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: Meningococcal Infections
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: Meningococcal 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
THEME: Meningococcal Infections
1. Place of the lessons, equipping
- The auditorium;
- The emergency room;
- Department of meningitis;
- Intensive care unit;
- Bacteriological laboratory.
- TCO: Case patients with meningococcal disease; TV - video, training, supervising the program,
methods of work scenarios in small groups, case studies, business games.
2.The duration of the study subjects
Number of hours - 4
3.The purpose of classes
- To familiarize students with the basic clinical Symptoms MI, diagnostic methods, the principles
of treatment and prevention of disease;
- Bring a sense of interest in the problem of MI;
- Bring a sense of responsibility for the lives of patients with MI;
- Develop scientific, logical thinking at the bedside;
- A creative approach to the diagnosis and treatment of patients with MI.
Objectives
The student should know:
- Statement of the clinical diagnosis of MI;
- Therapeutic tactics MI;
- Complications of MI;
- Prevention of MI.
The student should be able to:
- To collect patient complaints of MI;
- To collect epid.anamnesis;
- Examine the patient for organs and systems;
- Identify the symptoms characteristic of MI;
- To formulate a preliminary clinical diagnosis;
-Evaluate the severity of the patient;
- Interpret the results of laboratory tests;
- Draw the patient's medical history of MI;
- Draw up a plan of treatmentMI patients.
As a result of training the student should learn practical skills:
- Check the presence of meningeal symptoms;
- Differentiate between haemorrhagicrash;
- To conduct therapy with hyperthermic syndrome;
- To provide emergency care for complications of MI: ITSH, swelling of the brain;
- The right to take the cerebrospinal fluid for bacteriological examination.
4.Motivation
The high frequency of occurrence among the population of meningococcal infection,
light is notdiagnosed form of meningococcal nasopharyngitis, and severity of generalized
clinical variants of this infection, especially in children's contingent of possible fatalities on top
of the first day of the disease necessitates knowledge of the doctor early clinical symptoms of
MI.
5.Interdisciplinary communication
Teaching this topic is based on the knowledge of biochemistry metabolism,
microbiology, immunology, and pat. Anatomy pathological physiology, physiology of the upper
respiratory tract infections.The findings of the studies of knowledge will be used during the
passage of medicine, surgery, obstetrics, gynecology, hematology and other clinical disciplines.
6.The content of training
6.1.The theoretical part
Meningococcal infection - isan acute infectious disease of humans caused by
meningococcus, which is transmitted by airborne droplets and is characterized by a variety of
clinical forms, from nasopharyngitis and healthy carriers to generalized forms that occur in the
form of meningococcemia (septicemia), meningitis and meningoencephalitis.
It features a variety of clinical forms, the rapid development of symptoms, leading to a
threat to the life of the patient.
Etiology.The causative agent of meningococcal disease - Gr (+) diplococcus
Neisseriameningitidis, belongs to the genus Neisseria, family Neisserisasea.
Meningococci are highly sensitive to various environmental factors: die in the
temperature, humidity, solar radiation intensity. Regardless of the organism can survive for 30
minutes.
It grows well in high humidity, the reaction medium (pH 7.2-7.4), temperature of 3637C in media containing native protein (blood, serum, milk, etc.)
Meningococcus is sensitive to penicillin, chloramphenicol, erythromycin, tetracycline.
Selects endotoxin, which consists of protein-polysaccharide complex.
Divided into serogroup A, B, C, X, Y, Z.
Characteristics of agent: diplococci arranged in pairs in the form of coffee beans inside
the cell and extracellularly.The causative agent can be isolated from the cerebrospinal fluid,
blood, from skin rashes, nasal mucosa with, of necrotic skin.
Epidemiology.The source of infection - a sick person, or smear.The patient is contagious
early in the disease, especially if there is a catarrhal symptoms in the nasopharynx."Healthy"
bacillicarriers without catarrhal symptoms are also more dangerous becausetheir number in the
hundreds of times more than patients.Duration of bacteria is on average 2-3 weeks or more in the
presence of inflammatory lesions in the nasopharynx.The mechanism of transmission airborne.A value of congestion areas, the duration of contact.Meningococcal disease occurs in all
continents.Tends to be widespread, universal susceptibility.The incidence remains at a high
enough level, amounting in some regions of 20-30 thousand to 100 thousand people. Receptivity
is low, the general - is- 10-15%.Seasonality - the winter-spring period.
Pathogenesis.The leading role played by three factors: the pathogen, its endotoxin, a
substance allergenic.Atrium - the nasal mucosa and the oropharynx.
1 - phase - nasopharyngeal- On-site implementation of the pathogen (nasopharynx) is the
adaptation and accumulation with the formation of regional meningococcal infection
(nasopharyngitis).
2 - phase - a breakthroughmeningococcus in the blood (1-2% of cases) by lymphogenous and the
formation of generalized forms -meningococchemia meningitis.
3 - phase - the collapsepathogen in the blood with the release of endotoxin and development
toxinhemia.Metastasis to the local favorite locations: meninges, brain, skin and mucous
membranes, joints, adrenals, kidneys, endocardium, lungs, eyes, etc.
4 - phase - trombohaemorhagicsyndrome (endotoxin effect on the endothelium of blood vessels
and the cell membrane, leads to the breakdown of hemodynamics, microcirculation and blood
coagulation system
5 - Phase - Productsnumber of biologically active substances(Catecholamines, histamine,
serotonin, acetylcholine, etc.) leading to disruption of vascular tone and the formation of
microtrombs.
6 - phase -released in large amounts of biologically active substances, lead to disseminated
intravascular coagulation with DIVC: bleedings into the skin and internal organs.
The scheme of the pathogenesis of meningococcal disease:
1 - phase - invading pathogen: a)airborne, and b)contact and through everyday.
2 - phase -nasopharyngeal (adaptation of the pathogen - Regionalinfection - carrier,
nasopharyngitis).
3 - phase–Lymphoheamotogenous generalization (kokkemiya clinic with severe sepsis, and
without it).
4 - phase - the formation ofmetastatic foci(Parenchymal dissemination: meningitis,
meningoencephalitis, myocarditis, pneumonia, arthritis, etc.).
5 - phase - residual changes.
The pathogenesis of complications:
Edema - swelling of the brain is due to the impact of a large number of bradykinin,
serotonin, histamine and other substances on the vascular wall and the blood-brain barrier.
Clinically - ismanifested convulsions, disturbance of consciousness up to coma.
Infectious-toxic shock syndrome - a massive bacteremia intensive disintegration and
release of meningococcal toxin.Generalized antigen-antibody reaction with the formation of
pathogenic immune complexes, which develop trombohaemorhagic syndrome.
Ependymitis in the case of propagation of the inflammatory process in the ependyma of
the ventricles.
As a result of cerebral hypertension, possibly break-cerebellum in the foramen magnum
and compression of the medulla oblongata.
A heart attack is related to the adrenals pronounced endotoxemia and nonspecific
hypersensitivity.
Cerebral collapse(Hypotension) is associated with impaired cerebral hemodynamics
licvour production, holding intensive dehydration therapy.
CLINIC.The duration of the incubation period for meningococcal disease varies from 1
to 10 days, often accounting for 5-7 days. Clinicallclassification.A. Localized forms: a) carriers
of meningococcus b) meningococcal nasopharyngitis.2. Generalized forms: a) meningococcemia
b) meningitis) meningoencephlitis.3. Mixed forms: a) with meningitis and meningococchemia.4.
Rare forms: a)myocarditis b) pneumony, c) iridocyclitis d) arthritis, etc.
Meningococcal nasopharyngitis.Occurs up to 80% of all cases of MI.There are mild,
moderate and severe forms.The disease begins acutely with increasing temperature from 37,5C
to 39-40C, headache, dizziness, with catarrhal phenomena.There is hyperemia and edema of the
posterior pharyngeal wall: hyperplasia of lymphoid follicles, swelling of the lateral ridges, a
small amount of mucus.When severe fever 39-40,5C in addition to typical symptoms of
vomiting, joins, and sometimes convulsions, pain in the abdomen. On examination can identify
the individual meningeal symptoms.In peripheral blood leukocytosis of up to 15 * 10 * 9 / L,
neytrofillez, ESR 20-30 mm / hCSF is unchanged.
Meningococcemia (meningococcal bacteremia, meningococcal sepsis). Illness often
begins suddenly.Patients indicate the exact hour of onset. Body temperature rises to 39-40 ° C,
chills, vomiting, children are often seizures, disturbance of consciousness.All clinical symptoms
grow for 1-2 days. At the end of the 1st day of a characteristic hemorrhagic rash stellate
irregular, heavy on the oschu n b.As a rule, it appears simultaneously on the entire skin, but more
abundant on the arms, legs, buttocks.The value of the elements of rash varies from point to major
hemorrhage with necrosis in the center.Later in the areas of extensive lesions, necrosis rejected
and formed scars.Regression of the rash envy of the vastness and the nature of the
defeat.Roseolous-papular elements disappear after 1-3 days, and the place of deep necrosis
produced nonhealing ulcers.
In 3-7% of observed damage of the joints - arthritis.Can be uveitis, other organs and systems.
Criteria for the severity of meningococcal emii: symptoms of toxicity, changes in consciousness,
the degree of temperature increase, abundance and size of hemorrhagic-necrotic scars.
Fulminant form meningococcemia - (hyperacute meningococcal sepsis th s). Disease begins
rapidly, with a sudden rise in temperature, chills, profuse in his eyes the appearance of purpura,
which forms extensive hemorrhage, blood pressure drops, circulation develops ND, DIC,
seizures, muscular hypotonia.This form is regarded as toxic shock. In the absence of adequate
and timely therapy, death occurs within 12-24 hours.This usually occurs when total hemorrhage
in the adrenal glands (Waterhouse syndrome - Fridreksen) in the first hours of illness.
Meningococcal meningitis.The disease begins with fever, a rise in temperature to 39-40 °
C.Patients may call the day and hour of onset of the disease, complain of severe headache diffuse
character, vomiting, and hypersensitivity.2-3 days appear meningeal symptoms: neck stiffness,
Kernig's sign, the upper Brudzinskiy, the bottom symptom of Brudzinskiy is 7% of patients.The
appearance of symptoms indicating focal edema-swelling of the brain.In blood - atpatients with
hyperleukocytosis, stab shift, eosinophilia, increased erythrocyte sedimentation rate of 4570mm/ h
In young children can join in convulsions, meningeal symptoms are mild, but there are a
symptom ofLessazh, bulging fontanelle large, hand tremor, tilting the head and the patient takes
a characteristic pose "gundog."
Meningeal symptoms: positive Kernig's sign - when bent leg at the hip it is impossible to
straighten the knee.
Diagnosis. Isolation of the pathogen from the nasopharynx, cerebrospinal fluid and
blood.Lumbar puncture: fluid follows a stream or large droplets. Nature of cerebrospinal fluid in
meningitis: cloudy, high viscosity, high neutrophil cell count, a positive reaction Pandy, NonneApelta.Complete blood count - leukocytosiswith a left shift, eosinophilia, elevated erythrocyte
sedimentation rate.serological method- ELISA.
Differential diagnosis of meningococcal meningitis
Serous meningitiscaused by viruses, tubercle bacilli, mycobacteria.Secondary purulent
meningitis caused by staphylococci and stick Afanasyev-Pfeiffer.The disease begins acutely,
with the first days of the proceeds in the form of meningoencephalitis, characterized by a
particularly severe.
Purulent meningitis, caused by the GR (-) bacteria (enterobaktr, Escherichia coli,
Pseudomonas aeruginosa) usually occur as outbreaks.The disease occurs in waves, with frequent
residual effects.
Differential diagnosis of meningococcemia.
With the measles - distinguished by the presence of catarrhal symptoms, spots FilatovBelsky, gradual Makulo-papular rash in the blood - lymphocytosis, ESR is normal.
With scarlet fever - apart pronounced hyperemia of tonsils, soft palate, tonsillarlymph
nodes increase, with a characteristic rash Punctate localization on the skin hyperemic
background.
With yersiniosis - a rash spot, located around the joints, face, hands, feet, typical systemic
lesions(Abdominal pain, arthralgia, hepatomegaly, jaundice, etc.) weak toxicity.
With hemorrhagic vasculitis - a rash is symmetrical, usually on the extensor, buttocks,
there may be pain in the abdomen.The disease often occurs in separate attacks without affecting
overall health.
Treatment .All patients with suspected MI, or it is mandatory immediate
hospitalization.Treatment of severe forms must be in the ICU.
In generalized forms - sodium salt of penicillin in big doses (200-400 thousand per kg of
body weight per day) every 4 hours / m, semi-synthetic penicillins.If intolerance of penicillin
administered in doses of chloramphenicol succinate 50-100mg/kg weight per day / or / m
Detoxification therapy - 5-10% glucose, gemodez, reopolyglukine, etc.in / in.
Dehydration therapy - Lasix, furosemide, etc. diakarb
T CS: prednisone, dexamethasone for 1-3 days.
Symptomatic therapy.
Prevention.Early isolation of sick or bacillicarriers.Quarantine in a team where the
patient is detected for a period of 10 days with daily thermometry and inspection of the skin,
nose and throat.Contact - the tank. Culture from the nasopharynx at least 2 - times at intervals of
3-7 days.Pin to prevent the normal immune globulin is administered at a dose of 1.5 - 3.0
ml.Discharge of patients after complete recovery.
For active immunization is administered vaccines: A vaccine (Russia)In the vaccine,
VamegocBS (Cuba), divalent "meningitis A + C" in France.
Meningeal symptoms:
1. Severe headaches.
2. Kernig's sign.Patient lying on your back, bend the leg at the hip and knee at a right
angle and then straightening it in the knee joint.Kernig's sign is considered "+" if you can not
straighten the leg at the knee due to a sharp resistance flexor leg and pain reaction.
3. Stiff neck muscles.It is determined with the patient on his back through active or
passive Crouching low over the head to his chest.In the presence of neck stiffness.The chin does
not reach the patient's chest and there is a painful reaction.
4. Symptom Brudzinskiy top.Definitions of neck stiffness causes involuntary flexion of
the legs in the hip and knee joints.
5. Symptom Brudzinskiy average.When pressed in the area of symphysis (Symphys)
marked involuntary flexion of the legs in the hip and knee joints.
6. Symptom Brudzinskiylow.In determining Kernig symptom noted involuntary flexion
of the legs in the hip and knee joints at the other extremity.
7. Symptom Lessazh ("suspension").Take a child under the arms and lift, with his legs
pulled up to the stomach due to their involuntary flexion in the hip and knee joints.
8. Zygomatic symptom of spondylitis.At a percussion hammer on the zygomatic arch
occurs decrease the zygomatic muscles and involuntary painful grimace.
9. Symptom of Guillain.Squeezing the head of the four muscles of the thigh with one hand
leads to involuntary flexion of the other leg at the knee and hip joints.
USED IN THIS LESSON, NEW TEACHING TECHNOLOGIES: "THE HANDLE
ON THE MIDDLE OF THE TABLE," "BLACK BOX".
USE OF "PEN CENTER OF THE TABLE."
The method provides for joint activities and active participation in the classroom each
student, the teacher works with the entire group.
It is proposed the task to the whole group.Each student writes on a piece of an answer
and sends it to a neighbor, and his hand moves to the middle of the table.
The teacher monitors the work of the group and the involvement of everyone,
commented correctly answer, its validity, the degree of activity of students, a generic version is
written in the notebook.
This technique facilitates the formation of the foundations of critical thinking, asIn this
case the student to learn to defend their opinions, to analyze responses band members participants in this contest.
USE OF "BLACK BOX"
The method provides for joint activities and active participation in the classroom each
student, the teacher works with the entire group.
Each student gets out of the "black box" unknown question, a brief abstract of which is
written on the cards.Students are required to determine this question in detail justifying your
answer.
To think about each answer the student is given 3 minutes.Then discuss the answers, but
e tsya addition to the clinic, the treatment of disease.At the end of the method of the teacher
comments on the correctness of the answer, its validity, the degree of activity of students.
This contributes to the development of techniques and speech student, laying the
foundations of critical thinking, asIn this case the student to learn to defend the free e view,
analyze responses band members - in privateersthis competition.
Options for abstracts:
1.Meningococcal disease: acuteinfectious disease caused by Neisseria meningococcus, with a
drop transfer mechanismpathogen, clinically characterized by lesions of the mucous membrane
of nasopharynx (nasopharyngitis), generalization in the form of specific septicemia
(meningococcemia) and mild inflammation of the meninges (meningitis).
2. Etiology of meningococcal disease: meningococcal disease in ozbuditelVekselbauma Neisseriameningitid i s, a diplococcus, immobile, flagella and capsules has not, does not form
spores.Cultivated in media containing human or animal protein.Aerobic and facultative
anaerobic.
3. Epidemiology of meningococcal disease: Sources of infection and patients with
meningococcal infection (nasopharyngitis, meningitis, meningococcal Ia) and the different
categories of vehicles.Transmission - airborne.
4. Pathogenesis of meningococcal infection: pathogen imbedded in the nasopharynx and its
reproduction.Bacteremia, toksinemiya, toesikoallergicheskie reaction.Hematogenous drift to the
meninges.Hemodynamic disorders and disorders of microcirculation in the tissues.The formation
of specific and humoral immunity.
5. Classification of meningococcal disease: 1.form:a) Notices meningococcus - a typical,
chronic, lightning; b) meningococcal meningitis;a) meningoencyphalitis. 3. mixed form
(meningitis and meningococcal Ia). 4. Rare forms: a) endokarditis b) Arthritis c) arthritis, and d)
pneumonia e) iridocyclitis.
6. Clinic Acute nasopharyngitis: may be prodromal stage e and purulent meningitis or an
independent clinical manifestation of meningococcal disease.It is characterized by a moderate
increase in body temperature (up to 38, 5C), which keeps 1-3 days, mild symptoms of toxicity
(fatigue, headache, dizziness) and nasopharyngitis (nasal congestion, flushing, dryness, swelling
of the throat with hyperplasia of lymphoid follicles .)
7. Clinic meningococcal meningitis: meningitis begins acutely with fever and a sharp increase in
body temperature to 38-40C.The disease is characterized by severe general weakness, pain in
the eyeballs, especially when moving, then a headache.Headache increases rapidly becomes
diffuse, painful, oppressive, or Expander character.Nausea and vomiting,the patient does not
bring relief.After 12-14 hours of onset of the disease appearobjective symptoms of meningeal
irritation (neck stiffness, Kernig's sign, symptoms Brudzinskiy,Guillain).
8. Clinic meningococcemia: meningococcal meningitis without recorded infrequently.Disease
begins acutely with fever up to 40C.In the early hours of the disease on the skin of the lower
limbs, trunkappears hemorrhagic rash, petechial and star protruding above the skin, dense to the
touch.Signs of intoxication pronounced.
9. Clinic meningococcal characterized by severe, severe, and encephalitic syndromes.By the end
of the first start of the second day of the disease develop impaired consciousness in the form of
deep sopor, accompanied by psychomotor agitation, convulsions, often auditory and visual
hallucinations.Determined by the focal cerebral symptoms, usually in the form of pyramidal
insufficiency: paresis of the facial muscles on the central type, expressed tendon and periosteal
reflexes, sharp pathological symptoms coordinator violation.
10.Complications of meningococcal disease: the most formidable and frequent complications in
young people is acute edema and swelling of the brain, infectious - toxic shock syndrome,
hydrocephalus, acute renal failure, hemorrhagic manifestations - bleeding in the adrenal glands.
11.Diagnosis of meningococcal disease:Diagnostic is based on clinical and epidemiological data
(headache, hypersensitivity, nausea, vomiting, high fever, pain in the eyeballs, the changes of
abdominal, tendon and periosteal reflexes, neck stiffness, Kernig's symptoms, Brudzinskogo),
laboratory data.
12. Laboratory diagnosis of meningococcal disease: a) Bacterioscopicbacteriologic crops:
nasopharyngeal mucus, blood, cerebrospinal fluid, scrapings from the rash of hemorrhagic
components, tissue of internal organs, and b) bacterioscopic- cerebrospinal fluid (lumbar
puncture), c) serologic method: ELISA in the dynamics of the disease.
13. Differential diagnosis of meningococcal disease differential diagnosis is carried out with
meningitis caused by different bacterial flora, pneumococci, Haemophilusinfluenzae,
staphylococci, streptococci, fungi and other meningococcal uw must be distinguished from
measles, rubella, Henoch's disease, etc.
14. Treatment of meningococcal infection: etiotropic therapy - penicillin 200 000 - 500000 E D /
kg body weight, chloramphenicol succinate, 0.5 - 1.0 g, sulfonamides, pathogenetic therapy - the
fight against toxicity.Steroid drugs.Anticonvulsant ter Apia.Symptomatic therapy.
15.Prevention of meningococcal disease: the main important preventive measures are the early
detection and isolation of patients, decontamination of the meningococcus identified carriers
(benzylpenicillin 300 thousand units by intramuscular injection at 4 h for 6 days and 5 bitsillin
1.5 million unitsintramuscularly once or chloramphenicol in 0.5 ml of 4 times a day for 6 days),
the promotion of personal and public hygiene, hardening, self manitarian and educational work.
6.2.The analytical part of
Case studies:
Problem number 1. Patient A., aged 18, present illness began with the phenomena of light
nasopharyngitis, one day the state has deteriorated: fever with chills, headache, increased, there
were sharp pains in the joints.
He was hospitalized in the therapy department with a diagnosis of rheumatic fever.When
you receive a marked pallor of the skin rash was not.Observed swelling, mild redness, severe
pain and dysfunction of the joints of fingers on the left elbow.Tachycardia, heart sounds are
clear.BP 110/70 mm.mercury.of Art.
Complete blood count: hemoglobin - 110 g / l red blood cells - 4.0 x 1012/ L; color.index
- 0.9, white blood cells - 13.0 x 109/ l, p / - 16%, with / I - 73%, EPZs.- 1%, lymph.- 8%, Mon.1%, ESR - 30 mm / h
Started antirheumatic therapy (penicillin 200 000 IU every 6 hours, aspirin,
dexamethazone).After a day of pain in the joints decreased slightly, but joined vomiting.Detected
meningeal toms.At lumbar puncture a transparent liquor, cells 200 in 1 mm 3neutrophilic
character.A day later came the confusion, increased meningeal signs.When re-puncture of the
cerebrospinal fluid was purulent, with a high neutrophil cell count in blood smears and
inoculation detected meningococci.
1. Place a provisional diagnosis?
2. What meningeal toms know?
3. Sive laboratory to laboratory methods.
4. What materials are taken for b akteriologicheskogo research?
5. What diseases must be differentiated this disease?
6. Tactics GP doctor for a given event e.
7. Specificprofylaxis.
Number
Response
1.
Menigococcalinfection, generalized form (meningokokktsemiya, meningitis).
2.
Symptoms Brudzinskogo, Kernig, stiff neck, hyperesthesia.
3.
Bacteriological and sero logical, lumbar puncture.
4.
Mucus from the nasopharynx, blood and cerebrospinal fluid.
5.
ARD, rheumatism, sec ary and serous meningitis.
6.
7.
Give direction.
Call epidemiological.transportation for hospitalization of the patient to a hospital
infection profile.Givenoticeinanemergency SES.
Vaccine Types A, B, C gamma globulin.
Problem number 2.Patient M., aged 25, entered the clinic on the third day of illness with
complaints of headache, insomnia, high temperature.Ill three days ago, wrote a cold, the
temperature remained within normal limits.On the 2nd day of the disease about 17 hours, the
patient appeared sharp headache, chills, temperature rose to 39,9C, in a few hours from the
onset of the disease emerged repeated vomiting, the next day vomiting was repeated every 20-30
minutes.Increased headache.
At the time of admission to hospital the patient's condition was severe, the temperature of
38,7C, the consciousness is kept on the questions are answered with difficulty, occasionally
moaning.The face is pale.On the skin of the chest, abdomen, extremities abundant, polymorphic
rash with cyanotic tinge in the center of many elements of areas of necrosis.Pulse 92 beats.in
min., soft, rhythmic.BP 90/60 mm.tr.st.Cardiac sounds are muffled.In the lungs vesicular
breathing.Abdomen soft and painless.No neck stiffness.Symptoms of Kernig and Brudzinskogo
negative.
1.
Place a provisional diagnosis?
2.
What are the laboratory data can help you in making a diagnosis?
3.
Tactics doctor GP.
4.
Treatment of the patient.
Number
Response
1.
Meningococcaldisease, meningococcus.
2.
Complete blood count, bacteriological methods, blood, throat swab, scraping of the
rash.
3.
Give direction.
Call epidemiological.transportation for hospitalization of the patient to a hospital
infection profile.Givenoticeinanemergency SES.
4.
Causal therapy of penicillin-200-300 thousand units.1 kg of body weight;
pathogenetic therapy - the fight against
toxicity.Steroiddrugs.Anticonvulsanttherapy.Symptomatictherapy.
Problem number 3.Patient A., 24 years old.Addressed through the 22 hours from the
beginning of the disease.Complaints of fatigue, severe headache, fever 39,8 º C, vomiting 3
times.The disease started acutely with chills, fever, headache, 3:00 later, the patient's condition
deteriorated, there was vomiting, and dizziness.When applying general state of severe, the
temperature of 38,7 º C, a person hyperemic, the situation forced.In the lungs - vesicular
breathing, heart sounds are muffled, pulse 98 in 1 min., Filling and low voltage.BP
90/60mm.rt.st.Abdomen soft and painless.Positive meningeal symptoms (neck stiffness, Kernig's
sign, the upper Brudzinskogo).In the dormitory, home sick students with symptoms were
nasopharyngitis.
1.
Place a provisional diagnosis?
2.
What are the laboratory data can help you in making a diagnosis?
3.
The tactics of a doctor.
4.
Treatmentofthepatient.
Number
Response
1.
Meningococcaldiseaseandmeningitis.
2.
The study of cerebrospinal fluid (bacteriological, bacteriascopical).
Sowing of the throat swab at the meningococcus.
Completebloodandurine.
3.
Isolate the patient from others.Give direction.
4.
Call epidemiological.transportation for the hospitalization of the patient profile
infectious hospital.Givenoticetothe SEC anemergency.
To find out the amount of contact with the pin placed under observation for 10 days,
all the contacts to take the swab from the nasopharynx to the meningococcus.
All contact to impart to meningococcus.Ventilation of the room.Wet cleaning
disinfectants.
6.3.The practical part
Determination of meningeal symptoms and pathological reflexes.
Objective:Identification of meningeal syndrome.
Indications:Diseases accompanied by phenomena of meningitis and meningoencephalitis.
Equipment Needed:couch, a mask.
Runningsteps (steps):
Number
Action
Has not
Completely
executed has
(0 points) correctly
executed
(10 points)
A.
The physician must be in the mask. Determines a
strongly s sss brand of pain
0
10
Two.
Place the patient on the couch
0
10
Three. Define a stiffneck
0
10
4.
Identify Kernig's sign on both sides
0
10
Five.
Identify the symptom Brudzinskogo top
0
10
6.
Determine the average symptom Brudzinskogo
0
0
7.
Identify the symptom Brudzinskogo lower
0
10
Eight. IdentifythesymptomLessazha
0
10
9.
Determinetheabdominalreflexes
0
10
10.
Identify abnormal reflexes (On Babinsky, Rossolim
about, and Oppenheimer)
0
10
Only
0
100
Rules of the lumbar puncture.
Objective: Capture the CSF in a patient for diagnostic purposes.
Indications: meningitis, meningoencephalitis.
Equipment needed: a sterile operating unit on the table, sterile gloves, mask, 5% solution of
iodine, alcohol (70-96 º), sterile, disposable syringe, 0.5% solution of novocaine, sterile cotton
swabs, a needle with a stylet, sterile tubes, plaster , forms, directions to the lab.
Runningsteps (steps):
Number
1.
2.
3.
4.
Action
The physician must be in the mask. Wash hands
thoroughly with soap and treat them with alcohol
Wearsterilegloves
The patient was placed on a sterile table on its side, the
patient bends his legs to his stomach, his head to his chest
Define the puncture site: iodine spend two tentative lines -
Has not
executed
(0
points)
Completely
has
correctly
executed
(10 points)
0
0
10
10
0
10
5.
6.
7.
8.
9.
10.
one along the midline along the spine, the other perpendicular to the first level iliac crests
Treated the puncture 5% solution of iodine, then alcohol
(70-96 º)
Sterile disposable syringe hold a local anesthetic, 0.5%
solution of novocaine
Fixing the skin of the index finger of his left hand, rightadministered with a needle stylet
Mandrin is removed and take 3-5 ml of cerebrospinal fluid
in a sterile tube
Then, remove the needle, treated with the injection site
with alcohol and stick with plaster, the patient lay on his
back without a pillow for 2-3 hours
Indicate the patient's data on the form, direction, and send
a preliminary diagnosis of CSF in the slut with a hot water
bottle or thermos bacteriological laboratory
Only
0
10
0
10
0
10
0
10
0
10
0
10
0
10
0
100
7. Control questions
1. Definition of meningococcal infection.
2. Classification of meningococcal infection.
3. Etiology of meningococcal infection.
4. Epidemiology of meningococcal infection.
5. Pathogenesis of meningococcal infection.
6. Clinic of meningococcal infection.
8. Laboratory diagnostics of meningococcal infection.
9. Differential diagnostics of meningococcal infection.
11. Treatment of meningococcal infection.
8. 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/>).