INTRODUCTION TO INFECTOLOGYCONCEPT OF INFECTIOUS DISEASES;

SPECIAL INFECTIOUS DISEASES;CLASSIFICATION;PRINCIPLES OF DIAGNOSTICS,

TREATMENT AND PROPHYLAXIS

V. V. Zakhlebayeva, Candidate of Medicine, assosiate professorMEDICAL INSTITUTE;SUMY STATE UNIVERSITY DEPARTMENT OF EPIDEMIOLOGY AND INFECTIOUS DISEASES

After finishing the course, "Infectious diseases" , student should understand the following:Classification of infectious diseases.The periods of development of an infectious disease.Clinical symptoms and syndromes of an infectious disease.Clinical features of different nosological forms.Features of epidemiological process, its components at various infectious

disease.Clinical and epidemiological indications in hospitalization of patients with

infectious disease.Rules of hospitalizing/admitting patients with infectious diseases.Maintaining the epidemic measures in hospitals and at home before the

treatment.Basic diagnostic methods of infectious diseases.Basic complications and courses of infectious diseases.Principle treatment of infectious diseases.Principle and prophylactic methods of infectious diseases.Organization of emergency anti-epidemic measures for quarantine

diseases.Clinical manifestations of emergency conditions on infectious diseases  .Principles of out patient management to patients with: a) intestinal

infections, and b) with air-borne infections. Clinical manifestations of helminthiasis and methods of diagnosis. Deworming measures.Functions of infectious diseases cabinet at Outpatient department (OPD)

Must be able to; Collect anamnesis of the diseases,Collect epidemiological anamnesis,Carry out clinical examinations for patients with infectious disease, Set a previous diagnosis of infectious disease,Make a plan of examination, Determine the need for hospitalization or discharging the patients, Select the main clinical syndrome or symptom,Evaluate the results of laboratory investigations (clinical,

bacteriological, serological). Assign adequate etiotropic therapy, to determine the frequency of

administration of antibody(chemotherapy) whether given once or in daily doses with respect to a certain infectious disease,

Assign adequate oral rehydration and infusion, to determine the composition, amount and doses of drugs that are administered, 

Assign adequate detoxication therapy, to determine the composition, amount and dosage regimen,

Assign serotherapy, prior to desensitization,Prescribe the necessary medical drugs,Establish the presence of a medical emergency and complication, Carry out fecal analysis from patient,

Collect materials from the patients for bacteriological, virological, serological, biochemical and other tests (blood cultures, vomiting mass, gastric washings, feces, mucus and smear taken from the nose and throat). 

Collect smear from the nasal mucosa for rapid diagnostic immunological studies with influenza and SARS. 

Carry out the preparation of thick blood smears and for research on malaria,

Perform allergic skin-test to determine the results,Wash out the stomach, Determine the indications of lumbar puncture and analyze the results of

laboratory tests of cerebrospinal fluid,Make a plan of treatment to patients with an intestinal infection at

home,Make a plan of treatment to patients with air-borne infection at home, Make a plan for conduction of an anti-epidemic measures at home. Make a plan of vaccination at the clinic. Fill in the required documentation during the initial identification of an

infectious patient. 

Should acquire the practical habits of:-

Carrying out the allergy tests:      -Skin test with brucelin;      -Skin test to allergen ornithosis;      -Skin test with toxoplasmin;      -Skin test with tulaerin;      -Skin test with anthraxin. 

The introduction of therapeutic sera. Blood samples for blood culture. Blood samples for sterility. Blood samples for serological studies. Blood samples for biochemical studies. Examination of blood for malaria. Collection of material for virological investigations. Collection of material for bacteriological examination (feces, urine, bile). Lumbar puncture. Gastric lavage. Fractional duodenal intubation. Determination of urinary bile pigments (Rosina sample). Sigmoidoscopy. 

After completing the course of infectious diseases in accordance with the standards of higher education (educational-qualification, educational and vocational training programs and diagnostics of quality in higher education),the student must master the ability to solve some typical problems in the implementation of a determined production functions. 

Learning requires a 100% of visiting lectures and practical classes.Rating of discipline, "INFECTIOUS DISEASES" consists of 200 points. Curriculum of infectious diseases spread across five content

modules, which has total of 180 hours, including 20 – Lectures, 80 - practical classes and 80-for self-study 

In each practical classes, student receives two points(marks): - for control test-maximum of- 0.5 points, for the practical work -maximum of- 2.5 points, for total control - 4-6 points, of which 0.5 - for computer control of others - for oral (written) response. 

Maximum number of credits that a student can score before module is 200, including the ongoing training activities - 120 points, the results of the final module control - 80 points. 

 

REGULATIONS FOR “MRS”

RATING IN THE DISCIPLINE, "INFECTIOUS DISEASES"

CONSISTS OF 200 POINTS. 

The system provides additional incentives:  Participates in the students' circle with the training of student work

(published abstracts) + 4 points for the final evaluation scores;  Participation in a students’ conference + 4 points for the final

evaluation;  Prize in the competition for Students - for a prize winner + 12 points,

for 2nd + 8 points and for the third place + 6 points for final assessment. 

         …”Murphy Law”

When in doubt, try to speak clearly. 

FINAL ANNUAL MONITORING INCLUDES:

Computer testing (50-100 theoretical questions) and the solution of practical problems.

- Practical tasks include: examination of the patient, a plan to survey the patients(ward round), the treatment plan with mandatory prescriptions (10 points - computer test and 30 points - a practical problem).Solving situational tasks, interview (40 points).The final control module is enrolled, if the student has scored

at least 50 points from possible 80.

An Infection (infectio /lat./ contamination, pollution) - penetration in the organism of morbific microorganisms and appearance of difficult complex of interaction processes. I.I. Mechnikov considered that «Infection was a fight between two organisms».

An infectious process is an aggregate of physiological protective and pathological reactions, occurring in the certain terms of environment in reply to the influence of infectious agents (A.F. Bilibin, 1962).

An infectious disease is an extreme degree of development of infectious process. Manifests in different signs and changes of biological, chemical, clinical and epidemiological order. A «infectious process» and «infectious disease» are not equivalent concepts. Everybody daily faces millions of microbes, but the process of interaction ends, as a rule, with the victory of macro organism - and illness does not develop.

FORMS OF CLINICAL COURSE OF INFECTIOUS DISEASES

In the case of equilibrium between macro- and microorganisms, it would be well to talk about carriage. In this situation a person is not able to eradicate an infectious agent, but a microorganism does not cause a disease. The clinical and morphological signs of infection are absent (bacteria, viruses, protozoa), there is no antibody generation. Such «healthy» carrier meets rarely.

There are no clinical signs at the in apparent (latent) form of infectious disease, but antibody generation is present, some morphological signs of pathology are possible.

The subclinical form of infectious disease proceeds with minimum clinical signs.

Clinical form of infectious disease is the clinically expressed illness.

MECHANISMS OF DEVELOPMENT OF INFECTIOUS DISEASES: RECURRENCE,

PERIODICITY, STAGINGA cycle means total duration of disease:

A clinical cycle lasts from the first to the final date of illness (from appearance of the first symptom to disappearance of the last signs of disease);

Pathogenetic cycle – is longer, including latent period (from penetration of infectious agent to appearance of the first symptoms) and period of morphological and functional renewal of organs and tissues.

INFECTIOUS DISEASE PASSES THE FOLLOWING PERIODS:

- INCUBATION - an infectious agent is already in an organism, although it is not yet influence on its state;

- PRODROME - the first clinical signs of disease;

- CLINICS - the most typical and characteristic clinical signs of illness;

- RECONVALESCENCE - completion of forming of immune answer.

THE CLINICAL PERIOD IS COMMONLY SUBDIVIDED INTO THE STAGES:

Growths of symptoms (during several days, sometimes – hours, till maximal expression)

Height (most expressed signs, without a substantial dynamics)

Recession (reverse development of symptoms)

CLINICAL COURSE OF INFECTIOUS DISEASES

Clinical infection can have an acute, sub acute and chronic clinical course. Most often there are acute forms - with the expressed clinical signs, acute beginning, short duration cycle. As a rule, these infectious diseases are accompanied by a good immune answer. Some infections have an acute clinical course only: flu, measles, plague.

A subacute (protracted) clinical course proceeds longer than ordinary term (cycle); it can be the stage of conversion into the chronic process.

CLINICAL COURSE OF INFECTIOUS DISEASES

The chronic clinical course of infections meets relatively rarely; it is characteristic for brucellosis and parenterally viral hepatitis (B, C, G). The chronic clinical course of infectious diseases is conditioned by the protracted staying of infectious agent in an organism and autoimmune processes. Clinically it is characterized by an undulating clinical course with remissions, relapses and intensifying. Rational therapy can lead to the reconvalescence or, at least, improvement and protracted remission.

The blazing (fulminant) form of infections develops very quickly – in several hours, clinical course is malignant, as a rule – with a lethal outcome. Meets, for example, at meningococcemia.

The latent (or persistent) form of infection can be considered as the variant of unsteady equilibrium between micro- and macro organism. It arises up, as a rule, at persons with hyposthenic immunity, related with forming of L–forms and imperfect forms of infectious agents, proceeds over 6 months and has a favorable end in most cases. Example of latent infection is herpes.

Slow infections develop at penetration of viruses (virions, priones), they are characterized by the protracted latent period (months, years), slowly progressing clinical course, by development of pathological processes mainly in one organ or system (CNS is more frequent than others), by an oncogenic orientation and lethal outcome. Example: HIV-infection.

A DISEASE CAN BE CAUSED BY ONE OR SEVERAL INFECTIOUS AGENTS

An infection, conditioned by one infectious agent, is called a monoinfection, by several infectious agents – mixed infection. Mixed infection can arise up as a result of simultaneous penetration of two and more infectious agents (co-infection) or as a result of successive contamination (superinfection, overlaying of one infectious agent on other).

For example, at contamination through blood, development of viral hepatitis B, C and D can be as co infection, and as super infection.

The repeated contamination by the infectious agent of the same kind is called reinfection.

A.F. BILIBIN CREATED A CLASSIFICATION OF SYMPTOMS RELYING ON THEIR MEANINGFULNESS FOR DIAGNOSTICS OF INFECTION:

leading – meet at many diseases (rise in temperature, head pain, insomnia, pain in muscles and joints, hepatosplenomegaly) – suggest the group of infections;

supporting (optional) meet at 2-4 diseases (excrements with blood and mucus – at a dysentery, amebiasis, balantidiasis; meningeal symptoms – at meningitises of different etiology);

decisive (absolute) – at their presence the diagnose is clear enough, as they meet only at one disease.

CLASSIFICATION OF INFECTIOUS DISEASES

In the 19th Century, infectious diseases were classed as contagious(transmissible from person to person),miasmatic(transmitted through air), and contagious-miasmatic.

Late in the 19th century, in view of advances made in bacteriology, the diseases were classified according to their etiology.

These classifications could not satisfy Clinicians or Epidemiologists since the diseases with different pathogenesis, clinical course and epidemiologic characteristics were united in one group.

Classifications based on and epidemiological signs proved ineffective too.

The classification proposed by Gromashevsky seems to be more reasonable than many others;It is based on the location of infection in the macro organism. In accordance with the main sign that determines the transmission mechanism, all infectious diseases are divided by the author into FOUR groups:-I. Intestinal InfectionsII. Respiratory InfectionsIII.Blood InfectionsIV.Skin infections.

According to Gromashevsky, each group is subdivided into anthroponoses and zoonoses; their epidemiology and prevention differ substantially.

a) Intestinal Infections:- Intestinal infections are characterized by location of the causative agents in the intestines and their distribution in the environment with the excrements.

-If the causative agents circulates in the blood( typhoid fever, paratyphoid fever A and B, Leptospirosis, viral hepatitis, brucellosis, etc), it can also be withdrawn through various organs of the body, e.g. the kidneys, lungs, the mammary glands.

-As a microbe is released into the environment with feces, urine, vomitus(cholera), it can cause disease in a healthy person only after ingestion with food or water.

In other words, intestinal infections are characterized by the fecal-oral mechanism of transmission.

-Maximun incidence of intestinal infections occurs usually during the warm seasons.

-The anthroponoses includes typhoid fever, paratyphoid, bacterial and amoebic dysentery, cholera, viral hepatitis A, poliomyelitis, helminthiasis (without the second host).

-The zoonoses include:-brucellosis,l eptospirosis, salmonella, botulism etc.

- The main means of control of intestinal infections are sanitary measures that prevent possible transmission of the pathogenetic micro organisms with food, water, insects, soiled hands etc.

- Timely detection of the diseased and the carriers, their removal from food catering and the like establishments is also very important.

- Specific immunization is only of the secondary importance in intestinal infections.

b) Respiratory infections:-This group includes diseases whose causative agents parasitize on the respiratory mucosa and are liberated into the environment with droplets of sputum during sneezing, cough, loud talks, or noisy respiration.

-People get infected when the microbes contained in sputum get on the mucosa of the upper airways.

-If the causative agents is unstable in the environment, a person can only be infected by close contacts with the sick or carrier (pertussis).

-Pathogenic microorganisms causing some diseases can persist for a period of time in an enclosure where the sick is present. Infected particles of sputum or mucus can dry and be suspended in the air. Some diseases of this group can spread through contaminated linen, underwear, utensils, toys etc.

-Since susceptibility of people, and especially of children to respiratory infection is very high, and since the infection is easily transmitted from the diseased(or carriers) to healthy people, almost entire population of a given area usually gets infected, and some people can be infected several times.

Some diseases of this group form a special subgroup of children's infections(diphtheria, scarlet fever, measles, pertussis, epidemic parotitis, chickenpox, rubella).-A durable immunity is usually induced in children who sustained these diseases.-The main measure to control respiratory infections is to increase non-susceptibility of population, especially of children, by specific immunization.

-It is important to timely reveal the sick and carriers and also to break the mechanism of infection transmission:- Control of overcrowdingProper ventilation and isolation of enclosuresUsing UV –lampsWearing masks, respiratorsDisinfection and the like.

c) Blood infections:-The diseases of this group are transmitted by blood sucking insects, such as fleas, mosquitoes, ticks, etc. which bite people and introduce the pathogenic agent into the blood.-Tick-borne encephalitis, Japanese B encephalitis and some other infections are characterized by natural nidality which is due to specific geographic, climatic, soil, and other conditions of infection transmission.

The morbidity is the highest during the warm season which coincides with the maximum activity of the transmitters-ticks, mosquitoes, etc.Control of blood infections includes altering natural conditions, improvement of soils, draining swamps, destroying sites where the insects multiply, disinsection measures against mosquitoes, ticks, etc., detoxication sources of infection by their isolation and treatment carrying out preventive measures.

-If the source of infection are rodents, measures to control them are taken.-Active immunization is also effective.

d) Skin infections:- The diseases of this group occurs as a result of contamination of the skin or mucosa with the pathogenic microorganisms. They can remain at the portal of infection(tetanus, dermatomycoses), or affect the skin, enter the body and be carried to various organs and tissues with the circulating blood( erysipelas, anthrax).-The transmitting factors can includes bed linen, clothes, plates and dishes and other utensils that can be contaminated with mucus, pus, or scales.-Pathogenic microorganisms causing venereal diseases, rabies, AIDS, and some other diseases are transmitted without the agency of the environmental objects.Wound infections are characterized by damage to the skin as a result of injury(tetanus, erysipelas).

The main measures to control skin infections includes:- Isolation and treatment of the sources of infection, Killing diseased animals, homeless dogs and cats, Improving sanitation and living conditions of population,Personal hygiene,Control of traumatism and,Specific prophylaxis.

PREVENTION OF INFECTIOUS DISEASESPrevention and control of infectious diseases includes the following:-1)Mass-scale measures aimed at improvement of public health,

prevention and spread of infectious diseases;2)Medical measures aimed at reduction of infectious morbidity and

eradication of some diseases;3)Health education and involvement of population in prevention or

restriction of spread of infectious diseases;4)Prevention of import of infectious diseases from other countries.

-Improvement of people’s well being, adequate housing, medical aid, and health education should be adequately planned and carried out.-Preventive sanitary supervision is also necessary.-Industrial objects, residential houses, children’s and medical institutions should be constructed with strict adherence to the special sanitary requirements that are intended to improve labour and living conditions, prevention of onset and spread of infectious diseases.-Preventive measures aimed to control infectious diseases taken by medical personnel are divided into Preventive and Anti-epidemic.-Preventive measures are carried out regardless of the presence or absence of infectious diseases at a given time and locality. These measures are aimed at prevention of infectious diseases.-Anti-epidemic measures are necessary when an infectious disease develops. It has already been said that the following three basic factors are necessary for development of an epidemic:- The source of infectionTransmission mechanismSusceptibility of population.

DIAGNOSTIC OF INFECTIOUS DISEASESDiagnostics of infectious diseases must be early, clinical

(primary), epidemiological, taking into account the complex of received data, cyclic, period and stage of disease.

METHODS OF DIAGNOSIS AND THEIR VALUES1) Anamnesis – of disease, epidemiological, life (suffered in the past infections may recur, acute: for example, chronic hepatitis, spotted fever). 2) Clinical examination. 3) General clinical laboratory research. 4) Express-diagnosis: Immune fluorescence, Immune enzyme reaction. 5) Bacteriological diagnosis (determining of causative agent) is used at all bacterial infections, microscopic- at diphtheria, meningococcal infection, cholera. 6) Serological diagnostics is necessary for doctor for acknowledgement of the majority of infectious diseases. The level of antibodies is necessary for investigating in dynamics. It is important to provide the first research in the earliest terms (in the first days of disease) and then to repeat them in dynamics in 5-7 days. For the majority of infections the minimal diagnostic credit of antibodies is 1:200 (1:160), and authentic it is considered increase of solutions of antibodies in 4 and more solutions.

7) Biochemical methods of research are necessary at many infectious diseases, especially – at viral hepatitis.8) Intracutaneous tests are applied at some infections and have the different importance.9) Instrumental diagnostics is applied at intestinal infections (rectomanoscopia), at meningitis (lumbar puncture).10) Morphological diagnostics is necessary at diagnostics and curation of patients with chronic hepatitis.

TREATMENT OF INFECTIOUS PATIENTS

Complex therapy should be given along with specific treatment, that must be pathogenetically substantiated and individual for each particular patient, depend on the severity of the patient’s condition and the period of the disease.

Specific therapy is used to eradicate or neutralize the infective agent and its metabolites, and to strengthen the defensive forces of the patient.

Chemotherapy; Serotherapy Immunotherapy are indicated.

a) Chemotherapy:-Chemical drugs that produce a specific action on the pathogenic agent can be synthetic or vegetable by their origin. Synthetic antibiotics are also used.

-When a chemical drug is administered, it inhibits multiplication and vitality of the pathogenic micro organisms. Further eradication of the agent is ensured by the defensive force of the patient.

Sulpha drugs –include prolonged- action preparations such as sulphapyridazine, sulphadimethoxin, and other preparations. Limited use of these preparations is explained by the development of resistant strains and the irritation effect on the gastric mucosa( nausea, vomiting, gastric hypo secretion).

-Allergic rash and stones in the kidneys are also possible.-Taking great amount of alkaline drinks prevents formation of such stones.

Derivatives of 8-oxyquinoline(intestopan mexaform, mexase, 5-NOK) are used to treat intestinal infections. These preparations do not inhibit normal interstinal flora, decrease putrefactive and fermentative process in the intestines. Prolonged use of these drugs can cause peripheral neuritis and impair of vision.

Nitrofurans(furadonin, furacin, furazolidone, furagin) are effective against intestinal infections.

Antibiotics are efficacious in infectious patients. They shorten the course of the disease, prevent complications and decrease the mortality rate.

When prescribing antibiotics, duration of antibiotics therapy, the dose and the route of administration(oral, intramuscular, intravenous) , duration of treatment and toxicity of the antibiotic. Antibiotics give prompt therapeutic effect.

Chloramphenicol has a broad spectrum of its action and is effective against intestinal infections(typhoid fever, paratyphus A and B), rickettsiosis, spirochaetosis.

Penicillins(salts of benzypenicillin, bicillin, ampicillin) are highly effective against meningococcal infection and anthrax.

The Tetracycline(hydrochlorides of tetracycline and doxycycline, rondomycin) are effective against rickettsiosis, intestinal infections tularemia, and plague.

b) Serotherapy:-Serum of immune animals and people is used to treat infectious diseases. The preparations are classed as antitoxic(containing antitoxins) and antibacterial(containing bactericidal antibodies).-Antitoxic sera are highly effective. They are prepared by hyper immunization of animals( e.g.. Horses bulls, and other animals) with specific exotoxins.-Antitoxic sera are used to treat diphtheria, botulism, gaseous gangrene, etc. The serum should be administered as early as possible, before the toxins produce irreversible changes in the organs and tissues. Antibiotics serum should be given in various doses depending on severity of the disease. It can be administered intramuscularly, and in exceptional rare cases, intravenously.

-Antibacterial sera are prepared by hyper immunization of animals with bacterial vaccines. They are given in milliliters(50-100-150ml) depending on severity of the disease.

PATHOGENETIC THERAPYIncludes many medical measures aimed at elimination of toxemia by detoxicating or infusion-detoxicating therapy, and glucocorticosteroids therapy, depending on the clinical form of the disease, restoration of water-salt balance equilibrium by rehydration therapy, normalization of the cardiovascular and nervous function, and also increasing the impaired bodily functions by stimulating therapy. Detoxication therapy:- is given in mild and moderate forms of

infectious diseases. It is sufficient to give the patient ample drinking:-Juice, stewed fruits, mineral water, boiled water, tea, etc.

Patients with pronounced toxemia are given infusion-detoxicating therapy directed at neutralization and elimination from the body of microbial toxins and metabolites. To that end, haemodez is given intravenously, polyglucin, rheopolyglucin, blood plasma, and 10% albumin solution should be given for severe hypotension. A 5% glucose solution and isotonic sodium chloride solution should also be administered. The solutions can be infused separately or wherever possible, in mixtures(drip infusion).

Glucocorticosteroid therapy:- Is given to patients in septic shock and acute adrenal failure(meningococcal infection, influenza, hemorrhagic fever, poliomyelitis, typhoid fever, louse-borne typhus, salmonellosis, dysentery diphtheria, plague, cholera).

Glucocorticosteroids(prednisolone, dexamethazone, triamcinolone, cortisone, hydrocortisone) are given in large doses, better intravenously. For example, a daily dose of prednisolone is 120-300 mg, and more, after recovery of the patient from shock the daily of the preparation is decreased 2-4 times and is given intramuscularly or per os with control of arterial pressure.

Rehydration therapy:- Is directed at restoration of the water-salt equilibrium and is used in gastrointestinal forms of intestinal infections attended by incoercible vomiting, frequent stools(profuse diarrhea), and development of hypovolaemic shock.

The amount of repleted salts, their composition and the way of administration depend on the rate and the degree of dehydration and the character of water-salt disturbances.

Four degrees of dehydration are differentiated:-

1st degree dehydration:- The patient loses water in the amount of 1-3% of the body weight. The patient develops moderate thirst, dryness of the mucosa and moderate fatigue, stools are semi liquid or waterly,3-10 times a day, vomiting is rare.2nd degree dehydration:-The loss of liquid is 4-6% of body weight. Stools are ample, watery or resembling rice water, 10-20 times a day, vomiting is frequent(5-10 times). The patient develops thirst, the skin and mucosa are dry, the lips, fingers, and feet are cyanotic, fatigue is marked. Muscular cramping in the calves, wrist, and feet, signs of blood thickening develop, tachycardia, hypotension and oliguria are seen.3rd degree dehydration:- The loss of liquid is 7-9% of body weight. Stools are frequent and ample, vomiting and cramping of the limb muscles are seen, the skin and mucosa are dry, washerwoman’s hands symptom develops, hypotension is pronounced, oliguria or even anuria develops.4th degree dehydration(the algid form):-The liquid loss is 10% of body weight. The disease begins acutely. Diarrhoea and vomiting discontinue at the beginning of the disease. The body temperature falls to 35-35.5˚C, peripheral pulse and arterial pressure are absent, anuria and aphonia develop.Cyanosis is intensive, muscles are cramping,the facies are pinched, the eyes and cheeks are retracted(sunken eyes).

• In 1st and 2nd degree of dehydration, the patient is given gastric lavage and then one of the following solutions( to drink in small portions):-

1. Glucose-salt mixture(3.5g of sodium chloride, 2.5g of sodium hydrocarbonate,1.5g of potassium chloride, and 20g of glucose dissolved ex tempore in 1 litre of drinking water); a solution containing 4g of sodium hydrocarbonate, 5g of sodium chloride, and 1g of potassium chloride; a solution containing 2.6g of sodium acetate, 1g of sodium hydrocarbonate,6.2g of sodium chloride and 0.3g of potassium chloride; or Locke-Ringer solution containing glucose or sweet tea. If vomiting,continues, the liquid should be administered through a nasogastric tube.

In 2nd and 3rd degree of dehydration,and especially 4th degree, the patient should be given intravenously polyion buffer solutions preheated to 38-40ºC. In addition to the mentioned solutions, used also are solutions containing 2.0g of sodium acetate, 5.0 g of sodium chloride,1.0g of potassium chloride, or a solution containing 3.6g of sodium acetate, 4.75g of sodium chloride, and 1.5g of potassium chloride, or a solution containing 3.3g of sodium lactate,4.75g of sodium chloride, and 1.5g of potassium chloride.

• Treatment includes two states:-primary rehydration (repletion of the liquid lost before rehydration therapy is started) and compensatory (replenishment of the liquid lost during treatment).

• In 3rd degree of dehydration, the solution is given intravenously at a rate of 100ml/min.

• In 4th degree of dehydration, and if hypovolaemic shock develops, one of the specified solutions is infused at a rate of 100-120ml/min, 5-7litres during 60-90 minutes.

• After the patient’s condition is no longer critical, the second stage of treatment begins. The solution is now infused by drip at a rate of 100-150 drops per minutes with a gradual reduction of the rate to 60 and then 20-10 drops per minute.

• Liquid infusion can be suspended depending on the degree of improvement of the patient’s condition and normalization of the water salt metabolism.

• If necessary, the glucose salt solutions are given per os, by small portions at short intervals.

2. Stimulating therapy:- is aimed at normalization and intensification of dysfunctioning organs and systems.

• Cardiovascular dysfunction develops due to the action of toxins liberated by the pathogenic agent on the myocardium and the vessels.

• Dehydration of the body causes thickening of the blood, evokes circulatory and haemostatic disorders.cordiamine, caffeine, ephedrine, and other norepinephrine are given to neutralize the action of toxins.

3. Vitamin therapy:- is useful from the very beginning of the disease. Vitamins given together with hormones and enzymes catalyze the metabolic processes.

Vitamin B facilitates correction of some nervous disturbances, vitamin A, C, and B decrease the toxic effect of antibiotics, vitamin C,B,PP and P

produce an anti-inflammatory and detoxicating action, vitamin P decreases brittleness and permeability of vessels, Vitamin K promotes blood coagulation.

Vitamins are given per Os or intravenously with glucose solutions (vitamin C as a 5%solution of ascorbic acid, vitamin B as a 6% solution).

PROPHYLAXIS OF INFECTIOUS DISEASES

• At the last decades, certain successes were achieved in fighting with infectious diseases, massive epidemics of most dangerous infectious diseases (epidemic typhus fever, plague, small pox, tick borne relapsing fever and other). The struggle is realized successfully with diphtheria, poliomyelitis, measles, and many zoonotic infections. Undoubt success is achieved in malaria control.

• Every year multiple cases of streptococcus and staphylococcus infections, cholera, helminthiasis, viral hepatitis, meningococcal infection and diseases caused by conditional pathogenic flora are registered in the world.

Thus, prophylaxis of infectious diseases is actual question!!.• The measures of prophylaxis of infectious diseases may be

conditionally divided on 2 groups:-general and special measures.• The general measures are state measures directing on increase of

material favorable condition, improvement medical service and conditions of work and rest of the population, sanitary technique, hydrotechnic measures and also international measures in attitude of quarantine infections.

It is known about 3 links for development of epidemic process:-1. The sources of infection2. Ways of the transmission and 3. Susceptibility of the organism; The absence or rupture either of this link leads to cessation

of epidemic process.

There are 3 groups of prophylactic measures:- The measures directing on the source of infection, it’s

elimination. The measures directing on the mechanism of the transmission

of infection. Their purpose is rupture of the ways of transmission of infection.

The measures directing on increasing of insusceptibility of population to infection.

Prophylactic measures directing on the source of infection play an important role. It is known that when antroponotic infection, the source of infection is sick man or a carrier of the agent.

Also the source of infection in zoonotic infections is sick animal.

And the prophylactic measures of this group are diagnostic, isolative, medical and regimen-limitary measures.

In some infectious diseases, hospitalization into infectious hospital is obligatory (especially dangerous infections, typhoid fever, epidemic typhus, diphtheria, meningococcal disease).In other diseases, isolation may be at home if epidemiological and clinical features are absent( like shigellosis, escherichiosis, measles and others.) An important prophylactic measure is active revealing of carriers and their sanation.!! Revealing of carriers is performed in focuses of infection, among reconvalescents, and also among persons of food establishments, water pipe stations, and children’s establishments.It is necessary to perform their bacteriological examination and treatment. In prophylaxis of infectious diseases, an important measure is influence on mechanism of transmission of infection.Transmission of the agent from sick man to healthy man is realized with the help of different factors( water, food, dust, air, soil and others.

Specific prophylaxis is performed with the help of vaccines, anatoxins serum, gamma globulins.

Vaccines and anatoxins create active immunity, while serum and gamma globulins creates passive immunity.