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

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

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

Recognition. The presence of a bite or contact with saliva of rabid animals on damaged skin is of great importance. One of the most important signs human diseases - hydrophobia with symptoms of spasm 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 is a symptom of aerophobia - muscle cramps that occur at the slightest movement of air. Increased salivation is also characteristic; in some patients, a thin 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 developed Lately a method for detecting rabies virus antigen in prints from the surface of the eye.

Treatment. There are no effective methods, which makes saving the patient’s life problematic in most cases. We have to limit ourselves to purely symptomatic remedies for relief. painful state. Motor agitation is relieved with sedatives, and convulsions are eliminated with curare-like drugs. Respiratory disorders are compensated by tracheotomy and connecting the patient to an artificial respiration apparatus.

Prevention. Fighting rabies among dogs, exterminating stray ones. People bitten by animals known to be sick or suspected of rabies should immediately wash the wound with warm boiled water (with or without soap), then treat it with 70% alcohol or alcohol tincture iodine and contact a medical facility as soon as possible to get vaccinated. It consists of injecting anti-rabies serum or anti-rabies immunoglobulin into the depths of the wound and into the soft tissue around it. You need to know that vaccinations are effective only if they are done no later than 14 days from the moment of being bitten or salivated by a rabid animal and carried out according to strictly established rules with a highly immune vaccine.

Botulism. A disease caused by products contaminated with botulism bacilli. The pathogen is an anaerobe, widespread in nature, and can remain in the soil in the form of spores for a long time. It comes from the soil, from the intestines of farm animals, as well as some freshwater fish, onto 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 a powerful bacterial poison. It is not destroyed by intestinal juice, and some of its types (type E toxin) even enhance their effect.

Typically, the toxin accumulates in foods such as canned food, salted fish, sausage, ham, and mushrooms prepared in violation of technology, especially at home.

Symptoms and course. The incubation period lasts from 2-3 hours to 1-2 days. Initial signs - general weakness, slight headache. Vomiting and diarrhea do not always occur; more often, persistent constipation does not respond to enemas and laxatives. Botulism affects the nervous system (impaired vision, swallowing, voice changes). The patient sees all objects as if in a fog, double vision appears, the pupils are dilated, with one wider than the other. Strabismus and ptosis are often observed - drooping of the upper eyelid of one eye. Sometimes there is a lack of accommodation - the reaction of the pupils to light. The patient experiences dry mouth, his voice is weak, and his speech is slurred.

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

Recognition. It is carried out on the basis of anamnesis - the connection of the disease with the consumption of a certain food product and the development of similar phenomena in people who consumed the same product. In the early stages of the disease, it is necessary to distinguish between botulism and poisoning by poisonous mushrooms, methyl alcohol, atropine. Should be carried out differential diagnosis 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, magnesium sulfate), peach or other vegetable oil to bind toxins, gastric lavage with warm 5% sodium bicarbonate solution ( baking soda). And most importantly, the urgent administration of anti-botulinum serum. Therefore, all patients are subject to immediate hospitalization. In cases where 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 (for example, type A or E). If this cannot be established, use a polyvalent mixture of serums A, B and E.

Careful care of the patient is necessary, breathing equipment is used according to indications, and measures are taken to maintain the physiological functions of the body. For swallowing disorders, artificial nutrition is provided through a tube or nutritional enemas. Among medications, chloramphenicol (0.5 g 4-5 times a day for 5-6 days, as well as adenosine triphosphoric acid (intramuscular injection 1 ml of 1% solution 1 time a day) in the first 5 days of treatment has an auxiliary effect. monitor bowel regularity.

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

Compliance with sanitary and hygienic requirements is also mandatory when canning at home. Remember that spores of the anaerobic microbe botulism live in the soil, and multiply and release poison in conditions where there is no oxygen. The danger is posed by canned mushrooms that are not sufficiently cleared of soil, where 1 spores can remain, and canned meat and fish from bloated cans. Products with signs of poor quality are strictly prohibited: they have the smell of sharp cheese or rancid butter.

Brucellosis. An infectious disease caused by Brucella - small pathogenic bacteria. A person becomes infected from domestic animals (cows, sheep, goats, pigs) when caring for them (veterinarians, milkmaids, etc.) or by consuming infected products - milk, poorly aged cheese, poorly cooked or fried meat. The pathogen, 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) the size of lentils or larger appear. They cause pain in joints, bones, and 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 responds to infection by enlarging a number of lymph glands, the liver and the spleen. In its course, brucellosis can be acute (lasts 2 months), subacute (from 2 to 4-5 months) and chronic, including 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, and poor sleep. Patients complain of pain in the joints, lower back, and muscles. Body temperature gradually (3-7 days) rises to 39°C, subsequently taking on a wave-like character. Sweat profusely, moisture in the skin, especially the palms, is observed even when the temperature drops to normal.

After 20-30 days from the onset of the disease, the health of patients worsens, their pain increases, mainly in large joints - knees, then hips, ankles, shoulders, and less often elbows. The size and shape of the joint changes, its outlines are smoothed, the soft tissues surrounding it become inflamed and swell. The skin around the joint is shiny and may acquire a pink tint, and sometimes roseola-popular rashes of various types are observed.

Subsequently, without appropriate treatment, numerous disorders in musculoskeletal system(joints, bones, muscles) progress, which is caused by the spread of infection (bacteremia). Are growing pathological symptoms from the nervous system, patients become irritable, capricious, even whiny. They are tormented by neuralgic pain, sciatica, and radiculitis. Some have genital lesions. In men, brucellosis can be complicated by orchitis and epididymitis. In women, adnexitis, endometritis, mastitis, and spontaneous miscarriages are possible. From the blood side - anemia, leukopenia with lymphocytosis, monocytosis, increased ESR.

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

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

In the stage of attenuation of acute inflammatory phenomena, physical therapy and warm paraffin applications to the joints are prescribed. In case of stable remission - spa treatment taking into account existing contraindications.

Prevention. Combines a number of veterinary and health measures.

On farms, animals with brucellosis must be isolated. Their slaughter with subsequent processing of meat into canned food must be accompanied by autoclaving. Meat can also be eaten after boiling it in small pieces for 3 hours or salting it and keeping it in brine for at least 70 days. Milk from cows and goats in areas where there are cases of disease in 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. Brynza, made from sheep's milk, is aged for 70 days.

To prevent occupational infections when caring for sick animals, it is necessary to take all precautions (wear rubber boots, gloves, special gowns, aprons). The aborted fetus of an animal is buried in a hole 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. Immunization of people has limited value among other preventive measures.

Typhoid fever. An acute infectious disease caused by bacteria from the genus Salmonella. The pathogen can survive in soil and water for up to 1-5 months. Kills when heated and exposed to conventional disinfectants.

The only source of infection spread is a sick person and a bacteria carrier. Typhoid fever bacilli are transmitted directly with dirty hands, flies, sewage. Outbreaks associated with the consumption of infected food products(milk, cold meat dishes and etc.).

Symptoms and course. The incubation period lasts from 1 to 3 weeks. In typical cases, the disease begins gradually. Patients report weakness, fatigue, and 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 stool retention and flatulence. By day 7-9 of illness on the skin upper sections abdomen and lower regions chest, usually on the anterolateral surface, a characteristic rash appears, which consists of small red spots with clear edges, 23 mm in diameter, rising above the skin level (roseola). Disappearing roseolas may be replaced by new ones. Characterized by a peculiar lethargy of patients, paleness of the face, slowing of the pulse and decreased blood pressure. Scattered dry rales are heard 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 tooth marks. There is a rough rumbling of the cecum 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 increases to 15-20 mm/h. By the 4th week, the patients’ condition gradually improves, body temperature drops, headache disappears, and appetite appears. Terrible complications typhoid fever are intestinal perforation and intestinal bleeding.

In recognition of the disease, timely identification 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 disturbances, 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 (immunofluorescence method) blood culture on Rappoport's medium or bile broth is used; serological studies - Vidal reaction et al.

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

Prevention. Sanitary supervision of food enterprises, water supply, sewerage. Early identification of patients and their isolation. Disinfection of premises, linen, dishes that are boiled after use, control of flies. Dispensary observation of those who have had typhoid fever. Specific vaccination with vaccine (TAVTe).

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

Symptoms and course. The incubation period lasts on average 13-17 days. The disease begins with a rapid rise in temperature and the appearance of a rash on the various areas bodies. At the beginning, these are pink spots 2-4 mm in size, which within a few hours turn into papules, then into vesicles - vesicles filled with transparent contents and surrounded by a halo of hyperemia. In place of the burst vesicles, dark red and brown crusts form, which disappear in 2-3 weeks. The rash is characterized by polymorphism: on a separate area of ​​the skin you can simultaneously find spots, vesicles, papules and crusts. Enanthems appear on the mucous membranes of the respiratory tract (pharynx, larynx, trachea). These are blisters that quickly turn into an ulcer 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 be observed: encephalitis, myocarditis, pneumonia, false croup, various forms of pyoderma, etc.

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

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

Prevention. Isolation of the patient at home. Children of toddlers and preschool age who have been in contact with the patient are not allowed into child care facilities until 21 days. Weakened children who have not had chickenpox are administered immunoglobulin (3 ml intramuscularly).

Viral hepatitis. Infectious diseases that occur with general intoxication and primary 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 now 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 pre-icteric period, since at this time the pathogen is excreted in feces and transmitted through food, water, and household items if hygiene rules are not followed and 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 blood) when 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 occurs cyclically and is characterized by the presence of periods
- preicteric,
- icteric,
- post-icteric, moving into the recovery period.

The pre-icteric period of viral hepatitis A in half of the patients occurs 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. With the dyspeptic variant, pain and heaviness in the epigastric region, decreased appetite, nausea, vomiting, and sometimes increased stool frequency come to the fore. In the asthenovegetative variant, the temperature remains normal, weakness, headache, irritability, dizziness, and impaired performance and sleep are noted. The pre-icteric period of viral hepatitis B is most characterized by aching pain in large joints, bones, muscles, especially at night, sometimes swelling of the joints and redness of the skin. At the end of the pre-icteric period, urine becomes dark and 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, and in some patients itchy skin are noted. The liver is enlarged, hardened and somewhat painful on palpation, and an enlarged spleen is observed. Leukopenia, neutropenia, relative lymphocytosis and monocytosis are detected in the peripheral blood. ESR 2-4 mm/h. The content of total bilirubin in the blood 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 serious complication is the increase liver failure, manifested by memory impairment, increased general weakness, dizziness, agitation, increased vomiting, increased intensity of icteric coloration of the skin, decreased liver size, the appearance of hemorrhagic syndrome (bleeding of blood vessels), ascites, fever, neutrophilic leukocytosis, increased 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 presence in the infectious focus 15-40 days before the disease, a short pre-icteric period, often influenza-like variant, 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 transfusions, plasma, surgical interventions, and numerous injections. Laboratory values ​​confirm the diagnosis.

Treatment. There is no etiotropic therapy. The basis of treatment is regimen and proper nutrition. The diet must be complete and high in calories; fried foods, smoked meats, pork, lamb, chocolate, spices are excluded from the diet, and alcohol is absolutely prohibited. It is recommended to drink plenty of fluids, 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, hemodez, etc.). If there is a threat or development of liver failure, corticosteroids are indicated.

Prevention. Considering the fecal-oral mechanism of transmission of viral hepatitis A, it is necessary to control nutrition, water supply, and adherence to personal hygiene rules. To prevent 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 - bleeding from the vessels (bleeding, hemorrhage). The pathogens belong to the group of arboviruses, the reservoir of which is mainly mouse-like rodents and ixodid ticks. Infection occurs through tick bites, through contact of people 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 isolated cases or small outbreaks in rural areas, especially in areas not sufficiently developed by humans.

3 types of 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, muscle and eye pain, and sometimes blurred vision. The temperature rises to 39-40°C and lasts for 7-9 days. The patient is initially excited, then lethargic, apathetic, and sometimes delirious. The face, neck, upper chest and back are brightly hyperemic, there is redness of the mucous membranes and dilation of the blood vessels in the sclera. By the 3-4th day of illness, the condition worsens, intoxication increases, and repeated vomiting is observed. On the skin of the shoulder girdle and in armpits a hemorrhagic rash appears in the form of single or multiple small hemorrhages. These phenomena intensify every day, bleeding is noted, most often from the nose. The boundaries of the heart do not change, the sounds are muffled, sometimes arrhythmia appears and, less often, a pericardial friction noise (hemorrhage) suddenly appears. Blood pressure remains normal or decreases. Shortness of breath, in the lungs congestion. The tongue is dry, thickened, thickly covered with a gray-brown coating. The abdomen is painful (retroperitoneal hemorrhages), the liver and spleen are enlarged inconsistently. Renal syndrome is especially typical: severe pain in the abdomen and lower back when beating. Decreased amount of urine or its complete absence. The urine becomes cloudy due to the presence of blood and high protein content. Subsequently, recovery gradually occurs: pain subsides, vomiting stops, diuresis - the volume of urine excreted - increases. There has been weakness and instability of the cardiovascular system for a long time.

Crimean hemorrhagic fever. Body temperature reaches 39-40°C on day 1 and lasts for an average of 7-9 days. The patient is excited, the skin of the face and neck is red. Sharp redness of the conjunctiva of the eyes. The pulse is slow, blood pressure is low. Breathing is rapid, and there are often dry, scattered wheezes in the lungs. 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, gradual recovery occurs.

Omsk hemorrhagic fever the clinical picture resembles the Crimean one, but is more benign and has a short incubation period (2-4 days). Features are the wavy 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, dairy-vegetable diet. The pathogenetic means of therapy are corticosteroid drugs. To reduce toxicosis, solutions of sodium chloride or glucose (5%) up to 1 liter are administered intravenously. In acute renal failure, peritoneal dialysis is performed.

Prevention. Food storage areas are protected from rodents. Use repellents. Patients are isolated and hospitalized, an epidemiological examination of the source of infection and surveillance of the population are carried out. In rooms where patients are located, current and final disinfection is carried out.

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

Symptoms and course. The incubation period lasts 12-48 hours. The typical flu begins acutely, often with chills or chills. Body temperature reaches a maximum on day 1 (38-40°C). Clinical manifestations consist of a general toxicosis syndrome (fever, weakness, sweating, muscle pain, severe headache and pain in the eyeballs, lacrimation, photophobia) and signs of damage to the respiratory organs (dry cough, sore throat, soreness behind the sternum, hoarse voice, nasal congestion). During the examination, a decrease in blood pressure and muffled heart sounds are noted. Diffuse damage to the upper respiratory tract is detected (rhinitis, pharyngitis, tracheitis, larepgitis). Peripheral blood is characterized by leukopenia, neutropenia, monocytosis. ESR in uncomplicated cases is not increased. Frequent complications influenza are pneumonia, sinusitis, sinusitis, otitis, 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 warmth (hot water bottles on the feet, plenty of hot drinks). Multivitamins are prescribed. Pathogenetic and symptomatic drugs are widely used: antihistamines (pipolfen, suprastin, diphenhydramine), for runny nose, 2-5% solution of ephedrine, naphthyzine, galazolin, sanorip, 0.25% oxolinic ointment, etc. To improve drainage function respiratory tract - expectorants.

Prevention. Vaccination is used. Remantadine or amaptadine 0.1-0.2 g/day can be used to prevent influenza A. Those who are sick are given separate dishes, which are disinfected with boiling water. Caregivers are advised to wear a gauze dressing (4 layers of gauze).

Dysentery. An infectious disease caused by bacteria of the genus Shigella. The source of infection is a sick person and a bacteria carrier. Infection occurs when food, water, or objects are contaminated directly by 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, a feeling of heat, weakness, and loss of appetite. Then abdominal pain appears, initially dull, spread throughout the abdomen, later it becomes more acute, cramping. By location - lower abdomen, more often on the left, less often on the right. The pain usually intensifies before defecation. A kind of tenesmus also occurs ( nagging pain in the rectal area during defecation and for 5-15 minutes after it), a false urge to lower down appears. When palpating the abdomen, spasm and soreness of the colon are noted, more pronounced in the area of ​​the sigmoid colon, which is palpated in the form of a thick tourniquet. The stool is frequent, the bowel movements initially have a fecal character, then an admixture of mucus and blood appears in them, and then only a small amount of mucus streaked with blood is released. The duration of the disease ranges from 1-2 to 8-9 days.

Recognition. It is made on the basis of epidemiological history and clinical manifestations: general intoxication, frequent stools mixed with blood mucus and accompanied by tenesmus, cramping pain in the abdomen (left iliac region). The method of sigmoidoscopy is important, with the help of which signs of inflammation of the mucous membrane of the distal parts of the colon are revealed. Isolation of dysentery microbes during bacteriological examination of stool is an unconditional confirmation of the diagnosis.

Treatment. Patients with dysentery can be treated as in infectious diseases hospital, and at home. Among antibiotics, tetracycline (0.2-0.3 g 4 times a day) or chloramphenicol (0.5 g 4 times a day for 6 days) has recently been used. However, the resistance of microbes to them has increased significantly, and their 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 supplies, food enterprises, measures to combat flies, personal hygiene.

Diphtheria(from Greek - skin, film). An acute infectious disease mainly of children with damage to the pharynx (less often the nose, eyes, etc.), the formation of fibrinous plaque and general intoxication of the body. The causative agent - Lefler's bacillus - secretes 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 everyone infected gets sick. The majority develop healthy bacteria carriers. In recent years, there has been a tendency towards an increase in incidence, with seasonal increases occurring in the autumn.

Symptoms and course. By location, diphtheria is distinguished in the pharynx, larynx, nose, and rarely - eyes, ears, skin, genitals, wounds. At the site where the microbe is localized, a hard-to-remove grayish-white coating forms in the form of films, which is coughed out (if the larynx and bronchi are affected) as an impression of the organs. The incubation period is 2-10 days (usually 3-5). Currently, diphtheria of the pharynx 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, low-grade body temperature. Swelling of the tonsils and enlargement of the lymph nodes are minor. This form may end in recovery or develop into more typical forms.

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

Membranous diphtheria of the pharynx is characterized by a relatively acute onset, increased body temperature, and more pronounced symptoms of general intoxication. The tonsils are swollen, on their surface there are solid dense whitish films with a pearlescent tint - fibrinous deposits. They are difficult to remove, after which bleeding erosions remain on the surface of the tonsils. Regional lymph nodes are enlarged and somewhat painful. Without specific therapy, the process can progress and develop into more severe forms (common and toxic). In this case, the plaque tends to spread beyond the tonsils to the arches, uvula, lateral and posterior walls of the pharynx.

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

When the nasal mucosa is affected, sanguineous discharge is observed. In case of severe lesions of the larynx - difficulty breathing, 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, copious discharge pus on the conjunctiva of the eyelids, difficult to separate grayish-yellow deposits. With diphtheria of the vaginal opening - 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 is more common. Death may occur due to respiratory paralysis, asphyxia (suffocation) due to croup.

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

Treatment. The main method of specific therapy is the immediate administration of antitoxic anti-diphtheria serum, which is administered in fractions. For toxic diphtheria and croup, corticosteroid drugs are administered. Detoxification therapy, vitamin therapy, oxygen treatment are carried out. Sometimes croup requires urgent surgical intervention (intubation or tracheotomy) to avoid death from asphyxia.

Prevention. The basis of prevention is immunization. Adsorbed pertussis-diphtheria-tetanus vaccine (DTP) and ADS are used.

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 family of Enterobacteriaceae, the genus Yersinia. The role of different animals as a source of infections is unequal. The reservoir of the pathogen in nature is small rodents, living both in the wild and synanthropic. A more significant source of infection for people are cows and small cattle, which are acutely ill or excrete the pathogen. The main route of transmission of infection is nutritional, that is, through food, most often vegetables. People suffer from yersiniosis at any age, but more often children aged 1-3 years. Sporadic cases of the disease predominate, with autumn-winter seasonality observed.

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

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

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

Treatment. With absence concomitant diseases, in cases of mild and erased 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, and suppression of the pathogen. Medications - chloramphenicol at the rate of 2.0 g per day for 12 days, other drugs - tetracycline, gentamicin, rondomycin, doxycyclip and others in normal daily dosages.

Prevention. Compliance with sanitary rules in public catering establishments, preparation technology and shelf life of food products (vegetables, fruits, etc.). Timely identification of patients and carriers of yersiniosis, disinfection of premises.

Infectious mononucleosis (Filatov's disease). The causative agent is believed to be filterable Epstein-Barr virus. Infection is possible only through very close contact between a sick person and a healthy person and occurs through airborne droplets. Children get sick more often. The incidence occurs all year round, but is higher in the autumn months.

Symptoms and course. The duration of the incubation period is 5-20 days. Signs develop gradually, reaching a maximum at the end of the first, beginning of the second week. There is mild 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 cervical lymph nodes are observed.

Duration temperature reaction from 1-2 days to 3 weeks - the longer the period, the higher the temperature rise. Characteristic temperature changes during the day are 1-2°C. The enlargement of the lymph nodes is most pronounced and constant in the cervical group, along the posterior edge of the sternocleidomastoid muscle. They can be in the form of a chain or a package. The diameter of individual nodes reaches 2-3 cm. There is no swelling of the cervical tissue. The nodes are not soldered to each other, they are movable.

Nasopharyngitis can manifest as severe difficulty breathing and copious mucous discharge, as well as mild nasal congestion, soreness and mucous discharge on the back wall of the pharynx. A “spear-shaped” plaque hanging from the nasopharynx is usually combined with massive deposits on the tonsils, with a loose, cheesy 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 skin rashes are possible: the rash varies and lasts for several days. In some cases, conjunctivitis and damage to the mucous membranes may prevail over other symptoms.

Recognition. This is possible only with a comprehensive accounting of clinical and laboratory data. Typically, an increase in lymphocytes (at least 15% compared to the age norm) and the appearance of “atypical” mononuclear cells in the blood are noted in the blood formula. Serological studies are carried out to identify heterophilic antibodies to the erythrocytes of various animals.

Treatment. There is no specific therapy, so symptomatic therapy is used in practice. During fever, take antipyretics and drink plenty of fluids. If nasal breathing is difficult, use vasoconstrictor drugs (ephedrine, galazolin, etc.). Desensitizing drugs are used. It is recommended to gargle with warm solutions of furatsilin and sodium bicarbonate. The nutrition of patients with a successful course does not require special restrictions. Prevention has not been developed.

Whooping cough. Infectious disease with acute lesion respiratory tract and attacks of spasmodic cough. The causative agent is Bordet-Gengou bacillus. 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 become ill 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, a slight cough, runny nose, and low-grade fever.

Gradually the cough intensifies, children become irritable and capricious. At the end of the 2nd week of illness, a period of spasmodic cough begins. The attack is accompanied by a series of coughing impulses, followed by a deep whistling breath (reprise), followed by a series of short convulsive impulses. The number of such cycles ranges from 2 to 15. The attack ends with the release of viscous glassy sputum, and sometimes vomiting is observed at the end. 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, and respiratory arrest may occur, followed by asphyxia.

The number of attacks ranges 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 “regular cough” continues for 2-3 weeks.

In adults, the disease occurs without attacks of convulsive coughing and manifests itself as 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 laryngeal stenosis (false croup), bronchitis, broncholitis, bronchopneumonia, pulmonary atelectasis, rarely encephalopathy.

Recognition. It is possible only by analyzing clinical and laboratory data. The main method is to isolate 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 and severe forms of whooping cough, are hospitalized. The rest can be treated at home. Antibiotics are used at an early age, for severe and complicated forms. It is recommended to use specific anti-pertussis gamma globulin, which is administered intramuscularly in a dose of 3 ml daily for 3 days. During apnea it is necessary to cleanse Airways from mucus by suctioning it and perform artificial ventilation.

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

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

Measles. An acute, highly contagious disease accompanied by fever, inflammation of the mucous membranes, and rash.

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

Symptoms and course. In typical cases, from the moment of infection to the onset of the disease, 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 pharyngeal mucosa, the cervical lymph nodes are slightly enlarged, and dry wheezing is heard in the lungs. After 2-3 days, measles enanthema appears on the mucous membrane of the palate in the form of small pink elements. Almost simultaneously with enanthema, many pinpoint whitish areas can be detected on the mucous membrane of the cheeks, 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 doctor Koplik (1890). Belsky-Filatov-Koplik spots persist until the rash begins, then they become less and less noticeable and disappear, leaving behind roughness of the mucous membrane (pityriasis peeling).

During the period of the rash, catarrhal symptoms are much more pronounced, photophobia, lacrimation are noted, runny nose, cough, and symptoms of bronchitis intensify. A new rise in temperature to 39-40°C is observed, the patient’s condition worsens significantly, lethargy, drowsiness, refusal to eat, and in severe cases, delirium and hallucinations are noted. The first measles maculopapular rash appears on the skin of the face, initially located on the forehead and behind the ears. The size of individual elements is from 2-3 to 4-5 mm. Over the course of 3 days, the rash gradually spreads from top to bottom: on the first day it predominates on the skin of the face, on the 2nd day it becomes abundant on the torso and arms, and 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 expected. Body temperature normalizes, catarrhal symptoms 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, severe asthenia, increased fatigue, irritability, drowsiness, and decreased resistance to the effects of bacterial flora are noted.

Treatment. Mostly at home. You should cleanse your eyes, nose, and lips. Drinking plenty of fluids should meet the body's need for fluid. Food is complete, rich in vitamins, easily digestible. Symptomatic therapy includes antitussives, antipyretics, and antihistamines. For uncomplicated measles, there is usually no need to resort to antibiotics. They are prescribed at the slightest suspicion of bacterial complication. At in serious condition patients are treated with corticosteroids for a short course at a dose of up to 1 mg/kg of body weight.

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

Rubella. An acute viral disease with a characteristic small-spotted rash - exanthema, generalized lymphadenopathy, moderate fever and damage to the fetus in pregnant women. The causative agent belongs to the togaviruses and contains RNA. In the external environment it is unstable, quickly dies when heated to 56°C, when dried, under the influence 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. During inter-epidemic times, isolated cases are observed. The maximum number of diseases is recorded in April-June. The disease poses a particular danger to pregnant women due to intrauterine infection of the fetus. The rubella virus is released into the external environment a week before the rash appears and for 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 experience slight weakness, malaise, headache, and sometimes muscle and joint pain. Body temperature often remains subfebrile, although sometimes it reaches 38-39°C and lasts 1-3 days. At objective examination There are mild symptoms of catarrh of the upper respiratory tract, slight redness of the pharynx, and conjunctivitis. From the first days of the disease, generalized lymphadenopathy occurs (i.e., general damage to the lymphatic system). The enlargement and tenderness 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, and can be itchy. There is some thickening of the rash on the extensor surface of the limbs, back, and buttocks. The elements of the rash are small spots with a diameter of 2-4 mm; they usually do not merge, last 3-5 days and disappear, leaving no pigmentation. In 25-30% of cases, rubella occurs without a rash and 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 based on a combination of clinical and laboratory data.

Virological methods are not yet widely used. Among the serological reactions, the neutralization reaction and RTGA are used, which are performed with paired sera taken at an interval of 10-14 days.

Treatment. For uncomplicated rubella, therapy is symptomatic. For rubella arthritis, hingamin (delagil) is prescribed 0.25 g 2-3 times a day for 5-7 days. Use diphenhydramine (0.05 g 2 times a day), butadione (0.15 g 3-4 times a day), symptomatic remedies. For 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 aged 13-15 years. Patients with rubella are isolated until the 5th day from the moment the rash appears.

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 carriers - mosquitoes. The incidence is especially high among persons newly arrived in an endemic focus.

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

Internal leishmaniasis. Symptoms and course. A typical sign 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 enlarges and by the height of the disease reaches enormous size (sinks into the pelvis) and great density. The liver also enlarges. Various types of rashes appear on the skin, mostly papular. The skin is dry, pale earthy in color. There is a tendency to bleeding, cachexia (weight loss), anemia, and edema gradually develop.

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

Anthropotic (urban type) cutaneous leishmaniasis: incubation period 3-8 months. Initially, a tubercle with a diameter of 2-3 mm appears at the site of pathogen penetration. Gradually it increases in size, the skin over 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 purulent plaque. An infiltrate forms around the ulcer, during the disintegration 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 approximately a year after the onset of the disease. The number of ulcers ranges from 1-3 to 10; they are usually located on open areas of the skin accessible to mosquitoes (face, hands).

Zoonotic (rural type) cutaneous leishmaniasis. The incubation period is shorter. At the site of pathogen penetration, a cone-shaped tubercle with a diameter of 2-4 mm appears, which grows quickly and after a few days reaches 1-1.5 cm in diameter, necrosis occurs in its center. After the dead tissue is sloughed off, an ulcer opens and quickly expands. 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 copious serous-purulent discharge. By the 3rd month, the bottom of the ulcer is cleared, granulations grow. The process ends after 5 months. Lymphangitis and lymphadenitis are often observed. With both types of cutaneous leishmaniasis, a chronic tuberculoid form resembling lupus can develop.

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

Prevention. Fighting mosquitoes that carry the pathogen, exterminating infected dogs and rodents. Recently, preventive vaccinations with live cultures of Leishmania have been used.

KU fever. Acute rickettsial disease, characterized by general toxic phenomena, fever and often atypical pneumonia. The causative agent is a small microorganism. Very resistant to drying, heating, ultraviolet irradiation. The reservoir and source of infection are various wild and domestic animals, as well as ticks. Infection of people occurs through contact with them, consumption of dairy products and through airborne dust. The disease is detected throughout the year, but more often in spring and summer. KU 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 temperature fluctuations, accompanied by repeated chills and sweating. Symptoms of general intoxication are expressed (headache, muscle and joint pain, soreness of the eyeballs, loss of appetite). The facial skin is moderately hyperemic, and rashes are rare. Some patients develop a painful, dry cough from the 3rd to 5th day of illness. Pulmonary lesions are clearly identified during X-ray examination in the form of focal, round-shaped shadows. Subsequently, typical signs of pneumonia appear. The tongue is dry and coated. Enlargement of the liver (50%) and spleen are also noted. Diuresis is reduced, there are no significant changes in urine. Recovery is slow (2-4 weeks). Apathy, low-grade fever, and decreased ability to work persist for a long time. Relapses occur in 4-20% of patients.

Treatment. Use 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 5% glucose solution, a complex of vitamins, and, according to indications, oxygen therapy, blood transfusion, and cardiovascular drugs are prescribed.

Prevention. The fight against KU-rickettsiosis in domestic animals is underway. Livestock premises are disinfected with a 10% bleach solution. Milk from sick animals is boiled. In natural areas, it is recommended to combat ticks and use repellents. For specific prevention against KU fever, people in contact with animals are vaccinated. Patients with KU fever do not pose a great danger to others.

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

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

Symptoms and course. The incubation period is from 2 to 10 days. Identifies localized forms when the pathogen is in a specific organ (meningococcal carriage and acute nasopharyngitis); generalized forms when the infection spreads 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), signs of intoxication and damage to the mucous membrane of the pharynx and nose appear (nasal congestion, redness and swelling of the posterior wall of the pharynx).

Meningococcemia - meningococcal sepsis begins suddenly and proceeds violently. There is 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, and ears. There are no symptoms of meningitis (see below) with this form. Possible arthritis, pneumonia, myocarditis, endocarditis. In the blood there is a pronounced neutrophilic leukocytosis with a shift to the left.

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

Delirium, agitation, convulsions, tremors are possible; in some, cranial nerves are affected; in infants, bulging and tension of the fontanelles may be observed. In half of the patients, on days 2-5 of illness, a profuse herpetic rash appears, less often a petechial rash. There is neutrophilic leukocytosis in the blood, ESR is increased. With proper treatment, recovery occurs within 12-14 days 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. The body is detoxified, treated with oxygen and vitamins. When symptoms of edema and swelling of the brain appear, dehydration therapy is carried out to help 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 negative results of a double bacteriological examination. Work is underway to create a meningococcal vaccine.

ORZ. Acute respiratory diseases (acute catarrh of the respiratory tract). Very common diseases primarily affecting the respiratory tract. Caused by various etiological agents (viruses, mycoplasmas, bacteria). Immunity after illness is strictly type-specific, for example, to influenza virus, parainfluenza, herpes simplex, rhinovirus. Therefore, the same person can get sick with acute respiratory disease up to 5-7 times during the year. The source of infection is a person sick with clinically pronounced or erased forms of acute respiratory disease. Healthy virus carriers are less important. Transmission of infection occurs predominantly through 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, predominant damage to the upper parts of the respiratory tract and a benign course. Damage to the respiratory system manifests itself in the form of rhinitis, nasopharyngitis, pharyngitis, laryngitis, tracheolaryngitis, bronchitis, and pneumonia. Some etiological agents, in addition to these manifestations, cause a number of other symptoms: conjunctivitis and keratoconjunctivitis in adenoviral diseases, moderate symptoms herpetic sore throat for enteroviral diseases, rubella-like eczema for adenoviral and enteroviral diseases, false croup syndrome for adenoviral 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 interpretation (rhinitis, nasopharyngitis, acute laryngotracheobronchitis, etc.). Etiological diagnosis placed only after laboratory confirmation.

Treatment. Antibiotics and other chemotherapy drugs are ineffective because they do not affect the virus. Antibiotics can be prescribed for acute bacterial respiratory infections. Treatment is often carried out at home. During the febrile period, bed rest is recommended. Prescribe symptomatic drugs, antipyretics, etc.

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

Psittacosis. An acute infectious disease from the influenza group. Characterized by fever, general intoxication, damage to the lungs, nervous system, enlarged liver and spleen. The reservoir and source of infection are domestic and wild birds. Currently, the causative agent of psittacosis has been isolated from more than 140 species of birds. Domestic and indoor birds, especially city pigeons, are of greatest epidemiological importance. The share of occupational diseases accounts for 2-5% total number sick. Infection occurs by air, but 10% of patients have foodborne infection. The causative agent of psittacosis is classified as chlamydia and persists in the external environment for up to 2-3 weeks. Resistant to sulfonamide drugs, sensitive to tetracycline antibiotics 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) forms 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, severe headache in the frontoparietal region, pain in the muscles of the back and limbs; general weakness and adynamia increase, appetite disappears. Some experience vomiting and nosebleeds. On days 2-4 of illness, signs of lung damage appear, not very pronounced. There is a dry cough, sometimes stabbing pain in the chest, but there is no shortness of breath. Subsequently, 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, pale skin, bradycardia, decreased blood pressure, and muffled heart sounds are noted. X-ray examination reveals damage to the lower lobes of the lungs. Residual changes in them last for quite a long time. During recovery, especially after severe forms of ornithosis, asthenia with sharply reduced blood pressure and vegetative-vascular disorders persist for a long time.

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

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

Prevention. Combating ornithosis among poultry, regulating the number of pigeons, limiting contact with them. Specific prevention has not been developed.

Smallpox natural. Refers to quarantine infections, characterized by general intoxication, fever, pustulopapular rash, leaving scars. The pathogen found in the contents of pockmarks is a virus, contains DNA, reproduces well in human tissue culture, and is resistant to low temperature and drying. The sick person poses a danger from the first days of illness until the scabs fall off. Transmission of the pathogen occurs mainly by airborne droplets and airborne dust. Smallpox has now been eradicated throughout the world.

Symptoms and course. The incubation period lasts 10-12 days, less often 7-8 days. The onset of the disease is acute: chills or chills 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 pharynx. 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 torso 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 chewing, swallowing, and urinating. From the 7th-8th day of illness, the patient’s condition worsens even more, the body temperature reaches 39-40°C, the rash festeres, the contents of the vesicles first become cloudy and then become purulent. Sometimes individual pustules merge, causing painful swelling of the skin. The condition is serious, consciousness is confused, delirium. Tachycardia, arterial hypotension, shortness of breath, foul breath. The liver and spleen are enlarged. A variety of secondary complications may occur. 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 intensifies 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 have become much less common.

Recognition. For emergency diagnosis, the contents of pockmarks are examined for the presence of a virus using RNGA, which uses sheep red blood cells sensitized with anti-smallpox antibodies. At positive results An obligatory 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 effectiveness of anti-smallpox gamma globulin (3-6 ml intramuscularly) and metisazone (0.6 g 2 times a day for 4-6 days) is low. For the prevention and treatment of secondary purulent infection antibiotics are prescribed (oxalin, methicillin, erythromycin, tetracycline). Bed rest. Oral care (rinsing with 1% sodium bicarbonate solution, 0.1-0.2 g of anesthesin before meals). A 15-20% sodium sulfacyl solution 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 forms - 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. The causative agents are mobile bacteria from the genus Salmonella, stable in the external environment. Disinfectants in normal concentrations kill them within a few minutes. The only source of infection in paratyphoid A is patients and bacteria-shedding organisms, and in paratyphoid B it can also be animals (cattle, etc.). The routes of transmission are often fecal-oral, less often contact-household (including fly).

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

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

Features of clinical manifestations of paratyphoid A. The disease usually begins more acutely than paratyphoid B, with an incubation period of 1 to 3 weeks. Accompanied by dyspeptic disorders and catarrhal symptoms, possible redness of the face, herpes. The rash, as a rule, appears on days 4-7 of illness, and is often profuse. During the course of the disease, there are usually several waves of rashes. The temperature is remitting or hectic. The spleen rarely enlarges. Lymphopenia, leukocytosis are often observed in the peripheral blood, and eosinophils remain. Serological reactions are often negative. There is a greater possibility of relapses than with paratyphoid B and typhoid fever.

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

The clinical course is highly variable. When the infection is transmitted through water, a gradual onset of the disease and a relatively mild course are observed.

When Salmonella enters 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, mild and moderate forms of the disease are observed more often than with paratyphoid A and typhoid fever. Relapses are 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 enlarge earlier than with typhoid fever.

Treatment. It must be comprehensive, including care, diet, etiotropic and pathogenetic agents, and, if indicated, immune and stimulant 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. The food is easily digestible, gentle on the gastrointestinal tract.

During the period of fever, it is steamed or given pureed (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) until the 10th day of normal temperature. To increase the effectiveness of etiotropic therapy, mainly with the aim of preventing relapses and the formation of chronic bacterial excretion, it is recommended to carry it out in the process with drugs that stimulate protective forces organism and increasing 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 had paratyphoid fever is carried out for 3 months.

Epidemic mumps (mumps). Viral disease with general intoxication, enlargement of one or more salivary glands, and often damage to other glandular organs and the nervous system. The causative agent is a spherical virus with tropism for glandular and nervous tissues. Low resistance to physical and chemical factors. The source of the disease is a sick person. Infection occurs by droplets; the possibility of contact transmission cannot be ruled out. The virus is detected in saliva at the end of the incubation period on days 3-8, after which virus shedding 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 damage appear (dry mouth, pain in the ear area, aggravated by chewing and talking). The disease can occur in both mild and severe forms.

Depending on this, the temperature can range from low-grade to 40°C; intoxication also depends on the severity. A characteristic manifestation of the disease is damage to the salivary glands, most often the parotid glands. The gland enlarges, pain appears on palpation, which is especially pronounced in front of the ear, behind the earlobe and in the area of ​​the mastoid process. Big diagnostic value has Murson's symptom - an inflammatory reaction in the area excretory duct affected parotid gland. The skin over the inflamed gland is tense, shiny, and swelling may spread to the neck. Enlargement of the gland usually lasts 3 days, 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, restriction white bread, fats, coarse fiber (cabbage).

For orchitis, a suspension is prescribed, prednisolone for 5-7 days according to the schedule.

For meningitis, corticosteroid drugs are used, lumbar punctures are performed, and a 40% solution of Hexamine is administered intravenously. If acute pancreatitis has developed, a liquid gentle diet, atropine, papaverine, cold on the stomach are prescribed; for vomiting - aminazine and enzyme-inhibiting drugs - gordox, contrical trasylol.

The prognosis is favorable.

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

Foodborne toxic infections. 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 damage to the digestive organs. Pathogens: staphylococcal enterotoxins types A, B, C, D, E, salmonella, shigella, Escherichia, streptococci, spore anaerobes, spore aerobes, halophilic vibrios. The transmission mechanism is fecal-oral. The source of infection is a sick person or bacteria carrier, as well as sick animals and bacteria excretors. The disease can occur in both sporadic cases and outbreaks. The incidence is recorded throughout the year, but increases slightly in warm weather.

Symptoms and course. The incubation period is short - up to several hours. There are chills, increased body temperature, nausea, repeated vomiting, cramping pain in the abdomen, mainly in the iliac and periumbilical regions.

Frequent, loose stools sometimes mixed with mucus occur. Intoxication phenomena are observed: dizziness, headache, weakness, loss of appetite.

The skin and visible mucous membranes are dry. The tongue is coated and dry.

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

Treatment. To remove infected foods and their toxins, gastric lavage is necessary, which has the greatest effect in the first hours of the disease. However, in case of nausea and vomiting, this procedure can be performed at a later date. Rinsing is carried out with a 2% solution of sodium bicarbonate (baking soda) or 0.1% solution of potassium permanganate until discharge clean waters. For the purpose of detoxification and recovery water balance use saline solutions: trisol, quartasol, rehydron and others. The patient is given plenty of fluids to drink in small doses. Nutritional therapy is important. Avoid foods that can irritate the gastrointestinal tract 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). Recovery normal microflora intestines, the appointment of colibacterin, lactobacterin, bificol, bifidumbacterin is indicated.

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

Erysipelas. An infectious disease with general intoxication of the body and inflammatory skin lesions. The causative agent is streptococcus erysipelas, is stable outside the human body, tolerates drying and low temperatures, and 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 recorded in isolated cases. Infection occurs mainly when the integrity of the skin is damaged by contaminated objects, tools or hands.

According to the nature of the lesion, they are distinguished:
1) erythematous form in the form of redness and swelling of the skin;
2) hemorrhagic form with 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 are classified as mild, moderate, and severe.

By frequency - primary, recurrent, repeated.

According to the prevalence of local manifestations - localized (nose, face, head, back, etc.), wandering (moving 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, 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, a burning sensation, bursting pain appears, and redness (erythema) and swelling at the site of inflammation appear on the skin. The area affected by erysipelas is clearly separated from the healthy area by a raised, sharply painful ridge. The skin in the area of ​​the outbreak is hot to the touch and tense. If there are pinpoint hemorrhages, then they speak of an erythematous-hemorrhagic form of erysipelas. With bullous erysipelas, against the background of erythema, at various times after its appearance, bullous elements are formed - blisters containing a light and transparent liquid. Later they fall off, forming dense brown crusts that are rejected after 2-3 weeks. Erosion and trophic ulcers may form in place of the blisters. All forms of erysipelas are accompanied by damage to the lymphatic system - lymphadenitis, lymphangitis.

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

Duration of the disease: local manifestations of erythematous erysipelas disappear by 5-8 days of illness; in other forms they can last more than 10-14 days. Residual manifestations of erysipelas - pigmentation, peeling, pasty skin, the presence of dry dense crusts in place of bullous elements. Lymphostasis may develop, leading to elephantiasis of the extremities.

Treatment. Depends on the form of the disease, its frequency, degree of intoxication, and the presence of complications. Etiotropic therapy: penicillin antibiotics in average daily dosages (penicillin, tetracycline, erythromycin or oleandomycin, oletetrip, etc.). Sulfonamide drugs and combined chemotherapy drugs (Bactrim, Septin, Biseptol) are less effective. The course of treatment is usually 8-10 days. For frequent persistent relapses, ceporin, oxacillin, ampicillin and methicillin are recommended. It is advisable to carry out two courses of antibiotic therapy with a change in drugs (intervals between courses are 7-10 days). For frequently recurrent erysipelas, corticosteroids are used in a daily dosage of 30 mg. For persistent infiltration, non-steroidal anti-inflammatory drugs are indicated - chlotazol, butadione, reopirin, etc. It is advisable to prescribe ascorbic acid, rutin, and B vitamins. Autohemotherapy gives good results.

In the acute period of the disease, the appointment of ultraviolet irradiation, UHF followed by the use of ozokerite (paraffin) or naphthalan is indicated for the inflammation. Local treatment of uncomplicated erysipelas is carried out only in its bullous form: the bulla is incised at one of the edges and bandages with a solution of rivanol and furatsilin are applied to the site of inflammation. Subsequently, dressings with ectericin, Shostakovsky 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 blood vessels, as well as sanitation of foci of chronic streptococcal infection. Erysipelas does not provide immunity; there is a special increased sensitivity all those who have been ill.

Anthrax. An acute infectious disease from the group of zoonoses, characterized by fever, damage to the lymphatic system, intoxication, occurs in the form of a skin, rarely intestinal, pulmonary and septic form. The causative agent is aerobic bacterium- a fixed, large 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 infections are more common by contact(when cutting animal carcasses, processing hides, etc.) and when 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 - internal organs.

The incubation period is from 2 to 14 days.

For cutaneous form (carbunculosis) Exposed areas of the body are most susceptible to damage. The disease is more 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 microbe's entrance gate), 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, and a vesicle develops in place of the spot - a bubble filled with serous contents, then blood. When patients scratch, they tear off the blister and an ulcer with a black bottom forms. From this moment on, there is a rise in temperature, headache, and loss of appetite. From the moment of opening, the edges of the ulcer begin to swell, forming an inflammatory cushion, swelling occurs, which begins to spread quickly. The bottom of the ulcer sinks more and more, and “daughter” vesicles with transparent contents form at the edges. This growth of the ulcer continues for 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 anthrax carbuncle is the absence pain syndrome in the zone of necrosis and in a characteristic three-color color: black in the center (scab), around there is a narrow yellowish-purulent border, then a wide purple 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, the scab is rejected, the wound heals with the formation of a scar. In an unfavorable course, secondary sepsis develops with a repeated rise in temperature, a significant deterioration in the general condition, increased headache, increased tachycardia, and the appearance of secondary pustules on the skin. There may be bloody vomiting and diarrhea. A fatal outcome cannot be ruled out.

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

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

Clinically and radiologically, bronchopneumonia and effusion hemorrhagic pleurisy are determined. Death occurs on days 2-3 as a result of pulmonary edema and collapse.

Septic form It proceeds very violently 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).

Forecast at cutaneous forms anthrax is favorable. In septic cases it is doubtful, even with early treatment.

Prevention. Proper organization of veterinary supervision, vaccination of domestic animals. If animals die from anthrax, animal carcasses must be burned and food obtained from them destroyed. By epidemic indications People are being 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 pinpoint rash, fever, general intoxication, sore throat, tachycardia. The causative agent is toxigenic streptococcus group A. The source of infection is a sick person, the most dangerous in the first days of the disease. Children under 10 years of age are most often 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, and chills occur. A typical and constant symptom is tonsillitis: bright redness of the pharynx, enlarged lymph nodes, as well as tonsils, on the surface of which plaque is often found. By the end of the 1st, beginning of the 2nd day, characteristic exanthemas appear (a bright pink or red pinpoint rash that thickens in places of natural folds of the skin). The face is bright red with a pale nasolabial triangle, but the edges of which can be distinguished by a pinpoint rash. Petechial hemorrhages are common on the bends of the limbs. The rash may look like small blisters filled with clear contents (miliary rash). Some patients experience itchy skin. The rash lasts from 2 to 5 days, and then turns pale, while the body temperature decreases. In the second week, lamellar skin lesions begin, most pronounced on the folds of the arms (finely and coarsely tubular). The tongue is coated at the beginning of the disease, clears by the 2nd day and takes on a characteristic appearance (bright red or “crimson” tongue).

From the cardiovascular system, tachycardia and moderate muffling of 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 is increased. Typically, an increase in the number of eosinophils by the end of the 1st - beginning of the 2nd week of illness. Lymph nodes are enlarged and painful. Possible enlargement of the liver and 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 phenomena of bleeding occur with the syndrome of toxicosis (poisoning) coming to the fore: loss of consciousness, convulsions, renal and cardiovascular failure.

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

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

Prevention. Isolation of patients. Avoiding contact between convalescents and those newly admitted to the hospital. Discharge from the hospital no earlier than the 10th day of illness. Children's institutions are allowed to visit after 23 days from the moment of illness. The apartment where the patient is located must be regularly disinfected. Quarantine is imposed for 7 days for those who have not had scarlet fever after their separation from the patient.

Tetanus. An acute infectious disease with hypertonicity of skeletal muscles, periodic convulsions, increased excitability, symptoms of general intoxication, and high mortality.

The causative agent of the disease is a large anaerobic bacillus. This form of the microorganism is capable of producing a powerful toxin (poison), which causes increased secretion in the neuromuscular junctions. The microorganism is widespread in nature and persists in the soil for many years. It is a common, 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 is on average 5-14 days. The smaller it is, the more severe the disease. The disease begins with unpleasant sensations in the wound area (pulling pain, twitching of muscles around the wound); possible general malaise, anxiety, irritability, loss of appetite, headache, chills, low-grade fever. Due to spasms of the masticatory muscles (trismus), it is difficult for the patient to open his mouth, sometimes even impossible.

Spasm of the swallowing muscles causes a “sardonic smile” to appear on the face and also makes swallowing difficult. These early symptoms are unique to tetanus.

Later, rigidity of the neck muscles and long back muscles develops with increased back pain: the person is forced to lie in a typical position with the head thrown back and the lumbar part of the body raised above the bed. By 3-4 days, tension in the abdominal muscles is observed: the legs are extended, movements in them are sharply limited, arm movements are somewhat freer. Due to the sharp tension of the abdominal muscles and diaphragm, breathing is shallow and rapid.

Due to the contraction of the perineal muscles, urination and defecation are difficult. General convulsions appear lasting from several seconds to a minute or more, varying in frequency, often provoked 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 breathing can occur. Consciousness was maintained throughout the illness and even during convulsions. Tetanus is usually accompanied by fever and constant sweating (in many cases from the addition of pneumonia and even sepsis). The higher the temperature, the worse the forecast.

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

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

Treatment of tetanus is complex.
1. Surgical debridement wounds.
2. Ensuring complete rest for the patient.
3. Neutralization of toxin circulating in the blood.
4. Reduction or removal of convulsive syndrome.
5. Prevention and treatment of complications, especially pneumonia and sepsis.
6. Maintaining normal blood gas composition, acid-base and water-electrolyte balances.
7. Fighting hyperthermia.
8. Maintaining adequate cardiovascular activity.
9. Improving lung ventilation.
10. Proper nutrition sick.
11. Monitoring body functions, careful patient care.

Radical excision of the wound edges is performed, creating a good outflow; antibiotics (benzylpenicillin, oxytetracycline) are prescribed for prophylactic purposes. Unvaccinated people are given active-passive prophylaxis (APP) by administering different areas body 20 IU of tetanus toxoid and 3000 IU of antitetanus serum. Vaccinated individuals are given only 10 units of tetanus toxoid. Recently, specific gammaglobulin obtained from donors has been used (the dose of the drug for prophylaxis is 3 ml intramuscularly once, for treatment - 6 ml once). Adsorbed tetanus toxoid is administered intramuscularly 3 times 0.5 ml every 3-5 days. All of these drugs serve as means of influencing the toxin circulating in the blood. The central place in intensive therapy of tetanus is the reduction or complete elimination of tonic and tetanic convulsions. For this purpose, antipsychotics (aminazine, prolasil, droperidol) and tranquilizers are used. To eliminate severe seizures, muscle relaxants (tubarip, diplacin) are used. Treatment of respiratory failure is provided by well-developed respiratory resuscitation techniques.

Forecast. The mortality rate for tetanus is very high, the prognosis is serious.

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

Typhus. The disease is caused by Provacek's rickettsiae and is characterized by a cyclical course with fever, typhoid state, a peculiar 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 fed on blood containing rickettsia, transmit them to a healthy person. A person becomes infected by scratching bite sites and rubbing lice excrement into the skin. With the lice bite itself, infection does not occur, since in their salivary glands The causative agent of typhus is absent. People's susceptibility to typhus is quite high.

Symptoms and course. The incubation period lasts 12-14 days. Sometimes at the end of incubation a slight headache, body aches, and chills are noted.

Body temperature rises with slight chills and by the 2-3rd day it is already at high levels (38-39°C), sometimes it reaches its maximum value by the end of 1 day. Subsequently, the fever is constant with a slight decrease on the 4th, 8th, 12th day of illness. A sharp headache and insomnia appear early, loss of strength quickly sets in, and the patient is excited (talkative, active). The face is red and puffy. Small hemorrhages are sometimes visible on the conjunctiva of the eyes. There is diffuse hyperemia in the pharynx, soft palate Point hemorrhages may appear. The tongue is dry, not thickened, covered with a grayish-brown coating, and sometimes sticks out with difficulty. The skin is dry, hot to the touch, and there is almost no sweating in the first days. There is a weakening of heart sounds, increased breathing, 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 4th-5th day of illness. It is multiple, abundant, located mainly on the skin of the lateral surfaces of the chest and abdomen, in the bend of the arms, covers the palms and soles, and is 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. Excitement gives way to depression and lethargy. At this time, 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 days 8-12 of illness, a gradual decrease in headaches, improved sleep, appetite, and restoration of the activity of internal organs.

Treatment. The most effective antibiotics are the tetracycline group, which are prescribed 0.3-0.4 g 4 times a day. You can use chloramphenicol. Antibiotics are given for up to 2 days of normal temperature, the course duration is usually 4-5 days. For detoxification, a 5% glucose solution is administered. Oxygen therapy is used. In cases of severe agitation, barbiturates and chloral hydrate are indicated. Good nutrition and vitamin therapy are of great importance. Proper care of the patient plays an important role (complete rest, fresh air, comfortable bed and linen, daily hygiene of the skin and oral cavity).

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

Tularemia. Zoonotic infection with natural focality. 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. Reservoirs of tularemia bacilli are hares, rabbits, water rats, voles. Epizootics periodically occur in natural foci.

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

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

From the cardiovascular system, bradycardia and hypotension are noted. In the blood there was leukocytosis with a moderate neutrophilic shift. The liver and spleen do not enlarge in all cases. Abdominal pain is possible with significant enlargement of the mesenteric lymph nodes. Fever lasts from 6 to 30 days.

Bubonic form of tularemia. The pathogen penetrates the skin without leaving a trace; after 2-3 days of illness, regional lymphadenitis develops. The buboes are slightly painful and have clear contours up to 5 cm in size. Subsequently, either the bubo softens (1-4 months) or spontaneously opens with the release of thick, creamy pus and the formation of a tularemic fistula. The axillary, inguinal and femoral lymph nodes are most often affected.

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

Oculobubonic form develops when the pathogen enters the mucous membranes of the eyes. Typically, yellow follicular growths the size of millet grains appear on the conjunctiva.

The bubo develops in the parotid or submandibular areas, and the course of the disease is long.

Anginal-bubonic form
There are forms of tularemia that primarily affect internal organs. The pulmonary form is more often registered in the autumn-winter period. The generalized form occurs as a 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 an allergic skin 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 until the 5th day of normal temperature. For prolonged forms, combined treatment with antibiotics and 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. Vitamin therapy and repeated donor blood transfusions are recommended. If a fluctuation of the bubo appears, surgical intervention is required (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 homes, wells, open reservoirs, products from mouse-like rodents. Carrying out mass routine vaccination in 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 through watery stools and vomit. It is classified as a quarantine infection. The causative agent is Vibrio cholerae in the form of a curved stick (comma). When boiled, it dies within 1 minute. Some biotypes persist for a long time and reproduce in water, in silt, and in the organisms of water bodies. The source of infection is a person (patient and carrier of the bacteria). Vibrios are excreted in feces and vomit. Cholera epidemics can be waterborne, foodborne, household contact, or mixed. Susceptibility to cholera is high.

Symptoms and course. They are 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 onset of diarrhea, mainly at night or in the morning. The stool is initially watery, later it takes on the appearance of “rice water” without odor, and there may be an admixture of blood. Then comes profuse vomiting, 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. The leading ones are disturbances in the functioning of the main systems of the body, the severity of which is determined by the degree of dehydration. 1st degree: dehydration is slightly expressed. 2nd degree: decrease in body weight by 4-6%, decrease in the number of red blood cells and a drop in hemoglobin levels, acceleration of ESR. Patients complain about severe weakness, dizziness, dry mouth, thirst. The lips and fingers turn blue, hoarseness appears, and convulsive twitching of the calf muscles, fingers, and chewing muscles is possible. Stage 3: weight loss of 7-9%, while all of the listed symptoms of dehydration intensify. When blood pressure drops, collapse is possible, body temperature drops to 35.5-36°C, and urine output may stop completely. Blood thickens due to dehydration, and the concentration of potassium and chlorine in it decreases. Grade 4: fluid loss is more than 10% of body weight. Facial features become sharper, “dark glasses” appear around the eyes. The skin is cold, sticky to the touch, bluish, and prolonged tonic convulsions are frequent. Patients are in a state of prostration and shock develops. Heart sounds are sharply muffled, blood pressure drops sharply. The temperature drops to 34.5°C. Fatalities are common.

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

Recognition. Characteristic epidemiological history, 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 restoration of water-salt balance.

Solutions containing sodium chloride, potassium chloride, sodium bicarbonate, and glucose are recommended. For severe dehydration - jet injection liquid until the pulse normalizes, after which the solution is continued to be administered drip-wise. The diet should include foods containing large amounts of potassium salts (dried apricots, tomatoes, potatoes). Antibiotic therapy is carried out only for 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 with timely and adequate treatment is favorable.

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

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 special dangerous infections. It is preserved in nature due to periodically occurring epizootics in rodents, the main warm-blooded hosts of the plague microbe (marmots, gophers, gerbils). Transmission of the pathogen from animal to animal occurs through fleas. Infection of a person is possible through contact (during skinning and cutting meat), consumption of contaminated food products, flea bites, and airborne droplets. Human sensitivity is very high. A sick person is dangerous to others, especially those with a pulmonary form.

Symptoms and course. The incubation period lasts 3-6 days. The disease begins acutely with sudden chills and a rapid rise in temperature to 40°C. Chills are replaced by fever, severe headache, dizziness, severe weakness, insomnia, nausea, vomiting, and muscle pain. Intoxication is pronounced, disturbances of consciousness are frequent, psychomotor agitation, delirium, and hallucinations are not uncommon. Characterized by an unsteady gait, redness of the face and conjunctiva, slurred speech (patients resemble drunks). Facial features are pointed, puffy, appear dark circles under the eyes, a pained expression on the face, full of fear. The skin is dry and hot to the touch, there may be a petechial rash, extensive hemorrhages (bleeding), darkening on the corpses. Symptoms of damage to the cardiovascular system quickly develop: expansion of the boundaries of the heart, dullness 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 oral cavity are dry. The tonsils are often enlarged, ulcerated, and there are hemorrhages on the soft palate. In severe cases, vomiting is the color of “coffee grounds”, frequent loose stools mixed with mucus and blood. There may be blood and protein in the urine.

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

With bubonic pain, sharp pain appears in the area of ​​the affected lymph glands (usually inguinal) even before they noticeably enlarge, and in children, axillary and cervical pain. Regional lymph glands are affected at the site of the flea bite. Hemorrhagic necrotic inflammation quickly develops in them. The glands adhere to each other, to the adjacent skin and subcutaneous tissue, forming large packages (buboes). The skin becomes shiny, red, and subsequently ulcerates, and the bubo bursts open. In the hemorrhagic exudate of the glands there are a large number of plague bacilli.

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 take a deep breath. The cough appears early, with a large amount of viscous, transparent, glassy sputum, which then becomes foamy, liquid, and rusty. Chest pain intensifies, breathing suddenly weakens. Symptoms of general intoxication, rapid deterioration of the condition, and the development of infectious toxic shock are typical. The prognosis is difficult, death usually occurs within 3-5 days.

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

Treatment. All patients are subject to hospitalization. The basic principles of therapy are the integrated use of antibacterial, pathogenetic and symptomatic therapy. The administration of detoxication liquids (polyglucin, reopolyglucin, hemodez, neocompensan, plasma, glucose solution, saline solutions, etc.) is indicated.

Prevention. Control of rodents, especially rats. Monitoring of persons working with infectious materials or suspected of being infected with plague, preventing the import 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 the action of disinfectant solutions. Encephalitis is a natural focal disease. The reservoir is wild animals (mice, rats, chipmunks, etc.) and ixodid ticks, which are carriers of the infection. Infection of a person is possible through a tick bite and through the nutritional route (by consuming raw milk). The disease occurs more often in taiga and forest-steppe areas.

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

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

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

Meningoencephalitic form - lethargy, drowsiness, delirium, psychomotor agitation, loss of orientation, hallucinations, often severe convulsive syndrome according to the type of status epilepticus. Mortality 25%.

Poliomyelitis 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, and 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 prescribed intramuscularly. Dehydration agents. Intravenous administration of a hypertonic solution of glucose, sodium chloride, mannitol, furosemide, etc. Oxygen therapy. For seizures, aminazine 2.51 ml and diphenhydramine 2 ml-1%, for epileptic seizures phenobarbital or benzonal 0.1 g 3 times. Cardiovascular and respiratory stimulants.

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

Foot and mouth disease. A 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 environment. FMD affects artiodactyl animals (cattle and small cattle, pigs, sheep and goats). In sick animals, the virus is excreted in saliva, milk, urine, and manure. Human susceptibility to the lizard is low. Transmission routes are 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, muscle aches, lower back, weakness, and loss of appetite. After 2-3 days, dry mouth occurs, photophobia, drooling, and pain when urinating 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 usually decreases somewhat. Speech and swallowing are difficult, salivation (saliva production) is increased. In most patients, vesicles - bubbles can be located on the skin: in the area 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, and tongue disappear in 3-5 days and heal without leaving scars. New rashes are possible, delaying recovery for several months. Gastroenteritis is often observed in children.

Distinguish cutaneous, mucous and mucocutaneous forms of the disease. Often erased forms occur in the form of stomatitis.

Complications: the addition of a secondary infection leads 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 meals). Local treatment: solutions - 3% hydrogen peroxide; 0.1% rivanol; 0.1% potassium permanganate; 2% boric acid, chamomile infusion. Erosion is extinguished with a 2-5% solution of silver nitrate. In severe cases, it is recommended to administer immune serum and prescribe tetracycline or chloramphenicol.

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

The disease can occur in acute and chronic forms. In the acute form, the pathological process usually forms in the terminal ileum near the ileocecal anastomosis - terminal ileitis. The clinical picture of the disease resembles acute appendicitis. Patients suddenly begin to experience pain in the right iliac region. Diarrhea mixed with blood, vomiting, fever with chills appear. Palpation in the right iliac region, in the ileocecal zone, reveals a painful, thickened segment of the ileum.

The chronic form of CD is characterized by more pronounced general, systemic manifestations. Depending on the location of the affected intestinal segment, it occurs in three variants: small intestinal, large intestinal and mixed.

In all cases, the disease begins gradually, with general malaise, unmotivated weakness, low-grade fever not associated with a cold, and arthralgia. Facial puffiness and a tendency to edema appear as a result of chronic protein loss. Various skin lesions, cracks in the corners of the mouth, and hair loss due to hypovitaminosis occur. In the future, dark pigment spots on the skin, lethargy, a tendency to convulsions, polyuria, and thirst may appear, caused by polyglandular insufficiency of the endocrine system.

Sometimes at the beginning of the chronic variant of CD, systemic lesions come to the fore - erythema nodosum, pyoderma gangrenosum, ulcerations of the perianal area, iridocyclitis, keratitis, conjunctivitis. Arthritis with damage to large joints and ankylosing spondylitis are formed.

Whenever small intestinal variant Patients with chronic CD begin to notice that their stool gradually becomes semi-liquid or liquid, foamy, sometimes mixed with blood. Periodic and then constant pain appears in the projection of the inflamed segment of the intestine. If the duodenum is affected - on the right in the epigastrium, jejunum - above and to the left of the navel, ileum - below the navel on the right, ileocecal anastomosis - in the right iliac region.

Localization of the pathological process in the esophagus or stomach is accompanied by symptoms reminiscent of chronic esophagitis, gastritis, and peptic ulcer.

At the height of the disease, patients develop a slight low-grade fever. Upon palpation, dense, painful conglomerates and resistance of the abdominal wall are determined in the affected areas. The granulomatous inflammatory process, passing into the stage of fibrosis, causes stenosis of the intestine, leading to gradually worsening intestinal obstruction. Patients begin to experience persistent abdominal pain without specific localization, loud rumbling, nausea, and vomiting.

Slow, covered perforation intestinal wall leads to the formation of intra-abdominal interloop fistulas, and often external ones, opening into the lumbar or groin area. Such complications are accompanied by excruciating pain, fever, and rapid exhaustion.

Damage to the small intestine often manifests itself as malabsorption syndrome. Along with damage to the visceral lymph nodes, a syndrome of exudative enteropathy often occurs with protein loss through areas of the inflamed intestinal wall.

Quite often, symptoms of cholelithiasis are detected, which is formed due to impaired recirculation bile acids, urolithiasis resulting from calcium metabolism disorders.

Damage to the stomach, duodenum and ileum can be complicated by vitamin B 12-deficiency anemia, aggravating iron deficiency anemia resulting from blood loss from ulcerations in the intestines.

At colonic variant chronic CD with diffuse damage to the entire colon is dominated by extraintestinal, systemic manifestations of the disease.

Segmental damage to the intestine is characterized by complaints of cramping pain that appears after eating, bowel movements, and tenesmus. Worrying about diarrhea with frequent stools, up to 10 times a day, with blood and purulent mucus in the stool. In some cases, prolonged constipation occurs. In these same cases, a pronounced distension of the intestine may form above the site of segmental inflammation - megacolon. Fistulas of the intestinal wall often occur, usually together with infiltrates in the abdominal cavity

Damage to the anorectal zone is very typical in the form of multiple fissures, pararectal fistulas, paraanal “lip-protruding” granulations, pronounced weakening of tone, and gaping of the rectal sphincter.

In case of total defeat transverse colon Acute toxic dilatation of the intestine (toxic megacolon) may develop.

For mixed version Chronic CD is characterized by a combination of symptoms of the small intestinal and large intestinal variants with a predominance of one of them. Thus, when the colon is damaged in combination with damage to the terminal ileum, the symptoms of colitis predominate. Intestinal obstruction with the mixed variant occurs more often than with other variants of chronic VK.

With a long course of the chronic form of CD, it often occurs inflammatory lesion small intrahepatic bile ducts - sclerosing cholangitis, manifested by itching of the skin. Formed secondary amyloidosis. Kidney amyloidosis inevitably leads to nephrotic syndrome and renal failure.

There are many forms and types of bronchitis - inflammation of the bronchi, which primarily affects their mucous membrane. Some forms are relatively easy, there is a high chance of favorable outcome diseases. Others are severe and threaten dangerous complications, weakening or loss of ability to work, even death. Often a more severe form develops as the disease progresses and can be avoided if proper treatment is started early. In order to prescribe adequate treatment, the specialist must determine what particular form of bronchial inflammation the patient is suffering from.

Classification of bronchitis

Bronchitis can be caused by different causes; the forms of this disease differ in the nature of the course, characteristics of symptoms, localization of the inflammatory process, severity, presence or absence of complications and other signs. Exist different approaches To :

• according to the nature of the course - acute, recurrent, chronic;
• by etiology – infectious (viral, bacterial, chlamydial), toxic, allergic, mixed;
• by the nature of the bronchial contents, tissue changes - catarrhal, mucopurulent, purulent, putrefactive, atrophic, hypertrophic, destructive, fibrinous, fibrinous-ulcerative, obliterating, necrotic, hemorrhagic;
• according to the presence of bronchospasm, bronchial obstruction - obstructive and non-obstructive;
• according to the presence or absence of complications - uncomplicated and complicated by asthmatic syndrome, peribronchitis, pneumonia, pulmonary emphysema, heart failure and other pathological processes.

Depending on the extent of inflammation, bronchitis is divided into diffuse (spread) and limited (localized in individual lobes, segments of the bronchi). Also distinguished:

• peribronchitis (superficial) - inflammation of the outer lining of the bronchial wall, often involving the interstitial tissue of the lungs;
• endobronchitis (bronchitis itself) – inflammation of the mucous membrane;
• mesobronchitis - inflammation involving the middle layers of the bronchi - submucosal and muscular;
• panbronchitis (deep) – inflammation of all layers of the bronchial wall;
• proximal - with damage to mainly large bronchi;
• distal (bronchiolitis) – involving small bronchi (bronchioles) in the process.

Which form is more dangerous - acute or chronic?

Although an acute disease usually occurs with more severe symptoms than exacerbations of a chronic disease, the chronic form is more severe. usually responds well to treatment, and complete recovery occurs within 2–3 weeks from the onset of the disease. But if the disease is not treated, it can become chronic. Variety acute illness is recurrent, with frequent long-term episodes, but without irreversible changes in the bronchopulmonary tree. It is usually diagnosed in children and adolescents; with age, the frequency of relapses usually decreases, but there is a risk of the recurrent form becoming chronic.

There are 3 degrees of intensity of acute endobronchitis:

1. Slight swelling of the tissues, scanty, mucous sputum, periodic cough, discomfort in the chest.
2. In addition to severe swelling, redness of the mucous membrane is added, the lumen of the bronchi narrows, and during bronchoscopy, bleeding of blood vessels is possible. Coughing attacks become more frequent, become protracted, and chest pain occurs. The volume of sputum secreted increases and may contain purulent impurities.
3. Severe swelling and thickening of the walls of the bronchi; bronchoscopy shows that they have acquired a bluish tint. Symptoms of intoxication increase, the content of pus in the sputum increases, and blood may be present. Narrowing of the lumen of the bronchi due to severe swelling can lead to respiratory failure and shortness of breath.

During chronic bronchitis, stages of remission and exacerbations are distinguished. In progress remission the symptoms are not pronounced, the course is mild, and may not cause any special problems to the patient. Periods exacerbations proceed similarly to acute bronchitis, symptoms increase in a similar sequence. In the absence of enough effective treatment the disease gradually progresses, exacerbations become more frequent, and the patient’s condition worsens during the period of remission. Chronic bronchitis is accompanied by irreversible changes in tissues, so complete recovery in this form is rare.

What forms and types of bronchitis are more severe?

If we compare bronchitis of different etiologies, then viral bronchitis is relatively mild, bacterial or caused by atypical pathogen– much more severe, with high fever, intoxication. Atypical bronchitis is also dangerous because it is much less treatable. Among bronchitis of a non-infectious nature, allergic bronchitis is quite dangerous; it is the one that is usually complicated by asthmatic syndrome and even bronchial asthma.

Bronchospasm is also often caused by physical and chemical irritants; in combination with swelling of the mucous membrane, it leads to the phenomena respiratory obstruction. Occupational bronchitis, caused by regular contact with irritants, quickly becomes chronic.

Endobronchitis, which affects only the mucous membrane, is the least severe type of bronchitis; the tissue structure is completely restored after recovery. Mesobronchitis and panbronchitis are much more dangerous; the deeper layers of the bronchial walls are usually involved in the inflammatory process in severe cases of the disease. Deformation of the bronchial tree occurs due to tissue ulceration followed by scarring, the disease becomes chronic, and changes persist even in the remission stage. Peribronchitis is a complication of ordinary endobronchitis, it is dangerous disease, often combined with peribronchial pneumonia.

In mild forms of the disease, the spread of the inflammatory process is limited to large bronchi. As acute inflammation progresses, bronchiolitis may develop, which is characterized by a more severe course with an increase in temperature and a painful cough. Damage to the small bronchi leads to obstruction, difficult shallow breathing, and severe shortness of breath. Bronchiolitis is especially severe in children and the elderly and can be fatal. Distal bronchitis can develop into obliterative bronchitis, in which the lumen of the bronchi and bronchioles becomes overgrown with granulation tissue.

The danger of obstructive and spastic bronchitis

Obstructive bronchitis has a more severe course and a less favorable prognosis. The phenomena of obstruction progress, at first shortness of breath occurs only after exercise, and a study of external respiration function does not reveal significant deviations from the norm. At severe form In obstructive bronchitis, a person cannot breathe normally even at rest, the gas composition of the blood changes, signs of oxygen starvation and carbon dioxide intoxication appear. Gradually, changes in the bronchi become irreversible; due to a decrease in bronchial patency, ventilation of the lungs is impaired.

In the chronic course of obstructive bronchitis, there is a high risk of developing emphysema, cor pulmonale and heart failure; these diseases usually lead to disability and pose a threat to life. Young children often experience spastic bronchitis, caused by the narrowness of the bronchial passages and hyperreactivity of the mucous membrane. Although breathing disorders in this form are reversible, since there are no changes in the structure of the tissues, the disease requires serious comprehensive treatment. It is characterized by a protracted course with frequent relapses. There are known cases of transition of advanced spastic bronchitis to pulmonary emphysema.

Severe forms of chronic bronchitis

Acute bronchitis usually occurs in a catarrhal form, less often develops purulent process. It can be atrophic, with thinning and increased bleeding of the mucosa, or hypertrophic, with its thickening, leading to obstruction of the airway.

In the acute form of the disease, such changes are reversible. In the chronic form, the likelihood is significantly higher severe course diseases with severe obstruction and destructive changes fabrics.

Severe forms of chronic bronchitis include:

• purulent - usually develops due to the addition of a secondary bacterial infection, accompanied by the release of purulent sputum. It is highly viscous and can clog the respiratory passages. This form is also dangerous due to the possibility of spreading a bacterial infection to the lungs;
• fibrinous - the airways are blocked due to deposits of mucus and fibrin on the inner surface of the bronchi;
• hemorrhagic – characterized by thinning of the mucous membrane, increased fragility of the blood vessels penetrating it, often accompanied by hemoptysis;
• putrefactive – develops under the influence of putrefactive microflora, tissue melting is possible;
• destructive - infiltration of foreign cells into the mucous membrane and deeper layers of the bronchi occurs, damage functional fabric may be replaced by connective tissue, and dystrophic changes in the bronchi occur.

All of these forms except

The disease is acute. Sick animals are excited, there is increased sweating, thirst, body temperature rises by 1-2 °C, a pounding heartbeat is heard, cyanosis of the mucous membranes, tachycardia, and an empty pulse are noted. Then the excitement of the general state is replaced by depression, there is a decrease in the reaction to external irritations, a weakening conditioned reflexes. In the future, if the causes of overheating are not eliminated, the disease can occur in asphyxial, hyperpyretic and convulsive-paralytic forms. Asphyxial the form is characterized by progressive weakness, hyperemia and cyanosis of the mucous membranes, tachycardia, shortness of breath, hyperhidrosis, cardiovascular failure and respiratory failure, asphyxia. Hyperpyretic the form is manifested by a significant increase in body temperature. The pulse is rapid and weak. Heartbeat pounding. Cheyne-Stokes respiration is noted. The mucous membranes are cyanotic, in some cases foamy nasal discharge is observed, crepitating wheezing is heard on auscultation of the chest, excitement is replaced by depression up to a comatose state. The animal may die due to the phenomena of clonic convulsions. Convulsive-paralytic form is associated with a sharp disturbance of water-salt metabolism and progressive dehydration. In these cases, along with cardiovascular failure, nervous phenomena come to the fore. Dynamic and static ataxia, tonic and clonic muscle spasms of the limbs and torso appear. Body temperature rises slightly.

Pathological changes

Hyperemia is noted meninges and brain, its swelling, pinpoint hemorrhages in the brain and along the nerve trunks. Hyperemia and pulmonary edema are detected. The blood in the vessels is not clotted. The amount of cerebrospinal fluid is increased.

Diagnosis

Anamnestic data and clinical signs are taken into account. When differentiating the diagnosis, pasteurellosis, anthrax and plague are excluded, as well as sunstroke, active hyperemia and inflammation of the brain, and intoxication.

Treatment

Overheating factors are eliminated, animals are placed in a cool room and provided with drink. Animals are doused with cold water, cool enemas (T20-25 ° C) are recommended. A 20% solution of camphor (3-6 ml) or IV cordiamine (1-4 ml), 1% solution of lobeline IV, 0.15% solution of cititon IV are prescribed subcutaneously. To combat dehydration and intoxication, a physiological solution of sodium chloride with glucose, ascorbic acid and caffeine is administered, and plasma substitutes of the dextran series are used (polyglucin, reopoliglucin, reomacrodex, reogem, hemodez, etc.) at the rate of 10-30 ml per kg of animal body weight . For hyperemia and pulmonary edema, moderate bloodletting is indicated, followed by intravenous administration of physiological solutions or calcium chloride.