Download Measles, rubella, scarlet fever

MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
TASHKENT MEDICAL ACADEMY
Department of Infectious and Pediatric Infectious
DISEASES
"APPROVED"
Vice-Rector for
Academic Affairs TMA
Professor Teshaev OR
"_____" __________ 2014
Subject: Infectious diseases
CASE - TECHNOLOGY
on training on "measles, rubella, scarlet fever"
Considered
at a meeting of the SSC
medical faculty TMA
"___" ____________ 2014
Tashkent 2014
Compiled by:
Karimov MT - Head of the Department of Infectious and Pediatric Infectious Diseases, MD, PhD
Akhmedov, MD - Professor, Department of Infectious and Pediatric Infectious Diseases, MD
Maksudova ZS - Assistant Professor of Infectious and Pediatric Infectious Diseases
CASE
solves the problem, what is the tactic of general practitioners
with measles, rubella, scarlet fever
Educational abstract
The subject: "Infectious Diseases"
Theme: "Measles, rubella, scarlet fever"
The purpose of this case study: development of skills early and differential diagnosis of measles, scarlet
fever and rubella in children and adults with the history and clinical and laboratory examination. Define
rational therapeutic tactics and preventive measures in the hearth. Develop a sense of interest in the
problem of measles, rubella, scarlet fever, a sense of responsibility for the lives of patients with measles,
rubella, scarlet fever. Develop scientific, logical thinking at the bedside, creative approach to the
diagnosis and treatment of patients with measles, rubella, scarlet fever.
Expected learning outcomes - based on the results of work with a case, students acquire skills:
Assessment and analysis of the situation and the general condition of patients with infectious measles,
rubella, scarlet fever.
Choosing the right algorithm of actions for diagnosis.
early rational laboratory diagnosis of measles, rubella, scarlet fever
independently provide emergency assistance if necessary
referred to the hospital for treatment
To be able to carry out qualified poststatsionarnuyu rehabilitation.
For the successful solution of the case of a student should know
• Conduct a professional history and examination of the patient;
• give the characteristic rash;
• Create a preliminary diagnosis based on the early and differential diagnosis;
• appoint a targeted examination;
• interpret data of laboratory and instrumental methods of examination;
• own clinical decision logic (to form a definitive diagnosis, assess the severity of the patient's condition
and prognosis);
• diagnose emergency conditions and provide first medical aid in the prehospital phase;
• Justify the need for consultation specialists, hospitalization and hospital profile.
• On the forms, methods and content of work in counseling patients with the syndrome exanthema.
• Determine the extent of the need for follow-up (medical and non-medical treatment)
This case reflects the real situation in terms of primary care
Sources of information of the case
1. Tooth TM, Ivanov KS, AP Kazantsev, Foresters AL Differential diagnosis of infectious diseases.
Leningrad, 1991.
2. Vasiliev VS Mosquito VI, Tsyrkun VM The practice of infectious disease. Minsk, 1994.
3. AP Kazantsev, Tooth TM, Ivanov KS, Kazantsev VA Differential diagnosis of infectious diseases.
Moscow, 1999.
4. R. Emond, Rowland H., Uelsbi F. Infectious Diseases. Color Atlas. Moscow, 1998.
Additional
5. Madjidov VM Yukumli kasalliklar. Tashkent, 1992.
6. Mahmoudov OS Bolalar yukumli kasalliklari. Tashkent, 1995.
7. Uchaikin VR Guidance on infectious diseases in children. Moscow, 1999.
8. Shuvalov EP Infectious diseases. Moscow, 1999.
9. Musabaev IK "Guidelines for intestinal infections." Tashkent, 1982.
10. Pokrovsky VI, Pak SG and others. "Infectious diseases and epidemiology." Moscow, 2003.
11. Yushchuk ND, Vengerov YY "Lectures on infectious diseases." Moscow, 1999.
12. VF Uchaikin "Guidelines for Infectious Diseases in Children." Moscow, 1998.
13. Internet resources (www.medlinks.ru, www.cdc.gov, ...).
Characteristics of the case according to the typological features
This case is classified as a desk, a scene. He volumetric structured. This case-question.
According to the didactic goals keystreningovy stimulating thinking in a real situation in a hovercraft.
Case can be used in the disciplines: oncology, infectious diseases, Emergencies
I CASE
"Measles, rubella, scarlet fever"
Introduction
Characteristics of the various elements of exanthema.
1. Roseola (roseola) - a speck of light pink or red, round, vanishing when stretching the skin.
2. Spot (macula) - has an irregular shape, is the result of vasodilatation, pink and red.
3. Erythema (erythema) - large areas of congested, red skin appear at expansion vessels in the skin).
4. Hemorrhage (hamorrhagiae) - bleeding in the skin as a result of increased vascular permeability. Can
be of various shapes and sizes.
5. Erosion (erosio) - defect of the epidermis, which is formed after opening the cavity of primary cells
(vesicles, pustules, blisters).
6. Ulcer (ulcus) - deep skin defect, exciting epidermis, dermis, and sometimes the underlying tissues.
Ulcers develop as a result of the collapse of the primary elements in infiltrating regions of deep dermis hillocks nodes at necropsy deep pustules, when anthrax - as a consequence of successive subsidiary
fracture vesicles and pustules, which are formed on the edges of the ulcer, so that it seems to be
growing on the periphery . Shape and edge ulcers are of great importance for the differential diagnosis.
The edges of the ulcer may be podrytymi, steep, saucer, callous, soft and so on. The bottom of the ulcer
may be flat, smooth (chancre), crater-like (syphiloma) on its surface can be expressed granulation
(cutaneous leishmaniasis), etc.
7. papule (papula) - formed by the expansion of blood vessels and the formation of the cellular infiltrate
in the upper dermis, rises above the level of the skin.
8. tubercle (tuberculum) - bespolostnoy element-inflammatory granuloma in the dermis, is different
from the papules that always clearly detectable rather compact infiltrate in the skin.
9. Node (nodus) - limited education seal diameter of 1 to 5 cm extending into the skin.
10. Blister (urtica) - bespolostnoy limited swelling of the papillary layer of skin. Element quickly appears
and disappears quickly, leaving no trace, accompanied by itching.
11. Vial (vesicula) - small cavernous formation containing serous, less serous-hemorrhagic fluid develops
directly in the epidermis below the stratum corneum, in the middle or on the border of the dermis.
12. pustules (pustula) or abscess - festering vesicle.
13. Herpetic eruption (herpes) - a group of closely spaced small vesicles on erythematous inflammatory
base.
14. Scale (squama) - there is a rash at the site of a vanished due to the rejection of the epidermis horny
plates. Depending on the size of the flakes can be pityriasis peeling or plate.
15. Pigmentation (pigmentatio) - occurs at the site of a vanished rash, resulting in increased formation
of skin pigment.
16. Cork (crusta) - the product of condensation and drying of various kinds of exudates other elements
rash (pustules, vesicles, erosions, ulcers).
17. Scar (cicatrix) - coarse fiber connective tissue proliferation, replacing the deep skin defects.
Macula-papular rash.
Observed for the following diseases: measles, pseudotuberculosis (Far East Scarlatiniform fever,
measles, scarlet fever, rash Boston (enterovirus), Fifth disease Rosenberg, an acute febrile phase of HIV
infection, secondary syphilis, pink zoster, guttate psoriasis, urticaria, drug allergy.
Maculopapular and vesicular rash.
Observed at: chicken pox, herpes, shingles (herpes), impetigo, drug allergy.
Haemorrhagic rash.
When: drug allergy, meningokokktsemii, different vasculitis, hemorrhagic fevers.
The purpose of this case study is to develop the student - user case study analysis capacity situation at
admission of patients with measles, rubella skarlatinoyi. Skills selection tactics, diagnostics, emergency
assistance, transportation and rational poststatsionarnoy rehabilitation measles, rubella, scarlet fever at
the primary level.
The decision of the case will allow prospective students to achieve the following learning outcomes:
Assessment and analysis of the situation and the general condition of patients with measles, rubella,
scarlet fever.
Choosing the right algorithm of actions for diagnosis.
early laboratory diagnosis rational cortex, rubella, scarlet fever
independently provide emergency assistance if necessary
referred to the hospital for treatment
To be able to carry out qualified poststatsionarnuyu rehabilitation.
Location: In an appointment to SVP GP patient appealed A. aged 24, complained of fever, cough, runny
nose, sneezing, festering eyes, loss of appetite. At the 4-day disease rash on the face.
4 day history of the disease, never treated. Obstetric and early history without pathology. Works as a
driver. By the nature of introvert. Allergies to drugs not. Epidemiological. history: in contact with
infectious patients was not, did not receive blood products, at a reception at the dentist was not.
Inspection: The state of moderate severity, a clear conscience. Proper physique. In the observation
noted landmark spread the rash. Rash was plentiful, drain, strongly disturbed "cut" in the eyes.
Temperature remained high up to 7 days of illness. Expressed intoxication - headache, vomiting,
lethargy, weakness, insomnia. In the lungs, vesicular breathing. Cardiac sounds are muffled, HR 100 in 1
min. Furred tongue, we could see the small white spots on the mouth loosened congested (as semolina).
Ms about the correct form, is involved in the act of breathing, with superficial and deep palpation
painless, swollen belly. The liver is not increased. For other or¬ganam without pathology. Meningeal
phenomena not.
Surveys in MRA showed:
Jabs: Hb - 128 g / l, cs - 0.91, Ayr - 4,2hYu12 / l; Lake -3,6h109 / l;
p / - 1%, with / I - 42%, e - 6%, n - 42%, m - 7%, ESR - 10 mm / hour.
Urinalysis was normal.
Biochemistry of blood total protein - 72 g / l, thymol test - 4 units, total bilirubin - 15 mmol / l associated
-3 mol / l (within normal limits).
Questions and tasks
1. What kind of disease you can think of?
2. On what day of the disease appear exanthema?
3. Characteristics of the rash in measles?
4. What is the difference measles rash of rubella?
5. What is the difference scarlet rash of measles?
6. With what diseases it is necessary to carry out differential. diagnosis?
Task: On the basis of the patient's condition should make a preliminary diagnosis, carry out the
necessary diagnostic methods, make an informed decision for further reference to the patient.
II. Methodical instructions for students
2.1 Problem:
The choice of tactics and determination of the need for hospitalization of patients with measles, scarlet
fever, rubella in a hovercraft.
2.2. Subproblems
1. Analysis of appearance
2. Analysis of the history and pre-event is an etiological factor in the development of the syndrome
exanthema
3. Analysis inspection
4. Selection of the necessary diagnostic methods
5. Relate findings and differential diagnosis
6. Come to a specific problem-solving in a hovercraft.
2.3. Algorithm for solving
1. Analysis of appearance includes the following research
- Examination of the skin and visible mucous
- The face (eyes, tongue)
2. Analysis of history
- Borne diseases
- Family and social history
- Epidemiological. history
- The duration and nature of exanthema
3. Analysis inspection
- Ps, BP
- Auscultation of the heart and lungs
- Palpation of the abdomen
4. Selection of the necessary diagnostic methods
- KLA, OAM
- Tsitoskopiya nasal discharge
- IFA
- Virological
5. Relate the results and differential diagnosis with
- Infectious Diseases
- Oncology
- Therapeutic
6. To come to a definite decision problems under SVP
- Treatment if necessary
- Emergency hospitalization
- Emergency care
Instructions for independent work
analyze and solve practical situation
Sheet analysis of the situation
Stages of work
Hints and tips
1. Introduction to • Reading, Do not try to analyze the
the briefcase first
read with a case
2. Introduction to again read the information, select the paragraphs that
the given situation seemed important to you.
Try to describe the situation. Determine that it is important
and what is secondary.
3. Identification,
formulation and
justification of the
key problems and
subproblems
Problem:
The choice of tactics and determination of the need for
hospitalization of patients with the syndrome exanthema in
a hovercraft.
4. Diagnosis of the When analyzing the situation, answer the following
situation analysis
questions:
• What is the range of common and dangerous diseases,
accompanied with the syndrome exanthema?
• What nosologies need to make a differential diagnosis and
to determine the most likely cause of the syndrome
exanthema.
• What diagnostic methods must be applied, make a plan
and justify the examination at SVP and CRH.
• What additional advice specialists are needed for definitive
diagnosis?
• Determine the extent of the need for follow-up (medical
and non-medical treatment)При анализе ситуации ответьте
на следующие вопросы:
5. Selection and lists all the possible ways to solve this problem in a given
justification of the situation
ways and means
of addressing
6.
Development Diagnose, resolve the problem in a hovercraft
and resolve the
situation
III. OPTION solution to a case
Teachers - KEYSOLOGOM
CASE IV - TECHNOLOGY TRAINING WORKSHOP
Model 4.1 technology training
Subject measles, rubella, scarlet fever
Number of hours - 2 hours Number of students: 20-24 people
Form training session workshop to broaden and deepen knowledge, skills working
out tactics of patients with measles, rubella, scarlet fever.
Plan Seminar 1. Introduction to training session
2. Updating knowledge
3. Work with a case in mini - groups
4. Presentation of the results
5. Discussion, evaluation and selection of the best options strategies
6. Conclusion. Evaluation of groups and students, the degree of achievement of
lesson
The purpose of the lesson: to develop skills early and differential diagnosis of
measles, scarlet fever and rubella in children and adults with the history and
clinical and laboratory examination. Define rational therapeutic tactics and
preventive measures in the hearth. Develop a sense of interest in the problem of
measles, rubella, scarlet fever, a sense of responsibility for the lives of patients
with measles, rubella, scarlet fever. Develop scientific, logical thinking at the
bedside, creative approach to the diagnosis and treatment of patients with
measles, rubella, scarlet fever.
develop skills early and differential diagnosis of measles, scarlet fever and rubella
in children and adults with the history and clinical and laboratory examination.
Define rational therapeutic tactics and preventive measures in the hearth.
Develop a sense of interest in the problem of measles, rubella, scarlet fever, a
sense of responsibility for the lives of patients with measles, rubella, scarlet fever.
Develop scientific, logical thinking at the bedside, creative approach to the
diagnosis and treatment of patients with measles, rubella, scarlet fever.
The task of the teacher:
• consolidate and deepen knowledge assessment and analysis of the situation
and the general condition of patients with measles, scarlet fever, rubella
• develop the ability to select the correct action of the algorithm for diagnosis.
• Develop skills for emergency assistance
• Develop the skills of independent decision making in the management of
patients with measles, scarlet fever, rubella under SVP learning outcomes:
• assess and analyze the situation and the general condition of patients with
measles, scarlet fever, rubella
• choose the sequence of actions for diagnosis.
• develop the skills of independent decision making in the management of
patients with measles, scarlet fever, rubella under SVP
• develop an algorithm of actions for emergency assistance if necessary
Methods of teaching case studies, discussion, hands-on method
Learning Tools Case, guidelines
Individual form of training, front, group work
Terms of training audience with technical equipment adapted to work in groups
Monitoring and Evaluation Monitoring, blitz poll, presentation, evaluation
Flow chart of the training session, based on the case.
Stage and content of work activities
Student teacher
Explains the purpose of the preparatory stage of case - stage and its influence on
the development of professional knowledge. Distributes the materials of the case
and introduces the algorithm analysis of the situation (see. Guidelines for
students).
Gives the task independently analyze and record the results in the "Leaf situation
analysis Listen
Independently examine the contents of the case and fill the sheet individually
analyzing the situation.
I stage. Introduction to the training session
(10-15 min) 1.1. Called theme sessions, plan, its goals, objectives and planned
learning outcomes.
1.2. Introduces the operation mode of the lesson and the results of the evaluation
criteria (see. Instructions for students) Listen
Are the corresponding entries
IIetap main
2.1 60 min. Substantiates the statement of the problem and the choice situation relevance. Conducting a quiz in order to strengthen students' knowledge on the
subject (Annex №1):
• List the types of elements exanthema.
• What infectious disease is a syndrome exanthema?
• What complications are possible with delayed diagnosis measles, scarlet fever,
rubella?
• What is the difference scarlet rash of measles
2.2. Divides the students into groups. Reminiscent of the content and objectives
of the case. Introduces (reminds) the rules of group work and discussion rules.
2.3. Gives the task, specify the correct perception of the job (Appendix №2):
• Differential diagnosis and determination of the most likely causes measles and
rubella, scarlet fever
• Methods of diagnosis used under SVP
• Clinical management, treatment and monitoring of patients with measles,
rubella, scarlet fever
2.4. Coordinates, advises, directs training activities.
Evaluates the results of individual work: Sheets analysis of the situation.
2.5. Organizes presentations on the results of the work done by the decision of
the case, discussion.
The organizer of the discussion: asking questions, remarks, reminds theoretical
material
2.6. Organizer - GP algorithm of actions in a given situation (Appendix №3)
2.7. Informs his solution of the case
(Appendix №4)
Answer questions, discuss, ask clarifying questions.
Divided into groups
Discuss, conduct a joint analysis of individual problems, determine the most
important aspects of the situation, main problems and their solutions, process
solutions results
Are solutions to the problem Questions 10-15 minutes after the end of the
presentation, choose the best option
Develop a single system, the discussion
III Summary of lessons, analysis and evaluation
3.1 20 min. Summarizes the results of training activities, announces assess
individual with teamwork.
Analyzes and evaluates the group, said positive and negative points.
3.2. Stresses the importance of case - stage and its influence on the development
of future specialist to listen.
Can conduct self-esteem and vzaimootsenku
Express their opinions
Appendix №1
Measles (morbilli) - an acute infectious disease of viral etiology transmitted by
droplet infection, characterized by cyclical trends, intoxication syndrome, catarrh
and exanthema.
Etiology. Measles virus - Rolyinosa morbiliorum refers to a group of large
miksovirusov is a single-stranded RNA, has a complex antigenic structure and has
a contagious, complement-fixing, and hemagglutinating hemolysing properties.
The virus has a stable antigenic structure in response to antigens in the body (or
ill-vaccinated) produced by the corresponding antibodies, which may be identified
by serologic reactions.
Measles is unstable in the environment, sensitive to heat, UV and direct sunlight.
Resistant to antibiotics. The virus has a tropism for lymphoid, reticuloendothelial
tissues, epithelial cells of the respiratory tract and nervous system. Epidemiology.
Measles is a very common infection throughout the world. Susceptibility to the
bark almost absolute index of contagiousness is 0.96. Because of the high
infectiousness and susceptibility general almost all people suffer measles in early
childhood.
The source of infection is the patient at the end of the incubation period, all the
prodromal period and the first period of 3 days of the rash.
The disease is transmitted by airborne droplets when in direct contact with the
patient. Tiny droplets of mucus secreted sick when talking, coughing, sneezing,
contain a large number of measles virus, which is scattered by air. Since the virus
is spread by air currents in adjacent rooms through the keyhole, open doors,
windows, ventilation pipes. Therefore, all susceptible to measles, located in one
indoors with the patient may be infected. Autumn-winter, but you can get sick at
any time of the year. Is transmitted from mother to child immunity in the event
that the mother had been ill with measles or been vaccinated, the child is
breastfed. In this case, children under 6 months of age do not get sick with
measles. After the disease produced proof lifelong immunity. Repeated cases are
extremely rare. Pathogenesis. Measles is a common generalized process with the
electoral defeat of the central nervous system, respiratory system. Atrium nasopharyngeal mucosa and upper respiratory tract and possibly through the
conjunctiva of the eye. Pathogenesis measles process comprises 5 phases: Phase
1 - infection and virus adaptation to lymphoid tissue, its propagation in the
regional lymph nodes. 2-phase - the virus in the blood (primary viremia) and
generalized lesions lymphocytic system: the virus spreads to all organs and
systems, introduced in the lymphoid tissue and retikulogistiotsitarnye breeds in
them, which leads to the formation of giant multinucleated cells. In this phase,
the same occurs with the accumulation of immunological rearrangement of T and
B lymphocytes, plasma cells and the production of measles-specific antibodies. 3phase - secondary viremia and allergic reactions: under the influence of specific
antibodies and immune cells occurs cytolysis virus-containing cells. Freed the
virus is introduced into nearby epithelial cells, affects them again. 4th phase - in
the body parallel to develop allergic processes due to the protein components of
the virus, and histamine gistaminpodobnyh substances that lead to sensitization
of tissue. This dramatically damaged vessel walls, increasing their permeability,
edema and exudation, especially expressed in the tissues of the upper respiratory
tract, which leads to necrotic catarrhal inflammation of the mucous membranes
of the oropharynx and upper respiratory tract. Each element of the rash - is the
focus of inflammation around the vessel, alopecia-infiltrative character. As a
result of the spread of the rash on the Malpighian and granular layer of the skin
lesions occur degradation, which leads to the appearance of flaking in place of
abundant precipitation. Bielsko-spots Filatova-Koplik - a superficial necrosis of the
epithelium of the oral mucosa. Stages rashes associated with measles virus with
the highest concentration at the gate of the infection, with the abundance of
blood vessels in this area, which causes a rash on the first face, mucous
membranes of the mouth, then the trunk and then the limbs. In the period rashes
virus affects the nervous, endocrine system, which is manifested increase of
intoxication. Functional disorders of the nervous system, in turn, contributes to
the function of the adrenal glands release a large amount of blood SCS has
immunosuppressive effects (measles anergy). 5th phase - the formation of a
strong immunity - in the blood increases the concentration of specific antibodies
and the virus is neutralized.
Pathogenesis vaccination process. When vaccination of live measles vaccine virus
enters the body parenterally and multiplies in lymphoid tissue, but not in the
airway epithelium.
Immunity depends on the initial state of the immunological reactivity of the
organism, and the dose of vaccine quality, proper storage.
Post-vaccination measles continue to experience mild catarrhal symptoms,
absence of pulmonary lesions and nervous systems, less pronounced changes in
the immune cells without the development of measles anergy. Patients with
measles vaccinations free of infection.
Clinic. The clinical picture of measles are 4 period of illness. The incubation period
of 8-10 days, children immunized or measles immunoglobulin can be prolonged to
21 days. Catarrhal period lasts 3-4 days may be prolonged up to 5-7 days. Period
rash lasts 3-4 days. Pigmentation period lasts 1-2 weeks. The clinical picture of
measles supporting and leading are the following syndromes: the severity of
catarrhal symptoms; the nature of the temperature curve; the severity of
intoxication; Characteristic makulo-papular rash.
Features catarrhal period of measles are - acute onset disease characterized by an
increase in temperature to 38 ° C, and the advent of catarrhal symptoms of
conjunctivitis, which progresses, nasal discharge abundant mucous, mucopurulent. Patient becomes husky voice, joins cough - dry haunting, sometimes
early in the disease may occur syndrome of croup.
Marked photophobia, lacrimation, conjunctival hyperemia, eyelid edema,
injection of vascular sclera. Looseness of the oral mucosa, gums. Spots appear
Bielsko-Koplik Filatov - on the buccal mucosa opposite the molars grayish-white
dots, surrounded by flushing rim. On the soft and hard palate appears measles
enanthema - small pinkish-red spots.
Period rash starts with 4-5 days of illness and is characterized by the appearance
of maculopapular rash. The first elements of the rash appear behind the ears, on
the back of the nose, on the forehead in the form of small pinkish spots that grow
very quickly, merge with each other, have an irregular shape. 2-day rash
completely covers the entire body and upper arms, 3-day, the rash spreads to the
arms and legs konechnosti-.
Stages rash - a characteristic feature of measles.
In the period of high precipitation temperature to 39-40 ° C, catarrhal symptoms
worsen. The general condition of patients with severe, marked anxiety, delirium,
drowsiness, may be nosebleeds.
Characteristic appearance of the patient - the person puffy, pasty eyelids, nose
and lips swollen, red eyes, profuse discharge from the nose. Period rash lasts 3-4
days, and then the disease goes into the next period - the period of pigmentation
accounts for 6-7-day illness. During this period, measles rash starts to get dark,
Buret, takes brown. Pigmentation begins in the same manner as a rash. In the
field of continuous eruption may be defurfuration. Politically temperature
decreases to normal values. Catarrhal symptoms diminish and disappear. Overall
condition is slowly recovering.
In the period of pigmentation for a long time is the state of fatigue and anergy.
Clinical classification of measles: 1. The typical form: By gravity is divided into: a)
light; b) moderate and c) heavy. 2. Atypical forms: a) worn (abortive); b)
mitigirovannaya measles; c) hypertoxic; g) hemorrhagic (very rare).
Features mitigirovannoy measles. This form of measles can occur in receiving
immunoglobulin, blood products, or vaccinated. It is characterized by lengthening
the incubation period to 21 days, shortening catarrhal period up to 1 day with
mild catarrhal symptoms, lack enantemy and stains Bielsko-Filatov. Rashes period
is shortened to 1-2 days, the rash is soft, fine in violation of phasing rashes.
Pigmentation short, pale.
Features abortive measles. Process, beginning as it typically breaks after 1-2 days
from the appearance of the rash. The rash is small, the slim, only appears on the
face and trunk, and limbs are free from rashes. Pale pigmentation, short-term (13 days). Body temperature can be increased only 1 day of the rash.
Features of measles in adults. Has a high specific gravity. Proceeds with a
predominance of severe and moderate forms of the disease. Severe intoxication
(fever, headaches, dizziness, fainting, vomiting, nosebleeds, loss of
consciousness). Expressed cough, conjunctivitis. Rashes period extended up to 4-5
days, the rash is large, bright and plentiful. Complications are rare.
Mild form of measles: show moderate or mild catarrhal symptoms and
intoxication, the patient's condition is satisfactory, the body temperature is not
higher than 38,5 ° C. The rash can be patchy, with a weak trend towards mergers
and pale pigmentation.
Moderate form of measles. Intoxication sufficiently pronounced, the patient feel
much disturbed, may be delirium, vomiting, body temperature rises to 39 ° C.
Rash abundant, bright, makulo-papular unchanged background on skin prone to
merge. Severe measles. Characterized by pronounced symptoms of intoxication,
in the form of seizures, loss of consciousness, repeated vomiting, fever up to 40 °
C and above. Rash abundant, with hemorrhagic bluish tint, the drain. Pronounced
catarrhal symptoms: face puffy, pasty eyelids, purulent conjunctivitis
phenomenon, rhinitis, cough wet part. Frequent joining various suppurative
complications.
Diagnostics. Clinical and epidemiological methods. Hematologic data (leukopenia,
neutropenia, lymphocytosis, ESR moderately increased). Cytological (tsitoskopiya
nasal discharge for the detection of multinucleated giant cells characteristic of
measles). Virological method - virus detection by immunofluorescence.
Serological - TPHA, HI (detection of measles-specific antibodies by paired sera).
Linked immunosorbent assay (ELISA) detection of antibodies to measles virus
class IgM, IgG.
The differential diagnosis.
In catarrhal period - with ARI - acute onset, expressed catarrhal symptoms:
tearing, photophobia, rhinitis, injections of vascular sclera, looseness of the oral
mucosa, stains Belskogo- Filatov enanthema
In the period of rashes with rubella - a one-time appearance of the rash, the rash
is small, no pigmentation, increased neck and zadnesheynyh limfauzlov, mild
intoxication and catarrhal syndrome.
With pseudotuberculosis - no phasing rash, catarrhal syndrome, inflammatory
changes of the oral mucosa, polymorphism symptoms.
With scarlet fever - lack of catarrhal syndrome, the presence of punctate rash on
hyperemic skin background with concentration in places of natural folds, sore
throat, "crimson language", peeling skin, blood - leukocytosis.
With meningokokktsemiey - rapid onset, hyperthermia, severe headache,
vomiting, rash appears immediately on the whole body with hemorrhagic tint
increases in their eyes, is localized on the buttocks and lower extremities.
With allergic exanthema - do not have the inherent characteristic symptoms of
measles bizarre itchy skin.
Treatment. Bed rest for the entire febrile period. Caring for patients with measles:
body hygiene, face, hands; toilet mouth, nose and eyes. Nutrition - lactovegetarian diet, drinking plenty of fluids. Symptomatic therapy. Antibiotics for the
prevention and treatment of complications. Vitamin therapy. Indications for
hospitalization: heavy and complicated forms, children up to 2 years, epidem.
situation.
Prevention. Active immunization of live measles vaccine (ZHKV L-16, Ruvaks,
MMR (measles, rubella, mumps). The vaccination - 9 months and 16 months.
Passive immunization - measles donor immunoglobulin is administered 3-5 days
of contact.
General control measures - isolation of patients to 5 days from the date of rash, if
complications up to 10 days.
Ventilate the room for 30-45 minutes.
Kvartsevanie premises.
Scarlet fever - an acute infectious disease characterized by general intoxication,
sore throat and rash.
Pathogen B-hemolytic streptococcus.
The source of infection - the patient streptococcal infection. Modes of
transmission - airborne, contact-household through the third person, the wound
surface, nutritional. Infectious period - just not installed. Index contagious - 40%.
Immunity - antitoxic resistant.
Pathogenesis. 1. Causes of inflammation at the front gate of infection (sore
throat). 2. The toxin enters the bloodstream and has a tropism for the central
nervous system, autonomic nervous system, CCC (high fever, rash, general
intoxication). Infectious allergy - (the body's sensitivity to the protein components
of the microbe and its giperergicheskom reaction). Septic manifestations
(suppurative processes in the pharynx, nasopharynx, paranasal sinuses, etc).
Clinic. The incubation period - 2-7 days. The disease begins acutely with high
fever, vomiting, sore throat. A few hours later a rash appears on the body.
Punctulate hyperemic rash on the skin background with concentration in the
natural folds, which disappears in 3-5 days of illness, free from rashes nasolabial
triangle - a symptom Filatov. In the throat - a sore throat from bluetongue to
necrotic, bright red delimited hyperemia. Increase in regional limfauzlov.
Characteristic language - first illness covered with dense white bloom, 3-4 day of
illness becomes a "raspberry" and lasts for 2 weeks.
Cardiovascular changes in the form of "infection of the heart" are held for 2-4
weeks. In the blood - leukocytosis, neytrofillez, increased erythrocyte
sedimentation rate.
Clinical classification of scarlet fever: 1. The typical form, by gravity: a) light; b)
Moderate; c) heavy. 2. Atypical forms: a) ekstrabukkalnaya; b) worn (scarlet fever
without rash); c) hypertoxic; g) hemorrhagic.
Complications: early and late.
Rubella (Rubeola) - an acute infectious disease characterized by morbilliform rash,
slight catarrhal symptoms from the TTP and increased peripheral limfauzlov.
Pathogen - virus.
The source of infection - the patient. Transmission - airborne route. High
susceptibility of children - from 1 year to 7 years. Rubella is especially dangerous
for pregnant women in the first 3 mes.t.k. can be a threat to congenital
malformations. Infectious period - 2 weeks after illness.
Immunity resistant.
Virus penetrating through the VDP, enters the bloodstream, has tropism for
lymphoid and fetal tissue.
The incubation period is 15-24 days. The main symptom - a pink rash, papular,
smaller measles. Catarrhal symptoms are mild, the general condition does not
suffer Pathognomonic - increase zadnesheynyh and occipital limfauzlov.
Appendix №2
Methodical instructions for students
2.1 Problem:
The choice of tactics and determination of the need for hospitalization of patients
with korb, rubella, scarlet fever in a hovercraft.
2.2. Subproblems
7. Analysis of appearance
8. Analysis of the history and pre-event is a causative factor in the development of
measles, rubella, scarlet fever
9. Analysis of inspection
10. Selection of the necessary diagnostic methods
11. Relate findings and differential diagnosis
12. Come to a specific problem-solving in a hovercraft.
2.3. Algorithm for solving
2. Analysis of appearance includes the following research
- Examination of the skin and visible mucous
- The face (eyes, tongue)
2. Analysis of history
- Borne diseases
- Family and social history
- Epidemiological. history
- The duration and nature of the rash
3. Analysis inspection
- Ps, BP
- Auscultation of the heart and lungs
- Palpation of the abdomen
4. Selection of the necessary diagnostic methods
- KLA, OAM
- Tsitoskopiya nasal discharge
- IFA
- Virological
5. Relate the results and differential diagnosis with
- Infectious Diseases
- Oncology
- Therapeutic
6. To come to a definite decision problems under SVP
- Treatment if necessary
- Emergency hospitalization
- Emergency care
Appendix №3
Organiser (Venn Diagram)
Measles (features) Similar signs Rubella (features)
Appendix №4
Alternative solutions case study teacher - keysologom
1. On the basis of complaints of fever, cough, runny nose, sneezing, festering
eyes, loss of appetite. At the 4-day disease rash on the face.
4 day history of the disease. Obstetric and early history without pathology. Works
as a driver. By the nature of introvert. Allergies to drugs not. Epid.anamnez: In
contact with infectious patients was not patient did not receive blood products, at
a reception at the dentist was not.
Inspection: The state of moderate severity, a clear conscience. Proper physique.
In the observation noted landmark spread the rash. Rash was plentiful, drain,
strongly disturbed "cut" in the eyes.
Temperature remained high up to 7 days of illness. Expressed intoxication headache, vomiting, lethargy, weakness, insomnia. In the lungs, vesicular
breathing. Cardiac sounds are muffled, HR 100 in 1 min. Furred tongue, we could
see the small white spots on the mouth loosened congested (as semolina). Ms
about the correct form, is involved in the act of breathing, with superficial and
deep palpation painless, swollen belly. The liver is not increased. For other
or¬ganam without pathology. Meningeal phenomena not.
Jabs: Hb - 128 g / l, cs - 0.91, Ayr - 4,2hYu12 / l; Lake -3,6h109 / l;
p / - 1%, with / I - 42%, e - 6%, n - 42%, m - 7%, ESR - 10 mm / hour.
Survey data: the nasal discharge tsitoskopii revealed multinucleated giant cells.
In enzyme immunoassay (ELISA) to detect antibodies measles virus class IgM.
The diagnosis: Measles, moderate flow
2. Differential diagnosis of measles rubella is carried out, scarlet fever.
3. The general analysis of blood, urine (category 3.1);
-Biohimicheskie Blood (category 3.1. +3.2);
- Tsitoskopiya nasal discharge (Category 3.2)
- ELISA (category 3.2);
- Coprogram (Category 3.1)
4. Treatment:
Bed rest for the entire febrile period. Caring for patients with measles: body
hygiene, face, hands; toilet mouth, nose and eyes. Nutrition - lacto-vegetarian
diet, drinking plenty of fluids. Symptomatic therapy. Antibiotics for the prevention
and treatment of complications. Vitamin therapy. Indications for hospitalization:
heavy and complicated forms, children up to 2 years.