Particularly dangerous infections are diseases of an infectious nature that pose an extreme epidemic danger to others.

Particularly dangerous infections appear suddenly, spread with lightning speed, covering a significant part of the population in the shortest possible time. Such infections occur with a pronounced clinical picture and, as a rule, have a severe course and high mortality.

To date, the World Health Organization (WHO) has included more than 100 diseases in its list of especially dangerous infections.

A list of quarantine infections has also been established: polio, plague (pneumonic form), cholera, yellow fever, smallpox, Ebola and Marburg fever, influenza (new subtype), acute respiratory syndrome (TARS).

In countries with hot climates, particularly dangerous infectious diseases are common, such as cholera, Dengue fever, Zika, yellow fever, plague, malaria and a number of others. Every year, imported cases of malaria and tropical helminthiases are registered in the Russian Federation.

Every year, about 10-13 million Russian citizens travel abroad for tourism purposes and about 1 million citizens on business trips. More than 3.5 million foreigners enter our country for tourism and business purposes, including from countries with an unstable epidemiological situation.

List of especially dangerous infections for Russia:

Plague

Cholera

Smallpox

Yellow fever

Anthrax

Tularemia

Infection occurs through the skin either as a result of a flea bite, or when plague sticks get into the wound when the skin is broken (butchering the carcasses of an infected animal, skinning). The most common form of plague when infected through the skin is bubonic. In this case, the pathogen lingers in the lymph node closest to the site of the bite, this node becomes inflamed, becomes noticeable, and painful. The swelling of the lymph node is called a bubo.

To protect yourself from becoming infected with the plague, you must:

Do not rest near rodent burrows

Avoid contact with sick people, especially those with acute fevers

If your body temperature increases or your lymph nodes are swollen, consult a doctor immediately.

Infection occurs through contact with infected rodents (catching, cutting up carcasses, skinning) and water contaminated with rodent secretions. The pathogen enters the human blood through unprotected skin of the hands. In agricultural work - during harvesting, when eating food that has been touched by mice with tularemia, when eating undercooked meat. When drinking contaminated water from open reservoirs (for example, sick animals could get into the well). When bitten by blood-sucking arthropods (mosquitoes, horseflies, ticks).

How to protect yourself?

1 – vaccination. Carried out according to epidemic indications.

2 – rodent control; protection of food during storage; use of protective clothing.

The source of infection is sick animals. Sick people are not contagious.

The incidence is predominantly occupational in nature; single and group cases are registered in rural areas in the summer-autumn period, but are possible at any time of the year.

The source of infection is farm animals that are sick or have died from anthrax. The infection is transmitted through microtraumas, consumption of foods that have not undergone heat treatment, through airborne dust, as well as through insect bites (horseflies).

How to protect yourself?

1. Specific prevention for epidemic indications.

2. Vaccination of pets.

3. Compliance with the rules for the burial of dead animals and the construction of cattle burial grounds;

4. Compliance with safety regulations when working with livestock and livestock raw materials.

5. Meat and milk of sick animals are subject to destruction, and skins, wool, and bristles are disinfected.

6. Persons exposed to the risk of infection are subject to medical supervision for 2 weeks. They undergo emergency chemoprophylaxis.

7. If a disease is suspected, emergency hospitalization is required.

8. Final disinfection is carried out in the room where the patient was.

Infection occurs through water, food, objects, and hands contaminated with cholera vibrios.

To protect yourself and others from cholera infection, you must:

Before traveling to countries affected by cholera, get vaccinated.

The rules of personal hygiene - hand washing - must be strictly observed.

• Food must be protected from flies.

If diarrhea occurs, consult a doctor promptly.

The infectious agent is transmitted by contact, airborne droplets, from healthy carriers, and is able to remain viable on clothing and bedding.

Symptoms: general intoxication, characteristic rashes covering the skin and mucous membranes. Patients who suffered from smallpox suffered partial or complete loss of vision and in almost all cases were left with scars from the ulcers.

1. Vaccination against smallpox

2. Do not visit crowded places, do not enter premises where people with acute fevers are located.

3. Consult a doctor immediately if you feel unwell, general weakness, sore throat, or if your temperature rises.

With a lightning-fast form of the disease, the patient dies after 3-4 days.

Complications of the disease - gangrene of the limbs, soft tissues; sepsis (in case of secondary infection).

How to protect yourself?

1. When traveling to countries affected by yellow fever, get a vaccination that protects against the disease for 10 years. Vaccination is carried out 30 days before the planned trip

2. Protect yourself from mosquito bites, protect resting areas with nets, close windows and doors tightly.

While on vacation, avoid visiting swampy areas, forests and parks with dense vegetation. If it is not possible to avoid visiting, wear clothes that prevent the possibility of insect bites - long sleeves, trousers, a hat.

How to prevent insect bites:

There are 2 main ways to prevent insect bites - repellents and vigilance (avoiding bites).

The premises must have screens on windows and doors; if there are no screens, the windows must be closed. It is advisable to have air conditioning.

Apply repellent to skin every 3-4 hours between dusk and dawn.

If mosquitoes enter the room, there should be a net over the beds, tucked under the mattress, make sure that the net is not torn and there are no mosquitoes under it.

In rooms intended for sleeping, use aerosols and special spirals

Clothes must be closed.

If signs of an infectious disease appear (malaise, fever, headache), traces of bites of blood-sucking insects, rashes or any other skin manifestations, consult a doctor immediately.

Regional state budgetary healthcare institution

"Center for Medical Prevention of the City of Stary Oskol"

Restrictions on entry and exit, removal of property, etc.,

Removal of property only after disinfection and permission from the epidemiologist,

Strengthening control over food and water supply,

Normalization of communication between separate groups of people,

Carrying out disinfection, deratization and disinsection.

Prevention of especially dangerous infections

1. Specific prevention of especially dangerous infections is carried out with a vaccine. The purpose of vaccination is to induce immunity to the disease. Vaccination can prevent infection or significantly reduce its negative consequences. Vaccination is divided into planned and according to epidemic indications. It is carried out for anthrax, plague, cholera and tularemia.

2. Emergency prevention for persons who are at risk of contracting a particularly dangerous infection is carried out with antibacterial drugs (anthrax).

3. For prevention and in cases of disease, immunoglobulins (anthrax) are used.

Prevention of anthrax

Application of the vaccine

A live vaccine is used to prevent anthrax. Workers involved in livestock farming, meat processing plants and tanneries are subject to vaccination. Revaccination is carried out every other year.

Use of anthrax immunoglobulin

Anthrax immunoglobulin is used to prevent and treat anthrax. It is administered only after an intradermal test. When using the drug for therapeutic purposes, anthrax immunoglobulin is administered as soon as the diagnosis is established. For emergency prophylaxis, anthrax immunoglobulin is administered once. The drug contains antibodies against the pathogen and has an antitoxic effect. For seriously ill patients, immunoglobulin is administered for therapeutic purposes for health reasons under the guise of prednisolone.

Use of antibiotics

If necessary, for emergency reasons, antibiotics are used as a preventive measure. All persons who have contact with patients and infected material are subject to antibiotic therapy.

Anti-epidemic measures

Identification and strict accounting of disadvantaged settlements, livestock farms and pastures.

Establishing the time of the incident and confirming the diagnosis.

Identification of a population at high risk of disease and establishment of control over emergency prevention.

Medical and sanitary measures for plague

Plague patients and patients suspected of having the disease are immediately transported to a specially organized hospital. Patients with the pneumonic form of plague are placed one at a time in separate rooms, and patients with the bubonic form of plague are placed several in one room.

After discharge, patients are subject to 3-month observation.

Contact persons are observed for 6 days. When in contact with patients with pneumonic plague, contact persons are given antibiotic prophylaxis.

Prevention of plague(vaccination)

Preventive immunization of the population is carried out when a massive spread of plague among animals is detected and a particularly dangerous infection is introduced by a sick person.

Routine vaccinations are carried out in regions where natural endemic foci of the disease are located. A dry vaccine is used, which is administered intradermally once. It is possible to re-administer the vaccine after a year. After vaccination with an anti-plague vaccine, immunity lasts for a year.

Vaccination can be universal or selective - only for the threatened population: livestock breeders, agronomists, hunters, food processors, geologists, etc.

Re-vaccinate after 6 months. persons at risk of re-infection: shepherds, hunters, agricultural workers and employees of anti-plague institutions.

Maintenance personnel are given preventive antibacterial treatment.

Anti-epidemic measures for plague

Identification of a plague patient is a signal for the immediate implementation of anti-epidemic measures, which include:

Carrying out quarantine measures. The introduction of quarantine and the definition of a quarantine territory are carried out by order of the Extraordinary Anti-Epidemic Commission;

Contact persons from the plague outbreak are subject to observation (isolation) for six days;

Carrying out a set of measures aimed at destroying the pathogen (disinfection) and destroying pathogen carriers (deratization and disinfestation).

When a natural outbreak of plague is identified, measures are taken to exterminate rodents (deratization).

If the number of rodents living near people exceeds the 15% limit for getting caught in traps, measures are taken to destroy them.

There are two types of deratization: preventive and exterminatory. General sanitary measures, as the basis for rodent control, should be carried out by the entire population.

Epidemic threats and economic damage caused by rodents will be minimized if deratization is carried out in a timely manner.

Anti-plague suit

Work in a plague outbreak is carried out in an anti-plague suit. An anti-plague suit is a set of clothing that is used by medical personnel when carrying out work in conditions of possible infection with a particularly dangerous infection - plague and smallpox. It protects the respiratory organs, skin and mucous membranes of personnel involved in medical and diagnostic processes. It is used by sanitary and veterinary services.

Medical, sanitary and anti-epidemic measures for tularemia

Epidemic surveillance

Epidemic surveillance of tularemia is the continuous collection and analysis of information about episodes and vectors of the disease.

Prevention of tularemia

A live vaccine is used to prevent tularemia. It is intended to protect humans in areas of tularemia. The vaccine is administered once, starting at age 7.

Anti-epidemic measures for tularemia

Anti-epidemic measures for tularemia are aimed at implementing a set of measures, the purpose of which is the destruction of the pathogen (disinfection) and the destruction of carriers of the pathogen (deratization and disinfestation).

Preventive measures

Anti-epidemic measures, carried out on time and in full, can lead to a rapid cessation of the spread of especially dangerous infections, localize and eliminate the epidemic focus in the shortest possible time. Prevention of especially dangerous infections - plague, cholera, anthrax and tularemia is aimed at protecting the territory of our state from the spread of especially dangerous infections.

Basic literature

1. Bogomolov B.P. Differential diagnosis of infectious diseases. 2000

2. Lobzina Yu.V. Selected issues in the treatment of infectious patients. 2005

3. Vladimirova A.G. Infectious diseases. 1997

REMINDER TO THE MEDICAL WORKER WHEN CARRYING OUT PRIMARY MEASURES IN THE OCCU

If a patient is identified who is suspected of having plague, cholera, GVL or smallpox, based on the clinical picture of the disease, it is necessary to assume a case of hemorrhagic fever, tularemia, anthrax, brucellosis, etc., it is necessary first of all to establish the reliability of its connection with the natural source of infection.

Often the decisive factor in establishing a diagnosis is the following epidemiological history data:

• Arrival of a patient from an area unfavorable for these infections for a period of time equal to the incubation period;
• Communication of the identified patient with a similar patient along the route, at the place of residence, study or work, as well as the presence there of any group diseases or deaths of unknown etiology;
• Staying in areas bordering the parties that are unfavorable for these infections or in exotic territory for the plague.

During the initial manifestations of the disease, AIOs can give pictures similar to a number of other infections and non-infectious diseases:

For cholera- with acute intestinal diseases, toxic infections of various nature, poisoning with pesticides;

During the plague- with various pneumonias, lymphadenitis with elevated temperature, sepsis of various etiologies, tularemia, anthrax;

For monkeypox- with chickenpox, generalized vaccine and other diseases accompanied by rashes on the skin and mucous membranes;

For Lasa fever, Ebola, and Marburg- with typhoid fever, malaria. In the presence of hemorrhages, it is necessary to differentiate from yellow fever, Dengue fever (see clinical and epidemiological characteristics of these diseases).

If a patient is suspected of having one of the quarantine infections, the medical worker must:

1. Take measures to isolate the patient at the place of detection:

• Prohibit entry and exit from the outbreak, isolate family members from communicating with the sick person in another room, and if it is not possible to take other measures, isolate the patient;
• Before hospitalizing the patient and carrying out final disinfection, it is prohibited to pour the patient’s discharge into the sewer or cesspool, water after washing hands, dishes and care items, or remove things and various objects from the room where the patient was;

2. The patient is provided with the necessary medical care:

• if plague is suspected in a severe form of the disease, streptomycin or tetracycline antibiotics are administered immediately;
• in severe cases of cholera, only rehydration therapy is performed. Cardiovascular drugs are not administered (see assessment of the degree of dehydration in a patient with diarrhea);
• when carrying out symptomatic therapy for a patient with GVL, it is recommended to use disposable syringes;
• depending on the severity of the disease, all transportable patients are sent by ambulance to hospitals specially designated for these patients;
• for non-transportable patients, assistance is provided on site with the call of consultants and an ambulance equipped with everything necessary.

3. By telephone or by messenger, notify the head physician of the outpatient clinic about the identified patient and his condition:

• Request appropriate medications, stowage of protective clothing, personal prophylaxis, stowage for collection of material;
• Before receiving protective clothing, a medical worker who suspects plague, GVL, or monkeypox should temporarily cover his mouth and nose with a towel or mask made from improvised material. For cholera, personal prevention measures for gastrointestinal infections must be strictly observed;
• Upon receipt of protective clothing, they put it on without removing their own (except for those heavily contaminated with the patient’s secretions)
• Before putting on PPE, carry out emergency prevention:

A) in case of plague - treat the nasal mucosa and eyes with a solution of streptomycin (100 distilled water per 250 thousand), rinse the mouth with 70 grams. alcohol, hands - alcohol or 1% chloramine. Inject 500 thousand units intramuscularly. streptomycin - 2 times a day, for 5 days;

B) with monkeypox, GVL - like with the plague. Anti-smallpox gammaglobulin metisazon - in the isolation ward;

C) For cholera - one of the means of emergency prevention (tetracycline antibiotic);

4. If a patient is identified with plague, GVL, or monkeypox, the medical worker does not leave the office or apartment (in case of cholera, if necessary, he can leave the room after washing his hands and taking off the medical gown) and remain until the arrival of the epidemiological and disinfection brigade.

5. Persons who were in contact with the patient are identified among:

• Persons at the patient’s place of residence, visitors, including those who had left by the time the patient was identified;
• Patients who were in this institution, patients transferred or sent to other medical institutions, discharged;
• Medical and service personnel.

6. Collect material for testing (before the start of treatment), fill out a referral to the laboratory in pencil.

7. Carry out ongoing disinfection in the fireplace.

8. after the patient leaves for hospitalization, carry out a set of epidemiological measures in the outbreak until the arrival of the disinfection team.

9. Further use of a medical worker from the outbreak of plague, GVL, monkeypox is not permitted (sanitation and in the isolation ward). In case of cholera, after sanitization, the health worker continues to work, but he is subject to medical supervision at the place of work for the duration of the incubation period.

BRIEF EPIDEMIOLOGICAL CHARACTERISTICS OF OOI

Name of infection	Source of infection	Transmission path	Incubus period
Smallpox	Sick man		14 days
Plague	Rodents, humans	Transmissible - through fleas, airborne, possibly others	6 days
Cholera	Sick man	Water, food	5 days
Yellow fever	Sick man	Vector-borne - Aedes-Egyptian mosquito	6 days
Lasa fever	Rodents, sick person	Airborne, airborne, contact, parenteral	21 days (from 3 to 21 days, more often 7-10)
Marburg disease	Sick man		21 days (from 3 to 9 days)
Ebola fever	Sick man	Airborne, contact through the conjunctiva of the eyes, parapteral	21 days (usually up to 18 days)
Monkeypox	Monkeys, sick person until 2nd contact	Air-droplet, air-dust, contact-household	14 days (from 7 to 17 days)

MAIN SIGNAL SIGNS of OOI

PLAGUE- acute sudden onset, chills, temperature 38-40°C, severe headache, dizziness, impaired consciousness, insomnia, conjunctival hyperemia, agitation, tongue coated (chalky), phenomena of increasing cardiovascular insufficiency develop, within a day, characteristics characteristic of each develop forms of signs of the disease:

Bubonic form: the bubo is sharply painful, dense, fused with the surrounding subcutaneous tissue, immobile, its maximum development is 3-10 days. The temperature lasts 3-6 days, the general condition is serious.

Primary pulmonary: against the background of the listed signs, chest pain appears, shortness of breath, delirium, cough appears from the very beginning of the disease, sputum is often foamy with streaks of scarlet blood, and there is a discrepancy between the data of an objective examination of the lungs and the general serious condition of the patient. The duration of the disease is 2-4 days, without treatment 100% mortality;

Septic: early severe intoxication, a sharp drop in blood pressure, hemorrhage on the skin, mucous membranes, bleeding from internal organs.

CHOLERA- mild form: loss of fluid, loss of body weight occurs in 95% of cases. The onset of the disease is acute rumbling in the abdomen, loose stools 2-3 times a day, and maybe vomiting 1-2 times. The patient’s well-being is not affected, and working capacity is maintained.

Moderate form: fluid loss of 8% of body weight, occurs in 14% of cases. The onset is sudden, rumbling in the stomach, vague intense pain in the abdomen, then loose stools up to 16-20 times a day, which quickly loses the fecal character and smell, green, yellow and pink color of rice water and diluted lemon, defecation without urge uncontrollable (for 500-100 ml are excreted once; an increase in stool is typical with each defect). Vomiting occurs along with diarrhea; it is not preceded by nausea. Severe weakness develops and an unquenchable thirst appears. General acidosis develops and diuresis decreases. Blood pressure drops.

Severe form: algid develops with a loss of fluid and salts of more than 8% of body weight. The clinical picture is typical: severe emaciation, sunken eyes, dry sclera.

YELLOW FEVER: sudden acute onset, severe chills, headaches and muscle pain, high fever. The patients are safe, their condition is serious, nausea and painful vomiting occur. Pain in the pit of the stomach. 4-5 days after a short-term drop in temperature and improvement in general condition, a secondary rise in temperature occurs, nausea, vomiting of bile, and nosebleeds appear. At this stage, three warning signs are characteristic: jaundice, hemorrhage, and decreased urine output.

LASSA FEVER: in the early period, symptoms: - pathology is often not specific, a gradual increase in temperature, chills, malaise, headache and muscle pain. In the first week of the disease, severe pharyngitis develops with the appearance of white spots or ulcers on the mucous membrane of the pharynx and tonsils of the soft palate, followed by nausea, vomiting, diarrhea, chest and abdominal pain. By the 2nd week, diarrhea subsides, but abdominal pain and vomiting may persist. Dizziness, decreased vision and hearing are common. A maculopapular rash appears.

In severe cases, symptoms of toxicosis increase, the skin of the face and chest becomes red, the face and neck are swollen. Temperature is about 40°C, consciousness is confused, oliguria is noted. Subcutaneous hemorrhages may appear on the arms, legs, and abdomen. Hemorrhages into the pleura are common. The febrile period lasts 7-12 days. Death often occurs in the second week of illness from acute cardiovascular failure.

Along with severe ones, there are mild and subclinical forms of the disease.

MARBURG'S DISEASE: acute onset, characterized by fever, general malaise, headache. On the 3-4th day of illness, nausea, abdominal pain, severe vomiting, and diarrhea appear (diarrhea may last for several days). By the 5th day, in most patients, first on the torso, then on the arms, neck, face, a rash, conjunctivitis appears, and hemorrhoidal diathesis develops, which is expressed in the appearance of pitehia on the skin, emapthema on the soft palate, hematuria, bleeding from the gums, in places of syringe Kolov, etc. The acute febrile period lasts about 2 weeks.

EBOLA FEVER: acute onset, temperature up to 39°C, general weakness, severe headaches, then pain in the neck muscles, in the joints of the leg muscles, conjunctivitis develops. Often there is a dry cough, sharp pain in the chest, severe dryness in the throat and pharynx, which interfere with eating and drinking and often lead to the appearance of cracks and ulcers on the tongue and lips. On the 2-3rd day of illness, abdominal pain, vomiting, and diarrhea appear; after a few days, the stool becomes tar-like or contains bright blood.

Diarrhea often causes varying degrees of dehydration. Usually on the 5th day, patients have a characteristic appearance: sunken eyes, exhaustion, weak skin turgor, the oral cavity is dry, covered with small ulcers similar to aphthous ones. On the 5th-6th day of illness, a macular-potulous rash appears first on the chest, then on the back and limbs, which disappears after 2 days. On days 4-5, hemorrhagic diathesis develops (bleeding from the nose, gums, ears, syringe injection sites, bloody vomiting, melena) and severe sore throat. Often there are symptoms indicating involvement of the central nervous system in the process - tremor, convulsions, paresthesia, meningeal symptoms, lethargy or, conversely, agitation. In severe cases, cerebral edema and encephalitis develop.

MONKEYPOX: high fever, headache, pain in the sacrum, muscle pain, hyperemia and swelling of the mucous membrane of the pharynx, tonsils, nose, rashes are often observed on the mucous membrane of the oral cavity, larynx, nose. After 3-4 days, the temperature drops by 1-2°C, sometimes to low-grade fever, general toxic effects disappear, and health improves. After the temperature drops on the 3-4th day, a rash appears first on the head, then on the torso, arms, and legs. The duration of the rash is 2-3 days. Rashes on individual parts of the body occur simultaneously, the rash is predominantly localized on the arms and legs, simultaneously on the palms and soles. The nature of the rash is papular-vediculous. The development of the rash is from a spot to a pustule slowly, over 7-8 days. The rash is monomorphic (at one stage of development - only papules, vesicles, pustules and roots). Vesicles do not collapse when punctured (multi-locular). The base of the rash elements is dense (the presence of infiltrates), the inflammatory rim around the rash elements is narrow and clearly defined. Pustules form on the 8-9th day of illness (6-7th day of the appearance of the rash). The temperature rises again to 39-40°C, the patients' condition worsens sharply, headaches and delirium appear. The skin becomes tense and swollen. Crusts form on days 18-20 of illness. There are usually scars after the crusts fall off. There is lymphadenitis.

REGIME FOR DISINFECTION OF MAIN OBJECTS IN CHOLERA

	Disinfection method	Disinfectant	Contact time	Consumption rate
1. Room surfaces (floor, walls, furniture, etc.)	irrigation	0.5% solution DTSGK, NGK 1% chloramine solution 1% solution of clarified bleach	60 min	300ml/m3
2. Gloves	dive	3% myol solution, 1% chloramine solution	120 min
3.Glasses, phonendoscope	Wipe twice with an interval of 15 minutes	3% hydrogen peroxide	30 min
4. Rubber shoes, leather slippers	wiping	See point 1
5. Bedding, cotton trousers, jacket	chamber processing	Steam-air mixture 80-90°C	45 min
6. Dishes of the patient	boiling, immersion	2% soda solution, 1% chloramine solution, 3% rmezol solution, 0.2% DP-2 solution	15 min 20 min
7. Personnel protective clothing contaminated with secretions	boiling, soaking, autoclanning	See point 6 120°C p-1.1 at.	30 min	5l per 1 kg of dry laundry
8. Protective clothing for personnel without visible signs of contamination	boiling, soaking	2% soda solution 0.5% chloramine solution 3% misol solution, 0.1% DP-2 solution	15 min 60 min 30 min
9. patient's secretions	add, mix	Dry bleach, DTSGK, DP	60 min	200 gr. per 1 kg of discharge
10. Transport	irrigation	CM. point 1

ASSESSMENT OF THE DEGREE OF DEHYDRATION BY CLINICAL SIGNS

Symptom or sign	Degree of disinfection as a percentage
	I(3-5%)	II(6-8%)	III(10% and above)
1. Diarrhea	Watery stools 3-5 times a day	6-10 times a day	More than 10 times a day
2. Vomiting	No or insignificant amount	4-6 times a day	Very common
3. Thirst	moderate	Expressive, drinks greedily	Can't drink or drinks poorly
4. Urine	Not changed	Small quantity, dark	Not urinating for 6 hours
5. General condition	Good, cheerful	Feeling unwell, sleepy or irritable, agitated, restless	Very drowsy, lethargic, unconscious, lethargic
6. Tears	Eat	none	none
7. Eyes	Regular	Sunken	Very sunken and dry
8. Oral mucosa and tongue	Wet	dry	Very dry
9. Breathing	Normal	Rapid	Very frequent
10. Tissue turgor	Not changed	Each fold unravels slowly	Each fold is straightened. very slow
11. Pulse	normal	More often than usual	Frequent, weak filling or not palpable
12. Fontana (in young children)	Doesn't stick	sunken	Very sunken
13. Average estimated fluid deficit	30-50 ml/kg	60-90 ml/kg	90-100 ml/kg

EMERGENCY PREVENTION IN AREAS OF QUARANTINE DISEASES.

Emergency prevention applies to those who have contact with the patient in the family, apartment, place of work, study, recreation, treatment, as well as persons who are in the same conditions regarding the risk of infection (according to epidemiological indications). Taking into account the antibiogram of strains circulating in the outbreak, one of the following devices is prescribed:

DRUGS	One-time share, in gr.	Frequency of application per day	Average daily dose
Tetracycline	0,5-0,3
Doxycycline
Levomycetin
Erythromycin
Ciprofloxacin
Furazolidone

TREATMENT SCHEMES FOR PATIENTS WITH DANGEROUS INFECTIOUS DISEASES

Disease	Preparation	One-time share, in gr.	Frequency of application per day	Average daily dose	Duration of use, in days
Plague	Streptomycin	0,5 - 1,0		1,0-2,0	7-10
	Sizomycin				7-10
	Rifampicin				7-10
	Doxycycline				10-14
	Sulfatone
Anthrax	Ampicillin
	Doxycycline
	Tetracycline
	Sizomycin
Tularemia	Rifampicin				7-10
	Doxycycline				7-10
	Tetracycline				7-10
	Streptomycin				7-10
Cholera	Doxycycline
	Tetracycline	0,25
	Rifampicin
	Levomecithin
Brucellosis	Rifampicin
	Doxycycline
	Tetracycline

For cholera, an effective antibiotic can reduce the amount of diarrhea in patients with severe cholera, the period of vibrio excretion. Antibiotics are given after the patient is dehydrated (usually after 4-6 hours) and vomiting has stopped.

Doxycycline is the preferred antibiotic for adults (except pregnant women).

Furazolidone is the preferred antibiotic for pregnant women.

When vibrios cholerae resistant to these drugs are isolated in cholera foci, the issue of changing the drug is considered taking into account the antibiograms of the strains circulating in the foci.

UNIT FOR COLLECTING MATERIAL FROM A PATIENT WITH SUSPECTED CHOLERA (for non-infectious hospitals, emergency medical care stations, outpatient clinics).

1. Sterile wide-neck jars with lids or

Ground stoppers of at least 100 ml. 2 pcs.

2. Glass tubes (sterile) with rubber

small size necks or teaspoons. 2 pcs.

3. Rubber catheter No. 26 or No. 28 for taking material

Or 2 aluminum hinges 1 pc.

4.Plastic bag. 5 pcs.

5. Gauze napkins. 5 pcs.

7. Band-Aid. 1 pack

8. Simple pencil. 1 piece

9. Oilcloth (1 sq.m.). 1 piece

10. Bix (metal container) small. 1 piece

11. Chloramine in a 300g bag, designed to receive

10l. 3% solution and dry bleach in a bag of

calculation 200g. per 1 kg. discharge. 1 piece

12. Rubber gloves. 2 pairs

13. Cotton gauze mask (dust respirator) 2 pcs.

Installation for each line brigade of a joint venture, therapeutic area, local hospital, medical outpatient clinic, first aid station, health center - for everyday work when serving patients. Items subject to sterilization are sterilized once every 3 months.

SCHEME FOR COLLECTING MATERIAL FROM PATIENTS WITH OI:

Name of infection	Material under study	Quantity	Method of collecting material
Cholera	A) feces B)vomit B) bile	20-25 ml. pores B and C	The material is collected in a separate bin. The Petri dish, placed in a bedpan, is transferred to a glass jar. In the absence of discharge - with a boat, a loop (to a depth of 5-6 cm). Bile - with duonal probing
Plague	A) blood from a vein B) punctate from bubo B) department of the nasopharynx D) sputum	5-10 ml. 0.3 ml.	Blood from the cubital vein - into a sterile test tube, juice from a bubo from the dense peripheral part - a syringe with the material is placed in a test tube. Sputum - in a wide-necked jar. Nasopharyngeal discharge - using cotton swabs.
Monkeypox GVL	A) mucus from the nasopharynx B) blood from a vein C) contents of rashes, crusts, scales D) from a corpse - brain, liver, spleen (at sub-zero temperatures)	5-10 ml.	We separate it from the nasopharynx using cotton swabs into sterile plugs. Blood from the cubital vein - into sterile tubes; the contents of the rash are placed into sterile tubes with a syringe or scalpel. Blood for serology is taken 2 times in the first 2 days and after 2 weeks.

MAIN RESPONSIBILITIES OF THE MEDICAL PERSONNEL OF THE ENT DEPARTMENT OF THE CRH WHEN IDENTIFYING A PATIENT WITH OOI IN THE HOSPITAL (during a medical round)

1. Doctor, who identified a patient with an acute respiratory infection in the department (at the reception) is obliged to:
2. Temporarily isolate the patient at the site of detection, request containers for collecting secretions;
3. Notify by any means the head of your institution (head of department, head physician) about the identified patient;
4. Organize measures to comply with the rules of individual protection for health workers who have identified a patient (request and use anti-plague suits, means for treating mucous membranes and open areas of the body, emergency prevention, disinfectants);
5. Provide the patient with emergency medical care for life-saving reasons.

NOTE: the skin of the hands and face is generously moistened with 70° alcohol. The mucous membranes are immediately treated with a solution of streptomycin (250 thousand units in 1 ml), and for cholera - with a solution of tetracycline (200 thousand mcg/ml). In the absence of antibiotics, a few drops of 1% silver nitrate solution are injected into the eyes, 1% protargol solution is injected into the nose, the mouth and throat are rinsed with 70° alcohol.

1. Charge nurse who took part in a medical round is obliged to:
2. Request placement and collection of material from the patient for bacteriological examination;
3. Organize ongoing disinfection in the ward before the arrival of the disinfection team (collection and disinfection of the patient’s discharge, collection of contaminated linen, etc.).
4. Make lists of your closest contacts with the patient.

NOTE: After evacuating the patient, the doctor and nurse take off their protective clothing, pack it in bags and hand it over to the disinfection team, disinfect their shoes, undergo sanitary treatment and send it to their supervisor.

1. Head of department Having received a signal about a suspicious patient, he is obliged to:
2. Urgently organize the delivery to the ward of protective clothing, bacteriological equipment for collecting material, containers and disinfectants, as well as means for treating open areas of the body and mucous membranes, and means of emergency prevention;
3. Set up posts at the entrance to the ward where the patient is identified and at the exit from the building;
4. If possible, isolate contacts in wards;
5. Report the incident to the head of the institution;
6. Organize a census of your department’s contacts in the prescribed form:
7. No. pp., surname, first name, patronymic;
8. was undergoing treatment (date, department);
9. left the department (date);
10. the diagnosis with which the patient was in the hospital;
11. place of residence;
12. place of work.

1. Senior nurse of the department, having received instructions from the head of the department, is obliged to:
2. Urgently deliver protective clothing, containers for collecting secretions, bacteriological storage, disinfectants, antibiotics to the ward;
3. Separate patients from departments into wards;
4. Monitor the work of posted posts;
5. Conduct a census using the established contact form for your department;
6. Accept the container with the selected material and ensure delivery of samples to the laboratory.

OPERATIONAL PLAN

Department activities when identifying cases of acute respiratory infections.

№№ PP	Company name	Deadlines	Performers
	Notify and gather department officials at their workplaces in accordance with the existing scheme.	Immediately upon confirmation of diagnosis	Doctor on duty head department, head nurse
	Call a group of consultants through the head physician of the hospital to clarify the diagnosis.	Immediately if OI is suspected	Doctor on duty head department.
	Introduce restrictive measures in the hospital: Prohibit access of outsiders to the buildings and territory of the hospital; Introduce a strict anti-epidemic regime in hospital departments Prohibit the movement of patients and staff in the department; Place external and internal posts in the department.	Upon confirmation of diagnosis	Medical staff on duty
	Conduct instruction for department staff on the prevention of acute respiratory infections, personal protection measures, and hospital operating hours.	When gathering personnel	Head department
	Conduct explanatory work among patients in the department about measures to prevent this disease, adherence to the regimen in the department, and personal preventive measures.	In the first hours	Medical staff on duty
	Strengthen sanitary control over the work of the dispensing room, collection and disinfection of waste and garbage in the hospital. Carry out disinfection measures in the department	constantly	Medical staff on duty Head department

NOTE: further activities in the department are determined by a group of consultants and specialists from the sanitary and epidemiological station.

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questions to convey information about the patient (vibrio carrier)

1. Last name, first name, patronymic.
2. Age.
3. Address (during illness).
4. Permanent residence.
5. Profession (for children - child care institution).
6. Date of illness.
7. Date of request for help.
8. Date and place of hospitalization.
9. Date of collection of material for tank examination.
10. Diagnosis upon admission.
11. Final diagnosis.
12. Concomitant diseases.
13. Date of vaccination against cholera and drug.
14. Epidemiological history (connection with a body of water, food products, contact with a patient, vibrio carrier, etc.).
15. Alcohol abuse.
16. Use of antibiotics before illness (date of last dose).
17. Number of contacts and measures taken against them.
18. Measures to eliminate the outbreak and its localization.
19. Measures to localize and eliminate the outbreak.

SCHEME

specific emergency prophylaxis for a known pathogen

Name of infection	Name of the drug	Directions for use	Single dose (gr.)	Frequency of application (per day)	Average daily dose (gr.)	Average dose per course	Average course duration
Cholera	Tetracycline	Inside	0,25-0,5	3 times	0,75-1,5	3,0-6,0	4 days
	Levomycetin	Inside		2 times			4 days
Plague	Tetracycline	Inside		3 times		10,5	7 days
	Oletetrin	Inside	0,25	3-4 times	0,75-1,0	3,75-5,0	5 days

NOTE: Extract from the instructions,

approved deputy minister of health

USSR Ministry of Health P.N. Burgasov 06/10/79

SAMPLING FOR BACTERIOLOGICAL STUDIES IN OOI.

Material collected	The amount of material and what it is taken into	Property required when collecting material
I. MATERIAL ON CHOLERA
feces		Glass Petri dish, sterile teaspoon, sterile jar with ground stopper, tray (sterilizer) for emptying the spoon
Bowel movements without stool	Same	The same + sterile aluminum loop instead of a teaspoon
Vomit	10-15 gr. in a sterile jar with a ground stopper, filled 1/3 with 1% peptone water	A sterile Petri dish, a sterile teaspoon, a sterile jar with a ground stopper, a tray (sterilizer) for emptying the spoon
II.MATERIAL IN NATURAULAR SMALLPOX
Blood	A) 1-2 ml. dilute 1-2 ml of blood into a sterile test tube. sterile water.	Syringe 10 ml. with three needles and wide lumen
	B) 3-5 ml of blood into a sterile tube.	3 sterile test tubes, sterile rubber (cork) stoppers, sterile water in 10 ml ampoules.
	With a cotton swab on a stick and immersed in a sterile test tube	Cotton swab in a test tube (2 pcs.) Sterile tubes (2 pcs.)
Contents of rashes (papules, vesicles, pustules)	Before taking, wipe the area with alcohol. Sterile test tubes with ground-in stoppers and degreased glass slides.	96° alcohol, cotton balls in a jar. Tweezers, scalpel, smallpox inoculation feathers. Pasteur pipettes, slides, adhesive tape.
III. MATERIAL IN PLAGUE
Bubo punctate	A) the needle with punctate is placed in a sterile tube with a sterile rubber crust B) blood smear on glass slides	5% tincture of iodine, alcohol, cotton balls, tweezers, 2 ml syringe with thick needles, sterile tubes with stoppers, fat-free glass slides.
Sputum	In a sterile Petri dish or a sterile wide-mouth jar with a ground stopper.	Sterile Petri dish, sterile wide-necked jar with a ground stopper.
Discharge from the nasopharyngeal mucosa	On a cotton swab on a stick in a sterile test tube	Sterile cotton swabs in sterile tubes
Blood for homoculture	5 ml. blood into sterile tubes with sterile (cortical) stoppers.	10 ml syringe. with thick needles, sterile tubes with sterile (cork) stoppers.

MODE

Disinfection of various objects contaminated with pathogenic microbes

(plague, cholera, etc.)
Object to be disinfected	Disinfection method	Disinfectant	Time contact	Consumption rate
1.Room surfaces (floor, walls, furniture, etc.)	Irrigation, wiping, washing	1% chloramine solution	1 hour	300 ml/m 2
2. protective clothing (underwear, gowns, scarves, gloves)	autoclaving, boiling, soaking	Pressure 1.1 kg/cm 2. 120°	30 min.
		2% soda solution	15 min.
		3% Lysol solution	2 hours	5 l. per 1 kg.
		1% chloramine solution	2 hours	5 l. per 1 kg.
3. Glasses, phonendoscope	wiping
4. Liquid waste	Add and stir		1 hour	200gr./l.
5.Slippers, rubber boots	wiping	3% hydrogen peroxide solution with 0.5% detergent		2x wiping at intervals. 15min.
6. Discharge of the patient (sputum, feces, food debris)	Add and stir; Pour and stir	Dry bleach or DTSGK	1 hour	200 gr. /l. 1 hour of discharge and 2 hours of solution doses. volume ratio 1:2
		5% Lysol A solution	1 hour
		10% solution Lysol B (naphthalizol)	1 hour
7. Urine	Fill	2% chlorine solution. lime, 2% solution of Lysol or chloramine	1 hour	Ratio 1:1
8. Dishes of the patient	boiling	Boiling in 2% soda solution	15 min.	Full immersion
9. Used utensils (teaspoons, Petri dishes, etc.)	boiling	2% soda solution	30 min.
		3% solution chloramine B	1 hour
		3% per. hydrogen with 0.5 detergent	1 hour
		3% Lysol A solution	1 hour
10. Hands in rubber gloves.	Immersion and washing	Disinfectant solutions specified in paragraph 1	2 min.
Hands	-//-//-Wipe	0.5% chloramine solution	1 hour
		70° alcohol	1 hour
11.Bed accessories	Chamber disinfection	Steam-air mixture 80-90°	45 min.	60 kg/m2
12. Synthetic products. material	-//-//- Dive	Steam-air mixture 80-90°	30 min.	60 kg/m2
		1% chloramine solution	5 hours
		0.2% formaldehyde solution at t70°	1 hour

DESCRIPTION OF PROTECTIVE ANTIPLAGUE SUIT:

1. Pajama suit
2. Socks and stockings
3. Boots
4. Anti-plague medical gown
5. Kerchief
6. Fabric mask
7. Mask - glasses
8. Oilcloth sleeves
9. Oilcloth apron
10. Rubber gloves
11. Towel
12. Oilcloth

Particularly dangerous infections - category of infectious diseases that pose a potential danger to humanity. General characteristic signs: sudden appearance of a focus of the disease, rapid spread, pronounced acute symptoms, threat to the health and life of infected patients.

In modern world medical practice, the term “EPI” or “Particularly Dangerous Infections” has lost its relevance. Today, the generally accepted name for this category of diseases is: “Infectious diseases capable of triggering the development of an international emergency.”

A complete and current list of events associated with dangerous infections was adopted by WHO in 2005. and is set out in the International Health Regulations (IHR).

• unexpected and unusual cases of diseases that pose a threat to the life and health of the population: severe acute respiratory syndrome, polio caused by wild type poliovirus flu caused by a new strain, chicken pox
• cases of diseases affecting public health on a global scale: yellow fever, hemorrhagic fevers (fever Ebola, Marburg, Laos), feverish West Nile, pneumonic plague, fever Dengue, meningococcal infection, cholera, fever Rift Valley
• other cases of international concern occurring for unknown reasons, caused by diseases not listed in previous events

DOWNLOAD International Health Regulations IHR 2005:

In the Russian Federation, particularly dangerous infections also include: anthrax And tularemia.

Emergency prevention of acute infectious diseases - especially dangerous infections in cases of detection in health care facilities or other institutions

Actions of junior and paramedical personnel

1. Immediate notification of the institution's management about the possibility of accidents
2. Persons who were in the source of infection (building, room or floor of a building) should remain in place until specialists arrive and the circumstances are clarified.
3. Request for equipment packaging: kit for medical personnel, kit for collecting material, anti-plague suits, disinfectants
4. If OI kits are available, use them for their intended purpose. Wear anti-plague or other protective suits
5. In the absence of techniques used for particularly dangerous infections - make and apply cotton-gauze bandages yourself
6. Perform maximum isolation of the source of infection. Close the windows, turn off the hood. Use improvised means to close door cracks
7. If necessary, provide medical assistance to potentially infected persons, observing the necessary safety measures
8. Collection and transfer of material for research: smears from the mucous membrane of the pharynx, oropharynx and nose, blood serum
9. Disinfect the premises as usual

Actions of senior medical personnel and institution management

1. Notification of the regional sanitary-epidemiological service about suspected detection of an outbreak of acute infectious diseases
2. Close all entrances/exits to the room where the source of infection was identified
3. Post posts on the doors. Entry or exit from the outbreak is possible only with the permission of the head physician of the medical institution or his deputy
4. Delivery of the required number of equipment, disinfectants and medical supplies to the source of detection of a particularly dangerous infection
5. Notify all departments about the temporary cessation of work of the institution. Suspend the admission and discharge of patients from health care facilities.
6. Report to management on the activities carried out
7. Make lists of those in the outbreak. Also, compile the maximum possible list of people with whom infected patients have been in contact.

Composition of styling for personal emergency prevention of acute respiratory infections in accordance with guidelines MU-3.4.2552-09. + a set of additional means for disinfecting the premises

DOWNLOAD MU-3.4.2552-09. FOR ESPECIALLY DANGEROUS INFECTIONS:

№	Name	Quantity pcs.
	Medicines and medical products for personal prevention
1	Sulfacyl sodium 20% - 10ml - 1 pc.	1
2	Arbidol 0.1 No. 10 or other antiviral drug 1 pc.	1
3	Ethanol solution 70% - 200ml 1 pc.	1
4	1% AQUEOUS boric acid solution - 100 ml or Streptomycin 0.5+ 20 ml water for injection 1 pc.	1
5	Pipette - 1 pc.	1
6	Cotton wool 100g. — 1 pc.	1
	Additional funds
1	Gloves pair - 3 pcs.	3
2	Cotton-gauze mask	3
3	Canned glasses	3
4	Kerchief	3
5	journal of infectious diseases F. No. 060/u	1
	Disinfectants and detergents
1	Javel-solid tablets - 15 pcs. or Diseffect or other product for routine disinfection
2	Soap
3	Washing powder
	Anti-plague suit set
1	Cotton pajamas	1
2	Socks pair	1
3	Rubber boots	1
4	Kerchief	1
5	cap	1
6	Medical gown	1
7	Cotton gauze bandage	1
8	Safety glasses	1
9	Non-sterile medical gloves pair	2
10	Polymer apron (PVC, polyethylene)	1
11	Polymer sleeves	1
12	Towel	1

DOWNLOAD LIST OF STYLING FOR OOI:

Instructions for using styling for personal emergency prevention of infection with particularly dangerous infections

• Treat all exposed parts of the body with 70% ethanol solution.
• Wear gloves
• Rinse your throat and mouth with 70% ethanol solution.
• In the nose - solution of protargol 1% or solution of streptomycin 2.5% (dissolve 0.5 streptomycin in 20 ml of water or isotonic solution)
• Drop 2-3 drops of 20% sodium sulfacyl solution into the eyes
• Wear safety glasses
• Take an antiviral drug

Using an anti-plague suit

The anti-plague suit is put on in the following order: pajamas → socks → headscarf → hat → robe → rubber boots → mask → goggles → polymer apron → polymer sleeves → medical gloves → clothing. towel

Rules and procedure for removing an anti-plague suit

Take off the suit strictly with gloves. In this case, after removing each part, it is necessary to immerse your gloved hands in a disinfectant solution and remove the towel. The outer side of all elements of the suit, after removal, should be facing inward. Before removing the suit, wipe the boots with a disinfectant solution.

Procedure for removing the suit: apron (wipe with disinfectant solution before removing) → sleeves → glasses → mask → robe → headscarf → boots → gloves. Treat your hands with a 70% ethanol solution and wash with soap. The maximum duration of stay in the suit is 3 hours, in the warm season - 2 hours.

Algorithm for the actions of medical staff when identifying a patient suspected of having an acute respiratory infection

If a patient suspected of having an acute infectious disease is identified, a doctor organizes work in the outbreak. Nursing staff are required to know the scheme for carrying out anti-epidemic measures and carry them out as directed by the doctor and the administration.

Scheme of primary anti-epidemic measures.

I. Measures to isolate the patient at the place where he is identified and work with him.

If a patient is suspected of having acute respiratory infections, health workers do not leave the room where the patient was identified until the consultants arrive and perform the following functions:

1. Notification of suspected OI by phone or through the door (knock on the door to attract the attention of those outside the outbreak and verbally convey information through the door).
2. Request all settings for the general public health inspection (package for prophylaxis of medical staff, packing for collecting material for research, packing with anti-plague suits), disinfectant solutions for yourself.
3. Before receiving the emergency prevention treatment, make a mask from available materials (gauze, cotton wool, bandages, etc.) and use it.
4. Before the installation arrives, close the windows and transoms using available materials (rags, sheets, etc.), close the cracks in the doors.
5. When receiving the dressings, to prevent your own infection, carry out emergency infection prevention, put on an anti-plague suit (for cholera, a lightweight suit - a robe, an apron, or possibly without them).
6. Cover windows, doors, and ventilation grilles with adhesive tape (except for cholera outbreaks).
7. Provide emergency assistance to the patient.
8. Collect material for research and prepare records and referrals for research to the bacteriological laboratory.
9. Conduct routine disinfection of the premises.

^ II. Measures to prevent the spread of infection.

Head department, the administrator, upon receiving information about the possibility of identifying DUI, performs the following functions:

1. Closes all doors of the floor where the patient is identified and sets up guards.
2. At the same time, organizes the delivery to the patient’s room of all necessary equipment, disinfectants and containers for them, and medications.
3. The admission and discharge of patients is stopped.
4. Notifies the higher administration about the measures taken and awaits further orders.
5. Lists of contact patients and medical staff are compiled (taking into account close and distant contact).
6. Explanatory work is carried out with contact patients in the outbreak about the reason for their delay.
7. Gives permission for consultants to enter the fireplace and provides them with the necessary costumes.

Exit from the outbreak is possible with the permission of the head physician of the hospital in accordance with the established procedure.

Rabies

Rabies- an acute viral disease of warm-blooded animals and humans, characterized by progressive damage to the central nervous system (encephalitis), fatal to humans.

^ Rabies agent neurotropic virus of the Rabdoviridae family of the Lyssavirus genus. It has a bullet shape and reaches a size of 80-180 nm. The nucleocapsid of the virus is represented by single-stranded RNA. The exceptional affinity of the virus rabies to the central nervous system was proven by the work of Pasteur, as well as by microscopic studies of Negri and Babes, who invariably found peculiar inclusions, the so-called Babes-Negri bodies, in sections of the brains of people who died from rabies.

Source – domestic or wild animals (dogs, cats, foxes, wolves), birds, bats.

Epidemiology. Human infection rabies occurs as a result of bites by rabid animals or when they salivate on the skin and mucous membranes, if there are microtraumas on these covers (scratches, cracks, abrasions).

The incubation period is from 15 to 55 days, in some cases up to 1 year.

^ Clinical picture. Conventionally, there are 3 stages:

1. Harbingers. The disease begins with an increase temperature up to 37.2–37.5°C and malaise, irritability, itching at the site of the animal bite.

2. Excitement. The patient is excitable, aggressive, and has a pronounced fear of water. The sound of pouring water, and sometimes even the sight of it, can cause convulsions. Increased salivation.

3. Paralysis. The paralytic stage lasts from 10 to 24 hours. In this case, paresis or paralysis of the lower extremities develops, and paraplegia is more often observed. The patient lies motionless, muttering incoherent words. Death occurs from paralysis of the motor center.

Treatment. Wash the wound (bite site) with soap, treat with iodine, and apply a sterile bandage. Therapy is symptomatic. Mortality – 100%.

Disinfection. Treatment of dishes, linen, and care items with a 2% chloramine solution.

^ Precautions. Since the patient’s saliva contains the rabies virus, then nurse It is necessary to work in a mask and gloves.

Prevention. Timely and complete vaccinations.

^

Yellow fever

Yellow fever is an acute viral natural focal disease with transmissible transmission of the pathogen through mosquito bites, characterized by a sudden onset, high biphasic fever, hemorrhagic syndrome, jaundice and hepatorenal failure. The disease is common in tropical regions of America and Africa.

Etiology. The causative agent, yellow fever virus (flavivirus febricis), belongs to the genus flavivirus, family Togaviridae.

Epidemiology. There are two epidemiological types of yellow fever foci - natural, or jungle, and anthropourgic, or urban.
In the case of the jungle form, the reservoir of viruses is marmoset monkeys, possibly rodents, marsupials, hedgehogs and other animals.
The carriers of viruses in natural foci of yellow fever are mosquitoes Aedes simpsoni, A. africanus in Africa and Haemagogus sperazzini and others in South America. Infection of humans in natural foci occurs through the bite of an infected mosquito A. simpsoni or Haemagogus, which is capable of transmitting the virus 9-12 days after the infectious bloodsucking.
The source of infection in urban yellow fever foci is a sick person in the period of viremia. Virus carriers in urban areas are Aedes aegypti mosquitoes.
Currently, sporadic incidence and local group outbreaks are being recorded in the tropical forest zone in Africa (Zaire, Congo, Sudan, Somalia, Kenya, etc.), South and Central America.

Pathogenesis. The inoculated yellow fever virus hematogenously reaches the cells of the macrophage system, replicates in them for 3-6, less often 9-10 days, then re-enters the blood, causing viremia and clinical manifestation of the infectious process. Hematogenous dissemination of the virus ensures its introduction into the cells of the liver, kidneys, spleen, bone marrow and other organs, where pronounced dystrophic, necrobiotic and inflammatory changes develop. The most typical occurrences are the occurrence of foci of liquefaction and coagulation necrosis in the mesolobular parts of the hepatic lobule, the formation of Councilman's bodies, and the development of fatty and protein degeneration of hepatocytes. As a result of these injuries, cytolysis syndromes develop with an increase in ALT activity and a predominance of AST activity, cholestasis with severe hyperbilirubinemia.
Along with liver damage, yellow fever is characterized by the development of cloudy swelling and fatty degeneration in the epithelium of the renal tubules, the appearance of areas of necrosis, causing the progression of acute renal failure.
With a favorable course of the disease, stable immunity is formed.

Clinical picture. There are 5 periods during the course of the disease. The incubation period lasts 3-6 days, less often it extends to 9-10 days.
The initial period (hyperemia phase) lasts for 3-4 days and is characterized by a sudden increase in body temperature to 39-41 ° C, severe chills, intense headache and diffuse myalgia. As a rule, patients complain of severe pain in the lumbar region, they experience nausea and repeated vomiting. From the first days of illness, most patients experience pronounced hyperemia and puffiness of the face, neck and upper chest. The vessels of the sclera and conjunctiva are clearly hyperemic (“rabbit eyes”), photophobia and lacrimation are noted. Prostration, delirium, and psychomotor agitation can often be observed. The pulse is usually rapid, and bradycardia and hypotension develop in the following days. The persistence of tachycardia may indicate an unfavorable course of the disease. Many people have an enlarged and painful liver, and at the end of the initial phase one can notice icterus of the sclera and skin, the presence of petechiae or ecchymoses.
The hyperemia phase is replaced by short-term (from several hours to 1-1.5 days) remission with some subjective improvement. In some cases, recovery occurs in the future, but more often a period of venous stasis follows.
The patient's condition noticeably worsens during this period. The temperature rises again to a higher level, and jaundice increases. The skin is pale, in severe cases cyanotic. A widespread hemorrhagic rash appears on the skin of the trunk and limbs in the form of petechiae, purpura, and ecchymoses. Significant bleeding of the gums, repeated vomiting with blood, melena, nasal and uterine bleeding are observed. In severe cases of the disease, shock develops. The pulse is usually rare, weak filling, blood pressure is steadily decreasing; Oliguria or anuria develops, accompanied by azotemia. Toxic encephalitis is often observed.
The death of patients occurs as a result of shock, liver and kidney failure on the 7-9th day of illness.
The duration of the described periods of infection is on average 8-9 days, after which the disease enters the convalescence phase with a slow regression of pathological changes.
Among local residents of endemic areas, yellow fever can occur in a mild or abortive form without jaundice and hemorrhagic syndrome, which makes timely identification of patients difficult.

Forecast. Currently, the case fatality rate for yellow fever is approaching 5%.
Diagnostics. Recognition of the disease is based on identifying a characteristic clinical symptom complex in individuals classified as high risk of infection (unvaccinated people who visited jungle foci of yellow fever within 1 week before the onset of the disease).

The diagnosis of yellow fever is confirmed by the isolation of the virus from the patient’s blood (in the initial period of the disease) or antibodies to it (RSK, NRIF, RTPGA) in later periods of the disease.

Treatment. Patients with yellow fever are hospitalized in hospitals protected from mosquitoes; carry out prevention of parenteral infection.
Therapeutic measures include a complex of anti-shock and detoxification agents, correction of hemostasis. In cases of progression of hepatic-renal failure with severe azotemia, hemodialysis or peritoneal dialysis is performed.

Prevention. Specific prophylaxis in foci of infection is carried out with the live attenuated 17 D vaccine and, less commonly, with the Dakar vaccine. Vaccine 17 D is administered subcutaneously in a dilution of 1:10, 0.5 ml. Immunity develops in 7-10 days and lasts for six years. Vaccinations are registered in international certificates. Unvaccinated persons from endemic areas are quarantined for 9 days.

^

Smallpox

Smallpox is an acute, highly contagious viral disease that occurs with severe intoxication and the development of vesicular-pustular rashes on the skin and mucous membranes.

Etiology. The causative agent of smallpox - orthopoxvirus variola from the genus orthopoxvirus, family Poxviridae - is represented by two varieties: a) O. variola var. major – the actual causative agent of smallpox; b) O. variola var. minor is the causative agent of alastrima, a benign form of human smallpox in South America and Africa.

The causative agent of smallpox is a DNA-containing virus with a size of 240-269 x 150 nm; the virus is detected in a light microscope in the form of Paschen bodies. The smallpox causative agent is resistant to various physical and chemical factors; at room temperature it does not lose viability even after 17 months.

Epidemiology. Smallpox is a particularly dangerous infection. The reservoir and source of viruses is a sick person who is infectious from the last days of the incubation period until complete recovery and the scabs fall off. Maximum infectivity is observed from the 7-9th day of illness. Smallpox infection occurs through airborne droplets, airborne dust, household contact, inoculation and transplacental routes. The most important is the airborne transmission of pathogens. Human susceptibility to smallpox is absolute. After an illness, strong immunity remains.

Pathogenesis. After penetration into the human body, the virus replicates in regional lymph nodes, then spreads through the blood to internal organs (primary viremia), where it replicates in the elements of the mononuclear phagocyte system (within 10 days). Subsequently, the infection generalizes (secondary viremia), which corresponds to the onset of clinical manifestation of the disease.
Having a pronounced tropism for tissues of ectodermal origin, the virus causes swelling, inflammatory infiltration, ballooning and reticular degeneration in them, which is manifested by rashes on the skin and mucous membranes. In all forms of the disease, parenchymal changes develop in the internal organs.

Clinical picture. The following forms of the disease are distinguished: severe - hemorrhagic smallpox (smallpox purpura, pustular hemorrhagic, or black smallpox) and confluent smallpox; moderate severity – scattered smallpox; lungs - varioloid, smallpox without rash, smallpox without fever.
The clinical course of smallpox can be divided into a number of periods. The incubation period lasts on average 9-14 days, but can be 5-7 days or 17-22 days. The prodromal period lasts 3-4 days and is characterized by a sudden increase in body temperature, pain in the lumbar region, myalgia, headache, and often vomiting. Within 2-3 days, half of the patients develop a prodromal measles-like or scarlet-like rash, localized mainly in the area of ​​Simon's femoral triangle and thoracic triangles. Towards the end of the prodromal period, body temperature decreases: at the same time, a smallpox rash appears on the skin and mucous membranes.
The period of the rash is characterized by a repeated gradual increase in temperature and a staged spread of the smallpox rash: first it appears on the linden tree, then on the torso, on the extremities, affecting the palmar and plantar surfaces, condensing as much as possible on the face and extremities. On one area of ​​the skin the rash is always monomorphic. The rash elements look like pink spots, quickly turning into papules, and after 2-3 days into smallpox vesicles, which have a multi-chamber structure with an umbilical cord in the center of the element and surrounded by a zone of hyperemia.
From the 7-8th day of illness, suppuration of smallpox elements develops, accompanied by a significant rise in temperature and a sharp deterioration in the patient’s condition. Pustules lose their multi-chamber structure, collapse when punctured, and are extremely painful. By the 15-17th day, the pustules open, dry out with the formation of crusts, while the pain decreases, and unbearable skin itching appears.
During the 4-5th week of the disease, against the background of normal body temperature, intense peeling and falling off of crusts are observed, in the place of which deep whitish scars remain, giving the skin a rough (pockmarked) appearance. The duration of the disease in an uncomplicated course is 5-6 weeks. Hemorrhagic forms of smallpox are the most severe, often accompanied by the development of infectious-toxic shock.

Forecast. With an uncomplicated course of the disease, mortality reached 15%, with hemorrhagic forms - 70-100%.

Diagnostics. Based on epidemiological history data and the results of a clinical examination. Specific diagnosis involves isolating the virus from the elements of the rash (electron microscopy), infecting chicken embryos and detecting antibodies to the smallpox virus (using RNGA, RTGA and the fluorescent antibody method).

Treatment. Complex therapy is used, including the use of anti-smallpox immunoglobulin, metisazone, broad-spectrum antibiotics and detoxification agents.

Prevention. Patients should be isolated, and contact persons should be observed for 14 days and vaccinated. Quarantine measures are being implemented in full.

^

Anthrax

Anthrax is an acute bacterial zoonotic infection characterized by intoxication, the development of serous-hemorrhagic inflammation of the skin, lymph nodes and internal organs and occurs in the form of a cutaneous (with the formation in most cases of a specific carbuncle) or septic form.

Etiology. The causative agent of anthrax, bacillus anthracis, belongs to the genus Bacillus, family Bacillaceae. It is a large spore-forming gram-positive rod measuring (5-10) x (1-1.5) microns. Anthrax bacilli grow well on meat-peptone media. They contain capsular and somatic antigens and are capable of secreting exotoxin, which is a protein complex consisting of edema-causing protective and lethal components. Vegetative forms of anthrax bacillus quickly die when exposed to conventional disinfectants and boiling. Disputes are incomparably more stable. They persist in the soil for decades. When autoclaving (110 °C) they die only after 40 minutes. Activated solutions of chloramine, hot formaldehyde, and hydrogen peroxide also have a sporicidal effect.

Epidemiology. The source of anthrax is sick domestic animals: cattle, horses, donkeys, sheep, goats, deer, camels, pigs, in which the disease occurs in a generalized form. It is most often transmitted by contact, less often by nutrition, airborne dust and transmission. In addition to direct contact with sick animals, human infection can occur through the participation of a large number of transmission factors. These include secretions and skins of sick animals, their internal organs, meat and other food products, soil, water, air, environmental objects contaminated with anthrax spores. In the mechanical inoculative transmission of the pathogen, blood-sucking insects (horseflies, fly flies) are important.
Susceptibility to anthrax is associated with the route of infection and the magnitude of the infectious dose.
There are three types of anthrax foci: professional-agricultural, professional-industrial and household. The first type of outbreaks is characterized by summer-autumn seasonality, the others occur at any time of the year.

Pathogenesis. The entry point for anthrax pathogens is usually damaged skin. In rare cases, it enters the body through the mucous membranes of the respiratory tract and gastrointestinal tract. At the site of penetration of the pathogen into the skin, an anthrax carbuncle appears (less commonly, adematous, bullous and erysipeloid forms of skin lesions) in the form of a focus of serous-hemorrhagic inflammation with necrosis, edema of adjacent tissues, and regional lymphadenitis. The development of lymphadenitis is caused by the introduction of the pathogen by mobile macrophages from the site of penetration into the nearest regional lymph nodes. The local pathological process is caused by the action of anthrax exotoxin, individual components of which cause severe microcirculation disorders, tissue edema and coagulative necrosis. Further generalization of anthrax pathogens with their breakthrough into the blood and the development of a septic form occurs extremely rarely in the cutaneous form.
Anthrax sepsis usually develops when the pathogen enters the human body through the mucous membranes of the respiratory tract or gastrointestinal tract. In these cases, disruption of the barrier function of the tracheobronchial (bronchopulmonary) or mesenteric lymph nodes leads to generalization of the process.
Bacteremia and toxinemia can cause the development of infectious-toxic shock.

Clinical picture. The duration of the incubation period of anthrax ranges from several hours to 14 days, most often 2-3 days. The disease can occur in localized (skin) or generalized (septic) forms. The cutaneous form occurs in 98-99% of all cases of anthrax. Its most common variety is the carbunculous form; Edematous, bullous and erysipeloid are less common. Mostly exposed parts of the body are affected. The disease is especially severe when carbuncles are localized on the head, neck, mucous membranes of the mouth and nose.
Usually there is one carbuncle, but sometimes their number reaches 10-20 or more. At the site of the entrance gate of infection, a spot, papule, vesicle, and ulcer develop successively. A spot with a diameter of 1-3 mm is reddish-bluish in color, painless, and resembles marks from an insect bite. After a few hours, the spot becomes a copper-red papule. Local itching and burning sensation increase. After 12-24 hours, the papule turns into a vesicle with a diameter of 2-3 mm, filled with serous fluid, which darkens and becomes bloody. When scratched or spontaneously, the vesicle bursts, its walls collapse, and an ulcer with a dark brown bottom, raised edges and serous-hemorrhagic discharge is formed. Secondary (“daughter”) vesicles appear along the edges of the ulcer. These elements undergo the same stages of development as the primary vesicle and, merging, increase the size of the skin lesion.
After a day, the ulcer reaches 8-15 mm in diameter. New “daughter” vesicles that appear at the edges of the ulcer cause its eccentric growth. Due to necrosis, after 1-2 weeks the central part of the ulcer turns into a black, painless, dense scab, around which a pronounced red inflammatory ridge forms. In appearance, the scab resembles a coal on a red background, which was the reason for the name of this disease (from the Greek anthrax - coal). In general, this lesion is called a carbuncle. The diameter of the carbuncles ranges from a few millimeters to 10 cm.
The tissue swelling that occurs along the periphery of the carbuncle sometimes affects large areas with loose subcutaneous tissue, for example on the face. Hitting the area of ​​edema with a percussion hammer often causes gelatinous trembling (Stefansky's symptom).
Localization of the carbuncle on the face (nose, lips, cheeks) is very dangerous, since swelling can spread to the upper respiratory tract and lead to asphyxia and death.
Anthrax carbuncle in the necrosis zone is painless even when pricked with a needle, which serves as an important differential diagnostic sign. The lymphadenitis that develops with the cutaneous form of anthrax is usually painless and does not tend to suppurate.
The edematous variety of cutaneous anthrax is characterized by the development of edema without the presence of a visible carbuncle. In later stages of the disease, necrosis occurs and a large carbuncle is formed.
With the bullous variety, blisters with hemorrhagic fluid form at the site of the entrance gate of infection. After the opening of the blisters or necrotization of the affected area, extensive ulcerative surfaces are formed, taking the form of a carbuncle.
A peculiarity of the erysipeloid type of cutaneous anthrax is the development of a large number of blisters with clear liquid. After opening them, ulcers remain that undergo transformation into a scab.
The cutaneous form of anthrax occurs in mild to moderate severity in approximately 80% of patients, and in severe form in 20% of patients.
In mild cases of the disease, the intoxication syndrome is moderately expressed. Body temperature is normal or subfebrile. By the end of the 2-3rd week, the scab is rejected with the formation (or without it) of a granulating ulcer. After it heals, a dense scar remains. The mild course of the disease ends with recovery.
In moderate and severe cases of the disease, malaise, fatigue, and headache are noted. By the end of 2 days, body temperature may rise to 39-40°C, and the activity of the cardiovascular system is disrupted. With a favorable outcome of the disease, after 5-6 days the temperature drops critically, general and local symptoms reverse, swelling gradually decreases, lymphadenitis disappears, the scab disappears by the end of the 2-4th week, the granulating ulcer heals with the formation of a scar.
The severe course of the cutaneous form may be complicated by the development of anthrax sepsis and have an unfavorable outcome.
The septic form of anthrax is quite rare. The disease begins acutely with tremendous chills and an increase in temperature to 39-40 ° C.
Already in the initial period, pronounced tachycardia, tachypnea, and shortness of breath are observed. Patients often experience pain and a feeling of tightness in the chest, a cough with the release of foamy, bloody sputum. Physically and radiologically, signs of pneumonia and effusion pleurisy (serous-hemorrhagic) are determined. Often, especially with the development of infectious-toxic shock, hemorrhagic pulmonary edema occurs. The sputum secreted by patients coagulates in the form of cherry jelly. A large number of anthrax bacteria are found in the blood and sputum.
Some patients experience sharp cutting pain in the abdomen. They are accompanied by nausea, bloody vomiting, and loose bloody stools. Subsequently, intestinal paresis develops, and peritonitis is possible.
With the development of meningoencephalitis, the consciousness of patients becomes confused, meningeal and focal symptoms appear.
Infectious-toxic shock, edema and swelling of the brain, gastrointestinal bleeding and peritonitis can cause death in the first days of the disease.

Forecast. In the cutaneous form of anthrax it is usually favorable, in the septic form it is in all cases serious.

Diagnostics. It is carried out on the basis of clinical, epidemiological and laboratory data. Laboratory diagnostics includes bacterioscopic and bacteriological methods. For early diagnosis purposes, the immunofluorescent method is sometimes used. Allergological diagnostics of anthrax are also used. For this purpose, an intradermal test with anthraxin is performed, which gives positive results after the 5th day of illness.
The material for laboratory research in the cutaneous form is the contents of vesicles and carbuncles. In the septic form, sputum, vomit, feces, and blood are examined. Research requires compliance with work rules, as for especially dangerous infections, and is carried out in special laboratories.

Treatment. Etiotropic therapy for anthrax is carried out by prescribing antibiotics in combination with anti-anthrax immunoglobulin. Penicillin is used at a dose of 6-24 million units per day until the symptoms of the disease subside (but not less than 7-8 days). In case of septic form, it is advisable to use cephalosporins 4-6 g per day, chloramphenicol sodium succinate 3-4 g per day, gentamicin 240-320 mg per day. The choice of dose and combination of drugs is determined by the severity of the disease. Immunoglobulin is administered in a dose of 20 ml for mild forms, and 40-80 ml for moderate and severe cases. The course dose can reach 400 ml.
In the pathogenetic therapy of anthrax, colloid and crystalloid solutions, plasma, and albumin are used. Glucocorticosteroids are prescribed. Treatment of infectious-toxic shock is carried out in accordance with generally accepted techniques and means.
For the skin form, local treatment is not required, but surgical interventions can lead to generalization of the process.

Prevention. Preventive measures are carried out in close contact with the veterinary service. Of primary importance are measures to prevent and eliminate morbidity in farm animals. Identified sick animals should be isolated and their corpses burned; contaminated objects (stalls, feeders, etc.) must be disinfected.
To disinfect wool and fur products, the steam-formalline method of chamber disinfection is used.
Persons who have been in contact with sick animals or infectious material are subject to active medical observation for 2 weeks. If the development of the disease is suspected, antibacterial therapy is carried out.
Vaccination of people and animals is important, for which dry live vaccine is used.

Cholera

Cholera is an acute, anthroponotic infectious disease caused by Vibrio cholerae, with a fecal-oral transmission mechanism, occurring with the development of dehydration and demineralization as a result of watery diarrhea and vomiting.

Etiology. The causative agent of cholera - vibrio cholerae - is represented by two biovars - V. cholerae biovar (classical) and V. cholerae biovar El-Tor, similar in morphological and tinctorial properties.

Cholera vibrios have the appearance of small, sized (1.5-3.0) x (0.2-0.6) microns, curved rods with a polarly located flagellum (sometimes with 2 flagella), providing high mobility of pathogens, which is used for their identification, do not form spores or capsules, are gram-negative, stain well with aniline dyes. Toxic substances have been found in Vibrio cholerae.

Vibrios cholerae are highly sensitive to drying, ultraviolet irradiation, and chlorine-containing preparations. Heating to 56 °C kills them in 30 minutes, and boiling kills them instantly. They can be preserved for a long time at low temperatures and in the organisms of aquatic organisms. Vibrios cholerae are highly sensitive to tetracycline derivatives, ampicillin, and chloramphenicol.

Epidemiology. Cholera is an anthroponotic intestinal infection prone to pandemic spread. The reservoir and source of pathogens is an infected person who releases cholera vibrios with feces into the external environment. Vibrio excretors are patients with typical and erased forms of cholera, cholera convalescents and clinically healthy vibrio carriers. The most intense source of pathogens are patients with a clearly expressed clinical picture of cholera, who in the first 4-5 days of illness release up to 10-20 liters of feces into the external environment per day, containing 106 - 109 vibrios per ml. Patients with mild and erased forms of cholera excrete a small amount of feces, but remain in the group, which makes them epidemically dangerous.

Convalescent vibrio carriers release pathogens on average for 2-4 weeks, transient carriers - 9-14 days. Chronic carriers of V. cholerae can shed pathogens for a number of months. Lifelong carriage of vibrios is possible.

The mechanism of cholera infection is fecal-oral, realized through water, nutritional and contact-household routes of infection. The leading route of transmission of cholera pathogens, leading to the epidemic spread of the disease, is water. Infection occurs both when drinking contaminated water and when using it for household purposes - for washing vegetables, fruits and when swimming. Due to urbanization processes and insufficient levels of wastewater treatment and disinfection, many surface water bodies can become an independent contaminating environment. Facts have been established of repeated isolation of El Tor vibrios after exposure to disinfectants from sludge and mucus of the sewer system, in the absence of patients and carriers. All of the above allowed P.N. Burgasov to come to the conclusion that sewer discharges and infected open water bodies are the habitat, reproduction and accumulation of El Tor vibrios.

Foodborne cholera outbreaks usually occur among a limited number of people who consume contaminated food.

It has been established that the inhabitants of various bodies of water (fish, shrimp, crabs, mollusks, frogs and other aquatic organisms) are capable of accumulating and preserving El Tor cholera vibrios in their bodies for quite a long time (acting as a temporary reservoir of pathogens). Eating hydrobionts (oysters, etc.) without careful heat treatment led to the development of the disease. Food epidemics are characterized by an explosive onset with immediately emerging foci of the disease.

Infection with cholera is also possible through direct contact with a patient or a vibrio carrier: the pathogen can be brought into the mouth by hands contaminated with vibrios, or through objects infected with the secretions of patients (linen, dishes and other household items). The spread of cholera pathogens can be facilitated by flies, cockroaches and other household insects. Outbreaks of the disease caused by contact and household infection are rare and are characterized by slow spread.

There is often a combination of various transmission factors causing mixed outbreaks of cholera.

Cholera, like other intestinal infections, is characterized by seasonality with an increase in the incidence rate in the summer-autumn period of the year due to the activation of pathogen transmission routes and factors (drinking large amounts of water, an abundance of vegetables and fruits, bathing, “fly factor”, etc. .).

Susceptibility to cholera is general and high. The transferred disease leaves behind a relatively stable species-specific antitoxic immunity. Repeated cases of the disease are rare, although they do occur.

Pathogenesis. Cholera is a cyclic infection that leads to significant loss of water and electrolytes with intestinal contents due to the predominant damage to the enzyme systems of enterocytes. Cholera vibrios entering through the mouth with water or food partially die in the acidic environment of the gastric contents, and partially, bypassing the acidic barrier of the stomach, enter the lumen of the small intestine, where they multiply intensively due to the alkaline reaction of the environment and the high content of peptone. Vibrios are localized in the superficial layers of the mucous membrane of the small intestine or in its lumen. Intensive reproduction and destruction of vibrios is accompanied by the release of large amounts of endo- and exotoxic substances. The inflammatory reaction does not develop.

Clinical picture. The clinical manifestations of cholera caused by Vibrio species, including classical Vibrio El Tor, are similar.

The incubation period ranges from several hours to 5 days, averaging about 48 hours. The disease can develop in typical and atypical forms. In a typical course, mild, moderate and severe forms of the disease are distinguished according to the degree of dehydration. With an atypical course, erased and fulminant forms are distinguished. With El Tor cholera, a subclinical course of the infectious process in the form of vibrio carriage is often observed.

In typical cases, the disease develops acutely, often suddenly: at night or in the morning, patients feel an imperative urge to defecate without tenesmus and abdominal pain. Discomfort, rumbling and transfusion around the navel or lower abdomen are often noted. The stool is usually profuse, the bowel movements initially have a fecal character with particles of undigested food, then become liquid, watery, yellow in color with floating flakes, and then lighten, taking on the appearance of odorless rice water, with the smell of fish or grated potatoes. In case of mild disease, there may be from 3 to 10 bowel movements per day. The patient's appetite decreases, thirst and muscle weakness quickly appear. Body temperature usually remains normal; a number of patients develop low-grade fever. Upon examination, you can detect increased heart rate and dry tongue. The abdomen is retracted, painless, rumbling and fluid transfusion along the small intestine are detected. With a favorable course of the disease, diarrhea lasts from several hours to 1-2 days. Fluid loss does not exceed 1-3% of body weight (I degree of dehydration). The physical and chemical properties of blood are not affected. The disease ends in recovery. As the disease progresses, there is an increase in the frequency of stools (up to 15-20 times a day), the bowel movements are copious, watery in the form of rice water. Usually accompanied by repeated profuse vomiting “fountain” without nausea and pain in the epigastrium. Vomit quickly becomes watery with a yellowish discoloration due to the admixture of bile (Greek chole rheo - “flow of bile”). Profuse diarrhea and repeated profuse vomiting quickly, over several hours, lead to severe dehydration (II degree of dehydration) with a loss of fluid amounting to 4-6% of the patient’s body weight.

The general condition is deteriorating. Muscle weakness, thirst, and dry mouth increase. Some patients experience short-term cramps in the calf muscles, feet and hands, and diuresis decreases. Body temperature remains normal or low-grade. The skin of patients is dry, its turgor is reduced, and unstable cyanosis is often observed. The mucous membranes are also dry, and hoarseness often occurs. Characterized by increased heart rate and decreased blood pressure, mainly pulse pressure. Disturbances in the electrolyte composition of the blood are not permanent.

In the absence of rational and timely therapy, fluid loss often reaches 7-9% of body weight within a few hours (III degree of dehydration). The condition of the patients progressively worsens, signs of pronounced exicosis develop: facial features become sharper, the eyes become sunken, the dryness of the mucous membranes and skin increases, it wrinkles on the hands (“washerwoman’s hands”), the muscular relief of the body also increases, aphonia is expressed, tonic spasms of individual muscle groups appear . Severe arterial hypertension, tachycardia, and widespread cyanosis are noted. Oxygen deficiency in tissues aggravates acidosis and hypokalemia. As a result of hypovolemia, hypoxia and loss of electrolytes, glomerular filtration in the kidneys decreases and oliguria occurs. Body temperature is normal or reduced.

With the progressive course of the disease in untreated patients, the amount of fluid lost reaches 10% of body weight or more (IV degree of dehydration), and decompensated dehydration shock develops. In severe cases of cholera, shock may develop during the first 12 hours of illness. The condition of patients is steadily deteriorating: profuse diarrhea and repeated vomiting, observed at the beginning of the disease, are reduced or completely stopped during this period. Severe diffuse cyanosis is characteristic; often the tip of the nose, ears, lips, and marginal edges of the eyelids become purple or almost black in color. Facial features become even more sharpened, cyanosis appears around the eyes (symptom of “dark glasses”), eyeballs are deeply sunken, turned upward (symptom of “setting sun”). The patient’s face shows suffering and a plea for help – facies chorelica. The voice is silent, consciousness is preserved for a long time. Body temperature drops to 35-34 °C. The skin is cold to the touch, easily gathers into folds and does not straighten out for a long time (sometimes within an hour) - “cholera fold”. The pulse is arrhythmic, weak in filling and tension (thread-like), almost not palpable. Tachycardia is pronounced, heart sounds are almost inaudible, blood pressure is practically undetectable. Shortness of breath increases, breathing is arrhythmic, shallow (up to 40-60 breaths per minute), ineffective. Patients often breathe with an open mouth due to suffocation; the muscles of the chest are involved in the act of breathing. Tonic cramps spread to all muscle groups, including the diaphragm, which leads to painful hiccups. The abdomen sinks, is painful during muscle cramps, and is soft. Anuria usually occurs.

Dry cholera occurs without diarrhea and vomiting, and is characterized by an acute onset, rapid development of dehydration shock, a sharp drop in blood pressure, increased breathing, aphonia, anuria, cramps of all muscle groups, meningeal and encephalitic symptoms. Death occurs within a few hours. This form of cholera is very rare in weakened patients.

In the fulminant form of cholera, a sudden onset and rapid development of dehydration shock with severe dehydration of the body are observed.

Forecast. With timely and adequate therapy, the mortality rate is favorable and close to zero, but it can be significant in the fulminant form and delayed treatment.

Diagnostics. The diagnosis is based on a combination of anamnestic, epidemiological, clinical and laboratory data.

Treatment. Patients with all forms of cholera are subject to mandatory hospitalization in hospitals (specialized or temporary), where they receive pathogenetic and etiotropic therapy.

The main focus of treatment is the immediate replenishment of water and electrolyte deficiency - rehydration and remineralization using saline solutions.

Simultaneously with rehydration measures, patients with cholera are given etiotropic treatment - tetracycline is prescribed orally (for adults, 0.3-0.5 g every 6 hours) or chloramphenicol (for adults, 0.5 g 4 times a day) for 5 days. In severe cases of the disease with vomiting, the initial dose of antibiotics is administered parenterally. While taking antibiotics, the severity of diarrhea syndrome becomes less, and therefore the need for rehydration solutions is almost halved.

Patients with cholera do not need a special diet and, after vomiting stops, should receive regular food in a slightly reduced volume.

Patients are usually discharged from the hospital on the 8-10th day of illness after clinical recovery and three negative results of bacteriological examination of stool and a single examination of bile (portions B and C).

Prevention. The system of measures for the prevention of cholera is aimed at preventing the introduction of this infection into our country from disadvantaged areas, implementing epidemiological surveillance and improving the sanitary and communal condition of populated areas.

For the purpose of specific prevention, cholerogen is used - an toxoid, which in vaccinated people in 90-98% of cases causes not only the production of vibriocidal antibodies, but also antitoxins in high titers. Vaccinations are performed once with a needleless injector in a dose of 0.8 ml of the drug for adults. Revaccination according to epidemiological indications can be carried out no earlier than 3 months after primary vaccination. A more effective oral vaccine has been developed.

Plague

Plague is an acute natural focal transmissible disease caused by Y. pestis, characterized by fever, severe intoxication, serous-hemorrhagic inflammation in the lymph nodes, lungs and other organs, as well as sepsis. It is a particularly dangerous quarantine (conventional) infection, which is subject to the International Health Regulations. Carrying out scientifically based anti-plague measures in the 20th century. made it possible to eliminate plague epidemics in the world, but sporadic cases of the disease are recorded annually in natural foci.

Etiology. The causative agent of plague yersinia pestis belongs to the genus yersinia of the family Enterobacteriaceae and is a stationary ovoid short rod measuring 1.5-0.7 microns. The stability of the plague causative agent outside the body depends on the nature of the environmental factors affecting it. As the temperature decreases, the survival time of bacteria increases. At a temperature of –22 °C, bacteria remain viable for 4 months. At 50-70 °C the microbe dies after 30 minutes, at 100 °C - after 1 minute. Conventional disinfectants in working concentrations (sublimate 1:1000, 3-5% Lysol solution, 3% carbolic acid, 10% milk of lime solution) and antibiotics (streptomycin, chloramphenicol, tetracyclines) have a detrimental effect on Y. pestis.

Epidemiology. There are natural, primary (“wild plague”) and synanthropic (anthropurgic) foci of plague (“city”, “port”, “ship”, “rat”). Natural foci of diseases developed in ancient times. Their formation was not connected with man and his economic activities. The circulation of pathogens in natural foci of vector-borne diseases occurs between wild animals and blood-sucking arthropods (fleas, ticks). A person entering a natural focus can become infected with the disease through the bites of blood-sucking arthropods that carry the pathogen, or through direct contact with the blood of infected commercial animals. About 300 species and subspecies of rodents carrying the plague microbe have been identified. In rats and mice, plague infection often occurs in a chronic form or in the form of asymptomatic carriage of the pathogen. The most active carriers of plague pathogens are the rat flea, the flea of ​​human dwellings and the marmot flea. Infection of humans with plague occurs in several ways: transmissible - through the bites of infected fleas, contact - when skinning infected commercial rodents and cutting the meat of infected camels; nutritional – when eating foods contaminated with bacteria; aerogenic – from patients with pneumonic plague. Patients with pneumonic plague are the most dangerous to others. Patients with other forms may pose a threat if there is a sufficient flea population.

Pathogenesis is largely determined by the mechanism of infection transmission. Primary affect at the site of implementation is usually absent. With the flow of lymph, plague bacteria are carried to the nearest regional lymph nodes, where they multiply. Serous-hemorrhagic inflammation develops in the lymph nodes with the formation of a bubo. Loss of the lymph node's barrier function leads to generalization of the process. Bacteria are hematogenously spread to other lymph nodes and internal organs, causing inflammation (secondary buboes and hematogenous foci). The septic form of plague is accompanied by ecchymoses and hemorrhages in the skin, mucous and serous membranes, and the walls of large and medium-sized vessels. Severe degenerative changes in the heart, liver, spleen, kidneys and other internal organs are typical.

Clinical picture. The incubation period of the plague is 2-6 days. The disease, as a rule, begins acutely, with severe chills and a rapid increase in body temperature to 39-40 ° C. Chills, feeling of heat, myalgia, painful headache, dizziness are the characteristic initial signs of the disease. The face and conjunctiva are hyperemic. The lips are dry, the tongue is swollen, dry, trembling, covered with a thick white coating (as if rubbed with chalk), enlarged. Speech is slurred and unintelligible. Typically toxic damage to the nervous system, expressed to varying degrees. Damage to the cardiovascular system is detected early, tachycardia (up to 120-160 beats per minute), cyanosis and pulse arrhythmia appear, and blood pressure decreases significantly. Seriously ill patients experience bloody or coffee-ground-colored vomiting and loose stools with mucus and blood. An admixture of blood and protein is found in the urine, and oliguria develops. The liver and spleen are enlarged.

Clinical forms of plague:

A. Mainly local forms: cutaneous, bubonic, cutaneous-bubonic.

B. Internally disseminated, or generalized forms: primary septic, secondary septic.

B. Externally disseminated (central, often with abundant external dissemination): primary pulmonary, secondary pulmonary, intestinal.

The intestinal form is not recognized as an independent form by most authors.

Erased, mild, subclinical forms of plague are described.

Skin form. At the site of pathogen penetration, changes occur in the form of necrotic ulcers, boils, and carbuncles. Necrotic ulcers are characterized by a rapid, sequential change of stages: spot, vesicle, pustule, ulcer. Plague skin ulcers are characterized by a long course and slow healing with the formation of a scar. Secondary skin changes in the form of hemorrhagic rashes, bullous formations, secondary hematogenous pustules and carbuncles can be observed in any clinical form of plague.

Bubonic form. The most important sign of the bubonic form of plague is the bubo - a sharply painful enlargement of the lymph nodes. As a rule, there is only one bubo; less often, two or more buboes develop. The most common locations of plague buboes are the inguinal, axillary, and cervical areas. An early sign of a developing bubo is severe pain, forcing the patient to take unnatural positions. Small buboes are usually more painful than larger ones. In the first days, individual lymph nodes can be felt at the site of the developing bubo; later they become fused with the surrounding tissue. The skin over the bubo is tense, becomes red, and the skin pattern is smoothed out. No lymphangitis is observed. At the end of the stage of bubo formation, the phase of its resolution begins, which occurs in one of three forms: resorption, opening and sclerosis. With timely initiation of antibacterial treatment, complete resorption of the bubo often occurs within 15-20 days or its sclerosis. In terms of the severity of the clinical course, the first place is occupied by cervical buboes, then axillary and inguinal ones. The axillary plague poses the greatest danger due to the threat of developing secondary pneumonic plague. In the absence of adequate treatment, mortality in the bubonic form ranges from 40 to 90%. With early antibacterial and pathogenetic treatment, death rarely occurs.

Primary septic form. It develops rapidly after a short incubation, ranging from several hours to 1-2 days. The patient feels chills, body temperature rises sharply, severe headache, agitation, and delirium appear. Possible signs of meningoencephalitis. A picture of infectious-toxic shock develops, and coma quickly sets in. The duration of the disease is from several hours to three days. Cases of recovery are extremely rare. Patients die due to severe intoxication, severe hemorrhagic syndrome, and increasing cardiovascular failure.

Secondary septic form. It is a complication of other clinical forms of infection, characterized by an extremely severe course, the presence of secondary foci, buboes, and pronounced manifestations of hemorrhagic syndrome. Lifetime diagnosis of this form is difficult.

Primary pulmonary form. The most severe and epidemiologically most dangerous form. There are three main periods of the disease: the initial period, the height of the period and the soporous (terminal) period. The initial period is characterized by a sudden rise in temperature, accompanied by severe chills, vomiting, and severe headache. At the end of the first day of illness, cutting pain in the chest, tachycardia, shortness of breath, and delirium appear. The cough is accompanied by the release of sputum, the amount of which varies significantly (from a few “spits” with “dry” plague pneumonia to a huge mass with the “profuse wet” form). At first, the sputum is clear, glassy, ​​viscous, then it becomes foamy, bloody and, finally, bloody. Thin consistency of sputum is a typical sign of pneumonic plague. A huge amount of plague bacteria is released with sputum. Physical data are very scarce and do not correspond to the general serious condition of the patients. The peak period of the disease lasts from several hours to 2-3 days. Body temperature remains high. Noteworthy are facial hyperemia, red, “bloodshot” eyes, severe shortness of breath and tachypnea (up to 50-60 breaths per minute). Heart sounds are muffled, pulse is frequent, arrhythmic, blood pressure is reduced. As intoxication increases, the depressed state of patients is replaced by general excitement, and delirium appears. The terminal period of the disease is characterized by an extremely severe course. Patients develop a stuporous state. Shortness of breath increases, breathing becomes shallow. Blood pressure is almost undetectable. The pulse is rapid, thread-like. Petechiae and extensive hemorrhages appear on the skin. The face becomes blue, and then an earthy gray color, the nose is pointed, the eyes are sunken. The patient experiences fear of death. Later, prostration and coma develop. Death occurs on the 3-5th day of illness with increasing circulatory failure and, often, pulmonary edema.

Secondary pulmonary form. Develops as a complication of bubonic plague, clinically similar to primary pneumonic plague. Plague in vaccinated patients. It is characterized by an extension of the incubation period to 10 days and a slowdown in the development of the infectious process. During the first and second days of the disease, the fever is low-grade, general intoxication is mild, and the condition of the patients is satisfactory. The bubo is small in size, without pronounced manifestations of periadenitis. However, the symptom of sharp pain in the bubo always persists. If these patients do not receive antibiotic treatment for 3-4 days, then the further development of the disease will be no different from the clinical symptoms in unvaccinated patients.

Forecast. Almost always serious. A decisive role in recognizing plague is played by laboratory diagnostic methods (bacterioscopic, bacteriological, biological and serological), carried out in special laboratories operating in accordance with instructions on the operating hours of anti-plague institutions.

Treatment. Plague patients are subject to strict isolation and mandatory hospitalization. The main role in etiotropic treatment belongs to antibiotics - streptomycin, tetracycline drugs, chloramphenicol, prescribed in large doses. Along with antibacterial treatment, detoxification pathogenetic therapy is carried out, including the introduction of detoxification liquids (polyglucin, rheopolyglucin, hemodez, neocompensan, albumin, dry or native plasma, standard saline solutions), diuretics (furosemide, or lasix, mannitol, etc.) - if there is a delay fluids in the body, glucocorticosteroids, vascular and respiratory analeptics, cardiac glycosides, vitamins. Patients are discharged from the hospital with complete clinical recovery and negative results of bacteriological control.

Prevention. In Russia, and earlier in the USSR, the world's only powerful anti-plague system was created, which carries out preventive and anti-epidemic measures in natural plague foci.

Prevention includes the following measures:

a) prevention of human diseases and outbreaks in natural areas;

b) preventing infection of persons working with material infected or suspected of being infected with plague;

c) preventing the importation of plague into the country from abroad.

^ Procedure for using a protective (anti-plague) suit A protective (anti-plague) suit is designed to protect against infection by pathogens of particularly dangerous infections in all their main types of transmission. An anti-plague suit consists of pajamas or overalls, socks (stockings), slippers, a scarf, an anti-plague robe, a hood (large scarf), rubber gloves, rubber (tarpaulin) boots or deep galoshes, a cotton gauze mask (dust respirator, filtering or oxygen - insulating gas mask), flight-type safety glasses, towels. An anti-plague suit can, if necessary, be supplemented with a rubberized (polyethylene) apron and the same sleeves. ^ The procedure for putting on an anti-plague suit: overalls, socks, boots, hood or large headscarf and anti-plague robe. The ribbons at the collar of the robe, as well as the belt of the robe, must be tied in front on the left side with a loop, after which the ribbons are secured to the sleeves. The mask is put on the face so that the nose and mouth are covered, for which the upper edge of the mask should be at the level of the lower part of the orbits, and the lower edge should go under the chin. The upper straps of the mask are tied with a loop at the back of the head, and the lower ones - at the crown (like a sling bandage). Having put on a mask, cotton swabs are placed on the sides of the wings of the nose and all measures are taken to ensure that air does not get in outside the mask. The lenses of the glasses must first be rubbed with a special pencil or a piece of dry soap to prevent them from fogging up. Then put on gloves, having first checked them for integrity. A towel is placed in the waistband of the robe on the right side. Note: if it is necessary to use a phonendoscope, it is worn in front of a hood or a large scarf. ^ Procedure for removing the anti-plague suit: 1. Wash your gloved hands thoroughly in a disinfectant solution for 1-2 minutes. Subsequently, after removing each part of the suit, gloved hands are immersed in a disinfectant solution. 2. Slowly remove the towel from your belt and dump it into a basin with a disinfectant solution. 3. Wipe the oilcloth apron with a cotton swab, generously moistened with a disinfectant solution, remove it, folding it from the outside inward. 4. Remove the second pair of gloves and sleeves. 5. Without touching the exposed parts of the skin, remove the phonendoscope. 6. The glasses are removed with a smooth movement, pulling them forward, up, back, behind the head with both hands. 7.The cotton-gauze mask is removed without touching the face with its outer side. 8. Undo the ties of the collar of the robe, the belt and, lowering the upper edge of the gloves, untie the ties of the sleeves, remove the robe, turning the outer part of it inward. 9. Remove the scarf, carefully collecting all its ends in one hand at the back of the head. 10. Take off gloves and check them for integrity in a disinfectant solution (but not with air). 11. Boots are wiped from top to bottom with cotton swabs, generously moistened with a disinfectant solution (a separate swab is used for each boot), and removed without using hands. 12. Take off socks or stockings. 13. Take off pajamas. After removing the protective suit, wash your hands thoroughly with soap and warm water. 14. Protective clothing is disinfected after a single use by soaking in a disinfectant solution (2 hours), and when working with pathogens anthrax– autoclaving (1.5 atm – 2 hours) or boiling in a 2% soda solution – 1 hour. When disinfecting an anti-plague suit with disinfectant solutions, all its parts are completely immersed in the solution. The anti-plague suit should be removed slowly, without rushing, in a strictly established order. After removing each part of the anti-plague suit, gloved hands are immersed in a disinfectant solution.