ЗАТВЕРДЖЕНА

Дата добавления: 2015-10-15; просмотров: 509

The specific or characteristic symptoms may belocal and systemic, or systemic only.

Local symptoms.Since infection by inhalation is common, symptoms referable to the respiratory tract are frequent — so much so, indeed, that they almost lose their specificity. The commonest are: sore throat, coryza (running nose and eyes) and cough. Many diseases begin with one or more of these; but sore throat is particularly a feature of such diseases as scarlet fever and diphtheria; coryza appears in the common cold, measles and rubella; and cough in whooping cough and measles.

Certain common groupings of prodromal and local symptoms occur, of which headache, vomiting and sore throat are an example.

In some diseases the local manifestations at the site of entry are characteristic, e.g., the appearance of the throat in diphtheria. In others they may be quite inappreciable, but are followed by manifestations in some other part of the body, indicating the localization of the disease there, e. g., in cerebrospinal fever and acute poliomyelitis upper respiratory symptoms are common but subordinate to the most characteristic signs which appear in the central nervous system.

Answer the questions:

1. What are infectious diseases caused by?

2. What is the source of infections?

3. What is the principal classification of contagious diseases?

4. What stages are defined in the course of infectious diseases?

Complete the sentences using some of the following words in the right way: viral, a source of cause, a infection, communicable, a causative agent, to communicate, inoculation.

1. Chronic maternal………infections may ………severe sequelae in newborns.

2. Grippe is one of ……… and rapidly spreading diseases.

3. Contagious diseases…….. to others by different ways.

4. Only a full course of prophylactic…… is effective.

5. …… of measles penetrates through the respiratory tract during sneezing and coughing.

6. In the majority of cases the main…… of such diseases is the colon.

You are a pediatrician. Give the advice to young parents how to prevent their child from an infectious diseases. Use the following phrases: a chief sourse of infection, to penetrate through an abrasion or wound of the skin, to avoid direct contacts, an infected person, to be inoculated, etc.

Scarlet Fever(Text A)

The incidence of scarlet fever is the highest during the second five years of life. Infants arerarely attracted, butafter the age of six months their innate immunity gradually wanes.

Although there are several ways in which the disease may be disseminated the most common is undoubtedly by direct transmission of organisms from the nasal and aural secretions, and in certain instances from the discharge of an otitis media of an active or convalescent case. Hemolytic streptococcus of group A is commonly asso­ciated with scarlet fever. The usual incubation period is three days. It is always less than a week, but may be as long as six days or as short as twelve ours. The onset is usually sudden and is accom­panied by chillness, vomiting, headache and a sore throat as in diphtheria and acute tonsillitis, the child often makes no complaint of sore throat, which may only be discovered on routine examination. The face is flushed and the skin feels hot and dry. In children a rapid pulse rate out of proportion to the height of temperature is one of the features of the disease. The flash appears in twenty-four to forty eight hours. Occasionally it arises simultaneously, with the first symp­toms, or may be delayed until the fifth or sixth day of the disease. The usual duration of rash is three days, a profuse rash causing considerable itching. In most cases the tongue quickly becomes covered with white fur, through which the swollen papillae protrude as red points.

The temperature continues to rise with progressive development of the rash. Later defervescence occurs pari passuwith the disappearance of the rash and reaches the normal by lysis at about the seventh to tenth day of the illness.

Examination of the blood reveals marked polymorphonuclear leucocytoses. Eosinophilia is also found, varying with the stage and severity of the disease.

With the subsidence of the febrile symptoms desquama­tion sets in, usually towards the end of the first week it may begin with the rash still present, or be delayed for some weeks.

Scarlet fever may bring about serious complications such as otitis, nephritis, rheumocarditis, endocarditic, myocarditis, lymphadenitis, mastoiditis, pneumonia. Cardiac disorder commonly called “cor scarlatinosum” is a rather typical complication after scarlet fever. The symptoms of scarlatinous heart were first described by the foun­der of pediatrics N. Filatov.

The treatment for scarlet fever consists of giving anti­bacterial and anti- streptococcal preparations. The use of pen­icillin and other antibiotics not only relieves the clinical course of the disease but is an effective means of preventing complications.

General antiepidemic measures are carried out, prophy­lactic inoculation and sero- immunization being of great im­portance for prevention of scarlet fever. The children who nave been exposed to the disease must be given immunoglo­bulin. Soviet pediatricians Molchanov V. I., Lebedev D. D., Koltypin A. A. have contributed a great dеаl to the teaching of scarlet fever. They were the first to investigate the changes of vegetative system functions in scarlet fever. The know­ledge of these phenomena is of great value for understanding the nature of other infectious diseases.

Scarlet Fever(Text B)

Scarlet fever or scarlatina is an acute communicable disease, characterized by high fever, sore throat, and punctiform red rash upon the skin.

Etiology. Scarlet fever is caused by a variety of strains of Hemolytic streptococci. It is generally spread by direct contact, especially through throat, nasal and ear secretions; it may also be communicated by clothing, toys, and other articles, by a third person or through infected milk. As in diphtheria, the portal of entry is through the respiratory passages. Localization of the primary infection is most frequently in the throat or nasopharynx, but the organism may enter the body at other sites and in these cases the local symptoms in the throat and nasopharynx are often mild. The total number of cases in a community seems dependent on the size of the population, probably because in large cities there are more carriers. An individual usually becomes immune after an attack of scarlet fever, but some people experience recurrences which may be explained by the fact that so many strains of the Hemolytic streptococci cause the disease.

Signs and symptoms. The incubation period is from two to seven days. The onset is usually sudden with a complaint of sore throat, nausea and vomiting, headache and fever. The throat shows evidence of marked injection and edema. Occasionally exudate is present on the tonsils. The tongue will be coated at the start and subsequently desiccates from the tip backward, presenting red appearance on the fourth day with the red, glistening papillae present. This has been spoken of as the raspberry tongue of scarlet fever but is best termed "the glossitis" of the disease.

The rash appears from 10 to 36 hours after the onset of symptoms. It is a densely scattered, erythematous, punctate rash which may appear confluent. It is noted first on the upper chest and back, and then rapidly spreads over the body and extremities. The colour may vary from pale pink to deep scarlet, and disappears on pressure, leaving a yellowish mark on a background of scarlet. The skin is hot and dry, and may be oedematous. The face is usually flushed, without rash, except for the area around the mouth which remains white. There is a leucocytosis of from 10,000 to 18,000, and a trace of albumin is found in the urine.

As the fever increases, the throat symptoms become more severe; the fever usually reaches its height in 24 hours, remains there for four or five days, and then gradually falls by lysis as the rash fades. Desquamation begins about the sixth day when the temperature fails and eruption disappears. Desquamation does not always occur.

In the septic type, a profuse nasal discharge is present almost from onset. Throat symptoms are very severe and there may be difficulty in swallowing. Patches on the tonsils and throat suggest diphtheria. Despite unfavourable appearance of the patient, prognosis is much more hopeful than in the toxic cases. The fever reaches an unusual height of 40° to 41° С (104° to 106° F), in the latter case the pulse is rapid as are respirations. Death often occurs before the rash appears.

Complications.The complications of scarlet fever may result from the bacterial invasion or they may be due to the erythrogenic toxin. The bacterial invasion may cause peritonsillar abscess, sinusitis, otitis media, and mastoiditis. Rarely bacteriemia results in endocarditis. The toxin may cause lymphadenitis, arthritis, synovitis, and nephritis.

Treatment.In the treatment of scarlet fever, one of the first requirements is the isolation of the case, with the view of preventing the spread of the disease. Children who have been in contact with cases of scarlet fever should be quarantined for twelve days before being allowed to mix with other children in school or elsewhere. Scarlet fever is now regarded and treated as a highly infectious streptococcal infection, the chief source of contagion being the discharges of ear, nose and throat. Antiscarlatinal serum is of value in treating those seriously ill, and, as scarlet fever is predominantly a streptococcal infection, the sulphonamide drugs and penicillin have a place in treatment. During the progress of the fever, in favourable cases little is required beyond careful nursing and feeding.

Answer the questions:

1. When is the incidence of scarlet fever the highest?

2. How is scarlet fever disseminated?

3. What is the causative agent of scarlet fever accompanied by?

4. What does blood test reveal?

5. May the disease be accompanied by complications?

6. What is the usual treatment for scarlet fever?

7. What does the physical examination show?

8. What are the main features of the disease?

9. When does the period of desquamation usually start?

10. What preventive measures are usually carried out?

Choose the right version:

1. Contagiuns diseases …… to others by direct or indirect contact.

a) are communicated;

b) are recognized;

c) are contagious.

2. With the use of …….. many acute childhood infections have been successfully combated.

a) germ;

b) vaccine;

c) offspring.

3. The causative agent of measles…… through respiratory tract during sneezing.

a) penetrates;

b) suspects;

c) prevent.

4. Grippe is a highly………. and rapidly spreading disease.

a) infections;

b) capable;

c) communicable.

5. Immunity may be natural and………. .

a) reliable;

b) acquired;

c) respiratory.

Imagine you are a doctor. Now you are examining the child ill with scarlet fever. Discuss the condition of the child and the course of the disease with his mother, the following word combinations will help you. To be in direct contact with an infected person, to have a sore throat, a rapid pulse rate, a feature of the disease, a profuse rash, to cause itching, white fur, to prevent complications.

Measles

Measles is an acute infectious disease, occurring mostly in children. The infecting agent is a filtrable virus.

Measles is a disease which occurs mostly in the earlier years of childhood; it is admittedly rare in nurslings or infants under six months old. It is comparatively seldom met in adults, but this is largely due to the fact that most persons have undergone an attack in early life.

There are few diseases so infectious as measles. The disease is spread by infected droplets from the nose and throat. The patient becomes the source of infection beginning from the last two days of the incubation period, which contributes greatly to the spread of the disease. To diagnose the disease in its early period is very difficult as the temperature often falls to normal on the second day and the child appears to be much better, so that it is again allowed to mix with its playfellows, owing to the mistaken idea that it is suffering merely from a cold, till the rash appears on the fourth day and shows the real nature of the malady. Therefore the symptoms of the initial period of the disease should be well known and epidemical factors taken into account.

A period of incubation or latency precedes the development of the disease. During the second part of this period there appear some symptoms of the disease. This period appears to vary in duration, but it may be stated as generally lasting from ten to eleven days. The first symptom consists in the acute catarrh of the mucous membranes.

Sneezing accompanied with a watery discharge, sometimes bleeding from the nose, redness and watering of the eyes, cough of a short, frequent and noisy character, with little or no expectoration, hoarseness of the voice, and occasionally sickness and diarrhoea, are the chief local symptoms of this stage. But along with these there is well-marked febrile disturbance, the temperature being elevated 38°—38,5°C, and the pulse rapid, while headache, thirst, and restlessness are usually present to a greater or less degree. On the second and sometimes on the third day the temperature may become afebrile or even normal.

In some instances these initial symptoms are so slight that they almost escape notice, and the child is allowed to associate with others at a time when, as will be afterwards seen, the contagion of the disease is most active.

About the fourth day after the invasion, sometimes later, rarely earlier, the characteristic eruption appears on the skin being first noticed on the brow, cheeks, chin, also behind the ears and on the neck. Even before it appears on the skin, the rash is sometimes visible within the mouth on the soft palate; whitish spots on the mucous membrane of the mouth known as "Filatov spots" have a special value for the diagnosis.

The eruption spreads downwards over the body and limbs, which are soon thickly studded with the red spots or patches. The rash continues to come out for three days, and then begins to fade in order in which it first showed itself, namely from above downwards. By the end of about a week after its first appearance scarcely any trace of the eruption remains beyond a faint staining of the skin which disappears during the period of desquamation.

At the commencement of the eruptive stage, the fever, and catarrh, which were present from the beginning become aggravated, the temperature often rising to 39—40° С or more, and there are headache, thirst, and furred tongue. The patient is also usually much depressed. These symptoms usually decline as soon as the rash has attained its maximum, and sometimes there occurs a sudden and extensive fall of temperature, indicating that the crisis of the disease has been reached. In favourable cases, convalescence proceeds rapidly, the patient being perfectly well even before the rash has faded from the skin.

Measles as a disease is dangerous chiefly because of certain complications which are apt to arise during its course, more especially inflammatory affections of the lungs.

Answer the questions:

1. What is the causative agent of the disease?

2. What age is mostly affected by the disease?

3. What stages are there in the cyclic course of the disease?

4. When does rash appear?

5. What is the condition of the patient during the convalescent stage?

6. Why is the disease dangerous?