Professional Documents
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Infectious Orals
Infectious Orals
Emergency aid
Can be stopped endoscopically or with hemostatics such as tranexamic acid, aminocapronic acid,
vikasol.
In some of cases, bleeding can be rapidly fatal if large vessels is involved and in such cases only
surgery is uses
Supportive Therapy
• Bed rest and liquid diet during the fever period
• Adequate hydration
• Dietary Supplements with Ascorbic acid and vitamins
• Probiotics to prevent intestinal dysbiosis
** Prevention
• TAB Vaccine (Typhoid-paratyphoid A and B Vaccine) – 5-7years immunity
Epidemiology
• Source of infection: contaminated food (poultry, eggs, beef, etc), contaminated water, contact
with infected animals or their fecal matter, sick people or carriers
• Mode of transmission: Unhygienic cooking environments and persons, improperly cooked foods
• Vectors of the infection: Flies, cockroaches, rats
• Mechanism of transmission: Fecal-oral route
• Mode of occurrence: Occur as separate sporadic cases and as outbreaks
• Incubation period is 12-72 hours but can be longer
• Susceptibility of a person depends on the premorbid state of the macroorganism and the quantity
and variety (serotypes) of Salmonella present.
• Seasonality; mostly summer
** NB: Salmonella can remain viable in water for 11-120 days, in the sea water – 15-27 days, in soil
– 1-9 months , in sausage products – 60-130 days, in the eggs, vegetables and fruits till 2,5 months. **
Epidemiology
• Source of food poisoning: contaminated food (poultry, sausages, eggs, beef, vegetables, canned
foods, milk, etc), water or soil, contact with infected animals or their fecal matter, sick people or
carriers
• Mode of transmission: Unhygienic cooking environments and persons, improperly cooked foods
• Mechanism of transmission: Fecal-oral route
• Mode of occurrence: Occur as outbreaks with an explosive character of illness affecting a mass of
people that fall ill over a short period of time (e.g. After visiting a restaurant); and may also occur as
separate sporadic cases
• Incubation period: A few hours
• Susceptibility of a person to this group of diseases is very high, sometimes up to about 90-100%.
• Seasonality: Toxic food-borne infections may occur during the whole the year, but occur more
especially in summer.
It may either be
Foodborne infections – ingestion of viable pathogens e.g. Typhoid fever, Salmonellosis, Cholera,
Shigellosis, etc
Foodborne intoxication – ingestion of preformed toxins e.g. Botulism and Staphylococсal
poisoning
Food Toxicoinfection – microbes produce toxins insitu when ingested with the food e.g. Bacillus
cereus poisoning
** NB:
There are 2 types of Bacterial toxins: Exotoxins & Endotoxins
• Exotoxins are the toxic products of bacteria which are actively secreted into environment.
Some exotoxin-releasing bacteria are Clostridium species, Enterobacter, Proteus, etc. There
are 2 types of Enterotoxins (Exotoxins) of bacteria: thermolabile and thermostable. They
increase the secretion of the fluids and salts into the stomach and intestine and damage the
membranes of the epithelial cells. Majority of enterotoxins are thermolabile.
• Endotoxins are toxic substances which are liberated only during the lysis of microbial cells.
Some endotoxin-releasing bacteria are Salmonella. **
Septic form:
Sepsis develops when there is a sharp decrease in the immune system function of the patient and it
is characterized by symptoms such as
• Acute onset from hectic or prolonged fever, chills and sweating, after an Incubation period
of about 5-10 days
• Pallor, rash may appear on the skin (petechiae or large hemorrhages).
• Purulent metastases in different organs and tissues
• Presence of septic focus may cause complications such as meningitis, pneumonia,
osteomyelitis, pyelonephritis, enterocolitis, etc
• Hepatosplenomegaly sometimes with the development of jaundice
• Toxic-dystrophic syndrome (dystrophic changes to parenchyma of organs e.g. liver)
• The influence of intoxication on the central nervous system leads to irritation, violations of
sleep, and sometimes delirium.
SALMONELLOSIS SHIGELLOSIS
LABS High WBC with left shift; High WBC and bands
Positive stool culture for increase;
nontyphoid Salmonella species Positive stool culture for
of bacteria Shigella bacteria;
Positive stool Guaiac Test
Q.28 Clinical manifestations of dehydration shock.
Dehydration shock also known as hypovolemic shock is a serious and sometimes life threatening
complication of dehydration, characterized by severe hypotension and disturbance of
hemodynamic stability and vital signs.
Clinical Manifestation
• Patient is drowsy
• Cold extremities
• Lethargy and weakness
• Eyes are sunken and dry with absence of tears
• Mouth and tongue is dry
• Skin turgor and elasticity decreased
• Tachycardia, Hypotension
• Tachypnea with Deep and rapid breathing
• Increased capillary refill time
• Urine output reduced or absent
• Increased hematocrit
• Electrolytes imbalance
** NB:
According to the WHO classification, patients with cholera may be divided into three groups by
their degree of dehydration:
The first degree of dehydration (Mild) - Patients who have loss of fluid volume equal to 5
% of their body weight.
• The second degree of dehydration (Moderate) - Patients who have loss of fluid volume
equal to 6-9 % of their body weight.
• The third degree of dehydration (Severe) - Patients who have loss of fluid volume over
10% of their body weight. This dehydration is dangerous for life if the reanimation
measures are not done. **
Classification of Pocrovsky - patients can be divided into four groups by their degree of
dehydration:
• The first degree of dehydration (Mild) is with fluid loss of 1-3 % of body weight.
• The second degree of dehydration (Moderate) is with fluid loss of 4-6 % of body
weight.
• The third degree of dehydration (Severe) is with fluid loss of 7-9 % of body weight.
• The fourth degree of dehydration (Extremely severe) is with fluid loss of more then 10
% of body weight.
** NB:
Complications: collapse, renal failure, cardiac failure,, pneumonia, abscess, phlegmon **
Q.36 Laboratory diagnosis of cholera.
Cholera is an acute anthroponosic infectious disease caused by eating food or drinking water
contaminated by Vibrio bacteria species, that leads to severe watery diarrhea and vomiting, which
can result in dehydration and even death if untreated.
LABORATORY DIAGNOSIS
Specific Tests:
• Stool culture and bacteriological studies
- Stool specimen appears like rice water
- Culture on sucrose agar plates (thiosulfate-citrate-bile-sucrose agar) reveals growth of yellow
colonies to confirm Cholera
- Gram stain, with Dark field microscopy reveals Gram negative, non motile Vibrios
- Bacteriological studies reveal lactose negative, sucrose positive, oxidase positive microbes
• Serological tests reveal cholera Antigens and host Antibodies to antigens as well as serotypes O1
and O139.
Non-specific Tests:
• CBC reveals Increased Hematocrit and ESR, Leukocytosis with left shift, neutrophylia and
eosinophilia. May reveal lymphopenia and monocytopenia in some cases.
• Biochemical Blood Analysis reveals
- fluid-electrolyte imbalance (sodium, potassium, chlorine, etc)
- elevations of LDH, AST and ALT enzymes (during complications)
• Renal Function tests may reveal kidney failure
• Urine Analysis may reveal signs of kidney failure
CLINICAL FORMS
• Asymptomatic Infection
• Non specific Febrile illness
• Aseptic Meningitis
• Paralytic polio disease
• Encephalitis
• Hand foot and mouth disease
• Herpangina
• acute hemorrhagic conjunctivitis
• Generalized Disease of Newborn
• Skeletal Muscle Infection Manifest as Pleurodynia
• Myopericarditis
• Clinic with respiratory infection
➢ Asymptomatic Infection
More than 50% of EV infections are asymptomatic or result only in Nonspecific febrile illness.
Young age is associated with higher frequency of symptomatic infection.
➢ Nonspecific febrile illness
• Illness that manifests as sudden fever. The fever may last for as long as a week
• myalgia, headache, sore throat, nausea, vomiting, mild abdominal discomfort, and diarrhea.
➢ Aspetic Meningitis
• Caused by Enteroviruses of group B coxsackievirus and echovirus
• Nonspecific fevers with CNS symptoms.Symptoms may also include headache, malaise,
nausea, and vomiting.,photophobia. Physical examination typically demonstrates
generalized muscle stiffness or spasm.
➢ Paralytic Polio disease
• Rapid onset of paralysis occurs 1 to 3 days after a minor febrile illness with sore throat,
headache, and myalgias.
• The paralysis is asymmetric and affects the proximal muscles more than the distal muscles.
• Lower limbs are more frequently affected and sensation is usually intact except in severe
cases.
➢ Encephalitis
• Echovirus 9 is the most common etiologic agent.
• lethargy, drowsiness, and personality change to seizures, paresis, and coma. Children with
focal encephalitis present with partial motor seizures, hemichorea, and acute cerebellar
ataxia
➢ Herpangina.
• This is an enanthematous (mucous membrane) disease that
• Painful vesicles of the oral mucosa along with fever and sore throat,
• The onset is sudden, with high temperatures [39.4-40°C].
• The oropharyngeal lesions usually erupt around the time of first fever.The duration of
illness is 3 to 6 days.
➢ Hand-foot-and-mouth Disease.
• Manifests as a vesicular skin rash on the hands and feet along with vesicles in the oral
cavity.
• Mainly caused by Coxsackie virus and echovirus.
• The oral vesicles usually are located on the buccal mucosa and tongue and are only mildly
painful.
• The exanthem involves vesicles on the palms, soles, and the interdigital surfaces of the
hands and feet.
➢ Skeletal Muscle Infection
• Manifest as Pleurodynia (Bornholm disease) which is characterized by an acute onset of
severe muscular pain in the chest and abdomen accompanied by fever.
• Coxsackie Virus 5 are the major causes.
• The muscular pain is sharp and spasmodic, with episodes typically lasting 15 to 30 minutes.
• During spasms, patients can have signs of respiratory distress or appear in shock, with
diaphoresis and pallor.
➢ Heart Infections
• In myopericarditis, Coxscakie virus B5 the most common causative agent.
• Fever, fatigue, and dyspnea on exertion, but more fulminant symptoms, including heart
failure or dysrhythmia, can occur.
➢ Respiratory infections
• These infections may result from enteroviruses.
• Symptoms include fever, coryza, pharyngitis, and, in some infants and children,
vomiting and diarrhea.
Herpangina
This is an enanthematous (mucous membrane) disease that presents with painful vesicles of the oral
mucosa along with fever and sore throat. The onset is sudden, with high temperatures [39.4-40°C].
The oropharyngeal lesions usually erupt around the time of first fever. The duration of illness is 3
to 6 days.
Hand-foot-and-mouth Disease
This common clinical syndrome manifests as a vesicular skin rash on the hands and feet along with
vesicles in the oral cavity. Mainly caused by Coxsackie virus and echovirus. Fever could also be
present. The oral vesicles usually are located on the buccal mucosa and tongue and are only mildly
painful. The exanthem involves vesicles on the palms, soles, and the interdigital surfaces of the
hands and feet.
Q.46 Etiology and epidemiology of shigellosis.
DEFINITION- Shigellosis is a bacterial infection that affects the digestive system. Shigellosis is
caused by a group of bacteria called Shigella. Gram negative bacteria from the family
enterobacteriaceae, most non-motile, non-sporing. Possess capsule (K antigen) and O antigen
Etiology: 4 subgroup based on biological and serological characteristics
Shigella dysenteriae
Shigella flexneri,
Shigella boydii
Shigella sonnei
Epidemiology
• Source- Sick patients, patients in period of convalescence and carriers.
• Mechanism of transmission: fecal-oral
• Ways of transmission: water (Shigella,.flexneri), food stuffs (Shigella .sonnei), dishes, dirty
hands, flies ! Epidemic features:
• season: summer & fall
• age: affects younger children more
• Incubation period 2-5 days
*** Shigella dysenteriae causes the most serious form of bacillary dysentery
Three medications are used most often to treat Balantidium coli: tetracycline, metronidazole,
and iodoquinol.
➢ Tetracycline*: adults, 500 mg orally four times daily for 10 days; children ≥ 8 years old, 40
mg/kg/day (max. 2 grams) orally in four doses for 10 days. (Note: Tetracyclines are
contraindicated in pregnancy and in children < 8 years old. Tetracycline should be taken 1 hour
before or 2 hours after meals or ingestion of dairy products.)
Alternatives:
➢ Metronidazole*: adults, 500-750 mg orally three times daily for 5 days; children, 35-50
mg/kg/day orally in three doses for 5 days.
OR
➢ Iodoquinol*: adults, 650 mg orally three times daily for 20 days; children, 30-40 mg/kg/day
(max 2 g) orally in three doses for 20 days. (Note: iodoquinol should be taken after meals.)
➢ Nitazoxanide*: has been tried in small studies, which suggest some therapeutic benefit (adults,
500 mg orally twice daily for 3 days; children age 4-11 years old 200 mg orally twice daily for
3 days; children 1-3 years old 100 mg orally twice daily for 3 days).
Management
Avoid ingestion of material contaminated with animal feces
Treatment of infected pigs
Prevention of contaminated food
Simanovsky-Plaut Diphtheria
Vincent tonsillitis
Leading symptoms severe pain in mouth and gums, Fibrinous inflammation in throat, toxic
foul smelling breath syndrome
Throat changes Grey-white pseudo membrane on Cyanotic, hyperemic, edema
gums that can ulcerate and cause
bad taste in mouth
Character of tonsillar Grey-white pseudo membrane on Grey or white yellow membranes can
exudates tonsils that can ulcerate and spread outside the tonsils. They are
become necrotic. Easily dense, hard to remove and bleed when
removable removed. After removal, they reappear
and cannot be separated
Lymphadenitis Cervical lymphadenopathy Regional
Toxic sign Absent or minor Proportional to surface of inflammation.
(mild, moderate and severe)
Subcutaneous fat Absent Typical for toxic forms (bull neck sign)
edema
Changes on the tongue Absent Coated
Peculiarities:
● Incubation period 8-12 days
● Prodromal period: high fever lasting 4-7 days. Malaise, anorexia. Cough, coryza and
conjunctivitis. Koplick spots inside the cheek opposite second molar
● Period of exanthema: Erythematous Maculopapular rash that becomes confluent begins on the
face and then proceeds to trunk, extremities, palms and soles. Lasts about 5 days.
● Desquamation and brown staining which spares palms and soles
● Generalized lymphadenopathy, mild hepatomegaly and appendicitis may occur due to
generalized involvement of lymphoid tissues.
● The characteristic of measles rash is classically described as a generalized, macropapular,
erythematous rash that begins several days after the fever starts. It starts on the head before
spreading to cover most of the body, often causing itching. The rash is said to “stain”, changing
color from red to dark brown, before disappearing. The measles rash appears two to four days
after initial symptoms, and lasts for up to eight days
Q.106 Peculiarities of rubella in adults.
DEFINITION – Rubella (also known as German measles) is an infection caused by the rubella virus.
Commonly it occurs in young children but it can affect anyone. The illness is usually mild but rubella
in pregnancy can cause serious damage to the fetus.
Mode of transmission- the virus is transmitted by droplets, air-born route or direct contact
Causative organism- rubella virus is a member of togaviridae family
PECULIARITIES:
● Incubation period 14-21 days
● Prodromal period (usually absent in children): eye pain on lateral and upward eye
movement, conjunctivitis, sore throat, headache, general body aches, low grade fever, chills,
anorexia. Tender lymphadenopathy particularly posterior auricular and suboccipital lymph
nodes. Forchheimer sign: pinpoint maculopapular Enanthema on soft palate.
● Exanthema (called 3 day measles): discrete rose-pink maculopapular rash which can be pruritic.
Begins on face and neck and spreads to trunk and extremities in 24 hours. Then on 2nd say they
begin to fade on face and disappear throughout the body on third day
CLASSIFICATION:
● Primary localized forms
o Meningococcal carrier state
o Acute nasopharyngitis
● Hematogenic generalized forms
o Meningococcemia: typical acute meningococcal sepsis, chronic
o Meningitis
o Meningoencephalitis
● Mixed forms (meningococcemia and meningitis)
● Rare forms: endocarditis, arthritis, irideocyclitis, pneumonia
● Complications: sepsis, DIC syndrome, toxic shock, brain edema
LABORATORY
● CBC: left shift leukocytosis with neutrophilia, increased ESR
● Bacteriological exam of nasopharyngeal mucus, blood, CSF, bacterioscopy of blood (thick
smear) and CSF
● CSF: neutrophil pleocytosis, protein increase, positive Pandy test, elevated pressure, slight
decrease of glucose level
● Serological
● Coagulogram: hypercoagulation or coagulopathy
SECTION 2
SECTION 3
Q.6 Sick person and the carrier and their epidemiological value.
Sick person is the primary source from which the infection spreads and is the most dangerous
source of infection because he or she releases a great quantity of the pathogenic microorganisms.
A carrier is a person with infection who is capable of transmitting the pathogen to others Carriers
release pathogenic agents into the environment in a smaller quantity than patients with clinically
manifest diseases, but they are danger to community too since they actively associate with healthy
people and spread the infection.
Carriers commonly transmit disease because they do not realize they are infected, and consequently
take no special precautions to prevent transmission. Symptomatic persons who are aware of their
illness, on the other hand, may be less likely to transmit infection because they are either too sick to
be out and about, take precautions to reduce transmission, or receive treatment that limits the
disease.
Categories of infectious diseases carriers.
• Asymptomatic or passive or healthy carriers are those who never experience symptoms
despite being infected.
• Incubatory carriers are those who can transmit the agent during the incubation period before
clinical illness begins.
• Convalescent carriers are those who have recovered from their illness but remain capable of
transmitting to others.
• Chronic carriers are those who continue to harbor a pathogen such as hepatitis B virus or
Salmonella Typhi, the causative agent of typhoid fever, for months or even years after their
initial infection.
METHODS
● Chemical Method
- Alcohol
- Chlorine and chlorine compounds
- Formaldehyde
- Glutaraldehyde
- Hydrogen peroxide
-Iodophors
- Halogen
- Peracetic acid
- Peracetic acid and hydrogen peroxide
● Physical method
Boiling at 100°C for 15 minutes, which kills vegetative bacteria.
Pasteurizing at 63°C for 30 minutes or 72°C for 15 seconds, which kills food pathogens.
Using nonionizing radiation such as ultraviolet (UV) light. UV rays are long wavelength and low
energy.
● Mechanical method
Cleaning, washing, filtration
PREVENTIVE MEASURES aimed to control infectious diseases taken by medical personnel are
divided into:
1. Preventive
2. Anti-epidemic
➢ Preventive measures: are carried out regardless of the presence or absence of infectious diseases
at a given time and locality. These measures are aimed at prevention of infectious diseases.
➢ Anti-epidemic measures: measures must be put in place to control or terminate the source of
infection, transmission mechanism, and susceptibility of population.
ANTIEPIDEMIC MEASURES:
• Examination on typhoid fever and paratyphoids all patients with fever, which last more than 5 days
(once on hemo-culture, and if fever continue more than 10 days Widal’s reaction of
hemaaglutination or RIHA)
• Examination of all persons, who are working at the industries dealing with food, for detection of
bacteriocarriers
• Obligatory hospitalization infectious hospital of patients and carriers into infectious hospital
• Observation of contact persons during 25 days and their separation from other people
• Every day thermometry, interrogation and medical examination
• One analyze of feces on coproculture and blood antibodies on Vi-antibodies
• Convalescents are discharged from hospital only after clinical recovery and three-time analysis of
feces and urine with 5-days interval, and bile in 10 days after disappearing of clinical signs, if results
are negative
• Three-month observation and 2-years registration in sanitary-epidemic department with several
times bacterial examination
• Current and final disinfection.
Q.22 Hepatitis A. Epidemiological features (source of agent, factors of
transmission, signs of epidemic process), preventive and anti-epidemic
measures.
Hepatitis A (formerly known as infectious hepatitis) is an acute infectious disease of the liver caused
by the hepatitis A virus (HAV).
EPIDEMIOLOGY:
• Mechanism of transmission - Fecal-oral, Watery route Alimentary route Contact way (dirty hands,
towels, dishes etc.)
• Source of infection - Patients in the incubation, prodromal period and climax of the disease
• Susceptibility - Children after the first year of life, teenagers, young people up to 35 years, patients
with immunosuppression.
• Factors - Contaminated Water, infected food products and household items.
• Incubation period - between 2 and 6 weeks and the average incubation period is 28 days
CLINICAL MANIFESTATION:
• Phenomena of intoxication (high fever, malaise, general weakness, headache)
• Pharyngalgia - moderate
• Changes of a throat mucous - soft hyperemia, edema of tonsills, covers on their surface (grey colour,
dense, hard to remove with bleeding, slime), spread out of tonsills limits (palatopharyngeal arches,
uvula, soft palate)
• Augmentation and moderate morbidness of regional lymph nodes
• Edema of a hypodermic fat of a neck.
ETIOLOGY: It is caused by Salmonella species of bacteria from the Enterobacteriaceae family. All
nontyphoid species of Salmonella may cause Salmonellosis.
Eg. Salmonella typhimurium, Salmonella enteritidis
EPIDEMIOLOGY:
• Source of infection: contaminated food (poultry, eggs, beef, etc.), contaminated water, contact with
infected animals or their faecal matter, sick people or carriers.
• Mode of transmission: Unhygienic cooking environments and persons, improperly cooked foods.
• Vectors of the infection: Flies, cockroaches, rats.
• Mechanism of transmission: Faecal-oral route.
• Mode of occurrence: Occur as separate sporadic cases and as outbreaks.
• Incubation period: 12-72 hours but can be longer.
• Susceptibility of a person depends on the premorbid state of the macroorganism and the quantity
and variety (serotypes) of Salmonella present.
Salmonella can remain viable in water for 11-120 days, in the sea water - 15-27 days, in soil - 1-9
months, in sausage products - 60-130 days, in the eggs, vegetables and fruits till 2.5 months.
PREVENTION:
• Veterinary-surveillance upon animals and production of meat and dairy industry, laboratory control
of food stuffs.
• It is necessary to reveal carriers on milk farms, in foods, children’s and medical establishments.
• The maintenance of the rules of personal hygiene and rules of food’s cooking plays an important
role in prophylaxis of Salmonellosis.
Mechanism of transmission:
• Food borne (canned foods) contact, airborne
• Spores widespread in soil, contaminated vegetables and meat
• Foods canned without adequate sterilization
PREVENTION:
• The observance of the sanitary and hygienic rules at processing, transportation, keeping and
preparing of the food-stuffs expert possibility of accumulation of botulotoxin.
• It is necessary to perform the strict control under sterilization and keeping preserved food-stuffs.
Cook meats, mushrooms and vegetables properly.
PREVENTION MEASURES:
• Sanitarian patrolling of the state from delivery (quarantine infection contamination)
• Mandatory registration
• Sterilization of toolkit
• At detection of sick or carrier - parasitoscopy examination of all family members
• Anti-mosquito measures (melioration, usage of insecticides, repellents)
• Drug prophylaxis - primachinum 0,027gm/day for 14 days