Download Department of infectious diseases

MINISTRY OF PUBLIC HEALTH OF UKRAINE
Vinnitsya National Medical Pirogov Memorial University.
Department of infectious diseases
Ratified
on a methodical conference
“____” _____________ 2008
Chief of department, professor Moroz L.V.
METHODICAL MATERIALS
for organization of self-contained work of V course medical faculty students
(on the topic included in the education plan).
Topic 3.1: INTESTINAL INFECTIOUS DISEASE WITH
PRIMARYLESION OF COLON: SHIGELLOSIS,
AMBIASIS.
Prepared by: assistant Oliper E.A.
2009
1. Urgency of the issue:
Among the acute infectious lesions of the digestive system take a
large percentage of diseases such as shigellosis and amebiasis. In the last
10-15 years in the world there is an increase in the incidence of both
acute intestinal infections (AII) in general, and in shigellosis. The reasons
for this are different. Researcher also point to a significant increase in
Shigellosisstrains, which are resistant to many antibiotics, and to reduce
the resistance of the human body because of disease of immunity etc. The
structure of one of the leading CROs place belongs acute Shigellosis, the
weight on the incidence of which is presented in different countries from
6-10 to 60-70%. Beginning in 1998, the rise of the disease in Ukraine: an
intensive incidence in 1999 was 68.8 per 100 thousand populations in
2001 - 54.6 and currently remains high.
The problem of amoebiasis also of particular importance in
connection with the expansion of contacts with other countries, lack of
alertness of physicians and knowledge of this disease makes statistical
data on the incidence of amebiasis in these regions is not entirely
accurate, especially as carriers of dysentery amoeba with careful
examinations are in the 5-15 % of surveyed here. In our country, sporadic
cases of amoebic dysentery are found mainly in the south. In the CIS
countries have the most dysfunctional states of Central Asia and the
Caucasus, where the carrier identified in 15-35% of the population.
2.Learning goals and objectives (with indication of the achievement
level being planned):
а=2
2.1. Students should know:
• Etiology of shigellosis and amebiasis, pathogenicity factors of
the pathogen;
• Epidemiology of these diseases;
• Pathogenesis;
• Clinical manifestations of shigellosis and amebiasis;
• Clinical and epidemiological features of shigellosis and
amebiasis;
• Pathogenesis, the term of the clinical manifestations and
complications of shigellosis;
• Laboratory diagnosis of shigellosis and amebiasis;
• Principles of treatment;
• Principles of prevention;
• Forecast of shigellosis and amebiasis;
• Rules convalescent hospital discharge;
• Rules of dispensary convalescents.
2.2. Students should be able:
а=3
• Observe the basic rules of work at the bedside;
• Collect medical history to assess the epidemiological data;
• Examine the patient and identify the main symptoms and
syndromes of shigellosis and amebiasis, substantiate the
clinical diagnosis for timely referral of patients to the hospital;
• Make a differential diagnosis of shigellosis;
• On the basis of clinical examination spot the potential
complications of botulism emergency conditions;
• Draw upon medical documentation establishing a preliminary
diagnosis "shigellosis" (emergency notification in SES);
• Plan the laboratory and further examination of the patient;
• Interpret the results of laboratory tests;
• Develop a treatment plan to epidemiological data, severity,
presence of complications, allergic history, comorbidities,
provide emergency pre-hospital care;
• Plan and anti-prevention measures in the site of infection;
• Make recommendations relating to the treatment, diet,
inspection, observation in the recovery period.
3. Basic knowledge and skills necessary for subject learning
(interdisciplinary integration)
Discipline
Microbiology
Physiology
Pathophysiology
Immunology and
allergology
To know
Previous subjects
Properties of
microorganisms of the
genus Shigella. Rules and
terms of collection of
material for the specific
diagnosis
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).
Mechanism of dysfunction
of organs and systems in
pathologic conditions of
different genesis.
Basic concept on the
subject; role of immune
system in infectious
process, influence on the
To be able to carry out
Interpret the results specific
methods diagnosis of
shigellosis.
To evaluate laboratory
results.
To give an interpretation to
pathologic changes on the
base of laboratory and clinic
investigation.
To evaluate the results of
immunological
investigations.
Epidemiology
duration of isolation
infectious organisms from
the human body.
Main stages of
epidemiological process
(source, mechanism of
introduction of infection,
transmission routes) in
Shigellosis, the prevalence
of disease in the world and
Ukraine.
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.).
Infectious diseases
To collect epidemiological
anamnesis, to take
antiepidemic and preventive
measures in the center of
infection.
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 regimen of
preparations; to make out
prescriptions.
Inter-subject integration
Characteristics of
Make a differential diagnosis
infectious diseases.
of diseases of different
Principles of diagnostics, genesis of shigellosis and
treatment, preventive
amebiasis. Recognize this
measures of infectious
disease, it complications,
diseases. Pathogenesis,
interpret laboratory findings.
epidemiology, dynamics
Hospitalize a patient in the
of clinical manifestations, infectious ward in time. Fill
laboratory diagnosis,
specials.
complications, clinical
features of shigellosis and
amebiasis. Principles of
prevention and treatment.
4. Structural scheme of the lesson.
Shigellosis
Shіgella
Etiology
Sh.dysenterіae
Sh.flexnerі
Sh.boydіі
Sh.sonneі
Source - a sick man bacillicarriers. Fecal-oral transmission: water, food, household contact and transmission.
Postinfectious immunity.
Epidimiology
Delivery of the toxin in the
wall of the large intestine
Partial loss Sh
Pathogenesis
Absorption of endotoxin
in the blood
Penetration into the stomach
Sh penetration into the
large intestine
Activation into cAMF
Accumulation of
toxins
Hypovolemia
Toxemia
Sensitization of the mucous membrane of
the large intestine, impaired autonomic
innervation
Sh effect on the mucous
membrane of the large intestine
For the duration of the flow
Сlassification
Сolitis syndrome
By the nature of the flow
By severity
- subclinical
- blurred
- easy
- moderate
- heavy
- Acute (up to 2 months.)
- Long (more than 2 months.)
- Chronic
Colitis form
Diarrhea
Gastroenterocolitic form
Enterocolitic form
syndrome distal colitis
intoxication syndrome
gastroenteritis
syndrome
Clinic
Colicky pain, tenesmus,
stool streaked with blood and mucus
Complications
Diagnostics
TSS
Hypovolemic shock
General clinical
Complete blood count (ESR ↑,
leukocytosis)
Koprotsitogramma (mucus,
nezmenennye red blood cells,
white blood cells - 30-40 in n /
h)
Treatment
Prevention
Etiotropic therapy
Nonspecific
Watery stools,
vomiting,
dehydration
fever, headache
Archoptoma
Biochemical
Bacteriological
method
Antibacterial drugs
(nitrofurans,
fluoroquinolones)
Invagination
Specific
Rapid tests
Serological methods
(RA, IHA, PHA)
Pathogenetic
Enterorrhagia
Additional
Sigmoidoscopy (if
necessary)
Detoxification therapy,
chelators, enzymes,
probiotics
Amebiasis
Entamoebahystolytica
Etiology
Small vegetative form
(luminal)
Big vegetative form
(Interstitial)
Cysts
Source - carrier, at least - the patient on Kish. Amoebiasis people. Fecal-oral carry-over:
water, food, domestic contact and transmission. Immunity unstable.
Epidimiology
Enterorrhagia
Patogenesis
Amebomas
Penetration into the
stomach
Cytolysis of the intestinal wall
Penetration of cysts
in the small intestine
Formation of luminal
form in the large intestine
Pericolitis
Ulceration
Amebic abscess ext.
organs
Asymptomatic
carriage
Classification
According to
By the nature of the flow By severity of the flow significant clinical
findings
continuously progressed; mild;
recrudescent
moderate;
manifest forms;
heavy
subclinical
For the duration of the
flow
acute (up to 3 months.)
long (up to 6 months.)
chronic (more than 6
months)
Clinical forms
Diagnostics
General clinical
General blood analysis
Koprotsitogramma (glassy
mucus, red blood cells,
eosinophils, CharcotLeyden crystals)
Anemia
Asthenia
The abscesses of
the liver, lungs,
brain
Breakthrough
abscess
Dysbacteriosis
Fever
Intestinal
urinary
ulcers
Chronic
ulcerative
colitis
Peritonitis
Excrement as
raspberry jelly
intestinal
obstruction
Pericolitis
Complications
Right-handed
colitis
Intestinal
bleeding
Clinic
Extraintestinal amebiasis
Carrier
state
Parasite
spectroscopy
Serological
Additional
Detection and
identification of
vegetative
forms and cysts
Haemagglutination
, IIR, ELISA, latex
agglutination
Sigmoidoscopy,
irigografiya,
ultrasound, CT, Xray, puncture the
abscess
Amoebocytes direct action (yatren, osarsol)
Treatment
Etiotropic therapy
Histionic amoebocytes (chloroquine)
Preparations of universal
action (metronidazole,
tinidazole)
Action in center of infection
Examination of patients
Disinfection
Pathogenetic
Operative therapy
Isolation of patients
Prevention
Secondary
infection
abscess
Intestinal amebiasis
Antihistamines
drugs, enzymes,
probiotics,
immunostimulю
5. Classroom-based materials for self-study
5.1. Test questions for the individual interview
1.Which group of infectious diseases are shigellosis and amebiasis.
2. Source of infection and transmission factors in shigellosis
3. Source of infection and transmission factors for amoebiasis
4. Pathogenesis of shigellosis and amebiasis.
5. Classification of shigellosis.
6. The main clinical symptoms of shigellosis.
7. Clinical manifestations depending on the severity
8. Specific complications of shigellosis.
9. The differential diagnosis of shigellosis.
10. Survey plan of the patient to shigellosis
11. Methods for specific diagnosis of shigellosis.
12. Interpretation of the results of laboratory research.
13. Specific therapy of shigellosis: dose, route of administration, duration
of treatment.
14. Emergency care to patients with shigellosis
15. Rules discharge convalescent hospital
16. Prevention and measures in the hearth
17. Characteristics of excretes at shigellosis
18. Clinical manifestations of infectious-toxic shock.
19. Clinical manifestations of gastrointestinal bleeding.
20. Haemogram patient for shigellosis in the midst of illness.
21. Features specific diagnosis of amebiasis.
22. Diagnosis shigellosis carriers.
5.2. Tests Level 2
α=2
Version 1.
3.1.1. Pathogen, which often gives severe dysentery and shock:
A. Shygelladysenteriae
B. Shygellaflexneri
C. Shygellaboydii
D. Shygellasonnei
3.1.2. Name the pathogen, which frequently recorded gastroenterocolitic
form of shigellosis:
A Shigellasonnei
B. Shigellaflexneri
C. GrigorievShigella-Shigi
D. ShigellaLardzha-Sachs
3.1.3. Mechanism of infection in shigellosis:
A. airborne
B. transmissible
C. fecal-oral
3.1.4. Pain syndrome in shigellosis due to:
A. The presence of the destructive process in the gut
B. defeat neuromuscular system and bowel spasm
C. Central heating nervous system lesion
3.1.5. The most characteristic changes in the intestinal mucosa in severe
shigellosis Grigoriev-Shigi in the midst of the disease:
A congestion
B. congestion, edema, hemorrhage, ulcers
C. hyperemia, hemorrhage
D. edema
3.1.6. The most characteristic mucosal changes in protracted forms of
shigellosis:
A. mucosa pale pink
B. redness, swelling
C. mucous thinned, pronounced vascular pattern
D. sores, redness
3.1.7. Characteristic changes in blood counts in chronic intestinal
amebiasis:
A. Anemia, eosinophilia, monocytosis, lymphocytosis, increased
ESR
B. Anemia, significant leukocytosis, neytrofillez
C. leukocytosisneytrofiloz, increased ESR
D. Leukopenia, eosinophilia, anemia
E. No change
3.1.8. Koprotsitogramma acute manifestations of intestinal amebiasis:
A. Large amount of mucus, red blood cells, eosinophils, CharcotLeyden crystals
B. red blood cells arranged in groups in the form of columns,
single leukocytes
C. erythrocytes cover the entire field of view, a small amount of
mucus
D. Red blood cells, white blood cells cover the entire field of view,
amoeba cysts
E. A moderate amount of white blood cells, mucus, cysts, amoebae
3.1.9. To tissue amebotsidam enjoy the following products:
A. delagil
B. metronidazole
C. yatren
D. emetine
E. degidroemetin
3.1.10. The source of infection for amoebiasis is:
A. patients intestinal amebiasis
B. healthy carriers of
C. Cattle
D. Patient was extraintestinalamebiasis
E. Patients with any form of amebiasis
3.1.11. What methods are most useful for the diagnosis of extra-intestinal
amebiasis:
A. ultrasound
B. CBC
B. CT
G. sigmoidoscopy
D. X-ray
3.1.12. Forms of existence dysenteric amoeba in humans:
A.large vegetative form
B. cysts
C. small vegetative form
The average vegetative form
D. all of the above forms
Version 2.
3.2.13. Stool in shigellosis:
A copious, watery, frothy
B. frugal with mucus
C. lean streaked with blood
D. mushy with mucus and blood
E. frugal with mucus and blood
3.2.14. The most characteristic symptoms of clinical shigellosis:
A. acute onset, abdominal pain, vomiting, frequent stool looks like
porridge, possible constipation
B. acute onset, chills, fever, nausea and sometimes vomiting,
abdominal pain, cramping, stool with mucus, sometimes with
blood, spasm of the distal colon, tenesmus
C. gradual initiation, intoxication, fever, diffuse abdominal pain,
frequent stools fecal character, tenderness along the bowel
palpation
3.2.15. Full duration of morphological and functional recovery of the
mucous distal colon with moderate during acute shigellosis:
A.few months
B. 2-3 months
C. 6 months or more
3.2.16. To confirm the diagnosis of acute shigellosis must:
A. presence of tenesmus
B. presence of frequent watery stools with mucus and blood
C. paintingsproctosigmoiditis with sigmoidoscopy
D. presence in feces of a patient with diarrhea syndrome Shigella
3.2.17. The most virulent Shigella:
A. Sonne
B. Flexner
V. Grigoriev, Shigi
3.2.18. Pathogen that primarily promotes colitis forms of shigellosis:
A. Shigella Newcastle
B. Shigella Fittings-Schmitz
B. Shigellaflexneri
G. ShigellaLardzha-Sachs
3.2.19. Onset of the disease with a typical course of amebiasis:
A. gradual
B. acute
C. subacute
D. acute with the rapid development clinic
E. latent
3.2.20. Enter the complication of intestinal amebiasis:
A. pericolitis
B. bowel perforation
C. dehydration shock
D. toxic shock
E. intestinal bleeding
3.2.21. The material for the study parasitescopic intestinal amebiasis is:
A.blood
B. urine
C. feces
D. pus from the surface of ulcers, collected at sigmoidoscopy
E. all of the above
3.2.22. Characteristic changes in the mucous membrane of the large
intestine in acute amoebiasis:
A.mucous membrane is not changed, with swollen sores, saped
edges fringed area congestion, the bottom is covered with pus and
necrotic masses
B. language of different diameter, cysts, polyps, amoeboma
C. mucosa swollen, hyperemic, bleeding, ulcers on the surface
fibrinous raids, enterospasm
D. Poverty vascular pattern, single ulcer, "velvety" mucosa, contact
and spontaneous bleeding
E. No change
3.2.23. What are human pathogenic amoebae:
A. Entamoebahartmannі
B. Entamoebahіstolytіca
C. Entamoebacolі
D. nanaEndolіmax
E. Jodamoebabutschlіі
3.2.24. Byamebotsiduniversal action are the following:
A. yatren
B. metronidazole
C. diyodohin
D. tinidazole
E. delagil
Version 3.
3.3.25. Diarrhea, acute shigellosis due to:
A. intoxication
B. bowel dysfunction
C. activation of adenylatecyclase and increased production
cyclophosphate intestinal juice
3.3.26. Mucosal changes in severe acute shigellosis on the 2nd day of the
disease:
A normal mucosa
B. presence of ulcers with saped edges
C. easy Mucosal
D. hyperemia
3.3.27. The duration of acute shigellosis (morphological)
A.fortnight
B. one month
C. up to two months
D. to four months
E. 1 year.
3.3.28. Colitis symptoms of shigellosis form:
A. pain throughout the abdomen, loose stools
B. vomiting, profuse watery diarrhea
C. cramping abdominal pain
D. tenesmus
3.3.29. Clinical variant of shigellosis: cramping abdominal pain,
tenesmus, loose stools with a small amount of mucus and blood streaks:
A. enteritic
B. enterocolitic
C. gastroenteritic
D. gastroenterocolitic
E. colitis
3.3.30. The duration of clinical symptoms in mild acute shigellosis:
A. 2 weeks
B. 4-6 weeks
B. up to 1 week
G. 1-2 days
3.3.31. Characteristic changes in the intestinal mucosa in acute
amoebiasis:
A possible over the entire length of the large intestine
B. in the distal colon
C. in the proximal colon
D. deep ulcers on the background intact mucosa
E. ulcers of different diameters on a background of edematous
mucosa hyperemic
3.3.32. Identification in the faeces of small translucent forms of amoebae,
cysts indicates:
A. acute intestinal amebiasis, during the height of
B. remission of chronic amebiasis
C. exacerbation of chronic amebiasis
D. carriers of amoebae
E. recovery period of acute intestinal amebiasis
3.3.33. Terms of amebiasis patient discharge from hospital:
A clinical cure
B. two negative results parazitoskopii
C. lack of mucus in the stool, eosinophils, Charcot-Leyden crystals
D. negativePhragmites
E. absence of ulcers in endoscopic examination of the colon
3.3.34. Faithful statements regarding clinical examination of
convalescents after acute amebiasis:
A. 12 months.
B. 1 month.
C. Every 3 months exploring cal presence of cysts of amoebae
D. for clinical indications spend sigmoidoscopy
E. Serological diagnosis (IHA, ELISA) every 3 months
3.3.35. Enter the complication of intestinal amebiasis:
A. anemia
B. bowel perforation
C. subdiaphragmatic abscess
D. peritonitis
E. intestinal bleeding
3.3.36. Identification of a large vegetative form in the feces, a material
with the ulcer indicates:
A. acute intestinal amebiasis
B. remission of chronic amebiasis
C. exacerbation of chronic amebiasis
D. carriers of amoebae
E. period of convalescence
Version 4.
3.4.37. Which one of the leading modes of transmission in shigellosis
sonnei:
A.contact-household
B. dust
C. Water
D. sexual
E. food
3.4.38. Gastroenterokoliticheskaya form of shigellosis is most often
caused by Shigella:
A. sonnei
B. Boris Grigoriev-Shigi
C. Flexner
D. Lardzha-Sachs
E. Fittings-Schmitz
3.4.39. To confirm the diagnosis of acute shigellosis must:
A. The presence of tenesmus
B. presence of frequent watery stools with mucus and blood
C. selection of fecal shigella
D. atsigmoidoscopy - a picture proctosigmoiditis
E. spastic sigmoid
3.4.40. Excrement in shigellosis remind:
A. "pea" soup;
B. "raspberry" jelly;
C. "rice" broth;
D. "rectal" spit;
E. "meat" slop;
3.4.41. Ulcer healing in shigellosis is accompanied by:
A. The formation of rough scars with impaired intestinal
B. deformation mucous
C. formation of surface scarring without affecting bowel function
D. The development of obstruction
E. The development of intestinal bleeding
3.4.42. Rules discharge patients shigellosis, which do not belong to the
group decreed:
A. 3 days after the normalization of bowel movements and body
temperature
B. clinical recovery
C. 2 negative results of the tank. stool studies
D. 3 negative results tank. Research stool after 2 days after
antibiotic therapy
E. one negative result of the tank. study feces 2 days after
antibiotic therapy
3.4.43. Drugs that are used to treat amebiasis Cyst carriers:
A. yatren
B. osarsol
C. monomitsin
D. delagil
E. fazizhin
3.4.44. Localization of abdominal pain in patients with uncomplicated
amebiasis in the disease:
A. along the large intestine
B. around the abdomen
C. In the left pane,
D. In the right pane,
E. In the left and right page
3.4.45. The nature of faeces at amebize:
A. Liquid, neobilnye with glassy mucus
B. Lean, alloy lumps of mucus streaked with blood
C. Abundant green color, with lumps of mucus streaked with blood
D. melaena
E. A clearance, normal color, with streaks of blood on the surface
3.4.46. Characteristic of mature tissue-dissolving amoeba cysts:
A circular shape, size 10 - 12 mm, with 12 cores
B. a round or oval shape, size 14-17 mm, contains 1-2 kernels
C. round or oval in shape, size 10.12 mm, contains 3.2 kernel
D. round shape, size 10.12 mm, contains 4 cores
E. round, size 20 mm, contains 10 cores
3.4.47. Byamebotsidam direct owns the following medications:
A. yatren
B. metronidazole
C. diyodohin
D. emetine
E. delagil
3.4.48. Treatment of extra-intestinal amebiasis:
A. yatren, diyodohin, meksaform, aminarson, osarsol
B. emetine hydrochloride delagil
C. metronidazole, flag, fazizhin
D. furamid, meksaform, enteroseptol
E. surgical method
Version 5.
3.5.49. Forgastroenterokoliticheskoy form of shigellosis is characterized
by:
A.toxicity, which is the leading symptom severity;
B. Dehydration, which is the leading symptom severity;
C. Fever, nausea, repeated vomiting
D. frequent copious stools without pathological impurities;
E. scanty stools with mucus and blood;
3.5.50. Leading clinical syndromes of shigellosis are:
A. Toxemia;
B. Gastritis;
C. Myocarditis;
D. distal colitis;
E. meninigizm;
3.5.51. Causal treatment of shigellosis:
A. nifuroxazide
B. doxycycline
C. ampicillin
D. Intetriks
E. furazolidone
3.5.52. Among the activities for specific diagnosis of shigellosis use the
following:
A. Phragmites, TPHA, RA;
B. bacterioscopy stool;
C. bakposev stool;
D. sigmoidoscopy;
E. koprotsitogramma.
3.5.53. Pain syndrome in shigellosis caused by:
A.lesion of the neuromuscular system of the intestine
B. central nervous system
C. intestinalatony
D. presence of the destructive process in the gut
E. enterospasm
3.5.54. Promote the development of a prolonged shigellosis:
A. The presence of intestinal dysbiosis;
B. irrational causal treatment;
C. bacteriocarrier resistant;
D. the presence of chronic diseases of the digestive system;
E. gastric hyperacidity
3.5.55. Infection with amebiasis occurs when it enters the body:
A small vegetative form
B. large vegetative form
C. cysts 2-3 nuclear
D. cysts 4-core
E. small vegetative form cysts
3.5.56. Fever with moderate intestinal amebiasis:
A.low-grade
B. no
C. High
D. hyperpyrexia
E. febrile
3.5.57. What are the diagnostic criteria that indicate recovery of the
patient amebiasis recorded at discharge:
A negative Phragmites
B. negative RAC
C. 2 negative results coprocystscopic research
D. Clinical recovery
E. absencehematophagous in sputum
3.5.58. Whenextraintestinalamebiasis is most often affected:
A.liver
B. light
C. genitals
D. brain
E. pancreas
3.5.59. Typical symptoms of intestinal amebiasis:
A. gastroenterocolitic
B. enterokolitic
C. gemokolitic
D. intoxication
3.5.60. Foramebiasis is characterized by:
A. anthroponosis
B. zoonosis
C. affects only the intestines
D. has intestinal and extra-intestinal forms
E. diarrheal syndrome prevails over intoxication
Version 6.
3.6.61. Which one of the leading modes of transmission in shigellosis
Grigorieva-Shigi:
A contact-household
B. dust
C. Water
D. gender
E. food
3.6.62. Features of the flow of shigellosis in the elderly is:
A. It is easy for a long period without tenesmus and flatulence;
B. prolonged duration of illness;
C. colitis form prevails amid a low fever;
D. Were characterized by pain in the right iliac fossa and sigmoid;
E. destructive and ulcerative processes in the mucous of the colon;
3.6.63. What are the symptoms that are characteristic of colitis forms of
shigellosis:
A.cramping abdominal pain around the navel
B. cramping abdominal pain, mainly in the left pane
C. tenesmus, urgency
D. Vomiting, dehydration expressed
E. liquid stool, multiple, mixed with mucus and blood
3.6.64. The most characteristic changes in the colonic mucosa in severe
shigellosis Grigorieva-Shigi in the midst of the disease:
A. Hyperemia, edema
B. hyperemia, hemorrhage
C. hyperemia
D. edema, hyperemia, hemorrhage, ulcers
E. ulcers of different diameter, cysts, polyps
3.6.65. Tactics doctor's patient shigellosis and contact who live in the
hostel:
A hospitalized patient
B. hospitalization contact
C. Bak.obsledovanie contact, monitor hotbed for 7 days
D. send a message to SES
E. treatment in KIZ residence provided mildly ill
3.6.66. Diarrhea syndrome in shigellosis caused by:
A. The presence of the cytotoxin;
B. activation of prostaglandins;
C. increase in intracellular c-AMP;
D. secretion IgA;
E. activation transport of water and electrolytes;
3.6.67. What are human pathogenic amoebae:
A. Entamoebahartmannі
B. Entamoebahіstolytіca
C. Entamoebacolі
D. nanaEndolіmax
E. Entamoebabutschlіі
3.6.68. Byamebotsidam universal action are the following:
A. yatren
B. metronidazole
C. diyodohin
D. tinidazole
E. delagil
3.6.69. Characteristic changes in the intestinal mucosa in acute
amoebiasis:
A. the entire length of the colon
B. in the distal colon
C. in the proximal colon
D. sores on the mucous background unchanged
E. ulcers of different diameters on the background edematous,
hyperemic mucosa
3.6.70. Enter the complication of intestinal amebiasis:
A. pericolitis
B. bowel perforation
C. dehydration shock
D. toxic shock
E. intestinal bleeding
3.6.71. The material for the study parazitoskopicheskogo intestinal
amebiasis is:
A.blood
B. urine
C. feces
D. pus from the surface of ulcers, collected at sigmoidoscopy
E. all of the above named
3.6.72. Characteristic changes in the colonic mucosa in acute amoebiasis:
A.mucous membrane is not changed, with swollen sores, saped
edges fringed area congestion, the bottom is covered with pus and
necrotic masses
B. ulcers of different diameter, cysts, polyps, amoeboma
C. mucosa edematous, hyperemic, bleeding, ulcers on the surface
layers of fibrinous, intestinal cramps
D. Poverty vascular pattern, single ulcer, "velvety" mucosa, contact
and spontaneous bleeding
E. no change
5.3. List of educational practical tasks that must be done on a
practical lesson:
• Master the methods of examination of the patient to shigellosis
and amebiasis
• Conduct Supervision patient for shigellosis and amebiasis
• Conduct a differential diagnosis of salmonellosis and shigellosis
HTІ
• Make a plan of laboratory examination
• Interpret the results of a specific survey of the patient to
shigellosis and amebiasis
• Recognize the complications of shigellosis, amebiasis.
• Develop a treatment plan for the patient shigellosis, amebiasis.
• Identify medical tactics in case of emergency.
• Making medical records upon diagnosis "Shigella".
5.4. Professional algorithm for formation skills and experience in
diagnostics of Shigellosis.
№ Tasks
1.
To master the
methods for
clinical
examination of
patients with
Shigellosis.
2.
Sequence of actions
I. Inquire into patient
complaints.
II. To
clarify the
anamnesis:
1. Anamnesis of illness
2. Anamnesis of life
3. Epidemic anamnesis
To carry out
curation of the
patient
Notices and warnings concerning self-control
Separation of the complaints which are
characteristic for the following syndromes:
- general intoxication
- organic lesions
- Lesions of the gastrointestinal tract
To pay attention to acute onset of disease;
time, sequence of development, dynamics of
- Fever;
- Pain in the abdomen, its localization;
- Tenesmus, false urge to defecate;
- The nature of bowel movements;
- Other symptoms
To determine previous diseases.
Identify data related to the implementation of
the fecal-oral transmission.
use not thermally processed foods.
III. Conduct an objective
Severity, symptoms are caused by the
examination.
1. Appearance:
- The patient;
- The skin, mucous
membranes;
2. Digestive System:
- Examination of the
language;
- Palpation of the
abdomen;
- Characteristics of
faeces.
3. Cardiovascular
system:
- The pulse;
- Blood pressure
- Auscultation of the
heart.
4. Respiratory system
5. Urinary system
3.
To
prescribe 1. General blood test.
laboratory
and
additional
2. General urinalysis.
investigations, to
interpret
the 3. Koprotsitogramma.
results.
4. Biochemical methods.
5.Bacteriological
examination stool (with
gastroenterocolitic formstudy may vomit
6. Express diagnostics: fluorescence microscopy;
- Radioimmunoassay
(RIA)
7. Serological methods:
- RA
- Phragmites
dynamics of the duration and severity of the
disease.
Pay attention to:
-General weakness;
- Temperature of the body;
- Pale, dry skin and mucous membranes;
- Skin turgor;
Pay attention to:
- The presence of vomiting;
- Coated tongue;
- Spasm, thickened and painful especially the
sigmoid colon;
- In the form of colitis excrements gradually
lose their fecal character, have mucus and
streaks of blood, sometimes in the form of
"rectal spittle"
- In the form of gastroenterocolitic- frequent,
watery stools with undigested food, and later with mucus and blood streaks.
Pay attention to:
- Moderate tachycardia;
- Moderate decrease in blood pressure
- Moderate deafness heart tones.
No singularities
Pay attention to:
Possible dysuric manifestations
Pay attention to: - neutrophilic leukocytosis
with a shift to the left leukocyte - increased
ESR
In severe - proteinuria, red blood cell,
leukocyturia.
Mucus, white blood cells, red blood cells,
epithelial cells on microscopic examination.
At the height - the reduction in total protein
and albumin, increased globulins.at intervals
of 10 days
The result depends on the technique, the
multiplicity of periods fence and planting
material. The latter should be done as early as
possible, certainly before the start of
antimicrobial treatment, feces collected in
dishes without disinfectant and immediately
sent to the laboratory. For crop use Ploskireva
Wednesday, Levin, Endo, J. baktoagar.
Identification of Shigellosis antigen in stool
with anti shigellosis gluten-free serum,
adsorption on activated carbon.
7. Alergologic
diagnostics:
- The sample
Tserukalova
8. Additional methods:
- sigmoidoscopy
Specific. Diagnostic titer of 1:400 in
shigellosis Flexner, for other pathogens 1:100.
Minimum diagnostic titer - 1:160.
Currently not used (low specificity)
Catarrhal phenomena, erosive and ulcerative
proctosigmoiditis. Shown for diagnostic
purposes.
Professional algorithm for formation skills and experience in
diagnostics of Amebiasis.
№ Tasks
Sequence of actions
1. Master
the І. Clarify patient
technique of complaints.
clinical
examination
of the patient
amebiasis
ІІ.Find out history:
1. Anamnesis of illness
2.
Conduct
supervision
patient
2. Anamnesis of life
3. Epidemic anamnesis
III. Conduct an objective
examination.
1. Appearance:
- The patient;
- The skin, mucous
membranes;
2. Digestive System:
- Examination of the
language;
- Palpation of the
abdomen;
- Characteristics of
faeces.
3. Cardio - vascular
system:
4. Respiratory system:
- Auscultation of the
lungs:
Notices and warnings concerning self-control
Highlightcomplaintsthatcharacterizethesyndro
mes:
- hemorrhagiccolitiswith a tendencytorecurrent;
- Generalintoxication;
- Organdamage
Payattentiontothebeginning,
thetermofthesequenceofsymptoms,
theirdynamics:
- Fatigue;
- Temperatures
- Painintheabdomen, itslocalization;
- Thenatureofbowelmovements;
- Othersymptoms
Identifybornediseases.
Identifydatarelatedtotheimplementationofthefec
al-oraltransmission.
Payattentiontothepatient'sstayintropicalandsubtr
opicalregionsinthelocalitywith
a
poorwatersupply.
Remember:
thepresence,
dynamicsofsymptomscausedby
a
periodandtheseverityofthediseasedependsonthe
patient'sage.
Payattentionto:
-generalweakness;
- Thetemperatureofthebody;
- Weightloss, asthenia
- Pallor, jaundicepossible
Intheformofskin
thepresenceoferosionsandulcerswithblackedges
intheperianalregion, inthecrotchandbuttocks.
Payattentionto:
- Coatedtongue;
Painalongthelargeintestine,
mostlyblindandascending, theyspasm;
- Hepatomegaly (mainlyduetotherightlobe)
- Infrequent bowel movements, a significant
amount of glassy mucus krovyu ("raspberry
jelly")
- Sequential change of diarrhea and
constipation (chronic intestinal amebiasis)
Changes in non-specific.
5. Nervous System
3.
Assign
1.General blood.
additional
research
laboratory and
interpreting
the results.
2.The common urine
analysis.
3. Koprotsitogramma.
4. Biochemical methods.
5. Scopic study of the
parasite (feces, pus,
sobrannny with ulcers)
6. Parasitological
examination (optional
method).
7. Serologichnye
methods:
- Phragmites
- IEA
- RNIF
8. Additional methods:
- sigmoidoscopy
- ergography
- Ultrasound
- Chest X-ray
Changes in extraintestinal amebiasis:
Pay attention to:
- The presence of cough,
- A large number of sputum chocolate
-signs of pneumonia, dry pleurisy;
Neurological symptoms meets the location and
size of brain abscess
In acute amoebiasis - changes are generally not
available. In chronic - hypochromic anemia,
eosinophilia, monocytosis, lymphocytosis,
accelerated ESR. When liver abscess neutrophilic leukocytosis with zdvigom right
ESR acceleration. With typical flow - no
changes.
In a lot of glass-like mucus, red blood cells,
eosinophils, Charcot-Leyden Crystal.
With typical flow - no changes.
Examine natively processed Lugol solution or
jellyhematoxin (for Gandengaynom) samples:
- In acute intestinal amebiasis or exacerbation
of chronic matters identify large vegetative
form.
- The convalescents, in remission of chronic
amebiasis, the carriers are fine Way form
amoebae and cysts;
- With amebiasis internal organs in pus from
the lesions, the brackets with ulcers on the skin
tissue forms define amoebas.
NB! To collect the liquid portion of bowel
movements, which can hold mucus and
immediately transported to the laboratory. The
microscope stage, and isotonic sodium chloride
solution before microscopy heated to 37-38 º C
(vegetative form stop moving when cooled
after 20-30 min., And bits and pieces of their
obnatuzhit stool is not possible).
NB! In the human gut may be five types of
non-pathogenic amoebae.
Isolation of amoebae at cultivation on various
piece of life-giving environments (Wednesday
Pavlova, Beck).
Most sensitivity, diagnostic titer 1:128 and
Viseu. Positive with 2-3 weeks.
Diagnostic titer 1:80 and Viseu
At unchanged mucosa - diameter of 10-20 mm,
generally located in the folds of a puffy, saped
edges, surrounded by a zone of hyperemia, the
bottom is covered with pus, necrotic masses,
chronic process - ulcers, brush, polyps,
amoeboma (infiltration)
Uneven filling section of the large intestine, its
spasm.
To detect liver lesions.
To detect lung lesions.
-CT
- Puncture the abscess
The resulting thick liquid chocolate.
5.5.Case studies of the second level of assimilation (α-ІІ)
Case 1
Patient A., 22 years old, a student, was admitted to hospital an
infectious diseases for the third day of illness with complaints of general
weakness, cramping pain in the abdomen, frequent loose stools with
mucus and blood. The disease began with fever, headache, tenesmus, and
frequent bowel movements. He lives in an isolated apartment with
communal facilities. All family members are healthy. One week ago,
returned from the village, where there have been cases of this disease.
Additional: Body temperature 38,1 º C. Pale skin, no rash, tongue
moist, coated with white bloom. Muffled heart sounds, blood pressure
110/80 mm Hg., Pulse 96 beats / min. Abdomen moderately swollen,
painful on palpation of the colon. Palpation provokes desires on the
bottom. Sigma spasm, sharply painful. Stool before to 10 times a day, the
bowel movements is fluid, with mucus and blood.
1.Preliminary diagnosis.
2. Survey plan
3. Treatment.
Case studies in the third level of assimilation
a-3
Case 2
Patient 65 years old, retired, eat dairy products, which has acquired
a spontaneous market. Ill 5 days ago, felt increasing weakness, headache,
temperature, all the days of consecutive low-grade. On the 2nd day of the
disease appeared sharp pain in the left iliac region, bowel movements are
fluid, fecal character lost, saw blood. To the doctor did not turn, thinking
about concentrating on the hemorrhoids. Today the condition quickly
deteriorated narosla weakness was dizzy, "fly" before the eyes, three
times during stool blood stood out in large numbers. PCB taken to
hospital.
Adittional: flabby, pale skin turgor reduced. T 37,1 ° C, the pulse
120 beats, Blood pressure 95/65 mmHg Cardiac rhythmic, muffled. The
abdomen is swollen; sore on palpation of the sigmoid is determined
protective muscle tension in the left abdominal area. During digital
examination of the rectum - bright blood on the glove.
1.Preliminary diagnosis.
2. Survey plan
3. Treatment.
Tests of the 3rd level.
Fill the table
=3
Clinical manifestations of shigellosis according to the form:
Gastroenterocolitic form
Colitis form
Number of bowel movements
Vomiting
Signs of dehydration
Abdominal pain
Rumbling in the stomach
Remnants of undigested food
in the stool
The presence of blood in stool
Mucus in stool
Imperative desires
Tenesmus
Recommended readings
Main:
• Vozianova J.I. Infectious and parasitic diseases. - K.: Health, 2001. - Vol.1 - 903 s.
• Guidelines for Infectious Diseases / Ed. Lobzina Y. - St. Petersburg: Folio, 2003. 1040 s.
• Shuvalov E.P. Infectious diseases. - Rostov / A: Phoenix, 2001. - 953 p.
Additional:
• Gavrisheva O.N., Antonova TV Infection.Clinical and pathophysiological aspects. St.: Special Literature, 1999. - 255.
• Clinical and laboratory diagnosis of infectious diseases: a guide for doctors. - St.:
Folio, 2001. - 384 p.
6. Extracurricular self-study materials
Subject UDRS and NDRS:
• "The results of examination of patients with intestinal infections
according to the Regional Hospital of Infectious Diseases";
• "The experience of working at the heart of the Epidemic of intestinal
infections";
• "Differential criteria amoebas that live in the human intestine (results of
parasitological research";
• "Differential diagnosis of diarrhea."