemorrhagic fevers are natural focal diseases. They occur in the form of isolated cases or small outbreaks in rural areas, especially in areas not sufficiently developed by man.

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

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

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

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

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

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

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

Flu. An acute respiratory illness caused by various types of influenza viruses. Their source is a person, especially in the initial period of the disease. The virus is released when talking, coughing and sneezing up to 4-7 days of illness. Infection of healthy people occurs by airborne droplets.

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

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

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

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

Dysentery. An infectious disease caused by bacteria of the Shigella genus. The source of infection is a sick person and a bacteriocarrier. Infection occurs when contaminated food, water, objects directly with hands or flies. Dysenteric microbes are localized mainly in the large intestine, causing inflammation, superficial erosions and ulcers.

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

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

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

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

Diphtheria(from Greek - skin, film). An acute infectious disease predominantly in children with damage to the throat (less often - the nose, eyes, etc.), the formation of fibrinous plaque and general intoxication of the body. The causative agent - Lefler's wand releases a toxin, which causes the main symptoms of the disease. Infection from patients and bacteria carriers through the air (when coughing, sneezing) and objects. Not all infected people get sick. Most of them form a healthy bacteriocarrier. In recent years, there has been a tendency towards an increase in the incidence, seasonal rises occur in autumn.

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

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

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

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

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

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

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

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

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

Yersiniosis. Infectious disease of humans and animals. Typical fever, intoxication, damage to the gastrointestinal tract, joints, skin. Tendency to an undulating course with exacerbations and relapses. The causative agent belongs to the Enterobacteriaceae family, the Yersinia genus. The role of various animals as a source of infections is unequal. The reservoir of the pathogen in nature are small rodents that live both in the wild and synanthropic. A more significant source of infection for humans are cows and small cattle, which are acutely ill or excrete the pathogen. The main route of transmission of the infection is alimentary, that is, through food, most often vegetables. They suffer from yersiniosis at any age, but more often children at the age of 1-3 years. Basically, sporadic cases of the disease predominate, there is an autumn-winter seasonality.

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

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

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

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

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

Infectious mononucleosis (Filatov's disease). It is believed that the causative agent is a filterable Epstein-Barr virus. Infection is possible only with very close contact of the patient with a healthy one, occurs by airborne droplets. Children get sick more often. The incidence is noted all year round, but is higher in the autumn months.

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

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

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

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

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

Whooping cough. Infectious disease with acute damage to the respiratory tract and bouts of spasmodic cough. The causative agent is the Borde-Jangu wand. The source of infection is a sick person, bacteria carriers. Patients in the initial stage (catarrhal period of the disease) are especially dangerous. The infection is transmitted by airborne droplets; preschool children get sick more often, especially in autumn and winter.

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

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

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

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

Body temperature remains normal. General health is satisfactory.

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

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

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

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

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

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

Measles. Acute highly contagious disease, accompanied by fever, inflammation of the mucous membranes, rash.

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

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

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

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

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

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

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

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

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

Rubella. An acute viral disease with a characteristic small-spotted rash - exanthema, generalized lymphadenopathy, moderate fever and fetal damage in pregnant women. The causative agent belongs to togaviruses, contains RNA. In the external environment, it is unstable, quickly dies when heated to 56 ° C, when dried, under the influence of ultraviolet rays, ether, formalin, and other disinfectants. The source of infection is a person with rubella, especially in a subclinical form that occurs without a rash.

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

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

Complications: arthritis, rubella encephalitis.

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

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

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

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

Prevention. Most important in women of childbearing age. Some recommend starting vaccinations for girls at the age of 13-15 years. Patients with rubella are isolated until 5 days after the onset of the rash.

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

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

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

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

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

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

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

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

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

Q fever. Acute rickettsial disease, characterized by general toxic effects, fever and often atypical pneumonia. The causative agent is a small microorganism. Very resistant to drying, heat, UV radiation. The reservoir and source of infection are various wild and domestic animals, as well as ticks. Infection of people occurs by contact with them, the use of dairy products and airborne dust. The disease is detected throughout the year, but more often in spring and summer. QU fever is widespread throughout the globe, with natural foci found on 5 continents.

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

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

Prevention. The fight against KU-rickettsiosis in domestic animals is being carried out. Livestock rooms are disinfected with a 10% bleach solution. Milk from sick animals is boiled. In natural foci, it is recommended to fight ticks and use repellents. For the specific prevention of fever, KU vaccinates persons in contact with animals. Patients with KU-fever do not pose a great danger to the people around them.

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

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

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

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

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

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

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

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

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

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

ORZ. Acute respiratory diseases (acute catarrhs ​​of the respiratory tract). A very common disease with a primary lesion of the respiratory tract. Caused by various etiological agents (viruses, mycoplasmas, bacteria). Immunity after past diseases is strictly type-specific, for example, to the influenza virus, parainfluenza, herpes simplex, rhinovirus. Therefore, one and the same person can get acute respiratory disease up to 5-7 times during the year. The source of infection is a person with clinically expressed or erased forms of acute respiratory disease. Healthy virus carriers are of less importance. Transmission of infection occurs predominantly by airborne droplets. Diseases occur in the form of isolated cases and epidemic outbreaks.

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

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

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

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

Ornithosis. Acute infectious disease from the influenza group. It is characterized by fever, general intoxication, damage to the lungs, nervous system, enlargement of the liver and spleen. The reservoir and source of infection are domestic and wild birds. Currently, the causative agent of ornithosis has been isolated from more than 140 species of birds. Domestic and indoor birds, especially city pigeons, are of the greatest epidemiological importance. Occupational diseases account for 2-5% of the total number of cases. Infection occurs by air, but foodborne infection occurs in 10% of patients. The causative agent of ornithosis refers to chlamydia, it persists in the external environment for up to 2-3 weeks. Resistant to sulfanilamide drugs, sensitive to antibiotics of the tetracycline group and macrolides.

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

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

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

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

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

Smallpox is natural. Refers to quarantine infections, characterized by general intoxication, fever, pustular-papular rash, leaving scars. The causative agent found in the contents of smallpox refers to viruses, contains DNA, multiplies well in human tissue culture, and is resistant to low temperature and drying. The sick person is dangerous from the first days of illness until the crusts fall off. The transmission of the pathogen occurs mainly by airborne droplets and airborne dust. Smallpox has now been eradicated worldwide.

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

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

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

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

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

Paratyphoid A and B. Acute infectious diseases that are clinically similar to typhoid fever. Pathogens - mobile bacteria from the genus Salmonella, stable in the external environment. Disinfectants at normal concentrations will kill them in a few minutes. The only source of infection for paratyphoid A are sick and bacterial excretors, and for paratyphoid B, animals (cattle, etc.) can also be the source of infection. Ways of transmission are more often fecal-oral, less often contact-household (including fly).

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

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

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

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

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

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

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

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

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

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

Parotitis epidemic (mumps). A viral disease with general intoxication, an increase in one or more salivary glands, often damage to other glandular organs and the nervous system. The causative agent is a spherical virus with a tropism for glandular and nervous tissues. Little resistant to physical and chemical factors. The source of the disease is a sick person. Infection occurs by droplet, the possibility of a contact route of transmission is not excluded. The virus is found in saliva at the end of the incubation period for 3-8 days, after which the isolation of the virus stops. Outbreaks are often local in nature.

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

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

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

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

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

The prognosis is favorable.

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

Food poisoning. A polyetiological disease that occurs when microbial agents and (or) their toxins enter the body with food. The disease typically has an acute onset, a rapid course, symptoms of general intoxication and lesions of the digestive system. Pathogens - staphylococcal enterotoxins of type A, B, C, D, E, salmonella, shigella, escherichia, streptococci, spore anaerobes, spore aerobes, halophilic vibrios. The mechanism of transmission is fecal-oral. The source of infection is a sick person or bacterial carrier, as well as sick animals and bacterial excretors. The disease can occur both in the form of sporadic cases and outbreaks. The incidence is recorded throughout the year, but slightly increases in warm weather.

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

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

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

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

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

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

Erysipelas. Infectious disease with general intoxication of the body and inflammatory skin lesions. The causative agent - erysipelas streptococcus, is stable outside the human body, tolerates drying and low temperatures well, dies when heated to 56 ° C for 30 minutes. The source of the disease is the patient and the carrier. Contagiousness (infectiousness) is insignificant. The disease is registered in the form of individual cases. Infection occurs mainly when the integrity of the skin is violated by contaminated objects, tools or hands.

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

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

By multiplicity - primary, recurrent, repeated.

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

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

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

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

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

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

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

The prognosis is favorable.

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

Anthrax. An acute infectious disease from the group of zoonoses, characterized by fever, damage to the lymphatic apparatus, intoxication, occurs in the form of a skin, rarely intestinal, pulmonary and septic form. The causative agent is an aerobic bacterium - a motionless, large-sized stick with chopped ends. Outside the body of humans and animals, it forms spores that are highly resistant to physical and chemical influences. The source of anthrax bacteria is sick or dead animals. Human infection is more often carried out by contact (when cutting animal carcasses, processing skins, etc.) and by eating foods contaminated with spores, as well as through water, soil, fur products, etc.

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

The incubation period is from 2 to 14 days.

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

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

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

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

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

septic form proceeds very rapidly and ends in death.

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

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

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

Scarlet fever. Acute streptococcal disease with punctate rash, fever, general intoxication, tonsillitis, tachycardia. The causative agent is group A toxigenic streptococcus. The source of infection is a sick person, the most dangerous in the first days of illness. Children under 10 years of age are more commonly affected. The incidence also increases in the autumn-winter period.

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

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

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

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

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

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

Tetanus. An acute infectious disease with skeletal muscle hypertonicity, periodically occurring convulsions, increased excitability, general intoxication, and high mortality.

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

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

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

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

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

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

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

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

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

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

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

Typhus. The disease is caused by Provachek's rickettsia, characterized by a cyclic course with fever, typhoid condition, a kind of rash, as well as damage to the nervous and cardiovascular systems.

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

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

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

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

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

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

Tularemia. Zoonotic infection with natural foci. It is characterized by intoxication, fever, damage to the lymph nodes. The causative agent of the disease is a small bacterium. When heated to 60 ° C, it dies in 5-10 minutes. Tularemia bacillus reservoirs - hares, rabbits, water rats, voles. Epizootics periodically occur in natural foci.

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

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

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

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

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

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

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

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

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

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

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

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

Cholera. Acute infectious disease. It is characterized by damage to the small intestine, impaired water-salt metabolism, varying degrees of dehydration due to loss of fluid with watery stools and vomit. Refers to the number of quarantine infections. The causative agent is Vibrio cholerae in the form of a curved stick (comma). When boiled, it dies after 1 minute. Some biotypes persist for a long time and multiply in water, in silt, in the organisms of the inhabitants of water bodies. The source of infection is a person (patient and bacillus carrier). Vibrios are excreted in faeces, vomit. Epidemics of cholera are water, food, contact-household and mixed. Susceptibility to cholera is high.

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

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

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

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

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

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

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

Plague. Quarantine natural focal disease characterized by high fever, severe intoxication, the presence of buboes (hemorrhagic-necrotic changes in the lymph nodes, lungs and other organs), as well as sepsis. The causative agent is a motionless, barrel-shaped plague bacillus.

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

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

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

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

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

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

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

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

Tick-borne encephalitis (taiga, spring-summer). An acute neuroviral disease characterized by damage to the gray matter of the brain and spinal cord with the development of paresis and paralysis. The causative agent is an RNA genomic virus, from the group of arboviruses. Sensitive to disinfectant solutions. Encephalitis is a natural focal disease. Wild animals (mice, rats, chipmunks, etc.) and ixodid ticks, which are carriers of infection, serve as a reservoir. Infection of a person is possible with a tick bite and in the alimentary way (with the use of raw milk). The disease is more common in taiga and forest-steppe areas.

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

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

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

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

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

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

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

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

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

FMD. Viral infection with specific lesions of the mucous membrane of the mouth, lips, nose, skin, in the interdigital folds and at the nail bed. The causative agent is a filterable RNA containing a spherical virus. Well preserved in the environment. Artiodactyl animals (large and small cattle, pigs, sheep and goats) are ill with foot-and-mouth disease. In sick animals, the virus is shed in saliva, milk, urine, and manure. Human susceptibility to the lizard is low. Ways of transmission contact and food. The disease is not transmitted from person to person.

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

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

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

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

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

Acute respiratory diseases (ARI) are diseases of diverse origins that have similar epidemiological and clinical characteristics.. A typical clinical picture of this group of diseases is characterized by inflammatory changes in the mucous membranes of the respiratory tract. Currently, there are 2 groups of acute respiratory infections: 1) diseases of the upper respiratory tract: rhinitis, sinusitis, pharyngitis, tonsillitis, otitis media (ARI/URT); 2) diseases of the lower respiratory tract: laryngitis, tracheitis, bronchitis, pneumonia (ARI / NDP)

In addition, there is a diagnosis of ARVI - acute respiratory viral infections, when there is no clear idea of ​​a specific viral disease that caused damage to the child's respiratory tract.

ARI provokes the formation of foci of chronic inflammation in children, the development of allergic diseases, and the exacerbation of latent foci of infection. Therefore, the prevention of the incidence of acute respiratory infections in children in preschool institutions is an important task. The most common causative agents of acute respiratory diseases in children's organized groups are influenza viruses, parainfluenza, adenoviruses. An important role in the etiology is played by coronaviruses, mycoplasma infection, etc.

Close contact of children in groups where pathogens causing various respiratory diseases are widely circulating often leads to diseases of mixed etiology.

The causative agents of acute respiratory infections - low resistance in the external environment - when exposed to disinfectants, heat, ultraviolet irradiation and drying, quickly die. For some time they can exist in mucus, saliva, sputum, secreted by the sick and falling on handkerchiefs, towels, dishes used by a sick child.

The source of infection for all acute respiratory infections is a patient, less often - virus carriers. The maximum contagiousness of the patient is noted in the first 3 days of illness and is especially high during catarrhal changes. The duration of the infectious period is about a week, with adenovirus infection - up to 25 days. Infection occurs by airborne droplets, when the discharge of the upper respiratory tract enters the surrounding air when talking, coughing, sneezing.

The susceptibility of children to ARI is very high. Susceptibility especially increases in the period from 6 months to 3 years. Children over 3 years of age are mainly susceptible to influenza, relative immunity is acquired to all other acute respiratory infections, especially in children who attend preschool institutions for a long time.

Domestic pediatricians classify children as frequently ill on the basis of the criteria proposed by V. Yu. Albitsky and A. Baranov. So, often ill children of 1 year old are considered children who have had acute respiratory infections 4 times or more a year, from 1 year to 3 years - 6 times or more, from 4 to 5 years - 5 times or more, older than 5 years - 4 times or more . In children older than 3 years, the infection index (II) is used as a criterion for inclusion in the group of frequently ill children (FIC): the ratio of the sum of all cases of acute respiratory infections during the year to the age of the child. In rarely ill children, this index ranges from 0.2 to 0.3, in frequently ill children, from 1.1 to 3.5.

Foci of parainfluenza, rhinovirus, adenovirus and other infections usually have a limited, local character, although epidemic outbreaks have been described for adenovirus infection.

The incidence of acute respiratory infections is promoted by overcrowding, unsatisfactory hygienic condition of residential premises, public places, a cold factor, which causes the seasonality of the incidence. Influenza epidemics can occur at any time of the year.

Incubation period often calculated in hours, usually does not exceed 7 days; it can be somewhat lengthened with adenovirus infection. The onset of the disease is acute, mainly with symptoms of intoxication, which is especially characteristic of influenza, with the usual symptoms of CNS damage (fever, deterioration of health, sleep, appetite, etc.).

ARI can cause damage to the throat, respiratory tract, starting from the upper respiratory tract and ending with the lungs, hence the various clinical forms: rhinitis, pharyngitis, tonsillitis, laryngitis, tracheitis, bronchitis, pneumonia. Any of these forms can occur from the moment of the disease in the form of local processes, as it were. Their distinguishing feature is the predominantly catarrhal nature of inflammatory changes. In young children, asthmatic bronchitis often occurs with shortness of breath, symptoms of impaired gas exchange. Perhaps a violation of the function of the intestine associated with a viral lesion of its mucous membrane.

The course of acute respiratory infections is predominantly short, without complications, intoxication, including high body temperature, lasts 1-2 days, catarrhal and other phenomena disappear more slowly.

ARI can provoke an exacerbation of chronic diseases (tonsillitis, pneumonia, tuberculosis, rheumatism, etc.).

Flu

There are three independent types of influenza virus: A, B and C. In addition, there are varieties: A1, A2, B1.

The influenza virus is characterized by variability, resulting in the formation of new variants of the virus. With influenza, toxicosis and local changes are more pronounced than with other acute respiratory viral infections. The virus primarily affects the central and autonomic nervous systems, blood vessels, respiratory tract epithelium, and lung tissue. Due to toxicosis with influenza, violations of the functions of the liver, pancreas, and small intestine are possible (see Appendix 19).

Usually the disease begins suddenly, with a high rise in body temperature (39-40 ° C), chills, general malaise, headache, pain in the back, lower back, limbs. Some patients experience apathy, drowsiness, while others, on the contrary, have agitation, insomnia, and delirium. Sometimes the body temperature does not rise, but the course of the flu may not be easier than in cases with severe fever. Catarrhal phenomena: runny nose, tonsillitis, conjunctivitis - develop on the 2-3rd day of illness and are usually not as pronounced as with measles or other diseases of the upper respiratory tract.

If the flu proceeds without complications, then the disease ends in 5-7 days, but this rarely happens in children. Influenza causes changes in reactivity in them, a decrease in immunity, which often leads to an exacerbation of chronic diseases, as well as a layering of new diseases and complications.

Complications in some cases begin in the first days of the disease, in others - on the 5-7th day of the disease. The most common and severe complication of influenza is pneumonia. Otitis media, bronchitis, laryngitis, or influenza croup may also occur.

parainfluenza

Parainfluenza viruses are closely related to the influenza virus. 4 types are known. The disease is observed in the form of sporadic cases and periodic (more often in the spring months) group outbreaks. The clinical manifestations of parainfluenza are similar to those of influenza. The disease begins gradually, proceeds with less pronounced intoxication, without complications. The period of fever is usually longer than with influenza, about a week; there are catarrhal changes in the upper respiratory tract and pharynx. Parainfluenza is often accompanied by laryngitis with persistent cough, croup, pharyngitis, rhinitis, asthmatic bronchitis. There are also very mild forms of parainfluenza with mild symptoms of catarrh of the upper respiratory tract and normal body temperature. Complications are the same as with other acute respiratory infections.

adenovirus infection

Adenoviruses were first discovered in the adenoids and tonsils. About 50 types of viruses are currently known. Unlike other viruses, they are more resistant to external temperature influences; can be detected in smears from the throat and nose for 14-15 and even 25 days of the course of the disease. In addition, they can multiply in the intestines and are also excreted in faeces for a long time, which does not exclude the possibility of infection by the alimentary route (through food).

The disease is registered in all seasons of the year with separate intra-group outbreaks in the spring and autumn periods.

Adenovirus infection occurs in the form of acute catarrh of the upper respiratory tract, bronchitis and possible inflammation of the lungs are less common. Along with acute forms, there are subacute, protracted forms in the form of nasopharyngitis and tonsillitis, accompanied by constant release of the virus, which is dangerous from an epidemiological point of view.

Coronavirus infection is detected in all seasons of the year. Along with sporadic diseases, these viruses can cause local outbreaks, especially in the winter-spring period.

Coronavirus infection usually occurs with a moderate increase in body temperature, accompanied by malaise, profuse serous nasal discharge, hoarseness, sore throat, coughing, and cervical lymphadenitis.

Mycoplasma infection usually constantly circulates in the community. It proceeds with cough, mild catarrh, fever, sometimes accompanied by intoxication, which is manifested by vomiting, headaches, maculopapular rash. Expressed forms of the disease are usually observed if a viral infection joins it.

For the prevention of acute respiratory infections of viral etiology, systematic ventilation, irradiation of rooms where children are located with a mercury-quartz lamp, and wet cleaning are necessary. Of great importance are the correct physical education of children, their hardening. When serving toddlers, gauze masks are used. Sanitary-educational work among the population is necessary.

When the first symptoms of an acute respiratory illness appear, the child should be immediately isolated, regardless of the severity of the illness. The patient must observe bed rest until the disappearance of fever and severe toxicosis. This is necessary for his speedy recovery, as well as to prevent complications and spread the infection.

As a rule, the patient is isolated at home. The child is placed in a separate room or his bed is fenced off from the rest of the room with a screen, curtain, sheet. In some cases, patients with influenza are placed in the isolation ward of a children's institution. Only seriously ill patients with serious complications are hospitalized. The greatest number of acute respiratory infections is observed in the first months of children's admission to preschool institutions, therefore, serious attention should be paid to the preparation of newly arriving children for staying in children's groups. Children who are often ill, have anomalies of the constitution, allergic reactions, chronic foci of inflammation, it is necessary to carry out vigorous sanitation of the nasopharynx, paranasal sinuses, tonsils, and oral cavity organs. It is necessary to eliminate the most complete clinical manifestations of allergy on the part of the skin and mucous membranes, get recommendations from the allergist on the regimen, nutrition and treatment of such children. A child who has had an acute illness can be admitted to a preschool institution no earlier than 2 weeks after recovery.

Sick children need proper care. They should be watered more often, since the liquid eliminates the dryness of the mucous membranes of the upper respiratory tract, increases the excretion of urine and sweat, and thus helps to remove poisonous products produced by microorganisms through the kidneys and skin; change sweaty clothes in a timely manner; feed properly, limiting foods that can irritate the mucous membranes of the mouth (nuts, crackers, etc.). Patients with acute respiratory infections, more than healthy ones, need a constant supply of fresh air, which promotes better gas exchange and prevents the occurrence of pneumonia. At the slightest opportunity in warm weather, a sick child should be taken out for the whole day to fresh air. If the conditions do not allow this or if the weather is cold, the room where the patient is located should be carefully (up to 6 times a day) ventilated. Persons serving the patient, especially the flu, when caring for him, should cover his mouth and nose with masks of gauze folded 4 times. After use, the masks are either boiled or carefully ironed with a hot iron.

ARI is transmitted not only through direct communication, but also through the utensils and things of the patient, especially handkerchiefs, so all items must be disinfected: boil handkerchiefs, floors and furniture in the room where the patient is located, wipe daily with a solution of bleach or chloramine.

During an influenza epidemic, contact between children and other adults and children is limited to a minimum. Visits by children to cinemas, theaters, museums, matinees are temporarily stopped, their travel in city and railway transport is reduced if possible.

Currently, for preventive and therapeutic purposes, such agents as ribomunil, interferon are used, which increase the body's resistance to viruses. If an infection occurs in children's groups, in early age groups, all children are given gamma globulin with a high content of influenza antibodies.

Of great importance in the prevention of influenza is the fight against dust in the air. Irritating the mucous membranes of the upper respiratory tract, dust reduces their resistance to infection. In addition, the presence of dust particles contributes to the long-term persistence of the influenza virus in the air. Therefore, the room should be cleaned with a wet method.

Chlamydial infection

Chlamydial infections are a group of diseases that are caused by chlamydia. Chlamydia are bacterial in nature and are widespread throughout the world. The source of infection is a sick person. The main mechanisms of transmission include contact, drip and blood contact. The most common routes of transmission are contact-household (through toys, household items), airborne, transplacental. Chlamydia can cause eye, respiratory, and genitourinary diseases.

The most serious type of eye injury is trachoma , which is characterized by conjunctivitis, inflammatory changes in the cornea (keratitis), followed by its scarring and blindness. The disease was widespread in the Central Asian republics. On the territory of Russia, it is considered completely liquidated since 1969 (V.N. Timchenko).

Respiratory chlamydia can occur in children during the first months of life in the form of bronchitis and pneumonia. The incubation period lasts from 5 to 30 days. The onset of the disease is gradual, rarely acute.

With bronchitis, a pertussis-like paroxysmal cough is often observed against the background of normal or slightly elevated body temperature. The cough may continue for a week. Recovery occurs after 2 weeks.

Chlamydia pneumonia is accompanied by changes in the lungs and enlargement of the lymph nodes. Delayed treatment can contribute to the transition of the disease into a chronic form.

Urogenital chlamydia the most widespread among adults and adolescents, it is transmitted sexually. It almost never occurs in children.

Prevention consists in the timely detection and treatment of patients with chlamydia and the implementation of generally accepted measures. Children who were born from mothers with chlamydia, after microbiological confirmation of the presence of infection, are prescribed appropriate treatment. Only a doctor can establish the presence of chlamydia lesions after a clinical examination of children. Preschool workers should remember that under the "mask" of acute respiratory infections, many diseases can occur, including chlamydia.