Download NI Pirogov National Medical University

Ministry of Health of Ukraine
N.I. Pirogov National Medical University
Infectious Diseases Department
Approved
at the methodological meeting
on _____________ 2008
Professor L. V. Moroz,
Head of the Department
INSTRUCTION MANUAL
for organization of independent work of fifth-year students of medical
departments
(on the subject of the teaching plan).
Subject 2.3.:
Enterovirus infection
Rotavirus infection
Prepared by: Nikituk N.P., assistant professor
2009
1. Urgency of the issue:
Enteroviral infection - an acute infectious disease caused by intestinal viruses of the Coxsackie
group and ECHO, are characterized by numerous clinical manifestations, often, CNS, musculoskeletal
system, myocardium, and skin manifestations.
The disease is well established in Europe, North America and other countries. Often occurs
sporadically and rarely epidemiological morbidity. In some cases there may be a severe course that
threatens the patient's life.
Rotavirus infection each year draws to itself all the more attention. The accumulated data indicate
the important role of viral gastroenteritis in human pathology, which are spread in the world give way only
to respiratory infections.
Recently, acute gastrointestinal illness is not bacterial in nature, as a common cause of infant
mortality, interpreted as a disease of unknown etiology. Today, this gap in more occupied rotaviruses.
Rotavirus gastroenteritis prevalent in the world. The disease has been and this made it possible to achieve
significant success, as they have, and in other countries. Vaccine to be developed.
2. Learning goals and objectives (with indication of the achievement
level being planned): a-1
2.1. Students should know:
а=2
 Etiology enterovirus and rotavirus infection, rotavirus pathogenicity
factors
 Basic principles of pathogenesis
 Epidemiology of enterovirus and rotavirus infection: the source of
infection - a sick person or a carrier of the virus
 Susceptibility to enterovirus and rotavirus infection, risk, seasonal,
sporadic and epidemic disease
 specific diagnosis of enterovirus and rotavirus infection: electron
microscopy, imunoelktronnaya microscopy imunofermentny analysis
method flyuoristsiruyuschih antibodies
 serological diagnostic methods: RSK, neutralization of virus RGGA
 Clinical-important symptoms and syndromes of enterovirus and rotavirus
infection
 The principles of treatment, the importance of pathogenic and their
effectiveness
 Complications
 Features hemogram with enterovirus and rotavirus infection
 Rules discharge of patients with enterovirus and rotavirus infection
2.2. Students should be able:
а=3
 Adhere to the basic rules of the bed patient enterovirus and rotavirus
 Collect medical history with the assessment of epidemiological data
 examine the patient and find the main symptoms and syndromes of
enterovirus and rotavirus-based clinical diagnosis
 On the basis of the clinical diagnosis can detect possible complications
 Making medical records upon diagnosis with supply specials
 Make a plan of laboratory examination
 Make a treatment plan according to the severity: complications,
comorbidities
 Dates recommendations regarding the treatment, diet, inspection during
convalescence
3. Basic knowledge and skills necessary for subject learning
(interdisciplinary integration)
Discipline
Microbiology
To know
Microbiology Properties
viruses Coxsackie groups A,
B, ECHO diagnostics, to learn
principles of bacteriologic and
serologic investigations.
To be able to carry out
Interpret the results of specific
diagnostic methods enterovirus
infections of indirect
hemagglutination, complement
fixation test, immunofluorescence
test);
Physiology
Parameters of physiological
standard of human organs and
systems, results of laboratory
investigation in normal
condition (clinical blood test,
urinalysis, biochemical blood
assay, acid-base properties,
properties of electrolytes etc).
To evaluate laboratory results.
Pathophysiology
Mechanism of dysfunction of
organs and systems in
pathologic conditions of
different genesis (nature and
mechanism of biliousness
progression, diarrheic
syndrome etc).
Basic concept on the subject;
role of immune system in
infectious process, influence
on the duration of isolation
infectious organisms from the
human body.
Main stages of epidemiological
process (source, mechanism of
introduction of infection,
transmission routes), the
prevalence of disease.
To give an interpretation to
pathologic changes on the base of
laboratory investigation in the
case of dysfunction of organs and
systems of different genesis.
Neurology
Pathogenesis, clinical signs of
nervous system.
Dermatology
Pathogenesis, clinical
characteristics of exanthemas.
Propaedeutic of internal
diseases
Main stages and methods of
clinical examination of the
patient.
Clinical pharmacology.
Pharmacokinetics and
pharmacodynamics, unwanted
side effects (side effects of
ciprofloxacin and etc.).
Conduct the clinical examination
of patients with lesions of the
nervous system.
To identify eruption in the patient
with pseudotuberculosis, enteric
yersiniosis.
To collect anamnesis, conduct the
clinical examination of the
patient, to detect pathological
symptoms and syndromes.
Analyze collected data.
To prescribe treatment depending
on the age, personal traits of the
patient, clinical form, severity of
disease; to select the optimum
administration and dosage
Immunology and
allergology
Epidemiology
To evaluate the results of
immunological investigations.
To collect epidemiological
anamnesis, to take antiepidemic
and preventive measures in the
center of infection.
regimen of preparations; to make
out prescriptions.
Reanimation and
Intensive care
Emergency conditions:
 Toxic shock syndrome
 Infection-exhaustion
psychosis
 Paralytic form of CNS
№
1.
Discipline
Microbiology
2.
Physiology
3.
Pathophysiology
Mechanism of dysfunction of
organs and systems in
pathologic conditions of
different genesis.
4.
Epidemiology
Main stages of
epidemiological process
(source, mechanism of
introduction of infection,
transmission routes), the
prevalence of disease.
5.
Immunology and
allergology
Propedeutics of
internal diseases
Immunological aspects of
rotavirus infection.
Main stages and methods for
clinical examination of the
patient.
7.
Clinical
pharmacology.
8.
Infectious diseases
Pharmacokinetics and
pharmacodynamics,
unwanted side effects, means
of pathogenetic therapy.
Characteristics of infectious
diseases. Principles of
diagnostics, treatment,
preventive measures of
infectious diseases.
6.
To diagnose in time emergency
conditions and deliver emergency
aid:
 T Toxic shock syndrome
 Infection-exhaustion
psychosis
 Paralytic form of CNS
To know
To be able to carry out
Properties of rotavirus and
Interpret the results of specific
specific diagnostic methods
diagnostic of rotavirus infection.
of rotavirus infection.
Parameters of physiological
To evaluate laboratory results.
standard of human organs and
systems, results of laboratory
investigation in normal
condition (clinical blood test,
urinalysis, biochemical blood
assay, acid-base properties,
properties of electrolytes etc).
To give an interpretation to
pathologic changes on the base of
laboratory investigation in the
case of dysfunction of organs and
systems of different genesis.
To collect epidemiological
anamnesis, to take antiepidemic
and preventive measures in the
center of infection.
To evaluate the results of
immunological investigations.
To collect an anamnesis, to carry
out clinical examination of the
patient’s organs and systems, to
reveal clinical signs of pathology.
To analyze the obtained data.
To prescribe treatment depending
on the age, severity of disease; to
make out prescriptions.
To carry out differential
diagnostics of
pseudotuberculosis, enteric
yersiniosis with other infectious
diseases.
5. Structural scheme of the lesson.
Enteroviral disease (Coxsackie, ECHO)
Coxsackie virus A and B, and ECHO. Persistence in the
environment, pathogenicity factors
Etiology
Complications
Specific
diagnostics
Healing
Prevention
Pneumonias
Nonspecific
Interferon
Damage of the
peripheral muscle
Complement
fixation,
neutralization
recuperation
formation of immunity
Different forms encephalitis,
pericarditis, etc.
abjection of the
originator
parenchymal diffusion
hemorrhagic
conjunctivitis
toxemia
Heart and nervous
system diseases
Indirect
immunofluorescence
Glucocorticoids
enterovirus fever
myelitis
viremia
enterovirus exanthema
serosal meningitis
costalgia
ENT organs
failure
Virus isolation from
feces, oropharynx,
neurolymph
Pathogenic
therapy
sore throat, herpangina
dissemination of the
pathogen
lymphadenopathy
lesion of the oral
mucosa
flushing of the face,
sclera
penetration
nausea, vomiting
Clinic
methysis
Pathogenesis
affinity of the nervous
system, muscle,
epithelium
Source - a sick man and a virus carrier. Air - drop
mechanism and fecal - oral, high susceptibility,
postinfectious immunity resistant.
Epidemiology
Rotaviral infections
Ethiology
Rotaviruses: serovars 1, 11, 111, 1\/
Specific diagnostics
Consecutive
infection
Deaquation
Electron microscopy of
faeces
Dysbacteriosis
Rheumatoid arthritis
Haemagglutination
Healing
Prevention
Nutritional
care № 4 b
Nonspecific
Intestinal
enzymes
Rehydron,
Enterodez and etc.
Salt-water
fluids v/v
Antibiotics for
bacterial
complications
Immunity
Healing
Neutrophilia
Violation of the
circulating blood
volume
Serological diagnosis - Ig
M
Complication
Organs damage
Electrolyte disturbances
Moderate leukocytosis
Deaquation
Damage
Emesis
Methysis
Borborygmus
Emesis
Diarrhea
Diarrhea
Impaired absorption
and digestion
The defeat of the enterocytes
Gastroenteritis
Virus penetration
Complications
Acute incipience
Clinic
Incubation period
Pathogenesis
The loss of fluids
Source of infection: patient or virus carrier. Mechanism of carry-overing:
fecal-oral, impliable airborne. Water and pabular breakouts. Autumn-winter
seasonality. The total receptiveness.
Epidimiology
4. Classroom-based materials for self-study
4.1. Test questions for the individual interview
1. Master the technique of examination of patients enteroviral infection
2. Conduct Supervision patient
3. Make a differential diagnosis
4. Plan the laboratory examination
5. Interpret the results of a specific survey
6. Recognize possible complications
7. Treatment plan
8. Making medical records upon diagnosis
9. Serovars called rotavirus and virulence factors
10. The age structure of cases
11. The source of infection with rotavirus
12. The incubation period for rotavirus
13. Characterization of gastrointestinal syndrome and its features
14. Especially with rotavirus diarrhea
15. Features of intoxication
16. Features of upper respiratory tract
17. Characterization of fever with rotavirus
18. Features hemogram
19. The cardiovascular system
20. Degree of dehydration with rotavirus, the cause
21. Specific diagnosis of rotavirus infection
22. The principles of treatment of rotavirus infection
23. The main features of the pathogenesis of rotavirus
24. Rules discharge convalescent
4.2. Tests
Choose correct answer
Version 1
2.1.145. Name transfer mechanism with rotavirus:
1. fecal-oral
2. airborne
3. transmissible
4. percutaneous
2.1.146. Source of infection with rotavirus:
1. man
2. mammals
3. amphibia
4. insects
5. Pisces
2.1.147. State of the nasopharynx with enterovirus infection:
1. hyperaemic
2. normal
3. availability of skin
2.1.148. Rotavirus can not tolerate:
1. disinfecting solution
а=2
2. acid
3. sun
4. desiccation
2.1.149. For the epidemiology of rotavirus infection is true:
1. zoonosis
2. anthroponosis
3. autumn-winter season
4. tsource is water
2.1.150. Specific diagnosis of rotavirus infection include methods:
1. virological
2. serological
3. parasitological
4. electro-microscopic
2.1.151. Differential diagnosis of enterovirus infection is carried out:
1. cholera
2. salmonellosis
3. shigellosis
4. bowel cancer
5. holetsistopankreatitom
2.1.152. Feature defecation with rotavirus:
1. watery
2. with mucus and blood
3. has the character of "raspberry jelly"
.1.153. Especially the treatment of rotavirus infection:
1. chloramphenicol, tetracycline
2. rehydron, Enterodez
3. glucose-saline solutions parenterally
4. intestinal enzymes
2.1.154. Preventive measures for rotavirus infection:
1. specific vaccination
2. personal hygiene and disinfection regimen
3. use of medical masks
2.1.155. Causative agent of enterovirus infection is:
1. rotaviruses
2. Coxsackievirus
3. ECHO viruses
4. Salmonella typhi
5. virus Poliovirus
2.1.156. Source of infection for enterovirus infection is:
1. sick of enterovirus infection
2. virus carrier enterovirus infection
3. Cattle
4. poultry
5. rodents
Version 2
2.2.157. Preventive measures for rotavirus infections are associated with:
1. specific vaccination
2. holding disinfection regimen
3. personal hygiene
4. use of medical masks
2.2.158. In the treatment of rotavirus used:
1. hemodez
2. enterodez, rehydron
3. Chloramphenicol, tetracycline
4. Glucose-saline solutions
2.2.159. Feature chair with rotavirus:
1. with mucus and blood
2. like "raspberry jelly"
3. watery
4. slimy, lean
2.2.160. Differential diagnosis of enterovirus infection is carried out:
1. with bowel cancer
2. amebiasis
3. cholera
4. salmonellosis
2.2.161. Specific diagnosis of rotavirus infection:
1. parasitological methods
2. serological methods
3. virological methods
4. electron microscopic method
2.2.162. Source of the infection with rotavirus are:
1. Pisces
2. amphibia
3. man
4. mammals
2.2.163. Transfer mechanism for rotavirus infection:
1. transmissible
2. airborne
3. percutaneous
4. fecal-oral
2.2.164. For the epidemiology of rotavirus infection is true:
1. anthroponosis
2. zoonosis
3. autumn-winter season
2.2.165. Rotavirus is the causative agent of:
1. spirochete
2. virus
3. bacterium
4. leptospira
2.2.166. Incubation period for foot and mouth disease is most often are:
1. 1-2 days
2. 2-7 days
3. 7-10 days
4. more than 10 days
2.2.167. Typical clinical manifestations of enterovirus infection are:
1. acute onset
2. gradual onset
3. high temperature
4. intoxication
5. short-rash
6. hyperemia and granularity oropharynx
7. lymphadenopathy
8. moderate leukocytosis
2.2.168. Clinical types of enterovirus infection:
1. herpangina
2. epidemic myodynia
3. hydromeningitis
4. enterovirus exanthema
5. myelitis
6. minor illness
7. enterovirus epidemic conjunctivitis
8. acute respiratory infection
Version 3
2.3.169. Treatment of rotavirus used:
1. antibiotics
2. nitrofurans
3. glucose-saline solutions
4. vitamins
2.3.170. Material for a specific survey in enteroviral infection are:
1. blood
2. urine
3. excrement bowel
4. sputum
2.3.171. For clinical picture of rotavirus infection is characterized by:
1. jaundice
2. high fever
3. diarrhea
4. vomiting
2.3.172. Medical emergencies with rotavirus infection are:
1. DIC
2. arrester type of renal
3. dehydration Grade 1-2
4. cephaledema
2.3.173. Changes in the hemogram with rotavirus:
1. hyperskeocytosis
2. leukopenia
3. moderate leukocytosis
4. normocytosis
2.3.174. State of blood pressure with rotavirus infection:
1. normal
2. elevated
3. reduced
2.3.175. Total protein in the blood of rotavirus infection:
1. normal
2. reduced
3. heightened
2.3.176. State of the nasopharynx with enterovirus infection:
1. hyperaemic
2. normal
3. availability of skins
2.3.177. Heart sounds with rotavirus:
1. weakened
2. arrhythmic
3. normotonic
2.3.178. Specific diagnosis of enterovirus infection by:
1. hemoculture
2. virus isolation from feces
3. virus isolation from throat mucus
4. virus isolation from cerebrospinal fluid
5. serological methods - RAC, etc.
6. virus isolation from the bile
2.3.179. Principles of treatment of enterovirus infection:
1. antibiotic therapy in early disease
2. antibiotic treatment for complications
3. pathogenetic therapy
2.3.180. Causative agent of enterovirus infection is:
1. rotaviruses
2. Coxsackievirus
3. ECHO viruses
4. Salmonella typhi
5. poliovirus
Version 4
2.4.181. In convalescents after rotavirus remain:
1. encephalopathy
2. asthenic syndrome
3. hearing disorder
4. impaired vision
2.4.182. In the biochemical analysis of blood with rotavirus is determined by:
1. reducing sodium
2. reduction of potassium
3. reduction of chlorides
4. increase in calcium
2.4.183. Electrocardiogram with rotavirus:
1. normal
2. dystrophic changes
3. dysrhythmia
2.4.184. Medical emergencies with rotavirus infection are:
1. dehydration of 1-3 degrees
2. cephaledema
3. DIC
4. ARF-type renal
2.4.185. State of the nasopharynx with enterovirus infection:
1. hyperaemic
2. normal
3. availability of skins
2.4.186. Typical defecation with rotavirus:
1. slimy
2. with blood
3. watery
4. color "raspberry jelly"
2.4.187. Muscle cramps are caused by rotavirus infection:
1. death
2. electrolyte losses
3. inflammatory process
2.4.188. Nature of the temperature with rotavirus:
1. hyperthermia
2. normothermia
3. low-grade
4. hypothermia
2.4.189. The causative agent of rotavirus is:
1. spirochete
2. virus
3. bacterium
4. leptospira
2.4.190. Incubation period for foot and mouth disease is most often are:
1. 1-2 days
2. 2-7 days
3. 7-10 days
4. more than 10 days
2.4.191. Typical clinical manifestations of enterovirus infection is:
1. acute incipience
2. gradual incipience
3. high temperature
4. intoxication
5. short-rash
6. hyperemia and granularity oropharynx
7. lymphadenopathy
8. moderate leukocytosis
2.4.192. Clinical types of enterovirus infection:
1. herpangina
2. epidemic myodynia
3. hydromeningitis
4. enterovirus exanthema
5. myelitis
6. minor illness
7. enterovirus epidemic conjunctivitis
8. acute respiratory infection
Version 5
2.5.193. State of the nasopharynx with rotavirus:
1. normal
2. hyperaemic
3. availability of films
2.5.194. Defecation with rotavirus infection:
1. slimy
2. with mucus
3. watery
4. character of "raspberry jelly"
2.5.195. Emergencies with rotavirus infection:
1. DIC
2. ARF-type renal
3. cephaledema
4. dehydration of 1-3 degrees
2.5.196. Heart transient with rotavirus:
1. weakened
2. eutonic
3. arrhythmic
2.5.197. State of blood pressure with rotavirus infection:
1. normal
2. reduced
3. elevated
2.5.198. Changes in the hemogram with rotavirus:
1. moderate leukocytosis
2. leukopenia
3. normocytosis
2.5.199. In convalescent rotavirus infection persists:
1. hearing disorder
2. impaired vision
3. asthenic syndrome
4. encephalopathy
2.5.200. In the biochemical analysis of blood with rotavirus is determined by:
1. increase in calcium
2. reducing sodium
3. reduction of chlorides
4. increase in sodium
2.5.201. Nature of the temperature with rotavirus:
1. hyperthermic
2. low-grade
3. remittent
2.5.202. For clinical picture of rotavirus infection is characteristic:
1. vomiting
2. high fever
3. diarrhea
4. jaundice
2.5.203. Principles of treatment of enterovirus infection:
A. antibiotic therapy in early disease
B. antibiotic treatment for complications
V. pathogenetic therapy
2.5.204. Causative agent of enterovirus infection is:
A. rotaviruses
B. Coxsackievirus
B. viruses ECHO
G. Salmonella typhi
D. poliovirus
Version 6
2.6.205. State of blood pressure with rotavirus infection:
1. normal
2. reduced
3. elevated
2.6.206. Heart transient with rotavirus:
1. normal
2. weakened
3. arrhythmic
2.6.207. Character of defecation with rotavirus:
1. normal
2. slimy
3. watery
4. character of "raspberry jelly"
2.6.208. For clinical picture of rotavirus infection is characteristic:
1. jaundice
2. high temperature
3. vomiting
4. diarrhea
2.6.209. Nature of the temperature with rotavirus:
1. remitting
2. low-grade
3. normal
4. hyperthermic
2.6.210. State of the nasopharynx with rotavirus:
1. normal
2. catarrh
3. availability of skins
2.6.211. Urgent conditions with rotavirus:
1. ARF-type renal
2. DIC
3. dehydration of 1-3 degrees
4. cephaledema
2.6.212. Changes in haemograms with rotavirus:
1. leukopenia
2. normocytosis
3. moderate leukocytosis
2.6.213. In the biochemical analysis of blood with rotavirus:
1. increase in bilirubin
2. increase blood enzymes
3. increase in calcium
4. reducing sodium
2.6.214. Characteristic changes in the skin with a rotavirus infection:
1. hemorrhagic rash
2. paleness
3. typhoid maculopapular rash
2.6.215. Meningeal syndrome with rotavirus infection:
1. neck stiffness
2. none
3. Kernig
4. symptom Brudzinskogo
2.6.216. Principles of treatment of rotavirus infection:
1. antibiotics
2. corticosteroids
3. Glucose-saline solutions
4.2. Professional algorithm for formation skills and experience in diagnostication of
enetrovirus and rotavirus infections.
№ Tasks
Sequence of actions
Notices and warnings concerning self-control
1.
To master the
I. Inquire into patient
Separation of the complaints which are
methods for
complaints.
characteristic for the following syndromes:
clinical
- general intoxication
examination of
- organic lesions
patients with
-additional lesions
enetrovirus and II. To
clarify the
rotavirus
anamnesis:
To pay attention to acute onset of disease;
infections.
1. Anamnesis of disease
time, sequence of development, dynamics of
2. Life history
- fever;
3. Epidemiological
- Intoxication, myodynia
anamnesis
- spots
- other symptoms
To determine previous diseases.
2.
To determine the data on implementation of
infection transmission.
To carry out Conduct an objective It should be remembered that: occurrence,
curation of the examination:
intensity, symptom dynamics and severity of
patient
course of disease depend on the age of the
1. General examination:
patient, accompanying pathology.
1.1. The general
condition of the patient
1.2. Skin, mucous
oropharynx
2. Nervous system
3.
To
prescribe
laboratory
and
additional
investigations, to
interpret
the
results.
1. General blood test.
➢ The body temperature
➢ Skin color and the presence of a rash
➢ color of the mucous membranes and sclera
➢ Status of lymph nodes
To pay attention to:
➢ meningeal syndrome
➢ muscular system
➢ Peripheral nervous system
Pay attention to moderate leukocytosis,
leukopenia, dynamic formula
2. General urinalysis.
No change in the typical course
3. Virological
examination of stool and
mucus from the
nasopharynx
Administered in the acute phase
Assigned in paired sera at intervals of 10 days
4. Serologic methods:
- agglutination test,
-reaction of indirect
hemagglutination,
4.4. Case studies II level of adoption.
Case 1
At the patient suddenly appeared eye pain, photophobia, eyelid edema, hyperemia,
hemorrhage, serous discharge, low-grade fever. Oropharynx hyperemic, granular,
swollen.
1. Preliminary diagnosis
2. Survey plan
3. Treatment
Case studies III level of adoption
a=3
Case 2.
28 years old patient, forwarder of village store. Acutely ill, when there was a
severe weakness, nausea, repeated profuse vomiting, dull pain in the umbilical region,
frequent, profuse diarrhea up to 15-16 times a day, thirst, muscle cramps in the calf
muscles, dizziness. Pale. Tongue coated white bloom, oropharyngeal mucosa hyperemic.
Painless stomach, liver and spleen were not enlarged. Pulse 116 beats / min, weak filling.
AD-80/40 mmHg, muted tones. At the job has exposed to such patients.
1. Preliminary diagnosis and complications
2. Survey plan
3. Treatment plan
Content of the topic classes (abstract)
➢
➢
➢
➢
➢
➢
➢
➢
➢
Etiology rotavirus rotavirus pathogenicity factors
The epidemiology of rotavirus infection
Pathogenesis rotavirus
Clinical characteristics, course options
Pathogenesis of possible complications
Laboratory Tests
Treatment of patients with rotavirus
How to hospital discharge, clinical examination of convalescents
Principles of prevention
Recommended literature:
Main:
➢ Infections / Ed. Mikhail Titov - Kiev: High School, 1995. - P.143-147.
➢ Shuvalov E.P. Infectious diseases. - M.: Medicine, 1995. - P. 150-152.
➢ Vozianova J.L. Infectious and parasitic diseases - Kiev: Health, 2001.
Additional:
➢ Infectious diseases. Ed. V.I. Pokrovsky. - M.: Medicine, 1996. - P. 180-186.
➢ Infectious diseases in general practice and family medicine. Ed. M.A. Andreychina. Ternopil: Ukrkniga, 2007. - P. 315-316.
➢ Bukrinskaya A.G., Grachev M., V. Vasilyev: Rotavirus. Moscow, Medicine, 1989,
223s.
5. Materials for self-study after classes
➢ Modern methods of diagnosis of enterovirus infection
➢ Variants of the clinical course and complications of enterovirus infection
➢ The principles of treatment of enterovirus infection