MINISTRY OF HEALTH OFTHE REPUBLIC OF UZBEKISTAN
CENTER OF DEVELOPMENT OF MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
Department of infectious and pediatric infectious diseases
Subject: Infectious diseases
Theme: SALMONELLOSIS
Educational-methodical guideline for teachers and students of Treatment Faculty
TASHKENT
MINISTRY OF HEALTH OFTHE REPUBLIC OF UZBEKISTAN
CENTER OF DEVELOPMENT OF MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
"A F F I R M E D"
Pro-rector of educational work
Professor Teshaev O.R.
__________________________
«____»____________2012
Department of infectious and pediatric infectious diseases
Subject: Infectious diseases
Theme: SALMONELLOSIS
Educational-methodical guideline for teachers and students of Treatment Faculty
"A F F I R M E D"
at a DNC meeting of Therapeutic Faculty
Protocol № ___from_________2012
Chairman of DNC, Professor
Karimov M.Sh.___________
TASHKENT
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THEME: SALMONELLOSIS
1. Place of the lessons, equipping
- The auditorium;
- Accident ward;
- Branch OKZ;
- Diagnostic branch;
- Bacteriological laboratory.
- ТСО: thematic patients with a salmonellosis; slydoscope; TV-video; the training-supervising
program; scenarios of methods of work in small groups; situational problems.
2. Duration of studying of a theme
Quantity of hours - 2
3. The employment purpose
- To acquaint students with the basic clinical symptoms of a salmonellosis;
- Methods of diagnostics and principles of treatment of patients with a salmonellosis;
- To bring up feeling of interest to a salmonellosis problem;
- To bring up a sense of responsibility for life sick of a salmonellosis;
- To develop scientific, logic thinking at bed of the patient;
- The creative approach to questions of diagnostics and treatment sick of a salmonellosis.
Problems
The student should know:
- Statement of clinical diagnostics of a salmonellosis;
- To therapeutic tactics at a pre-hospital stage;
- To disease preventive maintenance.
The student should be able:
- To collect complaints sick of a salmonellosis;
- To collect epid.anamesis sick of a salmonellosis;
- To examine the patient on bodies and systems;
- To allocate symptoms characteristic for a salmonellosis;
- To formulate the preliminary clinical diagnosis;
- To estimate weight of a condition general salmonellosis forms;
- To interpret results of laboratory researches;
- To issue the case record sick of a salmonellosis;
- To make the treatment plan at a pre-hospital stage and to spend it;
- Will prepare sick of a salmonellosis for an extract from a hospital.
As a result of the conducted lesson the student should seize practical skills:
- To take blood on serologic researches;
- To take a material from the patient on bacteriological research;
- Will prepare in house conditions a solution for peroral regidratation;
- To carry out therapeutic actions at a pre-hospital stage;
- Will issue and send emergency the notice on the patient with suspicion on a salmonellosis;
- To spend primary antiepidemic actions in the salmonellosis centre.
4. Motivation
The salmonellosis is one of actual problems of the infectious pathology which important
questions still there is early diagnostics and pathogenetic therapy. Heightened interest to a
salmonellosis problem is connected now with changes of a clinical current and increase of
relative density of the lungs erased and назопаразитических of forms of disease, increase of an
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allergic component a clinical syndrome of decrease immunologic indicators of increase of
frequency long bacterialsecretion. At the present stage of communication with introduction in
practice immunoallergic and is functional-morphological methods of research ample
opportunities clinical and experimental studying патогенеза, immunity, diagnostics and
pathogenetic therapy of a salmonellosis open more.
5. Intersubject and intrasubject communications
Teaching of the given theme is based on knowledge students of bases of biochemistry of
infringement of a metabolism, microbiology, immunology, патанатомией, pathological
physiology, physiology GIS. The knowledge received during employment will be used at
passage of therapy by them, surgeries, obstetrics, gynecology, haematology and other clinical
disciplines.
6. The employment maintenance
6.1. A theoretical part
The salmonellosis is polietiologic an infectious disease caused various serothypes of a
bacterium of sort Salmonella, is characterized by various clinical displays from asymptomatic
carrity to heavy forms.
Aetiology. The activator: concerns sort Salmonella, family Enterobactericae.
Gramnegative, length 2-4 microns, width 0,5 microns, dispute and capsules do not form, has
flagellas from 8 to 12, mobile, forms colonies in weak alkaline Ó¡ 7,4-7,5 environment.
Antigene properties: a thermostable O-antigene on a membrane, flagellum thermolabile
N-antigene and superficial capsular To - an antigene.
Pathogenic properties of the activator. Pathogenic types of the activator for the person: a
belly typhus, a paratyphus - monopathogen. Pathogenic types of the activator for animals and
birds - monopathogen. Pathogenic types of the activator for animals and for the person bipatogen: Salmonella anatum, Salmonella London.
Epidemiology. The antropozoonose infection meets both at people and at animals. An
infection source: the sick person and bacteriacarrity. Meets sporadical. Infection ways:
alimentary - foodstuff; contact - household; the water. After recover it is formed тtypespecifical
monoimmunity. Disease meets in all age groups: especially at children and at the elderly
proceeds more hard.
Pathogenesis. Introduction of salmonellas  primary regionar infection  bacteriemia
 toxinemia  defeat of bodies and systems  restoration amazed functions.
Endotoxine - operates on mucous membrane GIS, the neurovascular device of intestines
 occurs general paralysis of vasomotours  tone decrease  permeability increase. It leads to
an inflammation mucous intestines and develops cataral-hemorrhagical gastroenteritis.
Under influence endtoxine enzyme adenilatcyclase, being on a membrane of eritrocytes
becomes more active, synthesis цАМФ is as a result broken that makes active endocellular
fermentative processes. It leads to allocation in a gleam of intestines of a considerable quantity
of electrolits and water that causes diarea a syndrome.
Endotoxine being soaked up in blood, influences on ЦНС and ВНС  decrease А/Д,
blood-groove delay in capillaries leads circulare to a collapse.
Endotoxine amazes capillaries and precapillares, system of a fibrillation and breaks
microcirculation in all bodies and fabrics. The dystrophy  necrosis  endotoxical shock
develops hypoxia  acidosis .
Clinical classification.
1) the Gastroenteritic form:
Sharp gastritis (5-7 %)
Sharp Gastroenteritis (75-80 %)
Sharp Gastroenterocolitis (5-10 %)
2) General form:
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The typhical
The septic
3) Bacteriocarrity:
The sharp
The long
The chronic
The transitor
4) nosohelmintical form
Clinic. The gastritical form: the incubatory period from 3 - 5 hours till 2-3 days. A
gastritical variant: there is in 5-10 % a case, a beginning sharp, a fever, a headache, body rise in
temperature, a pain in epigaster areas, an anorexia, a nausea, vomiting.
Gastroenteritical variant: the sharp beginning, symptoms of the general intoxication (a
fever, a headache, weakness, rise in temperature), схваткообразные pains on all stomach, a
nausea, the vomiting bringing simplification, a diarrhoeia - профузная, fetid, with slime,
метеоризм, гепатомегалия.
Gastroenterocolitical variant: the same symptoms, even more frequent chair, with slime,
blood, tenesms, false desires.
Diagnostics. The general analysis of blood, urine, an excrement; biochemical analyses;
the bacteriological; serological O-aha, RPHA - 1: 200; RSC - 1: 80.
Differential diagnostics. A dysentery, FTI, a botulism, a cholera, an iersiniosis, a belly
typhus, a paratyphus, septic conditions, a myocardium heart attack.
Treatment. A mode. A diet. Etiotropnoe treatment. Pathogenetic treatment.
Symptomatic treatment.
New pedagogical technologies used on given employment:
«the Handle on the table middle»,
«the Black box».
METHOD USE «THE HANDLE ON THE TABLE MIDDLE».
The method provides joint activity and active participation in employment of each
student, the teacher works with all group.
The task is offered to all group. Each student writes down one variant of the answer on
sheet and transfers to its neighbour, and the handle moves on the table middle.
The teacher supervises work of group and participation in it everyone, makes comments
on correctness of the answer, its validity, degree of activity of students, the general variant
registers in a writing-book.
The given technique promotes formation of bases of critical thinking since in this case
the student to learn to defend the opinion, to analyze answers course mates- participants of this
competition.
METHOD USE «THE BLACK BOX»
The method provides joint activity and active participation in employment of each
student, the teacher works with all group.
Each student gets from «black a box» the unknown question which short summary is
written on cards. Students should define this question in detail having proved the answer.
On considering of each answer 3 minutes are given to the student. Then answers are
discussed, addition on clinic, disease treatment is given. In the end of a method the teacher
makes comments on correctness of the answer, its validity, degree of activity of students.
The given technique promotes development of speech of the student, formation of bases
of critical thinking since in this case the student to learn to defend the opinion, to analyze
answers course mates - participants of this competition.
Variants of summaries:
1. Salmonellosis definition: salmonellosises are diseases from group of the intestinal infections,
the sorts of salmonellas having various simtomatology and extending in the form of sporadic
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cases and flashes caused by bacteria, and the basic sources of infection with them are animals,
and the leading factor of transfer - foodstuff.
2. The salmonellosis concerns what group of infectious diseases? The salmonellosis concerns:
bacterial intestinal infections, antroposoonosis.
3. A salmonellosis aetiology: salmonellas - small bacteria, with the rounded off ends in length
from 1 to 3 nanometers and width from 0,5 to 0,8 nanometers, gramnegative, facultative aerob,
mobile.
4. Epidemiology salmonellosis: an infection Source is the sick person and animals,
bacteriacarryties. The infection mechanism – fecal-oral. Transfer ways - food, contacthousehold, water.
5. Pathogenesis of diarrhoeia syndrome at a salmonellosis: at the heart of increase of secretion of
a liquid in intestines the activation mechanism adenilatcyclase of enterocites with salmonella
enterotoxine with the subsequent increase of endocellular concentration of biologically active
substances (cAMF, cGMF, etc.) lies that involves receipt in a gleam of intestines of a
considerable quantity of a liquid, potassium, sodium and chlorides. Patients have vomiting and a
diarrhoeia.
6. Clinical classification of a salmonellosis: gastrointestinal form (gastritic, gastroenteritic,
gastroenterocolitic); general form (typhosus, septicopiemia); bacteriocarrity (sharp, chronic,
transitor).
7. Clinical variants gastrointestinal salmonellosis forms: gastrointestinal salmonellosis form
consists of following variants: gastritical, gastroenteral, gastroenterocolitical.
8. Clinical variants general salmonellosis forms: general the salmonellosis form consists of
following variants: typhical; septicopiemia.
9. The basic symptoms of gastritical salmonellosis variant: it is observed seldom. Disease begins
sharply, is accompanied by rise in temperature of a body to subfebril figures, a fever, an
intoxication, pains in epigastral areas, a nausea and repeated vomiting. This form proceeds not
hard, and all symptoms disappear within 1-3 days.
10. The basic symptoms of gastroenteritical salmonellosis variant: it is considered the most
frequent clinical form. Begins sharply with rise in temperature of a body to 39-40ºС and above,
with a fever, sheathe weakness. There is a dryness in a mouth, vomiting repeated, plentiful,
swellings and belly-aches of pulling character, a frequent liquid chair of 10-15 and more times a
day. A chair liquid, plentiful, fetid, dark green or brown colour. Duration of illness within 1-4
days and by 5-7 day comes recover.
11. The basic symptoms enteritical salmonellosis variant: enteritical the form also is the frequent
clinical form. Begins sharply with rise in temperature of a body to 39-40ºС and above, with a
fever, sheathe weakness. There is a dryness in a mouth, swellings and belly-aches of cutting
character, a frequent liquid chair of 10-15 and more times a day. A chair liquid, watery, plentiful,
foamy, fetid, dark green or brown colour, without pathological impurity. Duration of illness
within 1-4 days and by 5-7 day comes recover. Vomiting it is not characteristic for
энтеритической salmonellosis forms.
12. Complications gastrointestinal salmonellosis forms: hipovolemic shock, infectious-toxic
shock, sharp nephritic insufficiency.
13. Complications general salmonellosis forms: infectious toxic shock, AKI, a brain hypostasis,
glomerulonefritis, arthritises, organic pus abscesses.
14. Differential diagnostics gastrointestinal salmonellosis forms: FTI, a cholera, a dysentery, a
iersinosis, a esherichiosis, a poisoning with mushrooms, sharp surgical pathologies of a belly
cavity (a pancreatitis, an appendicitis, a thrombosis мезентериальных vessels etc.).
15. Differential diagnostics of general salmonellosis forms: a belly typhus and a paratyphus And
and In, iersiniosis, a pseudo-tuberculosis, the Ku-fever, septic conditions.
16. Methods of laboratory diagnostics of a salmonellosis: bacteriological and serological
researches is the basic link in diagnostics of salmonellosises.
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17. Necessary materials for bacteriological research: blood, urine, bile, emetic weights, washing
waters of a stomach, an excrement, also foodstuff.
18. The basic pathogenetic methods of treatment of a salmonellosis: infusion therapy:
intravenously droperly - a haemolisinformation, Atsessol, Dissol, Hlasol, a solution of Ringera,
reosorbilact, poliglucine etc.
19. Etiotropnye methods of treatment of a salmonellosis: preparations of nitrofuranion number,
salmonellosis bacteriofag, at hard cases antibiotics of a wide spectrum of action.
20. An extract of reconvalescents from a hospital: clinical recover, the negative control
analysis a tank. Crops of excrements (at general forms - urine, bile, excrements).
6.2. Аналитическая часть
Ситуационные задачи:
6.2. An analytical part
Situational problems:
Problem № 1. Patient К, 27 years, was ill in 5-6 hours after the use samsa, bought on a
market. The general condition at receipt of average weight. The diarrhoeia complains of bellyaches, heat, a fever, spasms in sural muscles. A nausea, vomitings were not.
Temperature 38,8ºС. Pulse 88 beats. In a minute, satisfactory filling and pressure,
frequency of breath 20 in a minute. The HELL of 110/70 mm hg Tones of heart are muffled.
Language damp, is slightly imposed. The stomach is blown moderately up, at a palpation - the
rumbling, the poured morbidity on intestines course. A sygmoidal gut not spasmed. A chair
frequent, liquid, plentiful, fetid, slime and blood are not found out.
1. Make the preliminary diagnosis?
2. What clinical variant at the patient?
3. What clinical syndromes take place at the given patient?
4. What laboratory methods of research it is necessary for diagnosis statement?
5. What complications can develop at the sick?
6. Specify methods of pathogenetic therapy.
7. Specify etiotrofic treatment.
№
1.
2.
3.
4.
5.
6.
7.
Answer
Salmonellosis, gastrointestinal form.
Enteral variant
Enteritis (a chair frequent, liquid, plentiful, fetid, without mucosa and blood); the
Toxicosis (heat, a fever, spasms in sural muscles).
Bacteriological research of excrements
Hipovolemic shock
Infusion and desitoxical therapy (salt solutions, glucose, a haemomisinformation).
Preparations of nitrofuranion number, antibiotics.
Problem № 2. Patient Д, 23 years, is delivered in clinic in connection with by group food toxic
infection. At all arrived disease has arisen in 4-8 hours after the use in a dining room of chicken
meat. Disease has begun sharply, the temperature to 39,1ºС has raised, after a fever there were
belly-aches, a nausea, vomiting, a diarrhoeia.
Has arrived in 5 hours from an onset of the illness in a condition of average weight. Temperature
38,8ºС, a face skin hiperemised. Pulse 96 in a minute, weak filling and pressure; frequency of
breath - 16 in a minute; the HELL of 100/60 mm Hg Tones of heart are muffled. Language is
covered by white touch, damp. A stomach soft, rumbling on intestines course. The gut is
palpated painful sygmoid. Vomiting in receipt time has stopped (was 4-multiply). The diarrhoeia
proceeds. A chair frequent, liquid, fetid, with "greens", in excrements slime lumps are visible. At
excrementocytoscopic research many leukocytes are revealed.
1. Make the preliminary diagnosis?
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2. What laboratory data will help you directed by the diagnosis?
3. With what diseases it is necessary to differentiate.
4. Treatment.
№
1.
2.
3.
4.
Answer
Salmonellosis, gastroenterocolitic form, average weight of a current.
Bacteriological researches of excrements, emetic weights.
Dysentery, intestinal amebiasis, esherichiosis, iersiniosis, surgical diseases of a belly
cavity.
Washings of a stomach by a solution of a hydrocarbonate of sodium; инфузионная
therapy, vitamins.
6.3. A practical part
Rules of a fence of a material for bacteriological research at Oka (a salmonellosis and a
dysentery).
The purpose: to Allocate culture of activators various diarrhoeiadal diseases for diagnosis
acknowledgement.
Indications: All diseases diarrheas accompanied by a syndrome.
The necessary equipment: the Pure vessel for a fence of excrements of the patient, sterile
rubber gloves, preservatives (Tiga, Müller), sterile loops, the form-direction in laboratory.
Carried out stages (steps):
:
№
1.
2.
3.
4.
5.
6.
7.
Action
Has not
executed
(0 points)
To dress sterile rubber gloves
To rinse a vessel with flowing water not containing chlorine
0
Completely
has
correctly
executed
(10 points)
10
0
0
10
10
0
0
10
10
0
10
0
0
0
10
10
10
0
0
10
100
To submit a vessel to the patient for gathering of
excrements
To take a sterile loop
Take away sites of excrements with slime
From excrements it is impossible to make a fence where
there is a blood and pus
To sow the collected material in preservative (Tiga, Müller)
8. At a dysentery on Tiga 1:3
9. At a salmonellosis on Müller 1:5
10. To specify the data of the patient on the form-direction, the
preliminary diagnosis, a simple pencil and to send in
bacteriological laboratory
In total
7. The form of control of knowledge and ability
- The oral;
- The decision of situational problems;
- Demonstration of the mastered practical skills.
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8. Control questions
1. Salmonellosis definition.
2. Salmonellosis classification.
3. A salmonellosis aetiology.
4. Epidemilogy of salmonellosis.
5. Pathogenesis of salmonellosis.
6. Clinic of gastroentertical salmonellosis variant.
7. Clinic of enteritical a salmonellosis variant.
8. Laboratory diagnostics of a salmonellosis.
9. Differential diagnostics of a salmonellosis.
10. Outcomes and salmonellosis complications.
11. Salmonellosis treatment.
12. Salmonellosis preventive maintenance.
13. What practical skills are applied at a salmonellosis?
9. The recommended literature
1. Majidov V.M. Infectional diseases. Т., 1992.
2. Maxmudov O.S. Children inflectional diseases, Т., 1995.
3. Uchaykin V.R. Manual by children inflectional diseases, М.,2005.
4. Shuvalova E.P. Infectional diseases, М.,1999.
5. Musabaev I.K. «the Management on intestinal infections», Т, 1999.
7. Pokrovsk Century И, Pak Of this year, etc. «Infectious diseases and epidemiology». - М,
2003
8. Jushchuk N.D., Vengerov J.J. «Lectures on infectious diseases». - М, 1999.
9. Uchajkin V. F «the Management on infectious diseases at children», - М, 1998.
10. Internet resources (www <http://www.medlinks.ru/> medlinks
<http://www.medlinks.ru/><http://www.medlinks.ru/>ru <http://www.medlinks.ru/>,
www.cdc.gov <http://www.cdc.gov/>).
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