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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