Approved
at the Chair of Infection diseases and
epidemiology
meeting on
The Head of the Chair
Prof . G. M. Dubynska
The subject under the study
is
Infectious diseases
Methodical Instruction No. 4
For the 5th year students’ self – preparation work
(at class and at home)
in studying Infectious diseases
Topic: Food toxicoinfections . Viral infection diseases with faecal-oral mechanism of transmission.
Hours:
1. Urgency of the issue:
A great place among acute virulent infections of digestive system is taken by such diseases like
food toxicoinfections (FTI).Today, food toxicoinfections is one of the most widely spread
anthropoonoses in developed countries. There is a trend for care rate increase; in particular it concerns
big cities with centralized system of food supply. It is caused by ubiquitous nature of germs, their
resistance to ambient conditions and ability to accumulate beyond living organisms. Social aspect,
relative for Ukraine as well, play an important part - expansion of public food network, deviations in
manufacturing technologies and storage of food products, failure to follow rules of personal care and
low level of sanitary culture of some branches of population. Vast prevalence of FTI, quick
dehydratation and possible contamination during indoor treatment makes doctors of any profile
obliged to study this pathology.
2.Tasks of the training course:.
2.1. The student should have an idea of (get familiar with):
a-1

have a general idea about position FTI in the structure of virulent diseases, prevalence in different
areas of Ukraine and the world; study statistic data related to case rate, case mortality, event frequency
and bacteria carriage as for today .

get familiar with history of scientific study of FTI, have an idea of scientific contribution of native
scientists.
2.2. The student is should know:
а- 2
1. causation of FTI, aspects of germ pathogenicity
2. causation of FTI
3. pathogenesis
4. clinical signs of FTI caused by opportunistic germs
5. pathogenesis, genesis term and clinical aspects of FTI
6. salmonellosis and FTI laboratory diagnostics
7. the ways of treatment
8. principles of prophylactis
9. medical approach in case of emergencies
10. rules of discharge of recovered patients from in-patient hospital
2.3. The student should be able to:
а-3
1. Follow the main rules of behavior by sickbed.
2. Make up medical history estimating epidemiological data
3. Examine the patient and find out the main symptoms and syndromes of salmonellosis, justify the
clinical diagnosis, and solve the issue of necessary inpatient treatment
4. Based on clinical examination define possible complications of salmonellosis, emergencies
5. Fill in medical documentation based on previously stated diagnosis “salmonellosis” (emergency call to
regional epidemiological department)
6. Make up a plan of patient’s laboratory and instrumental examination
7. Analyze the results of laboratory examination
8. Give a proper estimate to the results of specific methods of diagnostics proceeding from material and
period of examination
9. Make up an individual treatment plan taking into account epidemiological data, stage of disease,
available complications, severity of the condition, allergic anamnesis, comorbidity, provide rescue
emergency care
10. Make up a preventive measures plan for the centre of infections
11. Provide recommendations related to mode of treatment, diet, examination and medical supervision
during recovery period
3. Information to be obtained during pre-classroom independent work.
3.1.Basic knowledge and skills necessary for subject learning (interdisciplinary integration)
Discipline
Know
Be able to
Microbiology
Propedeutics of medical
diseases
Features of opportunistic
microorganisms, rules and terms
for sampling for specific
diagnostics
Main stages and methods of
patient clinical examination
Epidemiology
Epidemiological process of food
toxicoinfections
Immunology and
allergology
Role of immunity system in
infectious process, influence on
the term of germ elimination
from human organism.
Aspects of physiological
standards of human organs and
systems; aspects of laboratory
examination in standard
condition
Physiology
Take samples of material for
bacteriological testing
Make up medical history, perform
clinical examination of the patient
by different organs and systems,
define clinical symptoms of
pathology
Make up an epidemiological
history, perform antiepidemic and
preventive measures in the centre
of infection
Analyze data of immunological
examinations
Estimate data of laboratory
examination
Clinical pharmacology
Pharmocological properties,
adverse effects of means of
nosotropic therapy
Prescribe treatment with regard to
age, individual symptoms of the
patient, chose an optimum mode of
drug intake and dosage, provide
prescriptions
Reanimation and intensive
care
Emergencies:
 TSS
 Dehydration shock
Make due diagnosis of and provide
rescue care in emergencies
Family practice
Other disciplines
Pathogenesis, epidemiology,
intensiveness of clinical signs,
possible complications of food
toxicoinfections. Principles of
prophylactics and treatment.
Perform differential diagnostics of
diseases with various geneses at
food toxicoinfections. Find out
food toxicoinfections and possible
complications; analyze results of
laboratory examination. Admit the
patient to contagious isolation ward
in due time. Fill in the emergency
notice. Provide rescue emergency
care if required
Integration between subjects
Virulent diseases
Features of infectious diseases.
Methods of diagnostics,
treatment and prophylactics of
infectious diseases.
Pathogenesis, epidemiology,
intensiveness of clinical signs,
laboratory diagnostics, possible
complications specific features
Perform differential diagnostics of
food toxicoinfections with other
infectious diseases. Define food
toxicoinfections, their
complications; analyze results of
laboratory examination. Prescribe
treatment. Provide rescue
emergency care in pre-hospital
of clinical progress of food
toxicoinfections. Prophylactics
and treatment methods
3.2. Structure and logic scheme of class content
stage.
Food toxicoinfections caused by opportunistic flora
Pathology
of organs
патологія
Metabolic
processes
failure
Recovery
Thirst
Vomiting
Collapse
Complications
Diarrhea
Toxin
elimination
Stomach-ache
Toxemia
Death
Convulsions
Generalization
Hypotonia
Clinics
Bacteria
destruction
бактерій
Fever
Pathogenesis
Way of transmission – food.
Infection source – person suffering from pyoinflammatory process of
various locations, germ carriers, cows suffering from blue bag
Intoxication
Epidemiology
Introduction of
bacteria and/or
toxins
Causation
Aerobic bacteria: Proteus, E.coli; gram-positive cocci: Staph., Str.
Sporogenous anaerobes: Cl.perfringens
Resistant to ambient conditions, able to accumulate in food products
and generate toxins
Dehydration
DS
Prophylactics
Non-specific
Rehydration
Absorbents
Deintoxication
Treatment
PHT, AT with
autohemagglutinin
GIT lavage
Bacterial inoculation of
biological material
Specific
diagnostics
3.3 Recommended literature
Basic literature:
Name of the source
№
Author(s)
(textbook, manual,
monograph, etc)
1. Pokrovsky.V.I.
Infectional disease and
epidemiology
2.
Park K.
3.
Volovskaya
M.L.
Park’s textbook of
Preventive and Social
medicine
Epidemiology and
Fundamentals of
Infectious Diseases
City,
Publishing
house
M.
GEOTAR.
Medicine
17th
edition,
India.
Mir
Publishers
Moscow.
Year of
edition, vol.,
issue.
2000
2002
1999
3.4. Materials for self-control
3.4.1. Questions for self-control
1. Source of infection at food toxicoinfections.
2. Ways and main aspects of food toxicoinfections transmission
3. Basic symptoms of food toxic infections caused by opportunistic germs.
4. Food toxicoinfections clinical classification.
5. Sequences of food toxicoinfections.
6. Specific complications of food toxicoinfections.
7. Biochemical aspects to be examined in patients with FTI.
8. Examination plan for patient with supposed FTI.
9. Factors of FTI specific diagnostics.
10. Indications for bacteriological blood testing at FTI..
11. Indications for etiotropic therapy of FTI. Drugs, dosing, ways of administration and duration of
treatment.
12. Emergency care at local forms of FTI.
3.4.2. Tests for self-control
Choose correct answers:
=2
VARIANT 1
1. What is duration of the food poisonings incubation period?
a) 1-12 hours;
b) 2-3 days;
c) 4-6 days;
d) 7-14 days;
e) 12-24 hours.
2. The is the main factor of the pathogenicity of food poisonings?
a) activity of microorganism;
b) production of toxin;
c) allergic.
3. What is the first method of food poisonings therapy?
a) antibacterial;
b) symptomatic
c) lavage of stomach;
d) diet;
e) immunocorrection.
RIGHT ANSWERS
1. A
2. B
3. C
3.4.3. Problems for self-control
Problem 1.
=2
Patient, 20 years old, has an acute form of the disease. He was complaining of rigor, hot flash,
temperature increase up to 39оС, nausea, vomiting, frequent bulky and nauseous stool without any
pathological tap, and ache in epigastric and mesogastric areas. His sister had the same disease. 6 hours
before sickness the patient ate a boiled duck, which had been stored for 10-12 hours at room
temperature.
Results of examination: moderate severe condition, body temperature – 39,2оС, tissue tension is
reduced, dry tongue with rich brown deposit. АТ – 100/60 mm of mercury column, beat – 100
strikes/minute, very weak. Tenderness in epigastric zone, close to omphalus. Rear convulsions of
calcaneal muscles.
1. Primary diagnosis. 2. Examination plan. 3. Treatment plan.
Give an answer:
=3
1. Methods of laboratory diagnostics of generalized forms of salmonellosis
- bacteriological: blood, bile and urine culture and sensitivity, if required – spinal liquid,
apostem content;
- serological: agglutination test, PHT with antigen of salmonellosis
2. Diagnostics of salmonellosis subclinical form
- separation of Salmonella from feces and presence of diagnostic titers of anti-Salmonella antigens
in serological reactions when clinical signs of the disesase are absent
3. Specific diagnostics of food toxicoinfections, caused by opportunistic flora
- simultaneous sampling of material from the patient and suspicious product;
- testing of one germ attributable to all patients;
- reduced amount of germ in feces in the course of recovery;
- increased antiserum activity with autohemagglutinin
4. Materials for classroom individual work
4.1. List of practical training tasks to be done during the practical class:
 Study methods of examination of patient with FTI
 Examine the patient for FTI
 Perform differential diagnostics of FTI
 Make up a plan of laboratory examination
 Study the results of specific examination of patients with FTI
 State the complications of FTI.
 Make up a treatment plan for the patient with FTI.
 Define medical approach in different clinical forms of FTI.
4.2. Professional algorithm of obtaining knowledge and skills of food toxicoinfections diagnostics
№ Task
Sequence of actions
Notices and warnings concerning selfcontrol
1.
Study
the I. Define the complaints
methods
of of the patient.
examination
of patient with
FTI
II. Define the history:
1. Medical history
2.
Examine
patient
the
2. Patient’s life history
3. Epidemic history
Divide
complaints
syndromes of:
- total toxicosis
- organs attack
- additional influences
attributable
to
Pay attention to acute start, period,
sequence of symptoms and intensiveness
of
- fever;
- nausea
- stomach-ache
- vomiting
- diarrhea
- other symptoms
Define pervious diseases
Specify data related to fecal-oral
mechanisms of transmission, pay attention
to consumption of products that can
constitute factors of germ transmission.
II.
Perform
examination.
proper Remember: presence, intensity and
dynamics of the symptoms is related to
the period and severity of disease
progress, and they depend on age of the
patient and comorbidity.
1. General examination:
Pay attention to:
- general condition of the - weakness, adynamia and retardation of
patient;
the patient;
- body temperature
- skin, mucous of oral - tissue tension, dryness
pharynx;
- dryness of mucous membranes
- muscle system
- possible convulsions
2. Digestive system:
- tongue examination;
Pay attention to:
- dryness, fusion
- stomach percussion;
- stomach palpation;
-feces analysis.
3. Heart-vascular system:
- beat;
- arterial tension;
- cardiac auscultation
- size of liver and spleen;
- meteorism;
- symptoms of peritonitis (availability
proves the fact of small intestine rupture);
- frequency, amount, color and odor
Pay attention to:
- polycardia
- strength and rhythm of pulse
- arterial tension reduction (great
reduction means complications!)
- moderate hollowness of cardiac sounds.
Impairment of consciousness is possible
in severe disease progress
5. Nervous system
3.
Prescribe
1. General blood analysis.
laboratory and
other testing,
estimate their
results
2. General urine analysis
Pay attention to standard changes:
leucocytosis, neutrocytosis, and IPT
acceleration
Increase of specific weight
4. Feces culture and Prescribed regardless of disease period
sensitivity,
vomited during fever period, but, recommended as
matter, lavage water and soon as possible
food products
Positive since the first day of the disease.
5. Serological methods:
-AT, PHT
Prescribed in paired serums with an
interval of 10 days; diagnostic titer –
1:200.
Diagnostic titer 1: 100
At FTI – with autohemagglutinin– titer
increase