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: FLU. Acute viral respiratory infections.
Educational-methodical guideline for teachers and students of Treatment Faculty
TASHKENT
1
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: FLU. Acute viral respiratory infections.
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
2
THEME: FLU. Acute viral respiratory infections.
1. Place of the lessons, equipping
- The auditorium;
- The emergency room;
- Diagnostic department;
- The laboratory.
- TCO: Case patients with influenza and SARS; slaydoskop; TV-video, teaching, supervising the
program, methods of work scenarios in small groups, case studies.
2. The duration of the study subjects
Number of hours - 4
3. The purpose of classes
- To familiarize students with the main clinical symptoms of influenza, adenovirus infection,
parainfluenza, rhinovirus infection, respiratory syncytial infection, diagnostic methods,
principles of treatment and prevention of disease;
- Bring a sense of interest in the issue of SARS and influenza;
- Bring a sense of responsibility for the lives of patients with SARS and influenza;
- Develop scientific, logical thinking at the bedside;
- A creative approach to the diagnosis and treatment of patients with SARS and influenza.
Objectives
The student should know:
- Statement of the clinical diagnosis of influenza, adenovirus infection, parainfluenza, rhinovirus
infection, respiratory syncytial infection;
- Therapeutic tactics;
- Prevention of disease.
The student should be able to:
- To collect patient complaints of influenza and SARS;
- To collect epid.anamnez;
- Examine the patient for organs and systems;
- Identify the symptoms typical of influenza and SARS;
- To formulate a preliminary clinical diagnosis;
- Assess the severity of the patient;
- Interpret the results of laboratory tests;
- Draw the patient's medical history of influenza and SARS;
- Draw up a plan of treatment the patient of influenza and SARS.
As a result of training the student should learn practical skills:
- Check the availability of patient meningeal symptoms;
- To conduct therapy with hyperthermic syndrome.
4. Motivation
The problem of anti-flu is a priority for public health. The incidence of influenza and other viral
respiratory infections than the general incidence of all other infections, and in some years,
influenza and SARS is 80% of all infectious disease and more than 60% of morbidity in children,
flu gives serious complications, death rates are still high.
5. Interdisciplinary communication
Teaching this topic is based on the knowledge bases of students of biochemistry metabolism,
microbiology, immunology, pathological anatomy, pathological physiology, physiology of the
upper respiratory tract infections. The findings of the studies of knowledge will be used during
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the passage of medicine, surgery, obstetrics, gynecology, hematology and other clinical
disciplines.
6. The content of training
6.1. The theoretical part
Influenza - highly contagious acute viral disease, manifested by chills, headache,
weakness, muscle aches, dry, painful cough, original, nasal congestion, conjunctival hyperemia,
and the phenomena of scleritis, possible abdominal pain, nausea and vomiting.
Etiology. The influenza virus belongs to the RNA containing, RNA polymerase is, in the outer
layer of the shell consists of glycoproteins that have hemagglutinating and neyroaminidaznoy
activity causes a change in their appearance of a new subtype of influenza A.
As part of the virus antigens are distinguished: S-internal nucleocapsid involves RNA and viral
protein - 40% by weight of the virion. In the outer shell of V-antigen in its composition of N and
N. C and B viruses do not alter the antigenic structure slaboustoychivy to physical and chemical
factors, die quickly when heated, dried, under the action of UV rays. For influenza A viruses
characterized by the constant variability of antigens, and the process variability can lead to a
change in a single antigen (antigenic drift) and two (antigenic shift).
Epidemiology. Influenza refers to airborne anthroponoses. Patients with flu are contagious from
the first days of illness to 5-6 days for complications up to 2-3 weeks. Epidemics are repeated
every 2-3 years and have an explosive character. For 1-1.5 months illing from 20 to 50% of the
population. The flu epidemic in developing more slowly, lasts for 2-3 months, affects about 25%
of the population, and alternated with an interval of 2 years. Since the flu virus does not
outbreaks.
Because immunity is determined by the presence of specific antibodies to these various antigens,
the susceptibility to influenza will depend solely on the degree of variability of influenza virus
antigens.
Pathogenesis. The virus enters the body through the upper respiratory tract and infects the
epithelium of the respiratory tract (trachea). The virus multiplies in the cells of columnar
epithelium and causes degenerative changes in them, using the contents of the epithelial particles
for the construction of new viruses. The mass yield of mature virus particles is often
accompanied by loss of epithelial cells, which leads to the destruction of the natural barrier, and
viremia. Toxins of the virus with the decay products of the epithelium have toxic effects on the
cardiovascular system, central nervous system and other systems of the body, suppress the
immune system, and the introduction of secondary bacterial flora lead to the development of
various complications.
There are five basic phases of pathogenesis: 1) reproduction of the virus in the cells lining the
airways, 2) viremia, toksinemiya and toxic-allergic reactions, and 3) respiratory failure with
predominant localization, and 4) the possible bacterial complications, 5) development of a
reversible disease process.
At the heart of lesions in various organs and systems play a leading role circulatory disorders associated with the violation of capillary permeability and the occurrence of hemorrhagic
syndrome (epistaxis, hemoptysis), and if severe - bleeding in the lining of the brain substance
and into the alveoli, which manifests an infectious-toxic encephalopathy, hemorrhagic
pulmonary edemas.
Influenza reduces immune reactivity and leads to an exacerbation of various chronic diseases and
the emergence of secondary bacterial complications.
Clinic. Infection occurs through airborne droplets from an infected person. The incubation period
for influenza from several hours to 2 days. Prodromal period is observed in 10-15% of patients in
a lung ailment, chilliness, muscle aches, short-term increase in temperature up to 37,1-37,5 C.
These symptoms appear within 2-3 hours after infection and disappear within the same time
interval and they often "viewed" as the very sick, and watching his doctor.
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Influenza typical acute onset of the disease, which is associated with a vibrant reproduction of
the virus in the body and is seen in the vast majority of patients.
Clinical classification of influenza and SARS.
Etiology
Virus:
influenza
A
influenza
B
influenza
C
Criteria
for
diagnosis
The epidemic rise
in incidence;
Two. Expressed
symp-toms
of
intoxication: acute
onset,
chills,
headache,
muscular pain, we
are in the weak
bovyrazhennyh
kata-eral
phenomena;
neurotoxicosis,
ship-to-goad
m,
encephalitis-lytic
reaction.
Three.
Typical
variation of the
part
of
bronchopulmonary
the
system
(bronchitis,
swelling of the
seg-mentary the
light-from-m
croup-ragichesky
hemorrhagic
pulmonary
edema).
4. Positive the
results of immunofluorescence (IF)
and
enzymelinked
immunosorbent
assay (ELISA).
The shape
of gravity
Light,
including
deleted and
subclinical.
Medium
heavy
Heavy
hypertoxic
Criteria for assessing the
severity of
Body temperature is
normal or within the 38,5
º C, an infectious
toxicosis symptoms are
mild or absent
Body temperature in the
range 38,5-39,5 ° C, an
infectious
toxicosis
pronounced: weakness,
headache, muscle aches,
dizziness
There may be: large,
segmental
pulmonary
edema,
abdominal
symptoms, etc.
The body temperature of
40-40,5 ° C. Briefly:
blackout,
delirium,
convulsions,
hallucinations,
and
vomiting.
character
1. A smooth, no
complications
2.
With
the
emergence of a
virus
associated
complications
(encephalitis, serous
meningitis, neuritis,
polyradiculoneuritis,
etc.)
3.
With
the
emergence
of
bacterial
complications
(pneumonia,
suppurative
necrotizing
laryngotracheitis
bronchitis,
otitis,
etc.)
Hyperthermia syndrome;
Meningoentsefalitichesky
syndrome hemorrhagic
syndrome
Influenza is characterized by the following symptom: 1) fever - one of the main
symptoms of influenza. The maximum temperature rise occurs naturally on the first day of
illness and in severe forms of up to 40 ˚ C, moderate - 39 ˚ C, with light - 38 ˚ C. Reduction of
fever in influenza is either critical or rapid lysis. Humped temperature curve is rare, second
wave, or more often associated with exacerbation of chronic infection (chronic tonsillitis,
chronic sinusitis), or with the addition of pneumonia. On the accession of pneumonia may also
indicate a prolonged fever (more than 9 days).
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2) the manifestation of intoxication. It starts with a disease with symptoms of intoxication:
headache, which is characterized by a typical localization in the fronto-parietal region, temples,
superciliary arches, chills, fainting and dizziness - are expressed, usually in youth and old age
and more frequently in patients suffering from what or chronic diseases (GB, atherosclerosis), or
the decline in power, pain in the muscles of the back, in the calf muscles, joints, back, or
generalized throughout the body.
3) symptoms of respiratory tract lesions at different levels. The most common symptoms are
catarrhal rhinitis, pharyngitis, laryngitis, nasopharyngitis, laryngotracheitis, tracheobronchitis.
The most typical tracheitis, which is accompanied by a dry cough is not productive. Hyperemia
of the pharynx is varying degrees in all patients, often combined with pharyngitis granulosa on
the back of the throat and fine grain size of the soft palate and uvula. Pharyngitis - dry cough,
chest soreness, pain on swallowing, an increase in regional lymph nodes. Laryngitis - sore throat,
soreness in the chest, hoarseness, harsh barking cough. In young children there is a picture of
false croup - shortness of breath on inhalation (inspiratory dyspnea), anxiety, change, hoarseness,
pale skin, acrocyanosis, cold sweat. Bronchiolitis (in young children) - is accompanied by
expiratory wheezing, painful cough with difficult expectoration detachable, chest pain, breathing
shallow, pale skin, the lungs moist rales finely.
Early pneumonia with typical physical signs, hemorrhagic pulmonary edema, cerebral edema,
toxic myocarditis is a consequence of toxicity with neurocirculatory disorders.
Changes in the cardiovascular system are manifested by tachycardia, bradycardia is replaced in
the future, muffled heart sounds, hypotension, toxic and degenerative changes of the
myocardium.
Depending on the severity distinguished: mild - t up to 38 º C, moderately severe symptoms of
intoxication and catarrhal syndrome, moderately - t to 40 º C, severe symptoms of intoxication,
catarrhal syndrome, dry, painful cough, severe - t 40 º C continuous, pronounced symptoms of
intoxication, painful and painful cough.
In the peripheral blood in the early days can be a mild leukocytosis, which is 2.3 to day of the
disease followed by leukopenia. ESR - normal, sometimes moderately increased. With the
addition of bacterial complications appear marked leukocytosis, neutrophilic left shift, high ESR
numbers
Complication. Specific: pulmonary edema, meningismus, serous meningitis, encephalitis,
meningoencephalitis, neuritis of the auditory nerve, false croup, an infectious-allergic
myocarditis, Reye's syndrome.
Nonspecific: Acute viral and bacterial pneumonia, sinusitis, evstaheity, otitis, mastoiditis,
tonsillitis, and activation of chronic infection (FA, rheumatism, chronic tonsillitis,
pyelonephritis).
Diagnosis. The diagnosis of influenza is on the basis of characteristic clinical and
epidemiological data. Laboratory confirmation required under orders number 198, 101 MH RU.
Laboratory examination includes blood tests and urine detection of influenza antigen in the
columnar epithelium of the nasal cavity by immunofluorescence or ELISA, detection of specific
antibodies titer rise in HI, RAC, etc., if necessary, blood biochemistry, coagulogram, x-ray of the
chest, Ultrasonography of the abdomen, bacteriological examination of mucus from the
oropharynx, blood, urine and cerebrospinal fluid.
Differential diagnosis of influenza should be carried out both with acute respiratory infections, as
well as a number of other infections as well as the beginning of many of them due to intoxication
and catarrhal symptoms similar to flu.
Influenza and other viral respiratory infections differ in location of the lesion and the number of
respiratory clinical signs. The flu affects all parts of the respiratory tract, but dominated by
tracheitis, manifested by a dry cough and pain in the course of the trachea. In parainfluenza
affected mainly the larynx laryngitis and there in the form of hoarseness and rough cough strong.
Adenovirus infection is manifested lesions of the mucous membranes of eyes, nose, throat,
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tonsils, with the most pronounced changes of the pharynx. When rhinovirus infection leading
symptoms - rhinitis and rhinorrhea.
In the differential diagnosis with other frequent communicable diseases must be remembered
that in their initial period may be symptoms of intoxication and catarrhal symptoms, but do not
have anything to do with influenza. Thus, when measles against severe intoxication has always
affected the respiratory tract (rhinitis, pharyngitis, laryngitis, tracheitis, bronchitis, sometimes).
However, a number of signs (conjunctivitis, and in particular spots Filatov-Belsky, Koplik the
mucous membrane of the cheeks) to diagnose measles before the characteristic measles
exanthema.
Inflammatory changes in the upper respiratory tract, along with fever and general intoxication
are typical manifestations of catarrhal (influenza), the initial version (predzheltushnogo) the
period of viral hepatitis.
Of the group of diseases tifoparatifoznyh differential diagnosis must be made with paratyphoid
A. In the initial stage of the disease is often a catarrhal symptoms (nasopharyngitis, bronchitis,
conjunctivitis). But in contrast to influenza A paratyphoid begins gradually, day by day increases
the height of fever, with marked effects of intoxication syndrome does not correspond to a
relatively easy changes in airway inflammation. Fever is a permanent type, and the emergence of
a 4-7-day sickness polymorphic rash exclude the likelihood of influenza.
For meningococcal disease, its localized form - characterized by mild nasopharyngitis
manifestations of intoxication, scratchy, sore throat, runny nose, difficulty in nasal breathing. On
examination, - a bright redness and swelling of the mucous membrane of the posterior
pharyngeal wall, the nasal mucosa. In the blood - neutrophilic leukocytosis with a left shift,
increased ESR. There are signs of meningism. Ongoing monitoring of such patients, follow-up
study of blood and cerebrospinal fluid dynamics to rule out the flu, or diagnose the transition to
the generalized form of meningococcal disease.
Treatment. Treatment should begin in the early stages of the disease, it is better on the first day
of the disease. Basic therapy: bed rest is up to the normalization of body temperature, milk and
vegetable enriched with vitamins, diet, drinking plenty of fluids in the form of hot tea, cranberry,
or cranberry fruit drink, alkaline mineral water (mineral water and milk, etc.) Antipyretics:
Paracetamol (Panadol, Coldrex ), nonsteroidal anti-inflammatory drugs (dosage brufen in age),
acetylsalicylic acid (aspirin) is contraindicated in children younger than 16 years because of the
risk of Reye's syndrome; mukaltin, licorice root or tincture Marshmallow and others to liquefy
and discharge of mucus; antitussives: pertussin ( with increased cough reflex), Tusupreks, or
Bronholitin Glauvent (with dry cough), libeksin (with persistent painful cough), Bromhexine
(with wet cough and sputum trudnoothodyaschey), collect the chest, including marshmallow
root, leaf and mother-stepmother, oregano , licorice root, sage, pine buds, the fruit of anise (if
long-term persistent cough) for children older than 2 years in the early days of the disease may
hold inhalations with infusions of chamomile, calendula, peppermint, sage, St. John's wort, wild
rosemary, pine buds, 1-2% solution of sodium bicarbonate, ascorbic acid or a multivitamin,
antihistamines (Tavegil, or Suprastin Zaditen, diazolin, Ketotifen, etc.).
Causal therapy. In moderate to severe forms of rimantadine administered 50 mg of 2 p / d
(children under 10 years) and 50 mg 3x / d (children over 10 years and adults) inside or arbidol
100 mg, 2 r / d and 100 mg 3 p / q, respectively. In severe cases, rimantadine can be given to
children aged 3-7 years to 4.5 mg per 1 kg of body weight in 2 divided doses. Donor normal
immunoglobulin with high content of influenza antibodies: children under 2 years - 1.5 ml, 2 to 7
years - 3 ml over 7 years and adults - 4.5-6 ml / m At age hypertoxic forms of immunoglobulin
dose can be repeated after 12 hours.
Intensification (gain) causal therapy in all patients, regardless of severity, should be given human
leukocyte interferon (CHLI) intranasally with 3-5 drops of 4 p / d by spraying or intratracheally
as an aerosol (2-3 ampules CHLI, dissolved in 3 -5 ml of boiled or distilled water) through
parokislorodnuyu tent or an inhaler-type IP-2 complex therapy of influenza and other viral
respiratory infections for children under 7 years of use Viferon-1, older than 7 years Viferon-2.
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Daily 1 suppository 2 times a day from 12 hours at intervals of 5 days. Seriously ill and often ill
children from 1 year to 7 years are designated Viferon-2, from 7 years to 14 years Viferon-3.
Candles administered daily for 5 days to 1 candle 2 times per day after 12 hours; amiksin taken
orally after meal dosing in age.
Syndromic treatment: the presence of a pronounced infectious toxicity (hyperthermia,
convulsions, loss of consciousness) are appointed: lytic mixture (50% solution of dipyrone, 1%
solution dimedrol, 0.5% solution of novocaine) in 0.1 ml 1 year of life / m, and with no effect in
patients with severe hyperemia of the skin ("red flushing") conduct a physical cooling (the child
to disclose wipe the body with warm water or a 50-tigradusnym alcohol, make cold to major
vessels or to make an enema with Cold water +8 +10 º C). In the "white hyperthermia"
(vasospasm) must be warm (heating pad, foot baths) and the introduction of antispasmodic drugs
(no-spa, papaverine) for removal of persistent seizures administered by intramuscular injection
of 0.5% p-p Seduxenum: 1 year - 0 3-0,5 ml, in 1-7 years - 0.5-1 ml, 8-14 years - 1-2 ml of 1 per
day, with signs of cardiovascular collapse in / injected 20% of p-p glucose with 0.06% p-rum
Korglikon or 0.05% p-strophanthin rum, or 1% solution in the age mezatona dosage, with signs
of cerebral edema (seizures, persistent pyrexia, loss of consciousness) in / or / m administered
hydrocortisone 5-10 mg per 1 kg of body weight per day, Lasix - 20-40 mg / kg, mannitol - 1.5 g
/ kg per day, in order to improve the rheological properties of blood injected trental 2% p -r of
0.25 mg / kg in case of obstructive syndrome is prescribed aminophylline, etimizol, alupent, etc.,
in order to detoxification / drip administered 10% solution of glucose, insulin (1 unit of 5.0
sugar) cocarboxylase, reopolyglukine (5-100 ml / kg), albumin (5 ml / kg) under the control of
diuresis, CBS, electrolyte levels, ECG. If there is oliguria or anuria fluid administration is
contraindicated until the restoration of diuresis.
Improve renal blood flow contribute to the solutions of aminophylline, calcium, glucose-insulin
mixture.
8 antibiotics should be prescribed only in the presence of complications (croup, pneumonia, otitis
media, sinusitis, urinary tract infection, etc.) or when it is difficult to exclude the occurrence of
bacterial complications, especially in young children, as well as the presence of chronic foci of
infection (chronic pyelonephritis , chronic sinusitis, etc.). Usually use penicillin, ampicillin,
oxacillin, erythromycin, etc. (per os or i / m), and sulfa drugs (Bactrim, lidaprim, etc.). In severe
bacterial complications of a group of antibiotics prescribed cephalosporins and aminoglycosides
in various combinations or in isolation. Treatment of patients with croup preferably carried out in
a special box office or a specially equipped room.
Prevention. In the fight against influenza is critical immunizations.
At the present time have been registered and approved for use following drugs:
A. Influenza vaccine trivalent polymer-subunit "Grippol" for adults (Ufa-24).
Two. VAXIGRIP - purified inactivated influenza virus vaccine firm Pasteur Mérieux-(France),
containing a single vaccination dose (0.5 ml.) 15 micrograms of hemagglutinin of influenza virus
A (NZM2), 15 micrograms of hemagglutinin of influenza virus A (NSH1) and 15 micrograms of
hemagglutinin of the virus influenza, as well as the minimum amount of thimerosal,
formaldehyde, buffered and undefined amount of neomycin.
Three. Inflyuva - high purity subunit vaccine firm Solvay pharma, containing only the surface
antigens: gemagllyutin and neuraminidase, has a very low rate of reactogenicity, is intended for
adults and children from 6 months of age
4. IRS-19 - liquid vaccine for intranasal administration, in an aerosol containing 20 ml company Solvay pharma, is a solution containing the antigenic determinants of microorganisms
that are the most common causative agents of SARS (19 strains), these determinants are
absolutely non-pathogenic antigens, stimulates the mucous membrane local protective immune
responses, is used as an aerosol intranasally.
8
USED IN THIS LESSON, NEW EDUCATIONAL TECHNOLOGY, "METHOD OF
SNOWBALLS."
USING "SNOWBALL"
SCENARIO:
For no more than 10 minutes.
Two groups of students together to discuss a problem or situation in order to set the maximum
number of correct answers.
Topic: Influenza. SARS.
Each answer to the question shall be credited as a reference point in this group as "snowballs."
The group treated with the most number of points put the highest mark.
№
QUESTIONS
ANSWERS
1
What types of viruses cause disease in
- A, B, C.
humans?
2
What is the influenza virus antigens?
- An antigen - a protein includes a "RNA."
- Antigen - obolochny.
3
List the phases of the pathogenesis?
- Reproduction of the virus in the
gastrointestinal tract, respiratory tract, viremia,
toksinemiya, toxic and allergic reactions,
damage to the respiratory tract, bacterial
complications, regression of the pathological
process.
4
What is the reason the rapid onset of the - Viremia, toxinemia.
disease?
5
For any form of flu is not characteristic - Toxic, hypertoxic.
of a cold "dry" flu?
6
What are the symptoms of the CCC are - The pulse corresponds to the temperature,
found in the midst of flu?
blood pressure, or rate of downward trend,
muted tones of the heart, myocardial dystrophy.
7
What are the signs of ANS revealed the - Apathy, agitation, delirium, meningismus.
flu?
8
What are the symptoms of PNS may
- Local hyperesthesia, paresthesia of the skin,
occur when flu?
trigeminal and intercostal nerves.
9
What is characteristic of pneumonia as a - Sluggish, prolonged duration, mild physical
complication of the flu?
data, the frequency of the transition to the
chronic form.
10 What methods are used early laboratory - Rinotsitoskopiya, immunofluorescent
diagnosis of influenza?
examination of smears from the nasopharynx
11 What characterizes the immunity of the - Tipospetsifichen, short (1-3 years).
flu?
12 Differential-diagnostic symptoms
- Abundant, serous, mucous, muco-purulent
adenoviral infection in contrast to the
discharge from the nose, a long and undulating
flu?
course, prolonged fever of up to 2 weeks.,
Enlarged liver, spleen and lymph nodes.
13 Differential diagnosis of typhoid fever
- The temperature of a long, high, lack of
from the flu?
respiratory symptoms, agitation of patients, a
positive symptom of Chiari-Avtsyna, GovorovaGadel.
14 Differential diagnosis of influenza with - Gradual increase in toxicity, step-like fever,
the TPZ?
typhoid tongue, positive symptom Padalka,
hepatosplenomegaly.
15 Differential diagnosis of influenza with - The beginning of a rapid, severe intoxication,
meningococcal disease?
hemorrhagic rash, blood neutrophilic
9
16
Differential diagnosis of leptospirosis
from the flu?
17
Name the four characteristic signs
(pathological changes) in the mucosa of
the respiratory tract:
Name the two major causes of bacterial
complications of the flu?
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Name the two types of the course of
influenza:
Name of the severity of the clinical
manifestations of four forms of
influenza:
List the four main clinical feature of
influenza:
What are the four characteristics of the
flu have a fever?
hyperleukocytosis, a shift to the left.
- Long-term, high fever, conjunctivitis, severe
pain in the muscles of the legs, hepatomegaly,
neutrophilic leukocytosis.
- Degeneration of the epithelial cells, the
disappearance of the villi, desquamation of the
epithelium, hypersecretion.
- Reduction of the phagocytic activity of
leukocytes, activation of conditionally
pathogenic respiratory tract.
- Typical, atypical course.
- Easy, medium, heavy, heavy lightning.
- Acute onset, fever, intoxication, and the
absence of mild catarrhal symptoms.
- A sharp rise to maximum numbers, the
temperature rise with a fever, decrease in
temperature is a critical or rapid lysis with
sweating, lack of a second wave.
Name the three characteristic features of - Temporo area, eyebrows, the eyeballs.
the localization of the headache the flu:
Intoxication is determined by the flu
- Weakness, fatigue, myalgia, arthralgia,
five major clinical features:
dizziness, vomiting, meningismus.
For the appearance of the patient's flu is - Redness and puffiness face, scleral injection
characterized by three main symptoms: vessels, herpes labialis (sometimes 3-4 days).
What changes occur in the throat of the - Diffuse hyperemia, granularity of the posterior
flu?
pharyngeal wall and soft palate, vascular
injection of the soft palate, uvula and arches.
What changes are observed in the
- Leukopenia, neutropenia, eosinopenia,
peripheral blood of the flu?
moderate monocytosis.
What are three features of influenza in
- The severity of CNS (vomiting, seizures,
young children:
meningismus), the early development of
pneumonia, the possibility of croup.
What are three features of influenza in
- Unexpressed febrile reaction, the rapid
the elderly:
development of the PRS and the NAM.
On the part of any observed
- Lungs (pneumonia, tracheobronchitis), ENT
complication of the flu?
organs (laryngitis, sinusitis, sinusitis, otitis),
nervous system (meningoencephalitis,
arachnoiditis, polyneuritis, radiculitis, etc.).
The highest value in the confirmation of - HI, RAC.
influenza are 2 methods of laboratory
diagnosis:
List etiotropic drugs, the most widely
- Influenza gamma-globulin, leukocyte
used of the flu:
interferon, rimantadine, oxalic Ointment 0.25%.
There are two main indications for
- Bacterial complications, presence of chronic
antibiotic treatment of influenza:
bacterial lesions.
What are the four clinical features are
- Gradual onset, absence of fever or mild,
characteristic of the flu?
moderate or no toxicity, expressed laryngitis.
10
35
36
37
38
39
40
41
42
Give the two basic characteristics of
headache during Parainfluenza:
Name the two major symptoms of
Parainfluenza:
Name the three most common methods
of laboratory diagnosis of
parainfluenza:
What are two main types of therapy for
parainfluenza:
Gateway adenovirus are three main
bodies:
Name the two major sites of adenovirus
reproduction in the body of an infected
person:
Name the five organs, the mucosa
which is involved in the pathological
process during adenovirus infection:
For adenoviral infection is characterized
by a combination of six major clinical
manifestations:
43
Rhinitis during adenoviral infection is
characterized by two main symptoms:
44
Name three specific changes in the
throat during adenovirus infection:
45
The appearance of the patient
adenoviral infection has three features:
What are the symptoms of
gastrointestinal lesions observed in
adenovirus infection?
What changes in the hemogram
observed in adenovirus infection?
There are four clinical forms of
adenovirus infection:
46
47
48
49
50
51
Name the three main methods of
laboratory diagnosis of adenovirus
infection:
What medications are used in the
treatment of adenoviral infection:
Name the four major manifestations of
rhinovirus infections:
- Moderate intensity, predominantly in the
frontal region.
- Rough barking cough, hoarseness.
- Immunofluorescence, HAI, RAC.
- Symptomatic, restorative.
- Nasopharynx, eyes, intestines.
- Epithelial cells of the mucous membranes,
regional lymph nodes.
- Pharynx, trachea, bronchi, tonsils, intestines.
- The maximum temperature increase of 3-th
day of illness, conjunctivitis, tonsillitis, mild
intoxication, hepatosplenomegaly, lymph node
enlargement.
- Nasal congestion, neobilnye serous-mucous
discharge.
- Bright redness and swelling of the posterior
wall, posterior wall grainy and soft palate,
tonsils with a whitish congestion point raids.
- Flushing of the face, injected sclera vessels,
conjunctivitis.
- Diarrhea, abdominal pain,
hepatosplenomegaly.
- No change, mild leukopenia, eosinopenia.
- Acute respiratory disease, faringo fever,
conjunctivitis and keratoconjunctivitis,
adenovirus SARS.
- Immunofluorescence, DCs, HI.
- Detoxification, desensitizing-reducing,
vitamins, symptomatic, donor gamma-globulin.
- Discomfort, heaviness in the head, sneezing,
profuse, slimy discharge from the nose, herpes
labialis et nasalis.
In summary, the teacher calculates the scores of each subgroup, announces the results and
according to the accumulated points of each student evaluates the student's knowledge.
11
6.2. The analytical part of
Case studies:
Objective number one. Patient D., aged 35, the disease started with fever, weakness, muscle
and joint pains, headaches in the forehead and superciliary arches. After a few hours of onset lost
consciousness. On admission the general condition of severe, body temperature is 39,5 º C,
darkened mind, there is delirium, restlessness. On examination, hip Jeremiah person expressed
conjunctivitis. Cold sores on the mucous membrane of lips, dry rales in the lungs, percussion lung sounds. Pulse 75 minutes. Cardiac sounds are muffled. BP 90/60 mm Hg Pronounced neck
stiffness. Performed lumbar puncture. CSF pressure 250 millimeter of water The study of
cerebrospinal fluid: a colorless, transparent, cells - 5 to 1 mm, a protein - 330 mg / dL, sugar 1.8 mmol / l. Reaction Pandey - Neg.
1. Put a preliminary diagnosis of the patient.
2. The necessary methods to confirm the diagnosis.
3. The tactics of a doctor.
№ Answer
1
The flu, severe, complication - meningoencephalitis.
2
RAC, Phragmites in paired sera with antigens.
3
Give direction. Immediately call the epidemiological. transportation for the hospitalization
of the patient profile infectious hospital. Give notice to the SEC an emergency.
Problem number 2. Patient R., 27 years old. I turned on the 4th day of illness. The
disease started acutely with increasing temperature 38,4 ° C, headache, joint pain, pain on
swallowing, tearing, pain in the eyeballs, nasal congestion. OBJECTIVE: temperature 37,4 ° C,
pale skin, mucous pharyngeal hyperemia. The rear wall of the throat swelling, hyperemic,
covered with muco-purulent coating. Conjunctiva is covered with white bloom, vascular
injection of sclera. Submandibular, anterior and zadnesheynye lymph nodes are enlarged to the
size of the bean, painful on palpation, are sealed. Pulse 82 minutes. Cardiac clean. In the lungs vesicular breathing. Tongue coated with white bloom. The liver appears from under the costal
arch by 0.5 cm, elastic, painless. The spleen was not enlarged.
1. Put a preliminary diagnosis of the patient.
2. The tactics of a doctor.
3. Control measures at the source of infection.
№ Answer
1
Adenovirus infection of moderate severity.
2
Bed rest, drinking plenty of fluids, antibiotics, vitamin therapy, and treatment of gargling
mucous eye Frc solution 1:5000
3
Isolate the patient. Ventilation of the room. Wet cleaning disinfectants.
12
6.3. The practical part
Terms of swabs from the mucous membranes of the nose of the patient.
Objective: Select the pathogen culture.
Indications: Disorders of the upper respiratory tract and the definition of bacteriocarrier.
Required equipment: sterile gloves, sterile cotton swab with a loop, a sterile test tube with a
medium-Leffler Clauberg, spatula, form-direction.
Running steps (steps):
№
1
2
3
4
5
6
7
8
9
10
Not
fulfilled (0
points)
Action
Sit a patient
Wear sterile gloves
Ask the patient to open his mouth
Fix tongue spatula
Inspect the mouth, tonsils
Under the supervision of view to introduce a sterile
cotton swab on a loop of the bow of tonsils
Swab performed on the edge of the plaque between
healthy and diseased tissue so that it remains enough
material
Produce seed for Wednesday-Leffler Clauberg
Provide details on the form of patient-direction
Transportation must ensure receipt of the material in the
tank. laboratory no later than 2-3 h after intake
All
0
0
0
0
0
Fully
implemented
correctly (10
points)
10
10
10
10
10
0
10
0
10
0
0
10
10
0
10
0
100
7. Test questions
1. Clinical variants of influenza and SARS.
2. Complications of the flu.
3. Laboratory diagnosis of influenza and SARS.
4. The principles of treatment of influenza and SARS.
5. Prevention of influenza and SARS.
8. Recommended Reading
1. Madzhidov V.M. Yukumli kasalliklar. T., 1992.
2. Makhmudov O.S. Bolalar yukumli kasalliklari, T., 1995.
3. Uchaikin W.R. Guide to Infectious Diseases in Children, M., 1999.
4. Shuvalov E.P. Infectious Diseases, Moscow, 1999.
5. Musabayev I.K. "Guide to intestinal infections", T., 1982.
7. Pokrovsky V.I., Pak SG et al, "Infectious disease and epidemiology." - Moscow, 2003
8. Yushchuk N.D., Vengerov YY "Lectures on infectious diseases." - M., 1999.
9. Uchaikin V.F. "Guidelines for Infectious Diseases in Children", - M., 1998.
10. Internet resources ( www . medlinks. RU , www. CDC. gov
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