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MINISTRY OF HEALTH STATE UNIVERSITY OF MEDICINE AND PHARMACY «NICOLAE TESTEMIŢANU» Approved by the Council of Medicine Faculty No. 2 Meeting Protocol No.__ from _________ Dean of Medicine Faculty No.2 Professor, PhD_________ M. Gavriliuc Approved at the meeting of Infectious diseases CEMPh Meeting Protocol No.__ from _________ Head of Infectious diseases CEMPh Professor, PhD_________ V.Pântea ANALYTICAL PROGRAM // Syllabus Name of the course: Infectious diseases of children Code of the course: S.11.O.098 Type of the course: mandatory Total number of academic hours – 70 hours Inclusively courses - 20, practical seminars – 50 Number of credits offered for course completion: 3 Names of lectures authors: Associated professor Tatiana Alexeev Assistant professor Tatiana Juravliov Chişinău 2011 Explanatory note Infectious diseases have a great importance in the structure of the general morbidity and children mortality. Nowadays the majority of children with acute infectious diseases may be treated at home and the doctor is obliged to establish as soon as possible the write diagnosis, to prescribe a correct treatment regimen, to assure if necessary the emergency medical assistance, to organize prevention measures in the epidemic place, etc. The aim of the Department Children’s Infectious Diseases activity is the training of doctors in order to assure good knowledge in the field of modern diagnosis, therapy and prevention procedures for infectious diseases at children. The training process will cover and epidemiological aspects of these diseases. This program will cover also a series of important problems within this field that are faced by students of VI year, after their familiarization with infectious diseases of adults, and our department will specify particular clinical and evolution features of infectious diseases in children according to the age and differential diagnosis. The student must have following knowledge: 1. Early diagnosis of infectious diseases of children 2. Clinical features, disease evolution, complications and particularities according to the age. Infectious diseases consequences at children. 3. Clinical symptoms of the cranial nerves affection. 4. Indications for hospitalization and rules for patient’s transportation in case of infectious diseases. 5. Laboratory diagnosis and treatment of infectious disease in home conditions (isolation, therapy regimen, diet, prescription’s fill in). 6. Clinical symptoms and laboratory tests of cerebral spinal fluid in viral and bacterial meningitis. 7. To perform a treatment plan for children with infectious diseases. 8. To perform a plan of emergency medical measures at the prehospital level of medical assistance in case of: Meningococcal infection; Meningitis, meningoencephalitis; Toxic scarlet fever. 9. To give medical emergent help to children with: Toxic-infectious shock; Acute cerebral edema. 10. Diet and hygienic regimen of patients with infectious diseases. 11. Criteria for admission to the institutions for children (kindergartens, schools). 12. The survey in dynamics of children with infectious diseases and their follow-up. 13. Immunization and prophylaxis of infectious diseases at children (national schedule of immunization). The student must possess following practical skills: 1. To perform an examination of a child with infectious diseases; 2. To establish and motivate the early diagnosis of infectious diseases at children; 3. To perform a plan of medical care at home in case of a patient with infectious disease; 4. To interpret the blood analysis at children with infectious diseases according to the age; 5. Organization of a correct transportation to the hospital of the child with infectious disease; 6. Isolation and treatment at home of a patient with infectious disease; 7. To perform a plan of laboratory examination of children infectious diseases and to mention basic (specific) diagnostic methods; 8. To characterize the rush in different infectious exanthematous diseases; 9. To characterize changes in the pharynx in different infectious diseases with angina syndrome; 10. To collect emetic masses, fecal material, urine and blood for bacteriological exam; 11. The gastric lavage method at children; 12. To appreciate the presence and the degree of dehydration at infants and small children in acute infectious gastroenteritis; 13. The stool characteristics at patients with acute infectious gastroenteritis and viral hepatitis; 14. Treatment and oral rehydration (plan A, B, C); 15. Qualitative laboratory test to exam biliary pigments in urine; 16. The appreciation of jaundice degree in viral hepatitis; 17. The examination of the abdomen, liver and spleen; 18. Meningeal symptoms at children; 19. To interpret correct the results of laboratory exams, CSF, bacteriological and virusological test of the blood, serological tests (complement fixation – CF, hemagglutination inhibition – HI, enzyme-linked immunosorbent assay – ELISA, polymerization chain reaction – PCR, neutralization reaction - NR) of nasopharyngeal eliminations, exam of intestinal bacterial colonies. The student must know following: 1. 2. 3. 4. 5. Specific features of infectious diseases agents at children; Morbidity by infectious diseases at children; Pathogenesis and pathology of infectious diseases; Principles and modern methods of infectious diseases diagnosis; Principles of specific therapy of infectious diseases (therapy with serums, immunotherapy); 6. Principles of antibiotic therapy in infectious diseases; 7. Principles of prevention and control of infectious diseases. Epidemiologic methods in the place of epidemic eruption; 8. Rules of behavior in patient’s room; 9. Principles to fill in clinical files of patients with infectious diseases; 10.Structure, functions, anatomic and physiological features of SNC, respirator and digestive tract, and other systems at infants and small children; 11.Specific features of infectious diseases at adults; 12.Indications, techniques and clinical interpreting of lumbar puncture. 13.Treat the child’s with acute intestinal infections and acute respiratory viral infections 14.Complications in infectious diseases at children 15.Criteria of hospitalizations in infectious diseases at children 16.Laboratory findings in infectious diseases at children STATE MEDICAL AND PHARMACEUTICAL UNIVERSITY “Nicolae Testemitanu” DEPARTMENT CHILDREN’S INFECTIOUS DISEASES The Plan of Lectures for students of VIth university year Faculty of General Medicine (XIth half-year) 2011-2012 THE NAME OF THE SUBJECT Number of hours 1. Streptococcal infection in children. Scarlet fever. 2 2. Diphtheria. 2 3. Measles (rubeola). Rubella. 2 4. Specific features of influenza and acute respiratory infections at children. 2 5. Mumps (epidemic parotitis). 2 6. Meningococcal infection at children. 2 7. Pertussis (whooping cough). Parapertussis. 1 № 8. 9. 10. Herpesvirus infections (Chickenpox, Herpes Zoster, Herpes simplex). Acute Intestinal Infections in children. Salmonellosis, Shigellosis, Escherichiosis. Differential diagnosis. Treatment in Acute Intestinal Infections in children. Syndrome of dehydration. Acute viral hepatitis at children. Fulminating hepatitis. TOTAL Chief of the Department, Professor PhD 2 2 2 Lecturer T.Alexeev T.Juravliov T.Alexeev T.Juravliov T.Alexeev T.Juravliov T.Alexeev T.Juravliov T. Alexeev T. Juravliov T. Alexeev T. Juravliov T. Alexeev T. Juravliov T. Alexeev T. Juravliov T.Alexeev T.Juravliov T.Alexeev T.Juravliov 20 V.Pântea STATE MEDICAL AND PHARMACEUTICAL UNIVERSITY “Nicolae Testemitanu” DEPARTMENT CHILDREN’S INFECTIOUS DISEASES The Plan of subjects for Practical work-sessions for students of VIth university year Faculty of General Medicine (XIth half-year) 2011-2012 № Number of hours THE NAME OF THE SUBJECT Rules of admission to the hospital, distribution to the rooms and discharge 1. of children with infectious diseases. Files and documentation. Case presentation. Acute Intestinal Infections at children. Salmonellosis, Shigellosis, 2. Escherichiosis. Treatment of acute gastroenteritis at children. Syndrome of dehydration, 3. pathogenesis, clinical manifestations, diagnosis and treatment. Oral rehydration. Acute viral hepatitis A at children. Peculiarities of evolution. Clinical 4. forms. Diagnosis. Differential diagnosis. Treatment. Enteroviral infections (non-poliomyelitis). 3 2 6 4 2 5. Poliomyelitis. 4 6. Diphtheria. Mumps. 5 7. Meningococcal infection at children. 5 8. Influenza and acute respiratory infections. 5 Herpesvirus infections (Chickenpox, Herpes Zoster, Herpes simplex). 9. Pertussis (whooping cough). Scarlet fever. 4 10. Measles . Rubeolla. 5 11. Practical skills. 5 TOTAL Chief of the Department, Professor PhD 50 V.Pântea UNFOLDED DISCIPLINE PROGRAM 1. Streptococcal infection. Scarlet fever. Etiology. Specific epidemiology features. Clinical forms. Erysipelas at children. Evolution. Complications. Atypical forms. Differential diagnosis. Treatment at home and at the hospital. Indications for hospitalization. Prevention. Finding and treatment of patients with angina. Prevention and measures necessary to be taken in the epidemic area. 2. Diphtheria. Disease history, successes achieved in the research, prevention and treatment of this disease. Specific epidemiology features of diphtheria nowadays. Etiology. Pathogenesis. Clinical forms. Clinical manifestations of angina in diphtheria, nasal diphtheria, croup in diphtheria, etc. Classification of pharyngeal diphtheria and characteristics of local forms, toxic forms. Evolution. Complications. Diagnosis. Differential diagnosis. Treatment (specific and non-specific). Specific prevention. Measures necessary to be taken in the epidemic area. 3. Measles (rubella). Rubella. Measles (rubella) at the stage of infection liquidation. Etiology. Pathogenesis. Specific epidemiology features. Clinical manifestations in typical forms, mitigate at children and adults and vaccinated people. Complications. Diagnosis. Differential diagnosis with scarlet fever, rubella, acute respiratory viral infections, allergic statements, etc. Treatment. Specific prevention. Measures necessary to be taken in the epidemic area. Rubella. Etiology. Pathogenesis. Clinical manifestations. Acquired rubella. Diagnosis. Prevention. Congenital rubella (embriopathy). 4. Mumps (epidemic parotitis). Etiology. Pathogenesis. Specific epidemiology features. Clinical forms. Clinical manifestations, diagnosis in different clinical forms (parotitis, submaxilitis, meningitis, meningoencephalitis, orchitis, pancreatitis). Specific features in adults. Evolution. Complications, outcomes. Differential diagnosis and treatment according to clinical forms. Prevention. Measures necessary to be taken in the epidemic area. 5. Pertussis (whooping cough). Etiology. Pathogenesis. Specific epidemiology features. Clinical manifestations in different stages of the disease. Clinical forms. Criteria of disease severity. Specific features at new-borns and infants, vaccinated children and adults. Parapertussis. Clinical manifestations. Complications. Diagnosis. Differential diagnosis. Treatment. Prevention. 6. Meningococcal infection at children. Etiology. Pathogenesis. Clinical forms. Clinical manifestations in local and generalized forms (meningitis, meningococcemia). Evolution. Emergency statements: toxic-infectious shock of I, II, III degree of severity, cerebral edema, intracranial hypotension. Evolution. Complications, outcomes. Treatment. Emergency medical assistance at home. Measures necessary to be taken in the epidemic area. 7. Influenza and acute respiratory viral infections at children. The role of viral infections in pediatric morbidity. Etiology and pathogenesis in different viral infections. Diagnosis. Treatment. a) Influenza. Specific clinical manifestations at children. Clinical syndromes. Criteria of severity. Evolution, complications. Influenza at new-borns and infants. Pathogenesis. Clinical manifestations. Diagnosis. Treatment. b) Parainfluenza. Clinical manifestations. Croup syndrome in influenza and Parainfluenza. Diagnosis. Treatment of the croup according to the stenosis degree at home. Complications. c) Adenoviral infections. Specific epidemiology features. Clinical forms. Clinical manifestations in pharyngeal-conjunctival fever and other forms. Evolution. Complications. Specific clinical and evolution features at infants. Diagnosis. d) Specific features of the infection with respiratory syncytial virus. Obstruction syndrome. RS-infection at premature and new-borns. 8. Herpesvirus infections. Etiology, pathogenesis and clinical manifestations of primary, latent and relapsing herpesvirus infection. Varicella. Etiology and pathogenesis. Clinical forms, clinical manifestations and evolution. Herpes Zoster, Herpes simplex. Specific clinical and evolution features at new-borns and infants. Diagnosis. Treatment at home and hospital. Prevention. 9. Acute gastroenteritis at children. The role of intestinal infections in children morbidity at different age. Bacterial dysentery. Etiology and pathogenesis. Clinical manifestations. Clinical forms, criteria of severity. Evolution. Specific clinical features at new-borns and infants. Diagnosis. Treatment at home and hospital. Prevention. Acute diarrhea with Escherichia coli. Etiology and pathogenesis. Clinical forms. Evolution of acute diarrhea caused by ECEP. Diarrheic and toxic syndromes. Dehydration. Diagnosis. Specific features at new-borns. Treatment of acute diarrhea according to WHO recommendations. Acute diarrhea with Salmonella. Etiology and pathogenesis. Clinical forms. Epidemiology. Clinical manifestations, evolution according to the age and ways of contamination. Specific features at new-borns and infants. Nosocomial infection. Generalized salmonellosis. Diagnosis. Treatment. Prevention. 10.Acute gastroenteritis caused by conditional pathogen bacteria and viruses. Intestinal dysbiosis. Characterization and classification of enterobacteria and other conditional pathogen agents. Definition of intestinal dysbiosis as disease, physiologic norms. Etiology and pathogenesis. Clinical manifestations in acute diarrhea caused by Proteus, Klebsiella, Staphylococcus, Campylobacter, Yersinia and Rotaviruses. Intestinal dysbiosis, diagnosis. Treatment. Prevention. 11.Treatment of acute gastroenteritis at children. Dehydration syndrome, pathogenesis, clinical manifestations, diagnosis. Treatment. Oral rehydration. Indications and basic principles of infusion therapy. 12.Acute viral hepatitis (A, B, C, D) at children. Etiology and pathogenesis. Epidemiology. Clinical manifestations. Evolution. Primary viral hepatitis (A,B,C,D) at children. Clinical forms. Criteria of the severity degree. Complications. Specific features at new-borns and infants. Congenital hepatitis. Fulminating hepatitis, evolution. Diagnosis, differential diagnosis. Treatment. Prevention. 13.Enteroviral infections and poliomyelitis at children. Etiology. The role of scientific research in study and prevention of poliomyelitis. Pathogenesis. Clinical manifestations of paralytic and non-paralytic forms in poliomyelitis. Diagnosis. Prognosis. Outcomes. Treatment. Prevention. Enteroviral infections with ECHO and Coxsackie viruses. Etiology and pathogenesis. Clinical forms. Clinical manifestations. Specific features of CSF in enteroviral meningitis. Diagnosis. Differential diagnosis of different forms of enteroviral infections. Treatment. Prevention. Optional subjects 1. Infectious mononucleosis. Etiology, pathogenesis, epidemiology. Clinical forms. Criteria of severity. Evolution, complications, outcomes. Specific features at infants. Diagnosis. Differential diagnosis. Treatment. Prevention. 2. Cytomegalovirus infection. Etiology, pathogenesis, epidemiology. The way of spread of disease (by direct contact, transplacentar, by injections, by food). Clinical manifestations. Clinical forms. Specific features in acquired and congenital cytomegalovirus infection. Early diagnosis at new-borns and infants. Diagnosis. Differential diagnosis. Evolution. Treatment. Prevention. DEPARTMENT CHILDREN’S INFECTIOUS DISEASES Practical skills for students of VIth university year 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Bacteriological test in Diphtheria, Pertussis, Meningococcal Infection. Bacteriological test in Salmonellosis, Shigellosis, Escherichiosis. Immunofluorescent test in respiratory viral infections, acute diarrhea (technique, importance). Blood cultures in infectious diseases. Technique, indications, clinical interpretation. Technique of “thick drop” of the blood. Indications. Lumbar puncture. Indications. Technique. Clinical interpretation of CSF. Coprological test, clinical interpretation. Serological tests in infectious diseases at children. Gastric lavage. Indications, technique, bacteriological test results. Examination of the patient in acute infectious disease (viral hepatitis, rubella, mumps, etc.) Interpretation the results of the blood tests in infectious diseases in children. Endovenous perfusions, indications, technique, fluids, complications. Criteria of hospitalizations in infectious diseases in children. Indications for discharge for patients with acute gastroenteritis, air ways infections, viral hepatitis. Diet and hygienic regimen for patient with infectious diseases (meningitis, mumps, diphtheria, viral hepatitis). Treatment of acute infectious diseases (medical prescriptions, regimen, diet). Follow-up of children after infectious diseases (hepatitis, salmonellosis, meningitis). Documentation. Immunization and prophylaxis of infectious diseases at children (national schedule of immunization). Rehydration of children with acute diarrhea (indications, technique). Emergency medical assistance in case of acute cerebral edema, toxic-infectious shock, seizures, hyperthermia, food toxic-infection. LITERATURE 1. Richard E., Behrman M.D., Robert Kliegman, M.D. Essentials of pediatrics. 2. Swapan K. Nath, Sanjay G. Revankar. Problem-Based Microbiology.2006. 3. Red Book.Report of the Coomittee on Infectious Diseases. American Academy of Pediatrics. 26th Edition, 2003. 4. A.M.Mikhailova, I.P.Mincov, A.I.Savchuk “Infectious Diseases in Children”, Odessa, 2003. 5. HIV Infection. A Clinical Overview of HIV Disease and, Related Diagnosis, Treatment, and Prevention. A Training Manual for HIV/AIDS Elective Course for International Medical Students. Moscow, 2010. 6. Integrated Management of Childhood Illness (IMCI). Handbook. World Health Organization, 2000. 7. Integrated Management of Childhood Illness (IMCI). Technical seminars. World Health Organization, 2000. 8. Nick Y.Beeching F.Y.Nye Mosby-Volfo Diagnostic picture tests in Clinical Infectious Disease, 2000. 9. Harison's Infectious diseases, 2010