Bacterial and fungal infectious diseases,

affecting the oral mucosa

Acute disease from the group of respiratory infections which characterized by fibrinous inflammation of mucous membranes of oral cavity, nasopharynx, larynx with toxic lesion of cardiovascular and nervous systems

Etiology

Grampositive, nonmotile

Don’t forms spores and capsulesColoured by Neisser in brown-yellow colorRu, Leffler, Clauberg mediums - blood agar with tellurium saltsCultural-biochemical types of C. diphtheriae - mitis, gravis, intermediusProduction of very strong exotoxin (gene tox +)Structure of exotocin - dermanecrotoxin, hemolysin, neuraminidase, hyaluronidaseFirm to low temperature, long save on a dry surfaces; high responsive to heating and desinfection solutions

Corynebacterium diphtheriae (Leffler rod)

EpidemiologySource – sick person or carrier (convalescent or health) of toxicogenic strains

Ways of transmission - airborne, contact - household (occasionally)

Sensibility is high, adults more often become sick (80 %)

Case rate sporadic, outbreaks are possible

Immunodefence antitoxic, postvaccine

Seasonal character - autumn - winter

Diphtheria cases reported to World Health Organization between 1997 and 2007

PathogenesisPenetration of the agent through entrance gate (mucous of upper respiratory tract, sometimes conjunctivas, skin)Production of exotoxin Local and systemic effects of the toxin:Dermonecrotoxin - necrosis of a surface epithelium, retardation of blood stream, rising of a permeability of vessels, their fragility, transuding of plasma in ambient tissues, formation of a fibrinous film, edema of tissues; downstroke of pain sensitivity

PathogenesisNeuraminidase - replacement of cytochrome, blockage of cellular respiration, destruction of a cell, violation of a function of organs and tissues (central and peripheric nervous system, cardiovascular system, kidneys)Hyaluronidase - destruction of a stroma of a connecting tissue (rising of permeability of vessels, edema of tissues) Hemolysin - hemorrhagic set of symptoms

Clinical manifestationIncubation period – 2-10 daysPhenomena of intoxication (high fever, malaise, general weakness, headache)Pharyngalgia - moderateChanges 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 nodesEdema of a hypodermic fat of a neck

Peculiarities of diphtheria covers(Grey colour, dense, hard to remove with bleeding, slime), spread out of tonsills limits (on uvula, soft palate, palatopharyngeal archs)

Edema of a hypodermic tissues of a neck

Swollen neck in diphtheria

Features of diphtheria toxicosis

(In wide-spread, combined, hypertoxical, hemorrhagic forms) toxicosis І, ІІ, ІІІ

Edema of the neck hypodermic tissues

Paleness of skin

Cyanosis of lips

Decreasing of arterial pressure

Tachycardia

Decreasing of a body temperature

Diphtheria of larynx

Real croup (stenosis of a larynx)

І degree (catarrhal) - labored inspiration, retraction of intercostal spaces, rasping “dog barking" cough, “horse” voice

ІІ degree (stenosis) - noisy respiration, inspiratory dyspnea with an elongated inspiration, participation in respiration of auxiliary muscles, aphonia

ІІІ degree (asphyxia) - acute oxygen insufficiency, sleepiness, cyanosis, cold sweat, cramps, paradoxical sphygmus

Complications

Infectious-toxic shockIntra vessels disseminated syndrome Myocarditis (early, late)Polyradiculoneuritis (early, late)Nephrosonephritis etc.

LABORATORY DIAGNOSTIC

Detection of the agent in smears from a throat and nose (taking of material on border between effected area and normal mucous)

Microscopy (colouring by Neisser) – typical locating of rods, grains of volutin in bacterias

Sowing on convolute serum or telluric blood agar for allocation of clean culture and recognizing of toxigenisity

Serological tests mirror a condition of immune defence (efficiency of vaccination)

TreatmentImmediate hospitalizationBed regimen (at localized forms - 10 days, at toxic - not less than 35-45 days)Specific treatment - introducing of antitoxic antidiphtherial Serum (from 30-50 thousand IU at the localized forms up to 100-120 thousand IU at toxic, by Bezredka method) Glucocorticoids (in toxic forms and croup)Antibiotics (penicilini, tetracyclini, erythromycini) Strychninum (in toxic forms) In case of croup - inhalations, broncholitics, diuretics, glucocorticoids, antibiotics, antihistamine, lytic admixture; under the indications - intubation, tracheotomy

Conditions of discharging from a hospital

Clinical convalescence

2 negative results of bacteriological research of smears from a throat and a nose with two-day interval

For decret group - additional double bacteriological examination in polyclinic

ProphylaxisPlan immunization (vaccination in 3, 4, 5 months. With АPДT vaccine, revaccination in 18 months; 6, 11, 14, 18 years and adults every 10 years with АДT-М vaccine)In the focus –

7 days medical observation after contact persons

Bacteriological examination

Sanation of detected carriers

Final disinfection

Revaccination

DesinfectionAeration and ultra-violet lighting of puttings, wet cleaning with usage of 2/3-basic salt of perchloron, calcium of hypochlorite, 3 % of solution of chloraminum, 1 % of solution amfolan

Sputum, the outwashes from a nasopharynx hash with double quantity of solutions, exposition 2 hours. The tableware is boiled in 2 % potassium solution 30 mines. Bed-clothes and clothes if necessary to decontaminate in desinfection camera

Differential diagnosisTonsillitis, including Plaut-Vincent-SimanovskyHerpetic tonsillitisARVI (adenoviral infection, false croup)Paratonsillar abscessInfectious mononucleosisScarlet feverPseudotuberculosisTonsillo-bubonic form of tularemiaMycotic affection of tonsillsEpidemic parotitisTyphoid fever LuesHematological diseases (acute leukosis, agranulocytosis)

Acute infection of respiratory tract, which is caused by meningococcous (Neisseria meningitidis) and clinically represents in the forms of nasopharyngitis, sepsis or meningitis

The source of disease:

carriers (1 case per 2000 carriers)

patients with meningococcal nasopharyngitis

patients with generalized forms of infection

Mechanism of transmission – air-drop

Seasonal occurrence – February-April

Most of the patients are children under 10

Morbidity is sporadic, sometimes epidemic

Immunity is type-specific, steady

Classification:

I. Primarily localized forms: - meningococcal carrier state; - acute nasopharyngitis; II. Hematogenic generalized forms: - meningococcemia; - meningitis; - meningoencephalitis; III. Mixed forms (meningococcemia+meningitis); IV. Rare forms (endocarditis, arthritis, irideocyclitis,

pneumonia). Complications: severe brain edema, infectious-toxic

shock

Rashes peculiarities: haemorrhagic;

localization on buttocks, thighs, shins, trunk;

a lot of elements;

different sizes of elements – from patechial to the spread hemorrhages;

non correct form, often star-like;

different coloring and brightness of elements;

necrosis in place of considerable hemorrhages with formation of defects;

often combination of hemorrhages with roseolla and papules.

Laboratory diagnostics1. Revealing of infectious agent in smears

from pharynx, blood, liquor

- the material for stain should be taken without touching of mucous membrane of cheeks and tongue.

Microscopy: gram-negative diplococci with intracellular localization

2. Serologic tests: in dynamic with interval 5-7 days

3. Express-diagnosis: immunofluorescent method.

TreatmentGeneralized forms: - immediate hospitalization- antibiotics in large doses (benzylpenicilline 200

000 – 500 000 U/kg, levomycetini succinatis)- corticosteroids- dehydratation therapy (in case of meningitis)- desintoxication- treatment of disseminated intravessel

coagulation (heparin, contrical, human plasma)Sanation of meningococcus carriers:- antibiotics in common doses (ampicillini,

levomycetini, rifampicini)- local sanation (ultraviolet, ultrasonic)- desensibilisation therapy

HIV-Infection -viral disease of human, which is passed mainly by sexual and parenteral ways and characterized by long-term persistence. Defeat of the thymus gland’s system of immunity, causes clinically expressed form – syndrome of acquired immune deficiency (AIDS) with lymphadenopathy, intoxication, spreading of infectious diseases and oncological processes

Properties of Kaposhi sarcoma in patients with

AIDS: - strike the persons of age young and middle - primary elements appear on a head and trunk - become purulent and varicosity - metastasizes in internal organs, has a malignant

course - is marked by high lethality, patients more frequent

does not exceed 1,5 year

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