Sanitary and epidemiological requirements for dispensary observation of persons who have recovered from acute intestinal infections. Anti-epidemic measures for dysentery Methods of dispensary examination
Measures regarding the source of infection. In recent years, there has been a trend towards a wider stay at home of patients with dysentery in order to create the best conditions for their recovery. However, in certain cases, the question of the advisability of hospitalization cannot be in doubt. According to clinical indications, hospitalization of debilitated patients is mandatory, primarily young children and the elderly, patients with a severe clinical picture of the disease, as well as in all cases when it is impossible to organize medical supervision and necessary treatment at home.
According to epidemiological indications, hospitalization of patients from children's institutions, closed educational institutions, hostels is mandatory. In addition, employees of food enterprises and institutions and persons equated to them are hospitalized in the event of a diarrheal disease with any diagnosis, as well as patients with dysentery living together with persons from these contingents.
Finally, according to epidemiological indications, hospitalization is mandatory in all cases where it is not possible to organize the necessary sanitary and anti-epidemic regime at the location of the patient.
If the decision to hospitalize the patient is made, its implementation should be carried out without delay, since late hospitalization with poor organization of the current disinfection increases the likelihood of successive diseases in the focus as a result of infection from an existing source of infection. This is shown, in particular, by A. L. Davydova: during hospitalization of patients on the 1-3rd day of the disease, consecutive diseases occurred in the foci in 4.7% of those who communicated, during hospitalization on the 4-6th day - in 8.2% , on the 7th day and later - in 14.6% of those who communicated.
In each case, the decision to leave the patient at home is agreed with the epidemiologist.
With exacerbation of chronic dysentery, the issue of hospitalization is also decided according to clinical and epidemiological indications. Patients receive a course of specific and restorative treatment.
When leaving the patient at home, he is prescribed treatment by an infectious diseases clinic or a local doctor. It is carried out under the supervision of the district nurse. Patients with dysentery undergoing treatment at home receive medicines free of charge.
In connection with the possibility of a protracted course of the disease, measures are regulated for convalescents. Children who have had acute dysentery are admitted to a children's institution immediately after the hospital for convalescents or 15 days after discharge from the infectious diseases hospital. The same period is set after home treatment, subject to a five-fold negative result of bacteriological examination. After recovering from illness, they are not allowed to be on duty in the catering unit of the orphanage, boarding school for 2 months. Children who have been ill with chronic dysentery (as well as long-term bacterial carriers) can be admitted to a preschool children's institution or other children's team only if the stool has been completely and persistently normalized for at least 2 months, in general good condition and normal temperature.
When establishing the procedure for dispensary observation of those who have been ill, the course of the disease, the condition of the patient and the profession are taken into account.
Persons who have had the disease without complications and side effects, with normal intestinal mucosa, not emitting the pathogen, are observed from 3 to 6 months from the day of the disease. At the same time, they are monthly examined by a doctor and subjected to bacteriological examination. Those who have been ill with a long-term unstable stool or a long-term release of the pathogen are observed for at least 6 months with a monthly examination and bacteriological examination.
Employees of food enterprises and institutions, children's institutions who have recovered from illness and persons equivalent to them after discharge from the hospital are not allowed to work for 10 days. He undergoes 5 bacteriological analyzes of feces and one scatological examination. After being admitted to work, they are registered at the dispensary for 1 year with a monthly bacteriological examination. Identified carriers are suspended from work in the food, children's and other epidemiologically important institutions. With a carrier duration of more than 2 months, they are transferred to another job and can be re-admitted to their previous job only 1 year after a 5-fold negative result of bacteriological examination and in the absence of damage to the intestinal mucosa according to sigmoidoscopy.
If a relapse occurs after the disease, the observation period is correspondingly lengthened.
Dispensary observation of the sick is carried out by a polyclinic, an outpatient clinic. In the conditions of the city among adults, this work is carried out under the guidance of the infectious diseases room of the polyclinic. If necessary, those who have been ill are treated here.
Dispensary observation with a monthly examination and bacteriological examination is also established for persons who have had a diarrheal disease of unknown etiology (enteritis, colitis, gastroenteritis, dyspepsia, etc.) for 3 months.
Measures against surrounding persons. Due to the fact that the survey does not allow to identify all potential sources of dysentery infection in the outbreak, methods of bacteriological examination of persons who have contacted the patient acquire an important role. These persons are subjected to a single bacteriological examination in the laboratory or in the outbreak (until bacteriophage is obtained), phage and observation (interrogation, examination) for 7 days. At the same time, people who directly serve the sick person require great attention.
When communicating with a patient at home, children visiting children's institutions, employees of food enterprises and institutions, water supply, children's and medical institutions are not allowed to join children's groups or to perform their permanent duties until the patient is hospitalized or recovers, provided that disinfection treatment is carried out and a negative result is obtained bacteriological research.
When a patient or suspected of dysentery is detected in a children's institution, children, group and catering personnel are subjected to a triple bacteriological examination, and children, in addition, to a single scatological examination.
Patients and carriers identified in the outbreak are subject to isolation and clinical examination.
During the examination and within 7 days after the isolation of the last sick person in a children's institution, it is prohibited to transfer children to other groups and institutions, as well as to admit new children.
All persons who communicated with the patient are subjected to double phage with a dysenteric bacteriophage during the hospitalization of the patient and three times when treating him at home.
Phageing, in principle, should be carried out after taking the material for bacteriological examination. However, for aesthetic reasons, it can be considered acceptable to take the material immediately after giving the phage.
In some cases, it becomes necessary to actively identify patients by door-to-door with the involvement of a sanitary asset.
Environmental measures. From the moment of suspicion of dysentery in the outbreak, current disinfection is organized, which is carried out until the patient is hospitalized, and if he is left at home, until he is completely cured.
The requirements for ongoing disinfection are the same as for typhoid fever.
After hospitalization of the patient, final disinfection is carried out.
In the process of a sanitary-educational conversation in the hearth, listeners should be led to master the following basic provisions:
1) dysentery is transmitted by the fecal-oral route, and therefore its prevention is reduced to: a) preventing contamination of food and water with human feces; b) to prevent the consumption of contaminated food and water;
2) any diarrhea is suspected of dysentery, but it can also be with other infectious and non-infectious diseases that require different methods of treatment; correct diagnosis is possible only in a medical institution;
3) late, insufficient or incorrect treatment hinders a quick cure; patients with a protracted form of the disease not only can infect others, but they themselves often suffer from relapses of the disease.
From these provisions, the most important conclusion follows that the diagnosis and treatment of diseases are the business of only medical workers, and preventive measures are primarily the business of the entire population.
Most of these provisions also apply to other intestinal infections.
The content of the article
Dysentery (shigellosis)- an acute infectious disease with a fecal-oral transmission mechanism, caused by various types of shigella, characterized by symptoms of general intoxication, damage to the colon, mainly its distal part, and signs of hemorrhagic colitis. In some cases, it acquires a protracted or chronic course.Historical data on dysentery
The term "dysentery" was proposed by Hippocrates (5th century BC), but it meant diarrhea accompanied by pain. Translated from Greek. dys - disorders, enteron - intestines. The disease was first described in detail by the Greek physician Aretheus (1st century AD) under the name "strained diarrhea." . The Japanese microbiologist K. Shiga studied these pathogens in more detail. Later, various causative agents of dysentery were described, which are combined under the name "shigella". S. Flexner, J. Boyd, M. I. Shtutser, K. Schmitz, W. Kruse, C. Sonne, E. M. Novgorodskaya and others worked on their discovery and study.Etiology of dysentery
. Bacterial dysentery is caused by the genus Shigella., of the Enterobacteriaceae family. These are immobile gram-negative rods with a size of 2-4X0.5-0.8 microns, which do not form spores and capsules, which grow well on ordinary nutrient media, are facultative anaerobes. Among the enzymes that determine the invasiveness of Shigella are hyaluronidase, plasmacoagulase, fibrinolysin, hemolysin, etc. Shigella are able to penetrate into the epithelial cells of the intestinal mucosa, where they can be stored and multiply (endocytosis). This is one of the factors that determine the pathogenicity of microorganisms.The combination of enzymatic, antigenic and biological properties of Shigella forms the basis of their classification. According to the international classification (1968), there are 4 subgroups of shigella. Subgroup A (Sh. dysenteriae) covers 10 serovars, including shigella Grigoriev-Shiga - serovars 1, Fitting-Schmitz - serovars 2, Large-Sachs - serovars 3-7. Subgroup B (Sh. flexneri) includes 8 serovars, including Shigella Newcastle - serovars 6. Subgroup C (Sh. boydii) has 15 serovars. Subgroup D (Sh. sonnei) has 14 serovars for enzymatic properties and 17 for colicinogenicity. In our country, a classification has been adopted, according to which there are 3 subgroups of shigella (subgroups B and C are combined into one - Sh. Flexneri). Sh. dysenteriae (Grigorieva-Shiga) are capable of producing strong thermostable exotoxin and thermolabile endotoxin, while all other Shigella produce only endotoxin.
The pathogenicity of different types of shigella is not the same. The most pathogenic are Shigella Grigoriev-Shiga. So, the infectious dose for this shigellosis in adults is 5-10 microbial bodies, for Flexner's shigella - about 100, Sonne - 10 million bacterial cells.
Shigella have significant resistance to environmental factors. They remain in moist soil for about 40 days, in dry soil - up to 15. In milk and dairy products they can be stored for 10 days, in water - up to 1 month, and in frozen foods and ice - about 6 months. On soiled linen, Shigella can survive for up to 6 months. They quickly die from exposure to direct sunlight (after 30-60 min), but in the shade they remain viable for up to 3 months. At a temperature of 60 ° C, shigella die after 10 minutes, and when boiled, they die immediately. All disinfectants kill shigella within 1-3 minutes.
The stability of Shigella in the external environment is the higher, the weaker their pathogenicity.
In the XX century. the etiological structure of dysentery changes. Until the 1930s, in the vast majority of patients, shigella Grigoryev-Shiga was isolated (about 80% of cases), from the 40s - Shigella Flexner, and from the 60s - Shigella Sonne. The latter is associated with greater resistance of the pathogen in the external environment, as well as with the frequent course of the disease in the form of erased and atypical forms, which creates conditions for the further spread of the pathogen. Noteworthy is the fact of a significant increase in the 70-80s of cases of Grigoriev-Shiga dysentery in the countries of Central America, where there were large epidemics, and its spread to the countries of Southeast Asia, which gives reason to talk about the modern pandemic of Grigoriev Prokofiev-Shiga dysentery .
Epidemiology of dysentery
The source of infection are patients with acute and chronic forms of the disease, as well as bacteria carriers. Patients with an acute form are most contagious in the first 3-4 days of illness, and with chronic dysentery - during exacerbations. The most dangerous source of infection is bacteria carriers and diseased lungs and erased forms of the disease, which may not manifest themselves.According to the duration of bacterial excretion, there are: acute bacteriocarrier (within 3 months), chronic (over 3 months) and transient.
The mechanism of infection is fecal-oral, occurs by water, food and contact household routes. Transmission factors, as in other intestinal infections, are food, water, flies, dirty hands, household items contaminated with the patient's feces, etc. In Sonne's dysentery, the main route of transmission is food, in Flexner's dysentery - water, Grigorieva - Shiga - contact-household. However, we must remember that all types of shigellosis can be transmitted in different ways.
Susceptibility to dysentery is high, little dependent on gender and age, however, the highest incidence is observed among preschool children due to their lack of sufficient hygiene skills. Increase the susceptibility of intestinal dysbacteriosis, other chronic diseases of the stomach and intestines.
Like other acute intestinal infections, dysentery is characterized by summer-autumn seasonality, which is associated with the activation of transmission routes, the creation of favorable external conditions for the preservation and reproduction of the pathogen, and the peculiarities of the morphofunctional properties of the digestive canal during this period.
The transferred disease leaves fragile (for a year), and with shigellosis Grigorieva-Shiga - longer (about two years), strictly type-and species-specific immunity.
Dysentery is a common infectious disease that is registered in all countries of the world. The most common shigellosis in the world is D (Sonne). Shigellosis A (Grigorieva-Shiga), in addition to the countries of Central America, Southeast Asia, and certain regions of Africa, is also found in European countries. In our country, shigellosis A occurred only in the form of isolated "imported" cases. Recently, the incidence of dysentery caused by this subtype of the pathogen has gradually begun to grow.
Pathogenesis and pathomorphology of dysentery
The mechanism of development of the pathological process in dysentery is quite complex and requires further study. Infection occurs only orally. This is evidenced by the fact that it is impossible to contract dysentery when Shigella is administered through the rectum in experiments.The passage of the pathogen through the digestive canal can lead to:
a) until the complete death of shigella with the release of toxins and the occurrence of reactive gastroenteritis,
b) to the transient passage of the pathogen through the digestive canal without clinical manifestations - transient bacteriocarrier;
c) to the development of dysentery. In addition to the premorbid state of the body, a significant role belongs to the pathogen: its invasiveness, colicinogenicity, enzymatic and antiphagocytic activity, antigenicity, and the like.
Penetrating into the digestive canal, Shigella are influenced by digestive enzymes and antagonistic intestinal flora, as a result of which a significant part of the pathogen dies in the stomach and small intestine with the release of endotoxins, which are absorbed through the intestinal wall into the blood. Part of dysentery toxins binds to cells of different tissues (including cells of the nervous system), causing intoxication of the initial period, and the other part is excreted from the body, including through the wall of the colon. At the same time, the toxins of the causative agent of dysentery sensitize the intestinal mucosa, cause trophic changes in the submucosal layer. Provided that the viability of the pathogen is preserved, it penetrates into the intestinal mucosa sensitized with toxins, causing destructive changes in it. It is believed that the foci of reproduction in the epithelium of the intestinal mucosa are formed due to the invasiveness of Shigella and their ability to endocytosis. At the same time, during the destruction of the affected epithelial cells, Shigella penetrate into the deep layers of the intestinal wall, where neutrophilic granulocytes and macrophages are phagocytosed. Defects appear on the mucous membrane (erosion, ulcers), often with a fibrinous coating. After phagocytosis, Shigella die (complete phagocytosis), toxins are released that affect small vessels, cause swelling of the submucosal layer and hemorrhages. At the same time, pathogen toxins stimulate the release of biologically active substances - histamine, acetylcholine, serotonin, which, in turn, further disrupt and discoordinate the capillary blood supply of the intestine and increase the intensity of the inflammatory process, thereby deepening the disorders of the secretory, motor and absorption functions of the colon.
As a result of the hematogenous circulation of toxins, a progressive increase in intoxication is observed, irritation of the receptor apparatus of the kidney vessels and their spasm increases, which, in turn, leads to a violation of the excretory function of the kidneys and an increase in the concentration of nitrogenous slags, salts, metabolic end products in the blood, deepening homeostasis disorders. In the case of such disorders, the excretory function is taken over by the vicarious excretory organs (skin, lungs, alimentary canal). The share of the colon accounts for the maximum load, which exacerbates the destructive processes in the mucous membrane. Since in children the functional differentiation and specialization of the various parts of the digestive canal is lower than in adults, the mentioned process of excretion of toxic substances from the body does not occur in any separate segment of the colon, but diffusely, behind the course of the entire digestive canal, which causes a more severe course. disease in young children.
As a result of endocytosis, toxin production, homeostasis disturbances, the release of thick slags and other products, trophic disturbance progresses, erosions and ulcers appear on the mucous membrane due to deprivation of tissues of nutrition and oxygen, and more extensive necrosis is also observed. In adults, these lesions are usually segmental according to the need for elimination.
The result of irritation of the nerve endings and nodes of the abdominal plexus with dysentery toxin are disorders of the secretion of the stomach and intestines, as well as discoordination of the peristalsis of the small and especially the large intestine, spasm of the undisturbed muscles of the intestinal wall, which causes paroxysmal pain in the abdomen.
Due to edema and spasm, the diameter of the lumen of the corresponding segment of the intestine decreases, so the urge to defecate occurs much more often. Based on this, the urge to defecate does not end with emptying (that is, it is not real), it is accompanied by pain and the release of only mucus, blood, pus (“rectal spitting”). Changes in the intestines are reversed gradually. Due to the death of part of the nerve formations of the intestines from hypoxia, morphological and functional disorders are observed for a long time, which can progress.
In acute dysentery, pathological changes are divided into stages according to the severity of the pathological process. Acute catarrhal inflammation - swelling of the mucous membrane and submucosal layer, hyperemia, often small hemorrhages, sometimes superficial necrotization of the epithelium (erosion); on the surface of the mucous membrane between the folds, mucopurulent or muco-hemorrhagic exudate; hyperemia is accompanied by lymphocytic-neutrophilic infiltration of the stroma. Fibrinous-necrotic inflammation is much less common, characterized by dirty gray dense layers of fibrin, necrotic epithelium, leukocytes on a hyperemic edematous mucosa, necrosis reaches the submucosal layer, which is intensively infiltrated by lymphocytes and neutrophilic leukocytes. The formation of ulcers - the melting of the affected cells and the gradual discharge of necrotic masses; the edges of the ulcers, located superficially, are quite dense; in the distal part of the colon, confluent ulcerative "fields" are observed, between which islands of unaffected mucous membrane sometimes remain; very rarely, penetration or perforation of the ulcer with the development of peritonitis is possible. Healing of ulcers and their scarring.
In chronic dysentery during remission, the intestines can be visually almost unchanged, but histologically they reveal sclerosis (atrophy) of the mucous membrane and submucosal layer, degeneration of intestinal crypts and glands, vascular disorders with inflammatory cell infiltrates and dystrophic changes. During an exacerbation, changes are observed similar to those in the acute form of the disease.
Regardless of the form of dysentery, changes in regional lymph nodes (infiltration, hemorrhages, edema), intramural nerve plexuses are also possible. The same changes occur in the abdominal plexus, cervical sympathetic ganglia, nodes of the vagus nerve.
Dystrophic processes are also observed in the myocardium, liver, adrenal glands, kidneys, brain and its membranes.
Dysentery Clinic
Dysentery is marked by polymorphism of clinical manifestations and is characterized by both local intestinal damage and general toxic manifestations. Such a clinical classification of dysentery has become widespread.1. Acute dysentery (lasts about 3 months):
a) typical (colitis) form,
b) toxicoinfection (gastroenterocolitis) form.
Both forms by move can be light, medium, heavy, erased.
2. Chronic dysentery (lasting more than 3 months):
a) recurrent;
b) continuous.
3. Bacteriocarrier.
Dysentery has a cyclic course. Conventionally, the following periods of the disease are distinguished: incubation, initial, peak, extinction of the manifestations of the disease, recovery, or, much less often, the transition to a chronic form.
Acute dysentery.
The incubation period lasts from 1 to 7 days (usually 2-3 days). The disease in most cases begins acutely, although in some patients prodromal phenomena are possible in the form of general malaise, headache, lethargy, loss of appetite, drowsiness, and a feeling of discomfort in the abdomen. As a rule, the disease begins with chills, a feeling of heat. Body temperature quickly rises to 38-39 ° C, intoxication increases. The duration of the fever is from several hours to 2-5 days. The course of the disease with subfebrile temperature or without its increase is possible.
From the first day of the disease, the leading symptom complex is spastic distal hemorrhagic colitis. There is paroxysmal spastic pain in the lower abdomen, mainly in the left iliac region. Spasmodic pains precede each bowel movement. There are also tenesmus typical of distal colitis: pulling pain in otkhodniks during defecation and within 5-10 minutes after it, which is caused by an inflammatory process in the region of the rectal ampulla. Feces of a liquid consistency, at first have a fecal character, which changes after 2-3 hours. The number of feces decreases each time, and the frequency of stools increases, an admixture of mucus appears, and with subsequent stools - blood, later manure.
The feces look bloody-mucous, less often a mucopurulent mass (15-30 ml) - lumps of mucus streaked with blood ("rectal spit"). There can be from 10 to 100 or more urges per day, and the total number of feces in typical cases is at the beginning of the disease does not exceed 0.2-0.5 liters, and in the following days even less.Pain in the left side of the abdomen increases, tenesmus and false (false) urge to go down become more frequent, which do not end with defecation and do not give relief. cases (especially in children) there may be a prolapse of the rectum, gaping of the posterior due to paresis of its sphincter from "overwork".
On palpation of the abdomen, there is a sharp pain in its left half, the sigmoid colon is spasmodic and palpable in the form of a dense, inactive, painful cord. Often, palpation of the abdomen increases intestinal spasm and provokes tenesmus and false urge to defecate. Soreness and spastic condition are also determined in other parts of the colon, especially in its descending part.
Already at the end of the first day the patient is weakened, adynamic, apathetic. The skin and visible mucous membranes are dry, pale, sometimes with a bluish tint, the tongue is covered with a white coating. Anorexia and fear of pain is the reason for refusing food. Heart sounds are weakened, the pulse is labile, blood pressure is reduced. Sometimes there is a disturbance in the rhythm of contractions of the heart, systolic murmur over the apex. Patients are restless, complain of insomnia. Sometimes there is pain along the nerve trunks, skin hyperesthesia, hand tremor.
In patients with dysentery, all types of metabolism are disturbed. In young children, metabolic disorders can cause the development of secondary toxicosis and, in especially severe cases, adverse effects. In some cases, toxic proteinuria is observed.
In the study of blood - neutrophilic leukocytosis with a shift of the leukocyte formula to the left, monocytosis, a moderate increase in ESR.
With sigmoidoscopy (colonoscopy), inflammation of the mucous membrane of the rectum and sigmoid colon of varying degrees is determined. The mucous membrane is hyperemic, edematous, easily injured at the slightest movement of the sigmoidoscope. Often there are hemorrhages, mucopurulent, and in some cases fibrinous and diphtheritic raids (similar to diphtheria), erosion of various sizes and ulcerative defects.
peak period the disease lasts from 1 to 7-8 days, depending on the severity of the course. Recovery is gradual. Normalization of bowel function does not yet indicate recovery, since, according to sigmoidoscopy, the restoration of the mucous membrane of the distal colon is slow.
Most often (60-70% of cases) there is a mild colitis form of the disease with a short (1-2 days) and mildly pronounced dysfunction of the digestive system without significant intoxication. Defecation is rare (3-8 times a day), with a small amount of mucus streaked with blood. Pain in the abdomen is not sharp, tenesmus may not be. Sigmoidoscopy reveals catarrhal, and in some cases catarrhal-hemorrhagic proctosigmoiditis. Patients, as a rule, remain efficient and do not always seek help. The illness lasts 3-7 days.
Moderate colitis form(15-30% of cases) is characterized by moderate intoxication in the initial period of the disease, an increase in body temperature up to 38-39 ° C, which persists for 1-3 days, spastic pain in the left side of the abdomen, tenesmus, false urge to defecate. The frequency of stool reaches 10-20 per day, feces in small quantities, quickly lose their fecal character - impurities of mucus and streaks of blood ("rectal spit"). With sigmoidoscopy, catarrhal-hemorrhagic or catarrhal-erosive proctosigmoiditis is determined. The illness lasts 8-14 days.
severe colitis form(10-15% of cases) has a violent onset with chills, fever up to 39-40 ° C, with significant intoxication. There is a sharp, paroxysmal pain in the left iliac region, tenesmus, frequent (about 40-60 times a day or more) bowel movements, feces of a mucous-bloody nature. The sigmoid colon is sharply painful, spasmodic. In severe cases, paresis of the intestines with flatulence is possible. Patients are adynamic, facial features are pointed, blood pressure is reduced to 8.0/5.3 kPa (60/40 mm Hg), Tachycardia, heart sounds are muffled. With sigmoidoscopy, catarrhal-hemorrhagic-erosive, catarrhal-ulcerative proctosigmoiditis is determined, fibrinous-necrotic changes in the mucous membrane are less commonly observed. The recovery period lasts 2-4 weeks.
to atypical forms. dysentery include gastroenterocolitis (toxicoinfection), hypertoxic (especially severe) and erased. gastroenterocolitis form observed in 5-7% of cases and has a course similar to food poisoning.
Hypertoxic (especially severe) form characterized by pronounced intoxication, collaptoid state, the development of thrombohemorrhagic syndrome, acute kidney failure. Due to the fulminant course of the disease, changes in the gastrointestinal tract do not have time to develop.
Erased form characterized by the absence of intoxication, tenesmus, intestinal dysfunction is negligible. Sometimes on palpation, mild soreness of the sigmoid colon is determined. This form of the disease does not lead to a change in the usual way of life, so patients do not seek help.
The course of dysentery depending on the type of pathogen has some features. So, Grigoriev-Shiga dysentery is determined by the features of a severe course, most often with a pronounced colitis syndrome, against the background of general intoxication, hyperthermia, neurotoxicosis, and sometimes convulsive syndrome. Flexner's dysentery is characterized by a slightly milder course, but severe forms with a pronounced colitis syndrome and a longer release from the pathogen are observed relatively often. Sonne's dysentery, as a rule, has a mild course, often in the form of food poisoning (gastroenterocolitis form). More often than in other forms, the caecum and ascending colon are affected. The overwhelming number of cases of bacteriocarrier is caused by Shigella Sonne.
Chronic dysentery
Recently, it is rarely observed (1-3% of cases) and has a recurrent or continuous course. More often it acquires a recurrent course with alternating phases of remission and exacerbation, during which, as in acute dysentery, signs of damage to the distal colon predominate. Exacerbations can be caused by dietary disorders, disorders of the stomach and intestines, acute respiratory infections and are more often accompanied by mild symptoms of spastic colitis (sometimes hemorrhagic colitis), but prolonged bacterial excretion.During an objective examination, spasm and soreness of the sigmoid colon, rumbling along the colon can be detected. During the period of exacerbation of the sigmoidoscopy, the picture resembles the changes typical of acute dysentery, however, the pathomorphological changes are more polymorphic, the mucosal zones with bright hyperemia border on areas of atrophy.
With a continuous form of chronic dysentery, there are practically no periods of remission, the patient's condition gradually worsens, deep digestive disorders appear, signs of hypovitaminosis, anemia. A constant companion of this form of chronic dysentery is intestinal dysbiocenosis.
Patients with a long course of chronic dysentery often develop postdysentery colitis, which is the result of deep trophic changes in the colon, especially its nervous structures. Dysfunction is contained for years, when pathogens are no longer isolated from the colon, and etiotropic treatment is ineffective. Patients constantly feel heaviness in the epigastric region, constipation and flatulence are periodically observed, which alternate with diarrhea. Sigmoidoscopy reveals total atrophy of the mucous membrane of the rectum and sigmoid colon without inflammation. The nervous system suffered to a greater extent - patients are irritable, their working capacity is sharply reduced, headaches, sleep disturbances, anorexia are frequent.
Feature of modern The course of dysentery is a relatively large proportion of mild and subclinical forms (which are usually caused by Shigella Sonne or Boyd), long-term stable bacteriocarrier, greater resistance to etiotropic therapy, and the rarity of chronic forms.
Complications have recently been observed extremely rarely. Relatively more often dysentery can be complicated by exacerbation of hemorrhoids, anal fissures. In debilitated patients, mainly in children, complications may occur (bronchopneumonia, urinary tract infections) caused by the activation of opportunistic low-, conditionally- and non-pathogenic flora, as well as rectal prolapse.
The prognosis is generally favorable, but in some cases the course of the disease becomes chronic. Lethal outcome in adults is rare, in debilitated young children with an unfavorable premorbid background, it is 2-10%.
Diagnosis of dysentery
The main symptoms of the clinical diagnosis of dysentery are signs of spastic terminal hemorrhagic colitis: paroxysmal pain in the left side of the abdomen, especially in the iliac region, tenesmus, frequent false urge to defecate, muco-bloody discharge (“rectal spitting”), spastic, sharply painful, inactive sigmoid colon, sigmoidoscopy picture of catarrhal, catarrhal-hemorrhagic or erosive-ulcerative proctosigmoiditis.In establishing the diagnosis, an important role is played by the data of the epidemiological history: the presence of an outbreak of the disease, cases of dysentery in the environment of the patient, seasonality, etc.
Specific diagnosis of dysentery
. The most reliable and common method of laboratory diagnosis of dysentery is bacteriological, which consists in the isolation of coproculture of Shigella, and in case of Grigoriev-Shiga dysentery, in some cases, blood cultures. It is desirable to take the material for research before the start of antibiotic therapy, repeatedly, which increases the frequency of isolation of the pathogen. The material is sown on the selective media of Ploskirev, Endo, Levin, etc. The frequency of isolation of the pathogen in bacteriological studies is 40-70%, and this figure is higher, the earlier studies and the greater their multiplicity.Along with bacteriological research, serological methods are used. Identification of specific antibodies is carried out using the RNGA reaction, less often RA. The diagnostic titer in RNGA is 1:100 for Sonne's dysentery and 1:200 for Flexner's dysentery. Antibodies in dysentery appear at the end of the first week of illness and reach a maximum on the 21st-25th day, so it is advisable to use the method of paired sera.
Skin allergy test with dysentery (Tsuverkalov reaction) is rarely used because it does not have sufficient specificity.
Auxiliary importance in establishing the diagnosis is scatological research, during which mucus, pus, a large number of leukocytes, mainly neutrophils, and erythrocytes are often found.
Differential diagnosis of dysentery
Dysentery should be differentiated from amoebiasis, food poisoning, cholera, sometimes with typhoid fever and paratyphoid A and B, exacerbation of hemorrhoids, proctitis, non-infectious colitis, ulcerative colitis, colon neoplasms. and Unlike dysentery, amebiasis is characterized by a chronic course, the absence of a significant temperature reaction. Feces retain a fecal character, mucus is evenly mixed with blood (“raspberry jelly”), amoebae are often found in them - the causative agents of the disease or their cysts, eosinophils, Charcot-Leiden crystals.With food poisoning the disease begins with chills, repeated vomiting, pain mainly in the epigastric region. Lesions of the colon are rare, so patients do not have spastic pain in the iliac region on the left, tenesmus. In the case of salmonellosis, the feces are greenish in color (a type of marsh mud).
For cholera no signs of spastic colitis. The disease begins with profuse diarrhea, followed by vomiting with a large amount of vomit. The faeces look like rice water, signs of dehydration quickly increase, which often reaches an alarming level and determines the severity of the condition. For cholera, atypical tenesmus, abdominal pain, high body temperature (more often even hypothermia).
With typhoid fever in some cases, the large intestine (colotife) is affected, but spastic colitis is not characteristic of it, prolonged fever, pronounced hepatolienal syndrome, and a specific roseolous rash are observed.
Bloody discharge with hemorrhoids are observed in the absence of inflammatory changes in the colon, blood is mixed with feces at the end of the act of defecation. An overview of otkhodniks, sigmoidoscopy allows you to avoid a diagnostic error.
Colitis non-infectious nature often occurs in case of poisoning with chemical compounds ("lead colitis"), with some internal diseases (cholecystitis, hypoacid gastritis), pathology of the small intestine, uremia. This secondary colitis is diagnosed taking into account the underlying disease and does not have contagiousness, seasonality.
Nonspecific ulcerative colitis begins in most cases gradually, has a progressive long-term course, a typical rectoromaioscopic and radiological picture. It is characterized by resistance to antibiotic therapy.
Neoplasms of the colon in the stage of disintegration, they can be accompanied by diarrhea with blood against the background of intoxication, but are characterized by a longer course, the presence of metastasis to regional lymph nodes and distant organs. To find out the diagnosis, you should apply a digital examination of the rectum, sigmoidoscopy, irrigography, coprocytoscopic studies.
Treatment of dysentery
The basic principle of treating patients with dysentery is to start therapeutic measures as early as possible. Treatment of patients with dysentery can be carried out both in an infectious diseases hospital and at home. Patients with mild forms of dysentery in the case of satisfactory sanitary conditions of life can be treated at home. This is reported by sanitary and epidemiological institutions. Mandatory hospitalization is subject to patients with moderate and severe forms of dysentery, decreed contingents and in the presence of epidemiological indications.Diet therapy is of great importance. In the acute phase of the disease, diet No. 4 (4a) is prescribed. They recommend mashed mucous soups from vegetables, cereals, mashed meat dishes, cottage cheese, boiled fish, wheat bread, and so on. food should be taken in small portions 5-6 times a day. After normalization of the stool, diet No. 4c is prescribed, and later - diet No. 15.
Etiotropic therapy involves the use of various antibacterial drugs, taking into account the sensitivity of the pathogen to them and after taking the material for bacteriological examination. Recently, the principles and methods of etiotropic treatment of patients with dysentery have been revised. It is recommended to limit the use of broad-spectrum antibiotics, which contribute to the formation of intestinal dysbiocenosis and prolong the recovery time.
Patients with mild forms of dysentery should be treated without the use of antibiotics. The best results are obtained when using in these cases drugs of the nitrofuran series (furazolidone 0.1-0.15 g 4 times a day for 5-7 days), 8-hydroxyquinoline derivatives (enteroseptol 0.5 g 4 times a day, intestopan 3 tablets 4 times a day), non-resorptive sulfa drugs (phthalazol 2-3 g 6 times a day, ftazin 1 g 2 times a day) for 6-7 days.
Antibiotics are used for moderate and severe colitis forms of dysentery, especially in the elderly and in young children. In this case, it is advisable to reduce the course of treatment to 2-3 days. The following drugs are used (in daily doses): levomycetin (0.5 g 4-6 times), tetracycline (0.2-0.3 g 4-6 times), ampicillin (0.5-1.0 g each 4 times), monomycin (0.25 g 4-5 times), biseptol-480 (2 tablets 2 times), etc. In the case of severe forms of the disease and in the treatment of young children, parenteral administration of antibiotics is advisable.
Of the means of pathogenetic therapy in severe and moderate cases of dysentery, polyglucin, reopoliglyukin, polyionic solutions, Quartasil, etc. are used for the purpose of detoxification. In especially severe cases, with infectious-toxic shock, glycocorticosteroids are prescribed. With mild and partially with moderate forms, you can limit yourself to drinking a glucose-salt solution (oralita) of the following composition: sodium chloride - 3.5 g, sodium bicarbonate - 2.5, potassium chloride-1.5, glucose - 20 g per 1 liter of drinking boiled water.
Pathogenetically justified is the appointment of antihistamines, vitamin therapy. In cases of prolonged dysentery, immunostimulants are used (pentoxyl, sodium nucleinate, methyluracil).
In order to compensate for the enzyme deficiency of the digestive canal, natural gastric juice, chlorine (hydrochloric) acid with pepsin, Acidin-pepsin, orase, pancreatin, panzinorm, festal, etc. are prescribed. If there are signs of dysbacteriosis, bactisubtil, colibacterin, bifidumbacterin, lactobacterin and others are effective in within 2-3 weeks. They prevent the transition of the process into a chronic form, the recurrence of the disease, and are also effective in cases of prolonged bacteriocarrier.
Treatment of patients with chronic dysentery includes anti-relapse treatment and treatment for exacerbations and includes diet, antibiotic therapy with a change of drugs according to the sensitivity of Shigella to them, vitamin therapy, the use of immunostimulants and bacterial preparations.
Prevention of dysentery
Priority is given to early diagnosis of dysentery and isolation of patients in an infectious diseases hospital or at home. Current and final disinfection is mandatory in the outbreaks.Persons who have had acute dysentery are discharged from the hospital no earlier than 3 days after clinical recovery and a single, and in decreed contingents - a double negative bacteriological study, which is carried out no earlier than 2 days after the completed course of antibiotic therapy. If the pathogen was not isolated during the illness, patients are discharged without a final bacteriological examination, and decreed contingents - after a single bacteriological examination. In chronic dysentery, patients are discharged after the exacerbation subsides, stable normalization of the stool and a negative single bacteriological examination. If the result of the final bacteriological examination is positive, such persons are given a second course of treatment.
Persons who have had dysentery with an established type of pathogen, carriers of shigella, as well as patients with chronic dysentery are subject to dispensary observation in the KIZ. Clinical examination is carried out within 3 months after discharge from the hospital, and in patients with chronic dysentery from among the decreed contingents - within 6 months.
Of great importance in the prevention of dysentery is the strict observance of sanitary-hygienic and sanitary-technical norms and rules at public catering establishments, food industry facilities, kindergartens, schools and other facilities.
For the specific prevention of dysentery, a dry lyophilized live anti-dysenteric vaccine (orally) made from Shigella Flexner and Sonne has been proposed, but its effectiveness has not been fully elucidated.
Dispensary observation of all categories of those who have been ill with acute dysentery and other intestinal diarrheal infections, as well as those who have been sanitized due to bacteriocarrier, is established for 3 months. Those who have been ill with dysentery after being discharged from a medical institution are prescribed dietary food * for 30 days. Dispensary observation is carried out by the doctor of the unit and the doctor of the office of infectious diseases. It includes: a monthly examination, a survey of those who have been ill and a macroscopic examination of stools; if necessary, conduct additional coprocytological and instrumental studies, as well as bacteriological studies within the periods indicated below.
In the first month after being discharged from a medical institution, sick food and water supply workers from among the military and employees of the Ministry of Defense are subjected to bacteriological studies three times with an interval of 8-10 days. For the next two months, bacteriological studies of these categories are carried out once a month. Food and water supply workers are not suspended from work in their specialty for the period of dispensary observation.
For sick servicemen who are not food and water supply workers, bacteriological examinations are carried out once a month. They are not assigned to the canteen outfit for the period of dispensary observation.
In case of recurrence of the disease or detection of pathogens of the intestinal group in the feces, all categories of those who have been ill again undergo treatment in a medical institution, after which the above-mentioned examinations are again carried out for 3 months.
If the bacteriocarrier continues for more than 3 months or 3 months after discharge from a medical institution, they have intestinal dysfunctions and pathological changes in the rectal mucosa, then they are treated as patients with a chronic form of dysentery, and military personnel and employees of the Ministry of Defense associated with objects food and water supply, are suspended from work in their specialty. They are allowed to work in their specialty only after complete recovery, confirmed by the results of clinical and bacteriological examinations, as well as sigmoidoscopy data.
Persons with chronic dysentery are on dispensary observation during the year. Bacteriological examinations and examination by an infectious disease doctor of these persons are carried out monthly.
Data on the state of health of the sick person during the period of dispensary observation, as well as the results of special laboratory and clinical examinations, are entered in the medical book of the subject.
After the last bacteriological examination, the final examination by an infectious disease doctor and the expiration of the period of dispensary observation, those who have been ill, who do not have signs of the disease, are removed from the register, and an appropriate mark is made in the medical book.
* - dietary nutrition is prescribed on the basis of the Order of the USSR Ministry of Defense No. 460 of December 29, 1989 "On measures to further improve the medical examination of military personnel of the SA and Navy." Appendix No. 1 for officers, ensigns and long-term service employees. Appendix No. 2 - for the rank and file of military service.
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63. Is it necessary to hospitalize a carrier of S. flexneri 2a - an engineer of a mechanical plant?
64. A patient with acute dysentery left at home is prescribed and carried out by: a) a local therapist; b) an infectious diseases doctor in the infectious disease cabinet of a polyclinic; c) a doctor at an infectious diseases hospital; d) district therapist after agreement with the epidemiologist of the Central State Sanitary and Epidemiological Service;
e) an epidemiologist.
65. The period of observation of persons who have been in contact with a patient with dysentery is: a) 3 days; b) 7 days; c) 14 days; d) 21 days; e) no medical supervision is carried out.
66. What to do with the employees of food enterprises, discharged from the hospital after contracting dysentery, if: a) the barmaid was discharged with a negative result of bacteriological examination of feces; b) S.sonnei were isolated from the cook of the kindergarten before discharge from the hospital; c) Has the head of the nursery been diagnosed with chronic dysentery?
67. Dispensary observation of those who have recovered from dysentery is subject to: a) a student of a technical school;
b) a non-working retired confectioner; c) a laboratory assistant at a dairy plant; d) librarian; e) a loader of a meat-packing plant; e) a bakery seller; g) mechanic factory; h) a neuropathologist; i) a kindergarten teacher; j) an employee of the dairy products base.
68. What is the period of dispensary observation of canteen workers who have recovered from acute dysentery?
69. Is a broker suffering from chronic dysentery subject to dispensary observation?
70. What is the period of dispensary observation of a cook discharged from a hospital with a diagnosis of "chronic dysentery"?
71. Who decides the issue of deregistration of a person who has had dysentery?
72. The diagnosis of "acute dysentery" was established according to clinical data to a student who has been ill for 3 days; the patient was left at home. Family: mother is a teacher, father is a journalist, sister is a student of the 9th grade; The family lives in a three-room apartment in a comfortable house. What anti-epidemic measures should be taken in the epidemic focus?
73. The accountant of the construction department fell ill acutely on the 2nd day after returning from a business trip. The diagnosis of acute dysentery was established clinically, the feces were sent to the laboratory for culture. The patient was left at home. Family: wife - a bakery technologist, daughter 6 years old attends a kindergarten. The family lives in a two-room apartment. What anti-epidemic measures should be taken in the epidemic focus?
74. A kindergarten teacher was discharged from the infectious diseases hospital after suffering from acute dysentery (the diagnosis was confirmed clinically and bacteriologically). What is the duration of dispensary observation of the recovered patient?
75. A kindergarten music worker was discharged from the infectious diseases hospital with a diagnosis of "chronic dysentery", a concomitant disease - ascariasis. How should the doctor of the infectious disease cabinet decide the issue of her employment and medical examination?
76. The source of pathogenic Escherichia coli is: a) a sick person; b) cattle; c) ticks;
d) insects.
77. Escherichiosis is: a) anthroponosis; b) obligate zoonosis;
78. List the measures to prevent coli infection:
a) control over the sanitary condition of catering units; b) control over the health status of employees of public catering enterprises; c) vaccination of the population; d) control over the pasteurization of dairy products.
79. Possible factors of coli infection transmission: a) food products; b) water; c) mosquitoes; d) household items; e) ticks.
. "O. Dysentery-like diseases are caused by the following pathogens: a) EPKD; b) EICP; c) ETCP; d) EGCP.
81. EPK 055 was isolated from a 45-year-old cook's assistant on the 4th day of illness with acute gastroenteritis during bacteriological examination of feces. The course of the disease is mild. The patient is at home. Lives in a one-room apartment, family composition: wife (pharmacist) and daughter (hairdresser). What measures to take in an epidemic outbreak?
82. Salmonellosis is: a) anthroponosis; b) obligate zoonosis;
c) sapronosis; d) non-obligate zoonosis.
83. Epidemic process of salmonellosis is characterized by: a) complete breakdown of outbreaks; b) the presence of undeciphered outbreaks (the so-called sporadic incidence); c) a large number of serovars; d) a small number of serovars; e) lack of carriage; e) the presence of carriage; g) the presence of nosocomial outbreaks; h) the absence of nosocomial outbreaks.
84. The source of the causative agent of salmonellosis can be: a) cattle; b) pigs; c) rodents; d) ducks; e) chickens;
e) ticks; g) migratory birds.
85. Is it possible to allow a nurse in a children's hospital to work, in which salmonella was isolated during a bacteriological examination before going to work?
86. Salmonella transmission factor can be: a) meat; b) chicken eggs; c) livestock feed; d) oysters; e) water; e) blood-sucking insects.
87. Is it possible to transmit Salmonella by airborne dust?
88. Danger as factors of transmission of salmonella are: a) dried bird droppings; b) feathers and down; c) duck eggs; d) mosquitoes, ticks; e) canned vegetables.
89. To prevent the spread of Salmonella among humans, the following measures are necessary:
a) veterinary and sanitary control over compliance with the rules for slaughtering livestock; b) vaccination of the population; c) labeling and proper storage of inventory at catering facilities; d) chemoprophylaxis of those in contact with the patient in the epidemic focus; e) compliance with the rules of storage and terms of sale of meat products.
90. In the therapeutic department, 8 cases of acute intestinal infections were registered in different wards within 2 days. During bacteriological examination of patients and staff of the department, salmonella was isolated from the barmaid and 6 patients. Decide on the possible source and factors of transmission of infection, list the activities in the department.
91. Engineer, 30 years old, fell ill acutely. The diagnosis of the polyclinic doctor is acute dysentery, in the hospital bacteriologically
confirmed salmonellosis. Epidemiological history: on the eve of the disease, he was visiting relatives, ate salad, roast duck, cake. According to the patient, among the hosts and guests there are 5 patients with a similar clinic. List the measures necessary to identify all patients and the factor of infection transmission.
92. A 48-year-old SMU master who had been ill with salmonellosis (the diagnosis was confirmed bacteriologically), was discharged from the hospital. Concomitant diseases: chronic cholecystitis and asthmatic bronchitis. Does he need follow-up care?
93. Match...
Nosological form Source of infection
A. Yersiniosis 1) A sick person
B. Pseudotuberculosis 2) Synanthropic rodents
3) Mouse-like rodents
4) Farm animals
94. Yersinia can survive and multiply: a) at a temperature of 20-30 °C; b) at a temperature of 4-20 °C; c) in an acidic environment; d) in a neutral environment; e) in an alkaline environment; e) in milk; g) in rotting vegetables; h) in the soil of greenhouses.
95. Yersiniosis was diagnosed in a 40-year-old patient. How could the patient become infected if it is known that: a) 2 days before the illness, he repaired the ventilation duct from the vivarium; b) 7 days before the illness, he harvested carrots in the garden and ate raw carrots; c) ate canned meat 3-4 days before the illness; d) 4-5 days before the illness in the buffet ate fresh cabbage salad; e) drank unpasteurized milk 2 days ago; e) on the eve of illness, did you eat a cake with cream?
96. Possible sources of infection in campylobacteriosis: a) cattle; b) poultry; c) cats;
I d) insects; d) people.
|97. The viability of campylobacter is preserved: a) in foodstuffs; b) in water; c) at the objects of the environment
I environment; d) only at room temperature; e) in a wide range of temperature fluctuations.
1. A - 1.5; B - 4, 8; B - 2, 3, 7; G - 6.
2. Fecal-oral transmission mechanism.
3. Water, food, contact household.
4. a, b, d, e.
5. g, b, a, d, e.
6. At any time of the year (find an explanation in the textbook, diagrams and lectures).
7. A - b, c; B - a.
8. A - a; B - b.
9. With poor sanitary and hygienic conditions, low sanitary culture and violations of the hygienic regime.
13. a, b, c, d, f.
14. Infected people and animals.
15. Food or contact-household.
16. a) water; b) food; c) contact-household.
17. Bacteriological examination of blood.
19. On the 3rd day - bacteriological examination of blood, on the 8th and 15th - bacteriological examination of blood, urine, feces, serological examinations.
20. On the 2nd day - 5 ml, on the 12th day - 10 ml.
21. Blood is inoculated into Rappoport medium at a ratio of 1:10.
22. A preliminary positive result can be obtained after 1 day.
23. After 7 days.
24. On the 4-5th day.
25. A - feces, urine, bile; B is blood.
26. a, c, d, e.
28. Typhoid fever was not suspected in time - a, b, c, e; suspicion of typhoid fever was confirmed in a timely manner by laboratory - d, clinical and epidemiological - f.
29. a) typhoid fever may be suspected. To confirm the diagnosis, it is necessary to conduct a bacteriological examination of the blood; b) convalescent carriage of typhoid bacteria can be assumed;
c) it is possible to assume transient or convalescent carriage, for the final decision it is necessary to clarify the history and conduct additional bacteriological studies of feces, bile and urine, RPHA.
31. a, c, d, f.
32. Those who contacted the patient due to nosocomial introduction of typhoid fever can be discharged after a laboratory examination. The extract must indicate contact with a patient with typhoid fever in order to organize observation at the place of residence.
33. Within 3 months for all those who have been ill, and for persons with epidemiologically significant professions (declared contingent) - throughout their entire working life.
34. A - a; B - c; C - b, d, e.
35. Throughout life.
38. No, hospitalization of a patient with typhoid fever is mandatory because of the risk of complications.
39. b, c, e, g, h.
40. a, b, c, d, e, f, h.
42. Vaccine typhoid alcohol dry; VIANVAK - Vi-polysaccharide liquid vaccine.
44. a, b, e - are observed during the entire labor activity; c - the duration of observation will be determined depending on the duration of the carriage (acute or chronic). As a carrier of typhoid bacteria, he must be removed from work at the bakery and employed; d, e - observation is carried out for 3 months; check the dispensary observation plan with the scheme given in chapter 6.
45. Find out the epidemiological history, describe the rash in detail; send the patient to the infectious diseases hospital, examine in order to exclude typhoid-paratyphoid disease; after hospitalization of the patient, carry out the final disinfection; report the patient at the place of work; find out from the mother if she had typhoid or paratyphoid fever in the past, carry out medical observation for 21 days, examine her bacteriologically (feces), take blood for RPHA, perform phage,
46. A - on the basis of the epidemiological history (mother is a chronic carrier of typhoid bacteria), the result of a serological study can suggest typhoid fever, the patient is transferred to an infectious diseases hospital for diagnosis and treatment.
Events in the therapeutic department: concluding
naya disinfection, identify those who communicated with the patient, medical observation of them for 21 days; examine patients and personnel bacteriologically (feces), conduct phage; upon discharge of patients from the hospital, report on their communication with patients with typhoid fever.
Measures in the patient's family: final disinfection, identify all those in contact with the patient in the family, their bacteriological and serological examination, phage those who contacted the patient and the bacteria carrier, report the patient at the place of work.
B - the district doctor did not find out the epidemiological history, hospitalized the patient late, incorrectly hospitalized the patient in the therapeutic department. The hospital doctor did not conduct a bacteriological examination of the pain
In addition, a lot of blood was taken to establish a serological reaction (1 ml is needed), the result of a serological study was received in the department later.
47. Immediately hospitalize the patient, carry out final disinfection in the apartment, find out the epidemiological history, report the patient at the place of work, who communicated to observe for 21 days and report them to the place of work and to the kindergarten. Bacteriologically examine those who communicated with the family (feces), take blood from the husband for RPHA, and carry out phage.
48. Transient carriage of typhoid bacteria can be assumed, for clarification, repeated bacteriological (feces, urine) and serological studies are necessary.
49. a, b, d, e, g, i.
50. A - 1; B - 3; IN 2 .
55. a, b, c, d.
57. A - b; B - c.
58. A - 2; B - 2; IN 1.
60. a - yes; b - yes; in - no.
62. Carry out a single bacteriological study of feces without being released from work, observe for 7 days, report to the place of work.
63. No, since it does not apply to the decreed contingents.
66. a - allow to work and conduct dispensary observation for 1 month; b - conduct a second course of treatment in a hospital; c - transfer for 6 months to a job not related to the catering department and serving children.
67. c, e, f, i, k.
68. In this case, the period of dispensary observation is 1 month.
69. Yes, within 3 months.
70. In this case, dispensary observation is carried out for 3 months. Patients with a chronic form of the disease are transferred in the prescribed manner to work not related to the preparation, production, transportation, storage, sale of food and maintenance of water supply facilities.
71. Doctor of the infectious diseases cabinet of a polyclinic or a district therapist.
72. Isolate the patient, examine bacteriologically, find out the epidemiological history, report the patient to the institute, carry out routine disinfection at home and educational work among family members.
73. Hospitalize the patient, collect an epidemiological history, send a request to the place of business trip, carry out final disinfection, educational work, medical supervision and a single bacteriological examination of family members without separation from the team, report on those who have been in contact with the patient at the place of work and to the kindergarten.
74. In this case, the period of dispensary observation is 1 month.
75. Transfer to another job and conduct observation (clinical and bacteriological) for 3 months. Treat ascariasis and conduct follow-up tests after treatment.
81. Leave the patient at home, find out the epidemiological history, carry out ongoing disinfection and educational work, report the patient at the place of work.
83. b, c, f, f.
84. a, b, c, d, e, f.
85. No, she is the source of the infection.
86. a, b, c, d, e.
90. A possible source of infection is a barmaid, the route of transmission is food. Patients with salmonellosis should be hospitalized in an infectious disease hospital or isolated in one ward, treated according to clinical indications, current disinfection should be carried out, and bacteriological patients with salmonellosis should be re-examined. Collect an epidemiological history, find out what kind of food the patients received in the therapeutic department and whether there are patients with salmonellosis among those who received the same food in other departments. Conduct a clinical and bacteriological examination of the hospital catering staff and take for bacteriological examination products suspected of being a factor in the transmission of salmonella.
91. Identify guests who were present at the celebration with relatives. Clarify the epidemiological history and find out the infection transmission factor common to all patients. Conduct a clinical and bacteriological examination of relatives and guests to identify patients and carriers.
92. Dispensary observation is not subject.
93. A - 1, 2, 3, 4, 5; B - 2, 3, 4, 5.
94. a, b, c, d, e, f, g, h.
96. a, b, c, e.
97. a, b, c, e.
Viral hepatitis is a group of acute human infectious diseases that have clinically similar
manifestations are polyetiological, but differ in epidemiological characteristics.
Currently, on the basis of a complex of clinical and epidemiological studies in combination with laboratory diagnostic methods, at least 5 nosological forms of viral hepatitis have been described: A, B, C, D, E. In addition, there is a group of undifferentiated viral hepatitis, formerly referred to as hepatitis A and B. It is from this group of hepatitis that hepatitis C and E were isolated. In recent years, G and TTV viruses have been identified, and their role in liver damage is being studied.
All forms of hepatitis cause systemic infection with pathological changes in the liver.
Main questions of the topic
1. Etiology of viral hepatitis.
2. Epidemiology of viral hepatitis with fecal-oral transmission mechanism (A, E).
3. Preventive and anti-epidemic measures for viral hepatitis A and E.
4. Epidemiology of viral hepatitis with contact and artificial transmission mechanisms (B. C, D).
5. Preventive and anti-epidemic measures for viral hepatitis B, C, D.
Viral hepatitis is one of the most important medical and social health problems in the Russian Federation.
Being a polyetiological group of diseases, viral hepatitis (A, B, C, D, E) has an unequal epidemiological role as a source of infection, various mechanisms of pathogen transmission, which is determined by social, natural and biological factors.
It is known that with parenteral hepatitis, the development of adverse outcomes is possible. Often, after suffering an acute form of the disease, chronic hepatitis is formed (especially with hepatitis C), in the future, some of these patients may develop cirrhosis of the liver. An etiological relationship has also been proven between primary hepatocellular carcinoma and hepatitis B and C viruses.
Despite the use of modern methods of treatment, in most cases it is not possible to prevent deaths in the fulminant course of hepatitis.
Hepatitis A
The causative agent is an RNA-containing virus, the genome of which consists of single-stranded RNA and does not have a core and shell, from the family Picornaviridae of the genus Hepatovims. Relatively stable in the environment. It remains in water from 3 to 10 months, in excrement - up to 30 days. This determines the duration of the persistence of the pathogen in water, food, wastewater and other environmental objects. At a temperature of 100 °C, it is inactivated within 5 minutes; under the action of chlorine at a dose of 0.5-1 ml/l at pH 7.0, it survives for 30 minutes.
The source of infection is a sick person (with any form of manifestation of the disease: icteric, anicteric, asymptomatic and inapparent); the period of contagiousness - the last 7-10 days of the incubation period, the entire preicteric period and 2-3 days of the icteric period. Chronic carriage of the virus has not been established. The duration of the incubation period is on average 15-30 days (from 7 to 50 days).
The mechanism of transmission is fecal-oral, realized through water, food, contaminated objects. The role of each of these pathways of transmission of the pathogen in different conditions is not the same. The waterway usually leads to outbreaks of infection. They cover the population using poor quality water. Food outbreaks are associated with contamination of food in catering establishments by undiagnosed patients among staff. In addition, infection of berries and vegetables is possible when irrigating the plantation with sewage and fertilizing with feces. The contact-household transmission route can be realized in case of violation of the sanitary and hygienic regime, for example, in preschool institutions, families, military units.
The natural susceptibility to hepatitis A is high, it is one of the most common intestinal infections in the world. Every year, according to WHO, approximately 1.4 million cases of hepatitis A are registered in the world. In areas with low and medium incidence rates, most residents acquire immunity due to hepatitis (not only icteric, but also anicteric and asymptomatic forms) by the age of 20-30 life. In contrast, in areas with a high incidence of post-infection immunity is formed by 4-6 years of age.
The epidemic process of hepatitis A is characterized by uneven incidence in certain areas, cyclicity in long-term dynamics, and seasonality. The long-term dynamics in the Russian Federation is shown in Fig. 7.1.
With the widespread spread of the disease, there are areas with high, low and low incidence rates.
The average incidence of hepatitis A in Russia over the past 5 years (1997-2001) was 51 per 100,000 population. Along with sporadic morbidity (familial foci with isolated cases prevailed), epidemic outbreaks were noted, mainly of water origin, which is associated with unsatisfactory provision of the population with good-quality drinking water (in 2-5% of water samples from water intakes, pathogens of intestinal infections and hepatitis A antigen are found ). It should also be noted that the highest incidence rates of hepatitis A are recorded in regions where open water bodies are mainly used as sources of water supply.
The disease is characterized by summer-autumn seasonality. The rise in incidence begins in July-August, reaching the highest rates in October-November and then decreasing in the first half of the next year. Children aged 3 to 6 years are predominantly affected, but in recent years in the Russian Federation there has been a shift in the maximum age-related incidence rates from younger age ipynn to older ones (11-14, 15-19 and 20-29 years old). If earlier the proportion of children under 14 who recovered from illness was 60% or more, then in 2000-2001. - 40-41%. Morbidity among the urban and rural population is almost equalized. Family foci are rarely recorded. The frequency of morbidity was revealed: rises in certain limited areas occur after 3-10 years, and in a large area, in the country as a whole, rises occur after 15-20 years. The epidemiology of viral hepatitis A is shown in Figure 7.1.
Epidemic process of viral hepatitis A
pathways of aquatic food transmissionhousehold contact Susceptibility - Universal
Formation of immunity I- post-infectious immunity "- post-vaccination immunity Manifestations of the epidemic process
■ Uneven distribution across the territory (type of incidence)
low (hypoendemic) intermediate (endemic) high (hyperendemic)
Periodicity
3-10 years in a limited area 15-20 years - rise in the country
■ Season summer, autumn
■ Age of patients
Preschool children (with hyperendemic type of morbidity)
Schoolchildren, persons aged 15-30 years (with an endemic type of morbidity)
Persons over 30 years of age (hypoendemic type of incidence)
Preventive and anti-epidemic measures.
Preventive measures (Scheme 7.2.), As with other intestinal infections, are mainly aimed at the second link of the epidemic process - the pathogen transmission mechanism.
Scheme 7.2. PREVENTIVE ACTIONS
FOR VIRAL HEPATITIS A
providing the population with good-quality drinking water
bringing water sources in line with sanitary standards
strengthening control over the treatment and disinfection of wastewater: regular cleaning and disinfection of garbage pits (containers), outdoor latrines, elimination of unorganized landfills
creation of conditions that guarantee the implementation of sanitary standards and rules for the procurement, storage, transportation, preparation and sale of food
compliance with the rules of personal hygiene in catering places
health education
In the epidemic focus of hepatitis A, a set of measures is carried out, presented in Scheme 7.3.
Scheme 7.3. WORKING IN THE EPIDEMIC FOCUS OF VIRUS
HEPATITIS
Direction and content of anti-epidemic measures
Source of infection U Patient
emergency notification to the Central State Sanitary and Epidemiological Service hospitalization
Transfer mechanism
I- Current final disinfection
Persons who have been in contact with the source of infection
Medical observation for 35 days thermometry 2 times a day examination of the skin, mucous membranes of the eyes, mouth control of the color of feces, urine palpation of the liver, spleen
Laboratory examination of alanine aminotransferase antibodies to hepatitis virus 1dM-class
Emergency prevention
vaccinal prophylaxis (see Appendix) immunoglobulin prophylaxis (as decided by an epidemiologist)
Hepatitis B
The causative agent is a virus containing single-stranded RNA. Its taxonomic position has not yet been determined. The virus is stable in the environment.
The source of infection is a sick person with acute, predominantly anicteric and obliterated forms of the disease. A severe course of the disease was noted, especially in pregnant women. In the second half of pregnancy, the disease has a high mortality rate.
Recent studies have shown that the hepatitis E virus circulates in various animal species (rats, pigs, lambs, chickens) and the possibility of transmitting the virus from an infected animal to people with the development of infection is not excluded.
The mechanism of transmission is fecal-oral, the route of transmission is predominantly water. Outbreaks of hepatitis E are characterized by suddenness, "explosive" nature and high incidence rates in areas with poor water supply. Infection is possible when eating thermally insufficiently processed mollusks and crustaceans.
Contact-household transmission of the pathogen in families was rarely detected. Epidemiological data indirectly indicate a significantly higher infectious dose in hepatitis E than in hepatitis A.
The incubation period lasts an average of about 30 days (from 14 to 60 days).
Natural susceptibility is high. In Russia, hepatitis E occurs only in people who come from abroad. Endemic regions are Turkmenistan, Tajikistan, Kyrgyzstan, Uzbekistan, as well as the countries of the South-East and
Manifestations of the epidemic process of hepatitis E
pronounced unevenness of the territorial distribution of morbidity
delineated waterborne outbreaks with high incidence
variable nature of the incidence
seasonal unevenness of incidence throughout the year with the beginning of the rise in the summer months
a peculiar age structure of patients aged 15-29 years with a predominant lesion (in regions with a high incidence of hepatitis E in this age group, up to 96% of those surveyed have antibodies to the hepatitis E virus lgG-class)
slight foci in families (largely foci with one disease)
recurring rises in incidence in endemic areas at intervals of 7-8 years
Central Asia (India, Pakistan, Afghanistan, etc.), North and West Africa and (partially) Central America. The epidemic process is manifested by sporadic and outbreaks of morbidity, predominantly of water origin, and has a number of features presented in Scheme 7.4. There is no official registration of the incidence of hepatitis P in Russia.
SHIGELLOSIS (DYSENTHERIA)
Dysentery - an anthroponotic infectious disease, characterized by a predominant lesion of the distal large intestine and manifested by intoxication, frequent and painful defecation, loose stools, in some cases with mucus and blood.
Etiology. The causative agents of dysentery belong to the genus Shigella families Enterobacteriaceae. Shigella are gram-negative bacteria 2-4 microns long, 0.5-0.8 microns wide, immobile, do not form spores and capsules. Shigella are divided into 4 subgroups - A, B, C, D, which correspond to 4 types - S. dysenteriae, S. flexneri, S. boydii, S. sonnei. In the population S. dysenteriae allocate 12 serological variants (1-12); population S. flexneri subdivided into 8 serovars (1-5, 6, X, Y-variants), while the first 5 serovars are divided into subserovars ( 1 a, 1 b, 2 a, 2 b, 3 a, 3 b, 4 a, 4 b, 5 a, 5 b); population S. boydii differentiates into 18 serovars (1-18). S. sonnei do not have serovars, but they can be divided into a number of types according to biochemical properties, relation to typical phages, ability to produce colicins, resistance to antibiotics. The dominant position in the etiology of dysentery is occupied by S. sonnei and S. flexneri 2 a.
The causative agents of the main etiological forms of dysentery have unequal virulence. The most virulent are S. dysenteriae 1 (causative agents of Grigoriev-Shiga dysentery), which produce a neurotoxin. The infectious dose of Shigella Grigoriev-Shiga is dozens of microbial cells. infectious dose S. flexneri 2 a, causing disease in 25% of infected volunteers, amounted to 180 microbial cells. Virulence S. sonnei significantly lower - the infectious dose of these microorganisms is at least 10 7 microbial cells. However S. sonnei have a number of properties that compensate for the lack of virulence (higher resistance in the external environment, increased antagonistic activity, more often produce colicins, greater resistance to antibiotics, etc.).
Shigella (S. sonnei, S. flexneri) relatively stable in the environment and remain viable in tap water for up to one month, in waste water - 1.5 months, in moist soil - 3 months, on food products - several weeks. Shigella Grigorieva-Shiga are less resistant.
The causative agents of dysentery at a temperature of 60С die within 10 minutes, while boiling - instantly. These pathogens are detrimentally affected by solutions of disinfectants in the usual working concentrations (1% chloramine solution, 1% phenol solution).
source of infection. Sources of infection are patients with an acute form, convalescents, as well as patients with protracted forms and bacteria carriers. In the structure of sources of infection in Sonne dysentery, 90% are in patients with an acute form, in which in 70-80% of cases the disease proceeds in a mild or erased form. Convalescents determine 1.5-3.0% of infections, patients with protracted forms - 0.6-3.3%, persons with subclinical forms - 4.3-4.8%. With Flexner's dysentery, the leading role in the structure of sources of infection also belongs to patients with acute forms, however, with this form of dysentery, the importance of convalescents (12%), patients with protracted and chronic forms (6-7%), and persons with a subclinical course of infection (15%) increases. .
The period of contagiousness of patients corresponds to the period of clinical manifestations. The maximum contagiousness is observed in the first 5 days of illness. In the vast majority of patients with acute dysentery, as a result of treatment, the release of pathogens stops in the first week and only occasionally continues for 2-3 weeks. Convalescents secrete pathogens until the end of the processes of restoration of the mucous membrane of the large intestine. In some cases (up to 3% of cases), carriage may continue for several months. The tendency to protracted course is more typical for Flexner's dysentery and less for Sonne's dysentery.
Incubation period- is 1-7 days, on average 2-3 days.
Transfer mechanism- fecal-oral.
Ways and factors of transmission. Transmission factors are food, water, household items. In the summer, the "fly" factor is important. A certain relationship has been established between transmission factors and etiological forms of dysentery. In Grigoriev-Shiga dysentery, the leading factors in the transmission of shigella are household items. S. flexneri transmitted mainly through the water factor. The nutritional factor plays a major role in the distribution S. sonnei. As transmission factors S. sonnei, the main place is occupied by milk, sour cream, cottage cheese, kefir.
susceptibility and immunity. The human population is heterogeneous in susceptibility to dysentery, which is associated with factors of general and local immunity, the frequency of infection with shigella, age and other factors. The factors of general immunity include serum antibodies of classes IgA, IgM, IgG. Local immunity is associated with the production of secretory immunoglobulins of the class BUT (IgA s ) and plays a major role in protection against infection. Local immunity is relatively short-term and after the disease provides immunity to re-infection for 2-3 months.
Manifestations of the epidemic process. Dysentery is ubiquitous. In recent years, in Belarus, the incidence of Sonne dysentery is in the range from 3.0 to 32.7, Flexner's dysentery - from 14.1 to 34.9 per 100,000 population. Most cases of dysentery are classified as sporadic; outbreaks in different years account for no more than 5-15% of cases. Risk time- periods of ups and downs in Sonne's dysentery alternate at intervals of 2-3 years, with Flexner's dysentery, the intervals are 8-9 years; the incidence of dysentery increases in the warm season; in the structure of causes leading to morbidity, seasonal factors account for 44 to 85% of annual morbidity rates; in cities, two seasonal rises in the incidence of dysentery are often detected - summer and autumn-winter. At-risk groups– children aged 1-2 years and 3-6 years old attending preschool institutions. Territories of risk- the incidence of dysentery in the urban population is 2-3 times higher than in the rural population.
Risk factors. Lack of conditions for fulfilling hygienic requirements, insufficient level of hygienic knowledge and skills, violation of hygienic and technological standards at epidemically significant facilities, reorganization of preschool institutions.
Prevention. In the prevention of the incidence of dysentery, measures aimed at breaking the mechanism of transmission occupy a leading place. First of all, these are sanitary and hygienic measures arising from the results of a retrospective epidemiological analysis to neutralize the spread of shigella through milk and dairy products. An important section of sanitary and hygienic measures is to provide the population with good-quality and epidemically safe drinking water. Compliance with sanitary norms and rules at food industry and public catering enterprises, as well as in preschool institutions, makes a significant contribution to the prevention of dysentery. The rupture of the fecal-oral mechanism of transmission of shigella is promoted by pest control measures aimed at the destruction of flies, as well as preventive disinfection at epidemically significant objects.
Considering the significant contribution of seasonal factors to the formation of the incidence of dysentery, advance measures should be taken to neutralize them.
Anti-epidemic measures- Table 1.
Table 1
Anti-epidemic measures in the foci of dysentery
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Name of the event |
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1. Measures aimed at the source of infection |
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Revealing |
Implemented: when seeking medical help; during medical examinations and when observing persons who have interacted with patients; in the event of an epidemic unfavorable condition in terms of OKI, extraordinary bacteriological examinations of the decreed contingents can be carried out in a given territory or facility (the need for their conduct, the frequency and volume is determined by the experts of the CGE); among children of preschool institutions, orphanages, boarding schools, summer health institutions during examination before registration in this institution and bacteriological examination in the presence of epidemic or clinical indications; when receiving children returning to the listed institutions after any illness or a long (3 days or more, excluding weekends) absence, (admission is carried out only if there is a certificate from a local doctor or from a hospital indicating the diagnosis of the disease); when a child is admitted to a kindergarten in the morning (a survey of parents is conducted about the general condition of the child, the nature of the stool; if there are complaints and clinical symptoms characteristic of OKI, the child is not allowed in the kindergarten, but is sent to a health care facility). |
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Diagnostics |
It is carried out according to clinical, epidemiological data and laboratory results. |
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Accounting and registration |
Primary documents for recording information about the disease are: medical record of an outpatient (f. 025u); history of the development of the child (f. 112 y), medical record (f. 026 y). The case of the disease is registered in the register of infectious diseases (f. 060 y). |
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Emergency notification to the CGE |
Patients with dysentery are subject to individual registration in the territorial CGE. The doctor who registered the case of the disease sends an emergency notification to the CGE (f. 058u): primary - orally, by phone in the city within the first 12 hours, in the countryside - 24 hours, final - in writing, after a differential diagnosis has been made and after bacteriological or serological results have been obtained research, no later than 24 hours from the moment of their receipt. |
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Insulation |
Hospitalization in an infectious disease hospital is carried out according to clinical and epidemic indications. Clinical indications: all severe forms of infection, regardless of the age of the patient; moderate forms in young children and in persons over 60 years of age with a aggravated premorbid background; diseases in persons who are sharply weakened and burdened with concomitant diseases; protracted and chronic forms of dysentery (with exacerbation). Epidemic indications: with the threat of the spread of infection at the place of residence of the patient; workers of food enterprises and persons equated to them if they are suspected as a source of infection (mandatory for a complete clinical examination). |
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Employees of food enterprises and persons equated to them, children attending preschool institutions, boarding schools and summer health institutions are discharged from the hospital after a complete clinical recovery and a single negative result of a bacteriological examination conducted 1-2 days after the end of treatment. In case of a positive result of bacteriological examination, the course of treatment is repeated. Categories of patients who do not belong to the above contingent are discharged after clinical recovery. The need for bacteriological examination before discharge is decided by the attending physician. |
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The procedure for admission to organized groups and work |
Employees of food enterprises and persons equated to them are allowed to work, and children attending kindergartens, being brought up in orphanages, in orphanages, boarding schools, vacationing in summer recreational institutions, are allowed to visit these institutions immediately after discharge from the hospital or treatment for home on the basis of a certificate of recovery and in the presence of a negative result of bacteriological analysis. Additional bacteriological examination in this case is not carried out. Food workers and persons equated to them with positive results of a control bacteriological examination conducted after a second course of treatment are transferred to another job not related to the production, storage, transportation and sale of food and water supply (until recovery). If their excretion of the pathogen continues for more than three months after the illness, then they, as chronic carriers, are transferred for life to work that is not related to food and water supply, and if it is impossible to transfer, they are suspended from work with the payment of social insurance benefits. Children who have had an exacerbation of chronic dysentery are allowed to join the children's team if the stool has been normalized for at least 5 days, in good general condition, and at normal temperature. Bacteriological examination is carried out at the discretion of the attending physician. |
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Dispensary observation |
Employees of food enterprises and persons equated to them who have recovered from dysentery are subject to dispensary observation for 1 month. At the end of dispensary observation, the need for bacteriological examination is determined by the attending physician. Children attending preschool institutions, boarding schools who have recovered from dysentery are subject to dispensary observation within 1 month after recovery. A bacteriological examination is prescribed by him according to indications (the presence of a long unstable stool, the release of a pathogen after a completed course of treatment, weight loss, etc.). Food workers and persons equated to them with positive results of a control bacteriological examination conducted after a second course of treatment are subject to dispensary observation for 3 months. At the end of each month, a single bacteriological examination is carried out. The need for sigmoidoscopy and serological studies is determined by the attending physician. Persons diagnosed with chronic dysentery are subject to dispensary observation within 6 months (from the date of diagnosis) with a monthly examination and bacteriological examination. At the end of the established period of medical examination, the observed person is removed from the register by an infectious disease specialist or a local doctor, provided that he has made a full clinical recovery and is in an epidemic state of well-being in the outbreak. |
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2. Activities aimed at the transmission mechanism |
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Current disinfection |
In home foci, it is carried out by the patient himself or by persons caring for him. It is organized by the medical worker who made the diagnosis. Sanitary and hygienic measures: the patient is isolated in a separate room or a fenced off part of it (the patient's room is subjected to daily wet cleaning and ventilation), contact with children is excluded, the number of objects with which the patient can come into contact is limited, personal hygiene rules are observed; allocate a separate bed, towels, care items, dishes for food and drink of the patient; utensils and patient care items are stored separately from the utensils of family members. The patient's dirty linen is kept separately from the linen of family members. Maintain cleanliness in rooms and common areas. In the summer, they systematically carry out the fight against flies. In apartment foci of dysentery, it is advisable to use physical and mechanical methods of disinfection, as well as to use detergents and disinfectants for household chemicals, soda, soap, clean rags, washing, ironing, airing, etc. It is carried out during the maximum incubation period by the personnel under the supervision of a medical worker in the kindergarten. |
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Final disinfection |
In apartment outbreaks, after hospitalization or treatment of the patient, it is performed by his relatives using physical methods of disinfection and the use of household detergents and disinfectants. Instruction on the procedure for their use and disinfection is carried out by medical workers of health care facilities, as well as an epidemiologist or an assistant epidemiologist of the territorial CGE. In kindergartens, boarding schools, orphanages, dormitories, hotels, health-improving institutions for children and adults, nursing homes, in apartment centers where large and socially disadvantaged families live, it is carried out when registering each case, the CDS or the disinfection department of the territorial CGE during the first days from the date of receipt of an emergency notification at the request of an epidemiologist or assistant epidemiologist. Chamber disinfection is not carried out. Various disinfectants are used - solutions of chloramine (0.5-1.0%), sulfochloranthin (0.1-0.2%), chlordesine (0.5-1.0%), hydrogen peroxide (3%), dezam (0.25-0.5%), etc. |
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Laboratory study of the external environment |
As a rule, sampling of food residues, water samples and washings from environmental objects for bacteriological examination is performed. |
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3. Activities aimed at persons who have been in contact with the source of infection |
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Revealing |
Those who communicated in the kindergarten are children who visited the same group at the estimated time of infection as the sick person, staff, employees of the catering unit, and in the apartment - living in this apartment. |
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Clinical examination |
It is carried out by a local doctor or an infectious disease doctor and includes a survey, assessment of the general condition, examination, palpation of the intestine, measurement of body temperature. The presence of symptoms of the disease and the date of their occurrence are specified. |
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Collecting an epidemiological history |
It turns out the presence of such diseases at the place of work / study of the sick person and those who communicated, the fact that the sick person and those who communicated used food, which are suspected as a transmission factor. |
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medical supervision |
It is set for 7 days from the moment of isolation of the source of infection. In a collective focus (child care center, hospital, sanatorium, school, boarding school, summer health institution, food and water supply enterprise) is carried out by a medical worker of the specified enterprise or territorial healthcare facility. In apartment centers, food workers and persons equated to them, children attending kindergartens, are subject to medical supervision. It is carried out by medical workers at the place of residence of those who communicated. Scope of observation: daily (at the kindergarten 2 times a day - in the morning and in the evening) a survey about the nature of the stool, examination, thermometry. The results of the observation are entered in the journal of observations of those who communicated, in the history of the development of the child (f.112u), in the outpatient card of the patient (f.025u) or in the medical record of the child (f.026u), and the results of observation of the workers of the catering department - in the journal "Health ". |
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Regime-restrictive measures |
Activities are carried out within 7 days after isolation of the patient. The admission of new and temporarily absent children to the DDU group, from which the patient is isolated, is stopped. It is forbidden to transfer children from this group to other groups after isolation of the patient. Communication with children of other groups is not allowed. Participation of the quarantine group in general cultural events is prohibited. Walks of the quarantine group are organized and the last return from them, compliance with group isolation at the site, receiving food last. |
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Emergency prevention |
Not carried out. You can use a dysenteric bacteriophage. |
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Laboratory examination |
The need for research, their type, volume, frequency rate is determined by the epidemiologist or assistant epidemiologist. As a rule, in an organized team, a bacteriological examination of communicating persons is performed if a child under 2 years old who attends a nursery, an employee of a food enterprise, or equivalent to him, falls ill. In apartment centers, food workers and persons equated to them, children attending kindergartens, boarding schools, and summer recreational institutions are examined. Upon receipt of a positive result of a bacteriological examination, persons belonging to the category of “food workers” and equated to them are suspended from work related to food products or from visiting organized groups and are sent to the KIZ of the territorial polyclinic to resolve the issue of their hospitalization. |
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health education |
A conversation is being held on the prevention of infection with pathogens of intestinal infections. |
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