MINISTRY OF PUBLIC HEALTH OF UKRAINEVinnitsya National Medical Pirogov Memorial University.

Department of infectious diseases

Ratified on a methodical conference“____” _____________ 2008

Chief of department, professor Moroz L.V.

M E T H O D I C A L M A T E R I A L S

for organization of self-contained work of V course medical faculty students (on the topic included in the education plan).

Topic 3.1: INTESTINAL INFECTIOUS DISEASE WITH PRIMARYLESION OF COLON: SHIGELLOSIS,

AMBIASIS.

Prepared by: assistant Oliper E.A.

2009

1. Urgency of the issue:

Among the acute infectious lesions of the digestive system take a large percentage of diseases such as shigellosis and amebiasis. In the last 10-15 years in the world there is an increase in the incidence of both acute intestinal infections (AII) in general, and in shigellosis. The reasons for this are different. Researcher also point to a significant increase in Shigellosisstrains, which are resistant to many antibiotics, and to reduce the resistance of the human body because of disease of immunity etc. The structure of one of the leading CROs place belongs acute Shigellosis, the weight on the incidence of which is presented in different countries from 6-10 to 60-70%. Beginning in 1998, the rise of the disease in Ukraine: an intensive incidence in 1999 was 68.8 per 100 thousand populations in 2001 - 54.6 and currently remains high.

The problem of amoebiasis also of particular importance in connection with the expansion of contacts with other countries, lack of alertness of physicians and knowledge of this disease makes statistical data on the incidence of amebiasis in these regions is not entirely accurate, especially as carriers of dysentery amoeba with careful examinations are in the 5-15 % of surveyed here. In our country, sporadic cases of amoebic dysentery are found mainly in the south. In the CIS countries have the most dysfunctional states of Central Asia and the Caucasus, where the carrier identified in 15-35% of the population.

2.Learning goals and objectives (with indication of the achievement level being planned):

2.1. Students should know: а=2

• Etiology of shigellosis and amebiasis, pathogenicity factors of the pathogen;• Epidemiology of these diseases;• Pathogenesis;• Clinical manifestations of shigellosis and amebiasis;• Clinical and epidemiological features of shigellosis and amebiasis;• Pathogenesis, the term of the clinical manifestations and complications of shigellosis;• Laboratory diagnosis of shigellosis and amebiasis;• Principles of treatment;• Principles of prevention;• Forecast of shigellosis and amebiasis;• Rules convalescent hospital discharge;• Rules of dispensary convalescents.

2.2. Students should be able: а=3

• Observe the basic rules of work at the bedside;

• Collect medical history to assess the epidemiological data;• Examine the patient and identify the main symptoms and syndromes of shigellosis and amebiasis, substantiate the clinical diagnosis for timely referral of patients to the hospital;• Make a differential diagnosis of shigellosis;• On the basis of clinical examination spot the potential complications of botulism emergency conditions;• Draw upon medical documentation establishing a preliminary diagnosis "shigellosis" (emergency notification in SES);• Plan the laboratory and further examination of the patient;• Interpret the results of laboratory tests;• Develop a treatment plan to epidemiological data, severity, presence of complications, allergic history, comorbidities, provide emergency pre-hospital care;• Plan and anti-prevention measures in the site of infection;• Make recommendations relating to the treatment, diet, inspection, observation in the recovery period.

3. Basic knowledge and skills necessary for subject learning (interdisciplinary integration)

Discipline To know To be able to carry outPrevious subjects

Microbiology Properties of microorganisms of the genus Shigella. Rules and terms of collection of material for the specific diagnosis

Interpret the results specific methods diagnosis of shigellosis.

Physiology Parameters of physiological standard of human organs and systems, results of laboratory investigation in normal condition (clinical blood test, urinalysis, biochemical blood assay, acid-base properties, properties of electrolytes etc).

To evaluate laboratory results.

Pathophysiology Mechanism of dysfunction of organs and systems in pathologic conditions of different genesis.

To give an interpretation to pathologic changes on the base of laboratory and clinic investigation.

Immunology and allergology

Basic concept on the subject; role of immune system in infectious process, influence on the

To evaluate the results of immunological investigations.

duration of isolation infectious organisms from the human body.

Epidemiology Main stages of epidemiological process (source, mechanism of introduction of infection, transmission routes) in Shigellosis, the prevalence of disease in the world and Ukraine.

To collect epidemiological anamnesis, to take antiepidemic and preventive measures in the center of infection.

Neurology Pathogenesis, clinical signs of nervous system.

Conduct the clinical examination of patients with lesions of the nervous system.

Dermatology Pathogenesis, clinical characteristics of exanthemas.

To identify eruption in the patient with pseudotuberculosis, enteric yersiniosis.

Propaedeutic of internal diseases

Main stages and methods of clinical examination of the patient.

To collect anamnesis, conduct the clinical examination of the patient, to detect pathological symptoms and syndromes. Analyze collected data.

Clinical pharmacology.

Pharmacokinetics and pharmacodynamics, unwanted side effects (side effects of ciprofloxacin and etc.).

To prescribe treatment depending on the age, personal traits of the patient, clinical form, severity of disease; to select the optimum administration and dosage regimen of preparations; to make out prescriptions.

Inter-subject integrationInfectious diseases Characteristics of

infectious diseases. Principles of diagnostics, treatment, preventive measures of infectious diseases. Pathogenesis, epidemiology, dynamics of clinical manifestations, laboratory diagnosis, complications, clinical features of shigellosis and amebiasis. Principles of

Make a differential diagnosis of diseases of different genesis of shigellosis and amebiasis. Recognize this disease, it complications, interpret laboratory findings. Hospitalize a patient in the infectious ward in time. Fill specials.

prevention and treatment.

Sh gellaіSh.dysenter aeі Sh.flexnerі Sh.boydіі Sh.sonneі

Etiology

Colicky pain, tenesmus,stool streaked with blood and mucus

TSS

Etiotropic therapy Pathogenetic

lassificationС

Clinic

Complications

Treatment

Pathogenesis

For the duration of the flow

By the nature of the flow

By severity

- Acute (up to 2 months.)- Long (more than 2 months.)- Chronic

- subclinical- blurred- easy- moderate- heavy

fever, headache

Watery stools, vomiting, dehydration

Hypovolemic shock Archoptoma Invagination

Enterorrhagia

EpidimiologySource - a sick man bacillicarriers. Fecal-oral transmission: water, food, household contact and transmission. Postinfectious immunity.

Penetration into the stomach

Partial loss Sh

Delivery of the toxin in the wall of the large intestine

Absorption of endotoxin in the blood

Activation into cAMF

Toxemia

Diarrhea

Hypovolemia

Sensitization of the mucous membrane of the large intestine, impaired autonomic innervation

Sh penetration into the large intestineAccumulation of toxins

Sh effect on the mucous membrane of the large intestineolitis syndromeС

Colitis form Gastroenterocolitic form

Enterocolitic form

intoxication syndrome

syndrome distal colitis

gastroenteritis syndrome

General clinical Biochemical Specific Additional

Complete blood count (ESR ↑, leukocytosis)Koprotsitogramma (mucus, nezmenennye red blood cells, white blood cells - 30-40 in n / h)

Bacteriological method

Rapid tests Serological methods (RA, IHA, PHA)

Sigmoidoscopy (if necessary)

Diagnostics

Antibacterial drugs (nitrofurans, fluoroquinolones)

Detoxification therapy, chelators, enzymes, probioticsPrevention Nonspecific

4. Structural scheme of the lesson.Shigellosis

acute (up to 3 months.)  long (up to 6 months.)  chronic (more than 6 months)

Operative therapy

Entamoebahystolytica

Small vegetative form (luminal)

Etiology

CystsBig vegetative form (Interstitial)

Pathogenetic

Classification

Clinic

Complications

Treatment

Patogenesis

For the duration of the flow By the nature of the flow By severity of the flow

mild;moderate;heavy

EpidimiologySource - carrier, at least - the patient on Kish. Amoebiasis people. Fecal-oral carry-over: water, food, domestic contact and transmission. Immunity unstable.

Carrier state

General clinical Serological Additional

General blood analysisKoprotsitogramma (glassy mucus, red blood cells, eosinophils, Charcot-Leyden crystals)

Detection and identification of vegetative forms and cystsHaemagglutination, IIR, ELISA, latex agglutinationSigmoidoscopy, irigografiya, ultrasound, CT, X-ray, puncture the abscess

Diagnostics

Antihistamines drugs, enzymes, probiotics, immunostimulю

Penetration into the stomach Cytolysis of the intestinal wall

Formation of luminal form in the large intestine

Ulceration

Amebic abscess ext. organs

Pericolitis

Penetration of cysts in the small intestine

Asymptomatic carriage

AmebomasEnterorrhagia

continuously progressed;recrudescent

According to significant clinical findings

manifest forms;subclinical

Clinical forms

Right-handed colitisExcrement as raspberry jelly Anemia AstheniaThe abscesses of the liver, lungs, brainFeverIntestinal bleedingPericolitis

Peritonitisintestinal obstruction

Chronic ulcerative colitis

Intestinal urinary ulcers D

ysbacteriosis

Breakthrough abscess

Secondary infection abscess

Etiotropic therapy

Amoebocytes direct action (yatren, osarsol)

Histionic amoebocytes (chloroquine)

Preparations of universal action (metronidazole, tinidazole)

Action in center of infectionPrevention

Isolation of patients

Examination of patientsDisinfection

Intestinal amebiasis Extraintestinal amebiasis

Parasite spectroscopy

Amebiasis

5. Classroom-based materials for self-study

5.1. Test questions for the individual interview

1.Which group of infectious diseases are shigellosis and amebiasis.2. Source of infection and transmission factors in shigellosis3. Source of infection and transmission factors for amoebiasis4. Pathogenesis of shigellosis and amebiasis.5. Classification of shigellosis.6. The main clinical symptoms of shigellosis.7. Clinical manifestations depending on the severity8. Specific complications of shigellosis.9. The differential diagnosis of shigellosis.10. Survey plan of the patient to shigellosis11. Methods for specific diagnosis of shigellosis.12. Interpretation of the results of laboratory research.13. Specific therapy of shigellosis: dose, route of administration, duration of treatment.14. Emergency care to patients with shigellosis15. Rules discharge convalescent hospital16. Prevention and measures in the hearth17. Characteristics of excretes at shigellosis18. Clinical manifestations of infectious-toxic shock.19. Clinical manifestations of gastrointestinal bleeding.20. Haemogram patient for shigellosis in the midst of illness.21. Features specific diagnosis of amebiasis.22. Diagnosis shigellosis carriers.

5.2. Tests Level 2 α = 2Version 1.

3.1.1. Pathogen, which often gives severe dysentery and shock:A. ShygelladysenteriaeB. ShygellaflexneriC. ShygellaboydiiD. Shygellasonnei

3.1.2. Name the pathogen, which frequently recorded gastroenterocolitic form of shigellosis:

A ShigellasonneiB. ShigellaflexneriC. GrigorievShigella-ShigiD. ShigellaLardzha-Sachs

3.1.3. Mechanism of infection in shigellosis:A. airborneB. transmissibleC. fecal-oral

3.1.4. Pain syndrome in shigellosis due to:A. The presence of the destructive process in the gutB. defeat neuromuscular system and bowel spasmC. Central heating nervous system lesion

3.1.5. The most characteristic changes in the intestinal mucosa in severe shigellosis Grigoriev-Shigi in the midst of the disease:

A congestionB. congestion, edema, hemorrhage, ulcersC. hyperemia, hemorrhageD. edema

3.1.6. The most characteristic mucosal changes in protracted forms of shigellosis:

A. mucosa pale pinkB. redness, swellingC. mucous thinned, pronounced vascular patternD. sores, redness

3.1.7. Characteristic changes in blood counts in chronic intestinal amebiasis:

A. Anemia, eosinophilia, monocytosis, lymphocytosis, increased ESRB. Anemia, significant leukocytosis, neytrofillezC. leukocytosisneytrofiloz, increased ESRD. Leukopenia, eosinophilia, anemiaE. No change

3.1.8. Koprotsitogramma acute manifestations of intestinal amebiasis:A. Large amount of mucus, red blood cells, eosinophils, Charcot-Leyden crystalsB. red blood cells arranged in groups in the form of columns, single leukocytesC. erythrocytes cover the entire field of view, a small amount of mucusD. Red blood cells, white blood cells cover the entire field of view, amoeba cystsE. A moderate amount of white blood cells, mucus, cysts, amoebae

3.1.9. To tissue amebotsidam enjoy the following products:A. delagilB. metronidazoleC. yatrenD. emetineE. degidroemetin

3.1.10. The source of infection for amoebiasis is:A. patients intestinal amebiasisB. healthy carriers ofC. CattleD. Patient was extraintestinalamebiasisE. Patients with any form of amebiasis

3.1.11. What methods are most useful for the diagnosis of extra-intestinal amebiasis:

A. ultrasoundB. CBCB. CTG. sigmoidoscopyD. X-ray

3.1.12. Forms of existence dysenteric amoeba in humans:A.large vegetative formB. cystsC. small vegetative formThe average vegetative formD. all of the above forms

Version 2.3.2.13. Stool in shigellosis:

A copious, watery, frothyB. frugal with mucusC. lean streaked with bloodD. mushy with mucus and bloodE. frugal with mucus and blood

3.2.14. The most characteristic symptoms of clinical shigellosis:A. acute onset, abdominal pain, vomiting, frequent stool looks like porridge, possible constipationB. acute onset, chills, fever, nausea and sometimes vomiting, abdominal pain, cramping, stool with mucus, sometimes with blood, spasm of the distal colon, tenesmusC. gradual initiation, intoxication, fever, diffuse abdominal pain, frequent stools fecal character, tenderness along the bowel palpation

3.2.15. Full duration of morphological and functional recovery of the mucous distal colon with moderate during acute shigellosis:

A.few monthsB. 2-3 monthsC. 6 months or more

3.2.16. To confirm the diagnosis of acute shigellosis must:A. presence of tenesmusB. presence of frequent watery stools with mucus and bloodC. paintingsproctosigmoiditis with sigmoidoscopyD. presence in feces of a patient with diarrhea syndrome Shigella

3.2.17. The most virulent Shigella:A. SonneB. FlexnerV. Grigoriev, Shigi

3.2.18. Pathogen that primarily promotes colitis forms of shigellosis:A. Shigella NewcastleB. Shigella Fittings-SchmitzB. ShigellaflexneriG. ShigellaLardzha-Sachs

3.2.19. Onset of the disease with a typical course of amebiasis:A. gradualB. acuteC. subacuteD. acute with the rapid development clinicE. latent

3.2.20. Enter the complication of intestinal amebiasis:

A. pericolitisB. bowel perforationC. dehydration shockD. toxic shockE. intestinal bleeding

3.2.21. The material for the study parasitescopic intestinal amebiasis is:A.bloodB. urineC. fecesD. pus from the surface of ulcers, collected at sigmoidoscopyE. all of the above

3.2.22. Characteristic changes in the mucous membrane of the large intestine in acute amoebiasis:

A.mucous membrane is not changed, with swollen sores, saped edges fringed area congestion, the bottom is covered with pus and necrotic massesB. language of different diameter, cysts, polyps, amoebomaC. mucosa swollen, hyperemic, bleeding, ulcers on the surface fibrinous raids, enterospasmD. Poverty vascular pattern, single ulcer, "velvety" mucosa, contact and spontaneous bleedingE. No change

3.2.23. What are human pathogenic amoebae:A. EntamoebahartmannіB. EntamoebahіstolytіcaC. EntamoebacolіD. nanaEndolіmaxE. Jodamoebabutschlіі

3.2.24. Byamebotsiduniversal action are the following:A. yatrenB. metronidazoleC. diyodohinD. tinidazoleE. delagil

Version 3.3.3.25. Diarrhea, acute shigellosis due to:

A. intoxicationB. bowel dysfunctionC. activation of adenylatecyclase and increased production cyclophosphate intestinal juice

3.3.26. Mucosal changes in severe acute shigellosis on the 2nd day of the disease:

A normal mucosaB. presence of ulcers with saped edgesC. easy MucosalD. hyperemia

3.3.27. The duration of acute shigellosis (morphological)A.fortnight

B. one monthC. up to two monthsD. to four monthsE. 1 year.

3.3.28. Colitis symptoms of shigellosis form:A. pain throughout the abdomen, loose stoolsB. vomiting, profuse watery diarrheaC. cramping abdominal painD. tenesmus

3.3.29. Clinical variant of shigellosis: cramping abdominal pain, tenesmus, loose stools with a small amount of mucus and blood streaks:

A. enteriticB. enterocoliticC. gastroenteriticD. gastroenterocoliticE. colitis

3.3.30. The duration of clinical symptoms in mild acute shigellosis:A. 2 weeksB. 4-6 weeksB. up to 1 weekG. 1-2 days

3.3.31. Characteristic changes in the intestinal mucosa in acute amoebiasis:

A possible over the entire length of the large intestineB. in the distal colonC. in the proximal colonD. deep ulcers on the background intact mucosaE. ulcers of different diameters on a background of edematous mucosa hyperemic

3.3.32. Identification in the faeces of small translucent forms of amoebae, cysts indicates:

A. acute intestinal amebiasis, during the height ofB. remission of chronic amebiasisC. exacerbation of chronic amebiasisD. carriers of amoebaeE. recovery period of acute intestinal amebiasis

3.3.33. Terms of amebiasis patient discharge from hospital:A clinical cureB. two negative results parazitoskopiiC. lack of mucus in the stool, eosinophils, Charcot-Leyden crystalsD. negativePhragmitesE. absence of ulcers in endoscopic examination of the colon

3.3.34. Faithful statements regarding clinical examination of convalescents after acute amebiasis:

A. 12 months.B. 1 month.C. Every 3 months exploring cal presence of cysts of amoebaeD. for clinical indications spend sigmoidoscopyE. Serological diagnosis (IHA, ELISA) every 3 months

3.3.35. Enter the complication of intestinal amebiasis:A. anemiaB. bowel perforationC. subdiaphragmatic abscessD. peritonitisE. intestinal bleeding

3.3.36. Identification of a large vegetative form in the feces, a material with the ulcer indicates:

A. acute intestinal amebiasisB. remission of chronic amebiasisC. exacerbation of chronic amebiasisD. carriers of amoebaeE. period of convalescence

Version 4.3.4.37. Which one of the leading modes of transmission in shigellosis sonnei:

A.contact-householdB. dustC. WaterD. sexualE. food

3.4.38. Gastroenterokoliticheskaya form of shigellosis is most often caused by Shigella:

A. sonneiB. Boris Grigoriev-ShigiC. FlexnerD. Lardzha-SachsE. Fittings-Schmitz

3.4.39. To confirm the diagnosis of acute shigellosis must:A. The presence of tenesmusB. presence of frequent watery stools with mucus and bloodC. selection of fecal shigellaD. atsigmoidoscopy - a picture proctosigmoiditisE. spastic sigmoid

3.4.40. Excrement in shigellosis remind:A. "pea" soup;B. "raspberry" jelly;C. "rice" broth;D. "rectal" spit;E. "meat" slop;

3.4.41. Ulcer healing in shigellosis is accompanied by:A. The formation of rough scars with impaired intestinalB. deformation mucousC. formation of surface scarring without affecting bowel functionD. The development of obstructionE. The development of intestinal bleeding

3.4.42. Rules discharge patients shigellosis, which do not belong to the group decreed:

A. 3 days after the normalization of bowel movements and body temperatureB. clinical recoveryC. 2 negative results of the tank. stool studiesD. 3 negative results tank. Research stool after 2 days after antibiotic therapyE. one negative result of the tank. study feces 2 days after antibiotic therapy

3.4.43. Drugs that are used to treat amebiasis Cyst carriers:A. yatrenB. osarsolC. monomitsinD. delagilE. fazizhin

3.4.44. Localization of abdominal pain in patients with uncomplicated amebiasis in the disease:

A. along the large intestineB. around the abdomenC. In the left pane,D. In the right pane,E. In the left and right page

3.4.45. The nature of faeces at amebize:A. Liquid, neobilnye with glassy mucusB. Lean, alloy lumps of mucus streaked with bloodC. Abundant green color, with lumps of mucus streaked with bloodD. melaenaE. A clearance, normal color, with streaks of blood on the surface

3.4.46. Characteristic of mature tissue-dissolving amoeba cysts:A circular shape, size 10 - 12 mm, with 12 coresB. a round or oval shape, size 14-17 mm, contains 1-2 kernelsC. round or oval in shape, size 10.12 mm, contains 3.2 kernelD. round shape, size 10.12 mm, contains 4 coresE. round, size 20 mm, contains 10 cores

3.4.47. Byamebotsidam direct owns the following medications:A. yatrenB. metronidazoleC. diyodohinD. emetineE. delagil

3.4.48. Treatment of extra-intestinal amebiasis:A. yatren, diyodohin, meksaform, aminarson, osarsolB. emetine hydrochloride delagilC. metronidazole, flag, fazizhinD. furamid, meksaform, enteroseptolE. surgical method

Version 5.3.5.49. Forgastroenterokoliticheskoy form of shigellosis is characterized by:

A.toxicity, which is the leading symptom severity;B. Dehydration, which is the leading symptom severity;C. Fever, nausea, repeated vomitingD. frequent copious stools without pathological impurities;E. scanty stools with mucus and blood;

3.5.50. Leading clinical syndromes of shigellosis are:A. Toxemia;B. Gastritis;C. Myocarditis;D. distal colitis;E. meninigizm;

3.5.51. Causal treatment of shigellosis:A. nifuroxazideB. doxycyclineC. ampicillinD. IntetriksE. furazolidone

3.5.52. Among the activities for specific diagnosis of shigellosis use the following:

A. Phragmites, TPHA, RA;B. bacterioscopy stool;C. bakposev stool;D. sigmoidoscopy;E. koprotsitogramma.

3.5.53. Pain syndrome in shigellosis caused by:A.lesion of the neuromuscular system of the intestineB. central nervous systemC. intestinalatonyD. presence of the destructive process in the gutE. enterospasm

3.5.54. Promote the development of a prolonged shigellosis:A. The presence of intestinal dysbiosis;B. irrational causal treatment;C. bacteriocarrier resistant;D. the presence of chronic diseases of the digestive system;E. gastric hyperacidity

3.5.55. Infection with amebiasis occurs when it enters the body:A small vegetative formB. large vegetative formC. cysts 2-3 nuclearD. cysts 4-coreE. small vegetative form cysts

3.5.56. Fever with moderate intestinal amebiasis:A.low-gradeB. noC. HighD. hyperpyrexiaE. febrile

3.5.57. What are the diagnostic criteria that indicate recovery of the patient amebiasis recorded at discharge:

A negative PhragmitesB. negative RACC. 2 negative results coprocystscopic researchD. Clinical recoveryE. absencehematophagous in sputum

3.5.58. Whenextraintestinalamebiasis is most often affected:A.liverB. lightC. genitalsD. brainE. pancreas

3.5.59. Typical symptoms of intestinal amebiasis:A. gastroenterocoliticB. enterokoliticC. gemokoliticD. intoxication

3.5.60. Foramebiasis is characterized by:A. anthroponosisB. zoonosisC. affects only the intestinesD. has intestinal and extra-intestinal formsE. diarrheal syndrome prevails over intoxication

Version 6.3.6.61. Which one of the leading modes of transmission in shigellosis Grigorieva-Shigi:

A contact-householdB. dustC. WaterD. genderE. food

3.6.62. Features of the flow of shigellosis in the elderly is:A. It is easy for a long period without tenesmus and flatulence;B. prolonged duration of illness;C. colitis form prevails amid a low fever;D. Were characterized by pain in the right iliac fossa and sigmoid;E. destructive and ulcerative processes in the mucous of the colon;

3.6.63. What are the symptoms that are characteristic of colitis forms of shigellosis:

A.cramping abdominal pain around the navelB. cramping abdominal pain, mainly in the left paneC. tenesmus, urgencyD. Vomiting, dehydration expressedE. liquid stool, multiple, mixed with mucus and blood

3.6.64. The most characteristic changes in the colonic mucosa in severe shigellosis Grigorieva-Shigi in the midst of the disease:

A. Hyperemia, edema

B. hyperemia, hemorrhageC. hyperemiaD. edema, hyperemia, hemorrhage, ulcersE. ulcers of different diameter, cysts, polyps

3.6.65. Tactics doctor's patient shigellosis and contact who live in the hostel:

A hospitalized patientB. hospitalization contactC. Bak.obsledovanie contact, monitor hotbed for 7 daysD. send a message to SESE. treatment in KIZ residence provided mildly ill

3.6.66. Diarrhea syndrome in shigellosis caused by:A. The presence of the cytotoxin;B. activation of prostaglandins;C. increase in intracellular c-AMP;D. secretion IgA;E. activation transport of water and electrolytes;

3.6.67. What are human pathogenic amoebae:A. EntamoebahartmannіB. EntamoebahіstolytіcaC. EntamoebacolіD. nanaEndolіmaxE. Entamoebabutschlіі

3.6.68. Byamebotsidam universal action are the following:A. yatrenB. metronidazoleC. diyodohinD. tinidazoleE. delagil

3.6.69. Characteristic changes in the intestinal mucosa in acute amoebiasis:

A. the entire length of the colonB. in the distal colonC. in the proximal colonD. sores on the mucous background unchangedE. ulcers of different diameters on the background edematous, hyperemic mucosa

3.6.70. Enter the complication of intestinal amebiasis:A. pericolitisB. bowel perforationC. dehydration shockD. toxic shockE. intestinal bleeding

3.6.71. The material for the study parazitoskopicheskogo intestinal amebiasis is:

A.bloodB. urineC. fecesD. pus from the surface of ulcers, collected at sigmoidoscopy

E. all of the above named3.6.72. Characteristic changes in the colonic mucosa in acute amoebiasis:

A.mucous membrane is not changed, with swollen sores, saped edges fringed area congestion, the bottom is covered with pus and necrotic massesB. ulcers of different diameter, cysts, polyps, amoebomaC. mucosa edematous, hyperemic, bleeding, ulcers on the surface layers of fibrinous, intestinal crampsD. Poverty vascular pattern, single ulcer, "velvety" mucosa, contact and spontaneous bleedingE. no change

5.3. List of educational practical tasks that must be done on a practical lesson:

• Master the methods of examination of the patient to shigellosis and amebiasis• Conduct Supervision patient for shigellosis and amebiasis• Conduct a differential diagnosis of salmonellosis and shigellosis HTІ• Make a plan of laboratory examination• Interpret the results of a specific survey of the patient to shigellosis and amebiasis• Recognize the complications of shigellosis, amebiasis.• Develop a treatment plan for the patient shigellosis, amebiasis.• Identify medical tactics in case of emergency.• Making medical records upon diagnosis "Shigella".

5.4. Professional algorithm for formation skills and experience in diagnostics of Shigellosis.

№ Tasks Sequence of actions Notices and warnings concerning self-control1.

2.

To master the methods for clinical examination of patients with Shigellosis.

To carry out curation of the patient

I. Inquire into patient complaints.

II. To clarify the anamnesis:1. Anamnesis of illness2. Anamnesis of life3. Epidemic anamnesis

III. Conduct an objective

Separation of the complaints which are characteristic for the following syndromes:- general intoxication- organic lesions- Lesions of the gastrointestinal tract

To pay attention to acute onset of disease; time, sequence of development, dynamics of - Fever;- Pain in the abdomen, its localization;- Tenesmus, false urge to defecate;- The nature of bowel movements;- Other symptoms

To determine previous diseases. Identify data related to the implementation of the fecal-oral transmission.use not thermally processed foods.

Severity, symptoms are caused by the

examination.

1. Appearance:- The patient;- The skin, mucous membranes;

2. Digestive System:

- Examination of the language;- Palpation of the abdomen;- Characteristics of faeces.

3. Cardiovascular system:- The pulse;- Blood pressure- Auscultation of the heart.4. Respiratory system5. Urinary system

dynamics of the duration and severity of the disease. Pay attention to: -General weakness;- Temperature of the body; - Pale, dry skin and mucous membranes; - Skin turgor;

Pay attention to:- The presence of vomiting;- Coated tongue;- Spasm, thickened and painful especially the sigmoid colon;

- In the form of colitis excrements gradually lose their fecal character, have mucus and streaks of blood, sometimes in the form of "rectal spittle"- In the form of gastroenterocolitic- frequent, watery stools with undigested food, and later - with mucus and blood streaks.

Pay attention to:- Moderate tachycardia;- Moderate decrease in blood pressure- Moderate deafness heart tones.

No singularitiesPay attention to:Possible dysuric manifestations

3. To prescribe laboratory and additional investigations, to interpret the results.

1. General blood test.

2. General urinalysis.

3. Koprotsitogramma.

4. Biochemical methods.

5.Bacteriological examination stool (with gastroenterocolitic form-study may vomit

6. Express diagnostics: - fluorescence microscopy;- Radioimmunoassay (RIA)

7. Serological methods:  - RA

- Phragmites

Pay attention to: - neutrophilic leukocytosis with a shift to the left leukocyte - increased ESRIn severe - proteinuria, red blood cell, leukocyturia.Mucus, white blood cells, red blood cells, epithelial cells on microscopic examination.At the height - the reduction in total protein and albumin, increased globulins.at intervals of 10 days

The result depends on the technique, the multiplicity of periods fence and planting material. The latter should be done as early as possible, certainly before the start of antimicrobial treatment, feces collected in dishes without disinfectant and immediately sent to the laboratory. For crop use Ploskireva Wednesday, Levin, Endo, J. baktoagar.

Identification of Shigellosis antigen in stool with anti shigellosis gluten-free serum, adsorption on activated carbon.

7. Alergologic diagnostics:- The sample Tserukalova

8. Additional methods:- sigmoidoscopy

Specific. Diagnostic titer of 1:400 in shigellosis Flexner, for other pathogens - 1:100.Minimum diagnostic titer - 1:160.Currently not used (low specificity)Catarrhal phenomena, erosive and ulcerative proctosigmoiditis. Shown for diagnostic purposes.

Professional algorithm for formation skills and experience in diagnostics of Amebiasis.№ Tasks Sequence of actions Notices and warnings concerning self-control1.

2.

Master the technique of clinical examination of the patient amebiasis

Conduct supervisionpatient

І. Clarify patient complaints.

ІІ.Find out history:1. Anamnesis of illness

2. Anamnesis of life3. Epidemic anamnesis

III. Conduct an objective examination.

1. Appearance:- The patient;

- The skin, mucous membranes;2. Digestive System:- Examination of the language;- Palpation of the abdomen;

- Characteristics of faeces.3. Cardio - vascular system:4. Respiratory system:

- Auscultation of the lungs:

Highlightcomplaintsthatcharacterizethesyndromes:- hemorrhagiccolitiswith a tendencytorecurrent;- Generalintoxication;- OrgandamagePayattentiontothebeginning, thetermofthesequenceofsymptoms, theirdynamics:- Fatigue;- Temperatures- Painintheabdomen, itslocalization;- Thenatureofbowelmovements;- OthersymptomsIdentifybornediseases.Identifydatarelatedtotheimplementationofthefecal-oraltransmission.Payattentiontothepatient'sstayintropicalandsubtropicalregionsinthelocalitywith a poorwatersupply.Remember: thepresence, dynamicsofsymptomscausedby a periodandtheseverityofthediseasedependsonthepatient'sage.

Payattentionto:-generalweakness;- Thetemperatureofthebody;- Weightloss, asthenia- Pallor, jaundicepossible- Intheformofskin - thepresenceoferosionsandulcerswithblackedgesintheperianalregion, inthecrotchandbuttocks.Payattentionto:- Coatedtongue;- Painalongthelargeintestine, mostlyblindandascending, theyspasm;- Hepatomegaly (mainlyduetotherightlobe)- Infrequent bowel movements, a significant amount of glassy mucus krovyu ("raspberry jelly") - Sequential change of diarrhea and constipation (chronic intestinal amebiasis)

Changes in non-specific.

5. Nervous SystemChanges in extraintestinal amebiasis:Pay attention to:- The presence of cough,3. Assign

additional research laboratory and interpreting the results.

1.General blood.

2.The common urine analysis.3. Koprotsitogramma.

4. Biochemical methods.5. Scopic study of the parasite (feces, pus, sobrannny with ulcers)

6. Parasitological examination (optional method).7. Serologichnye methods:- Phragmites- IEA- RNIF8. Additional methods:- sigmoidoscopy

- ergography

- Ultrasound- Chest X-ray

In acute amoebiasis - changes are generally not available. In chronic - hypochromic anemia, eosinophilia, monocytosis, lymphocytosis, accelerated ESR. When liver abscess - neutrophilic leukocytosis with zdvigom right ESR acceleration. With typical flow - no changes.In a lot of glass-like mucus, red blood cells, eosinophils, Charcot-Leyden Crystal.With typical flow - no changes.Examine natively processed Lugol solution or jellyhematoxin (for Gandengaynom) samples:- In acute intestinal amebiasis or exacerbation of chronic matters identify large vegetative form.- The convalescents, in remission of chronic amebiasis, the carriers are fine Way form amoebae and cysts;- With amebiasis internal organs in pus from the lesions, the brackets with ulcers on the skin tissue forms define amoebas.NB! To collect the liquid portion of bowel movements, which can hold mucus and immediately transported to the laboratory. The microscope stage, and isotonic sodium chloride solution before microscopy heated to 37-38 º C (vegetative form stop moving when cooled after 20-30 min., And bits and pieces of their obnatuzhit stool is not possible).NB! In the human gut may be five types of non-pathogenic amoebae.Isolation of amoebae at cultivation on various piece of life-giving environments (Wednesday Pavlova, Beck).Most sensitivity, diagnostic titer 1:128 and Viseu. Positive with 2-3 weeks.Diagnostic titer 1:80 and Viseu

At unchanged mucosa - diameter of 10-20 mm, generally located in the folds of a puffy, saped edges, surrounded by a zone of hyperemia, the bottom is covered with pus, necrotic masses, chronic process - ulcers, brush, polyps, amoeboma (infiltration)Uneven filling section of the large intestine, its spasm.To detect liver lesions.To detect lung lesions.

-CT- Puncture the abscess The resulting thick liquid chocolate.

5.5.Case studies of the second level of assimilation (α-ІІ)

Case 1Patient A., 22 years old, a student, was admitted to hospital an

infectious diseases for the third day of illness with complaints of general weakness, cramping pain in the abdomen, frequent loose stools with mucus and blood. The disease began with fever, headache, tenesmus, and frequent bowel movements. He lives in an isolated apartment with communal facilities. All family members are healthy. One week ago, returned from the village, where there have been cases of this disease.

Additional: Body temperature 38,1 º C. Pale skin, no rash, tongue moist, coated with white bloom. Muffled heart sounds, blood pressure 110/80 mm Hg., Pulse 96 beats / min. Abdomen moderately swollen, painful on palpation of the colon. Palpation provokes desires on the bottom. Sigma spasm, sharply painful. Stool before to 10 times a day, the bowel movements is fluid, with mucus and blood.

1.Preliminary diagnosis.2. Survey plan3. Treatment.

Case studies in the third level of assimilation a-3

Case 2Patient 65 years old, retired, eat dairy products, which has acquired

a spontaneous market. Ill 5 days ago, felt increasing weakness, headache, temperature, all the days of consecutive low-grade. On the 2nd day of the disease appeared sharp pain in the left iliac region, bowel movements are fluid, fecal character lost, saw blood. To the doctor did not turn, thinking about concentrating on the hemorrhoids. Today the condition quickly deteriorated narosla weakness was dizzy, "fly" before the eyes, three times during stool blood stood out in large numbers. PCB taken to hospital.

Adittional: flabby, pale skin turgor reduced. T 37,1 ° C, the pulse 120 beats, Blood pressure 95/65 mmHg Cardiac rhythmic, muffled. The abdomen is swollen; sore on palpation of the sigmoid is determined protective muscle tension in the left abdominal area. During digital examination of the rectum - bright blood on the glove.

1.Preliminary diagnosis.2. Survey plan3. Treatment.

Tests of the 3rd level.Fill the table =3

Clinical manifestations of shigellosis according to the form:

Gastroenterocolitic form Colitis formNumber of bowel movementsVomitingSigns of dehydrationAbdominal painRumbling in the stomachRemnants of undigested food in the stoolThe presence of blood in stoolMucus in stoolImperative desiresTenesmus

Recommended readings

Main:• Vozianova J.I. Infectious and parasitic diseases. - K.: Health, 2001. - Vol.1 - 903 s.

• Guidelines for Infectious Diseases / Ed. Lobzina Y. - St. Petersburg: Folio, 2003. - 1040 s.

• Shuvalov E.P. Infectious diseases. - Rostov / A: Phoenix, 2001. - 953 p.Additional:• Gavrisheva O.N., Antonova TV Infection.Clinical and pathophysiological aspects. -

St.: Special Literature, 1999. - 255.

• Clinical and laboratory diagnosis of infectious diseases: a guide for doctors. - St.:

Folio, 2001. - 384 p.

6. Extracurricular self-study materialsSubject UDRS and NDRS:

• "The results of examination of patients with intestinal infections according to the Regional Hospital of Infectious Diseases";• "The experience of working at the heart of the Epidemic of intestinal infections";• "Differential criteria amoebas that live in the human intestine (results of parasitological research";• "Differential diagnosis of diarrhea."