This document discusses respiratory infections and the mechanisms by which pathogens infect the respiratory tract. It first describes the three main segments of the respiratory tract: upper, lower airways, and lungs. It then explains various defense mechanisms in the lungs that protect against infection. Several strategies pathogens use to avoid these defenses are outlined, including capsule production, toxin production, replication within cells, and mimicry of host proteins. Key facts about influenza are provided, noting that it is an acute viral illness that spreads easily and causes annual epidemics during winter months.

1. Epidemiology ofEpidemiology of
respiratory infections.respiratory infections.
Influenza & other acuteInfluenza & other acute
respiratory infections.respiratory infections.
Diphtheria.Diphtheria.
Meningococcal infectionMeningococcal infection

2. Respiratory tract is usually divided into threeRespiratory tract is usually divided into three
segmentssegments
The Upper Respiratory tractThe Upper Respiratory tract
• This includes the nose,This includes the nose,
paranasal sinuses, andparanasal sinuses, and
throat.throat.

3. The Respiratory Airways:The Respiratory Airways:
 This includes theThis includes the
trachea, bronchi,trachea, bronchi,
and bronchioles.and bronchioles.

4. The Lungs:The Lungs:
This includes theThis includes the
respiratoryrespiratory
bronchioles,bronchioles,
alveolar ducts,alveolar ducts,
alveolar sacs,alveolar sacs,
and theand the
alveoli.alveoli.

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6. The following defense mechanisms in theThe following defense mechanisms in the
alveoli protect the parenchymal cells fromalveoli protect the parenchymal cells from
invasion by microorganismsinvasion by microorganisms
– Alveolar macrophages (the most important)Alveolar macrophages (the most important)
– Complement componentsComplement components
– Alveolar lining fluid containing surfactant,Alveolar lining fluid containing surfactant,
phospholipids, neutral lipids, IgG, IgE, IgA,phospholipids, neutral lipids, IgG, IgE, IgA,
secretory IgA, certain complement components,secretory IgA, certain complement components,
Factor B, and other unidentified agents that maybeFactor B, and other unidentified agents that maybe
important in activation of alveolar macrophagesimportant in activation of alveolar macrophages
– B cells, T cells, and null cells that can elicit aB cells, T cells, and null cells that can elicit a
localized immune response to infectionlocalized immune response to infection
– Lymphoid tissue associated with the lungsLymphoid tissue associated with the lungs

7. Mechanisms used to avoid phagocytosisMechanisms used to avoid phagocytosis
– Capsule productionCapsule production. (. (S. pneumoniae, H. influenza, B. anthracis, N.S. pneumoniae, H. influenza, B. anthracis, N.
meningitidis, K. pneumoniaemeningitidis, K. pneumoniae))
– Toxin productionToxin production. These toxins could include cytotoxins, leukocidins,. These toxins could include cytotoxins, leukocidins,
and exotoxins. (examples;and exotoxins. (examples; S. aureusS. aureus produces leukocidins andproduces leukocidins and
cytotoxins.cytotoxins. P. aeruginosaP. aeruginosa produces exotoxin A which destroys cellsproduces exotoxin A which destroys cells
much like the diphtheria toxin does.)much like the diphtheria toxin does.)
– BeingBeing too largetoo large to phagocytize. Parasites and fungi are often tooto phagocytize. Parasites and fungi are often too
large for the phagocyte to engulf.large for the phagocyte to engulf.
– Replication inside cellsReplication inside cells. Viruses and. Viruses and ChlamydiaChlamydia sp. are obligatesp. are obligate
intracellular parasites that replicate inside the cells of the lungintracellular parasites that replicate inside the cells of the lung
avoiding the phagocyte.avoiding the phagocyte.
– MimicryMimicry. Some parasites produce surface proteins which are very. Some parasites produce surface proteins which are very
similar to host proteins or acquire host proteins and appear to thesimilar to host proteins or acquire host proteins and appear to the
phagocyte as self. Some bacteria produce proteins that cause hostphagocyte as self. Some bacteria produce proteins that cause host
proteins to bind to their surfaces (ex. protein A/proteins to bind to their surfaces (ex. protein A/StaphylcoccusStaphylcoccus
aureusaureus))

8. Mechanisms used to survive in the phagocyteMechanisms used to survive in the phagocyte
 Inhibition of lysosome fusion with the phagosome.Inhibition of lysosome fusion with the phagosome.
((Toxoplasma gondii, Aspergillus sp., Chlamydia psittaciToxoplasma gondii, Aspergillus sp., Chlamydia psittaci))
 Escape from the phagosome. (Escape from the phagosome. (Mycobacterium leprae,Mycobacterium leprae,
Trypanosoma cruziTrypanosoma cruzi, Influenza virus escapes the, Influenza virus escapes the
phagolysosome)phagolysosome)
 Resistance to killing and digestion in the phagolysosome.Resistance to killing and digestion in the phagolysosome.
((Mycobacterium tuberculosis, Nocardia sp., Yersinia pestis)Mycobacterium tuberculosis, Nocardia sp., Yersinia pestis)
 Growth in the phagocytic cell. (Growth in the phagocytic cell. (M. tuberculosis, LegionellaM. tuberculosis, Legionella
pneumophilapneumophila, Cytomegalovirus), Cytomegalovirus)
 Entry into the phagocyte other than by phagocytosis. SomeEntry into the phagocyte other than by phagocytosis. Some
organisms avoid destruction by getting into the phagocyte'sorganisms avoid destruction by getting into the phagocyte's
cytoplasm. No phagosome-lysosome fusion occurs and thecytoplasm. No phagosome-lysosome fusion occurs and the
organisms can survive in the phagocyte. (organisms can survive in the phagocyte. (ToxoplasmaToxoplasma
gondiigondii, some enveloped viruses), some enveloped viruses)

9. To the infections of respiratory tract belongTo the infections of respiratory tract belong
about 20 % of all human infectiousabout 20 % of all human infectious
diseasesdiseases
Influenza (flu)Influenza (flu)
MeaslesMeasles
Pertussis (whooping cough)Pertussis (whooping cough)
ChickenpoxChickenpox
RubellaRubella
Scarlet feverScarlet fever
Meningococcal infectionMeningococcal infection
Acute tonsillitisAcute tonsillitis
DiphtheriaDiphtheria

10. AEROSOL MECHANISM OFAEROSOL MECHANISM OF
TRANSMISSIONTRANSMISSION
1 – the discharging of
agent from the organism
(expiration, sneezing,
cough, conversation)
2 – environment
(air, drops of
saliva, mucus)
3 – penetration of the
agent into the
susceptible organism
(inspiration)

11. AEROSOL MECHANISM OF TRANSMISSIONAEROSOL MECHANISM OF TRANSMISSION
 Subgroup ІSubgroup І –– the agents localized in the place of their penetrationthe agents localized in the place of their penetration
((measles, whooping cough , flumeasles, whooping cough , flu))
 Subgroup IІSubgroup IІ –– the agents from the penetration place moves intothe agents from the penetration place moves into
the deeper tissuesthe deeper tissues ((meningococcal infectionmeningococcal infection, mumps, mumps)) –– thethe
transmission from the secondary affected organs istransmission from the secondary affected organs is
impossibleimpossible
 Subgroup IІSubgroup IІ –– the penetration of the agent into the blood stream,the penetration of the agent into the blood stream,
the formation on the skin (and the mucous) the specific lesions, thatthe formation on the skin (and the mucous) the specific lesions, that
consist the agent (theoretically at their ulcerationconsist the agent (theoretically at their ulceration the contaminationthe contamination
can occurcan occur) –) – chickenpox, smallpoxchickenpox, smallpox
 Subgroup ІVSubgroup ІV –– can be transmitted not only by air butcan be transmitted not only by air but
also another factors,also another factors, contaminated by contagious dischargingcontaminated by contagious discharging
(household articles – dishes, toys; foods, water)(household articles – dishes, toys; foods, water) –– diphtheria, scarletdiphtheria, scarlet
fever, poliomyelitis and others.fever, poliomyelitis and others.

12. PECULIARITIES OF EPIDEMICPECULIARITIES OF EPIDEMIC
PROCESSPROCESS
 «Pure»«Pure» anthroponosisanthroponosis
 Infection at theInfection at the direct meeting the sourcedirect meeting the source
 «Child» infections:«Child» infections: as a rule the patientsas a rule the patients
are - childrenare - children
 SeasonalitySeasonality ((continuous staying in the closecontinuous staying in the close
room, the forming of new collectivesroom, the forming of new collectives))
 CyclicityCyclicity of epidemic processof epidemic process

13. SOCIAL FACTORSSOCIAL FACTORS
THAT INFLUENCE ON THE DEVEOPMENTTHAT INFLUENCE ON THE DEVEOPMENT
OF EPIDPROCESS AT AEROSOLOF EPIDPROCESS AT AEROSOL
ANTHROPONOSISANTHROPONOSIS
 Density of populationDensity of population
 Congestion of deploymentCongestion of deployment
 Infant natalityInfant natality
 The forming of organized collectivesThe forming of organized collectives
 MigrationMigration
 Organization of vaccinationOrganization of vaccination

14. (Flu, influenza) -(Flu, influenza) -
Acute viral illness with the directAcute viral illness with the direct
mechanism of transmission ofmechanism of transmission of
agent, distribution epidemic andagent, distribution epidemic and
pandemic; it is characterized bypandemic; it is characterized by
the infection of respiratory tracts,the infection of respiratory tracts,
expressed intoxication, fever andexpressed intoxication, fever and
moderate catarrhal phenomena.moderate catarrhal phenomena.

15. Key factsKey facts
 Influenza is an acute viral infection that spreadsInfluenza is an acute viral infection that spreads
easily from person to person.easily from person to person.
 Influenza circulates worldwide and can affectInfluenza circulates worldwide and can affect
anybody in any age group.anybody in any age group.
 Influenza causes annual epidemics that peakInfluenza causes annual epidemics that peak
during winter in temperate regions.during winter in temperate regions.
 Influenza is a serious public health problem thatInfluenza is a serious public health problem that
causes severe illnesses and deaths for higher riskcauses severe illnesses and deaths for higher risk
populations.populations.
 An epidemic can take an economic toll through lostAn epidemic can take an economic toll through lost
workforce productivity, and strain health services.workforce productivity, and strain health services.
 Vaccination is the most effective way to preventVaccination is the most effective way to prevent
infection.infection.

16. Flu agents–RNA-containingFlu agents–RNA-containing
virions, size varying from 80 tovirions, size varying from 80 to
120 nm120 nm

17. Different viral antigens ofDifferent viral antigens of
influenza A:influenza A:
1918 A.D– H1N1;1918 A.D– H1N1;
1957A.D– H2N2;1957A.D– H2N2;
1968A.D– H3N2;1968A.D– H3N2;
1977A.D– H3N2 and H1N1.1977A.D– H3N2 and H1N1.

18. INFLUENZA VIRUSINFLUENZA VIRUS
FORMULAFORMULA ::
А/Singapore/1/57/H2N2А/Singapore/1/57/H2N2
А/Honkong/1/68/H3N2А/Honkong/1/68/H3N2
А/Victoria/35/72/H3N2А/Victoria/35/72/H3N2
A/Texas/36/91/H1N1A/Texas/36/91/H1N1

19. SOURCES OF INFECTION:SOURCES OF INFECTION:
Healthy person in the latent period;Healthy person in the latent period;
Patient during whole periodPatient during whole period
Disease lasting -7 daysDisease lasting -7 days
Recovery– it is proved that inRecovery– it is proved that in
individuals a virus can be conserved upindividuals a virus can be conserved up
to 14-15 daysto 14-15 days
Birds.Birds.

20. Epidemiology:
• zoonotic
• source of infection – poultry
• mechanism of transmission – droplet?, fecal-oral?
contact?
• receptivity: mostly children
Infectious agent: H5N1, H7N7, H9N2
Clinic:
Flu-like symptoms:
fever, sensitivity to cold, headache, pain in muscles
and throat
symptoms of eyes infection
pneumonia

21. History:
in 1997 in to Hong Kong, virus H5N1 (18 people became ill, 6 died);
in 1999 in to Hong Kong, virus H9N2 (became ill 2 children);
in 2003 in to Hong Kong, virus H5N1 and H9N2 (became ill 3 persons,
a 1 man died);
in 2003 in Netherlands the virus H7N7 (89 people became ill, a 1 person died);
in 2004 – flash of bird flu H5N1 among people in China, Thailand, Vietnam
(35 persons died).
Features of virus of bird flu 2004:
The virus became more virulent, that testifies to his mutation
The virus overcame an inter-specific barrier from birds to the man, however
while there are no proofs of that an exciter is passed straight from a man to
the man (all sick people had the direct contact with the infected birds)
The virus will strike children mainly
the source of exciter and ways of distribution of virus are not certain, that does a
situation with distribution of virus not by practically controlled one
measures on prevention to distribution – complete elimination all total number
of birds of livestock

22. Classification of fluClassification of flu
(J10)(J10)
Serologic types of virus: A (H1N1), (H2N2),Serologic types of virus: A (H1N1), (H2N2),
(H3N2), B, C.(H3N2), B, C.
Clinical forms: typical, atypical (afebrile, acatarrhal,Clinical forms: typical, atypical (afebrile, acatarrhal,
hyper-acute).hyper-acute).
Degree of severity: mild, moderate, severe, veryDegree of severity: mild, moderate, severe, very
severe.severe.
Complication: pneumonia, otitis, sinusitis, tonsillitis,Complication: pneumonia, otitis, sinusitis, tonsillitis,
encephalitis, meningoencephalitis, pyelonephritis,encephalitis, meningoencephalitis, pyelonephritis,
pyelocystitis, cholangitis and others.pyelocystitis, cholangitis and others.

23. Clinical differences of flu and other ARIClinical differences of flu and other ARI
DiseaseDisease BeginningBeginning
BodyBody
TemperatureTemperature
IntoxicatioIntoxicatio
nn
Damage of respiratory pathwaysDamage of respiratory pathways
Other damagesOther damages
OftenOften RareRare
Influenza (flu)Influenza (flu) AcuteAcute
Febrile (3-5Febrile (3-5
days)days)
DevelopedDeveloped TrachitisTrachitis BronchitisBronchitis --
Para-influenzaPara-influenza
Progressive,Progressive,
rarely acuterarely acute
Sub-febrile (till 2Sub-febrile (till 2
weeks)weeks)
ImmeasuraImmeasura
bleble
LaryngitisLaryngitis
Rhino-Rhino-
pharyngitis,pharyngitis,
trachitistrachitis
--
AdenoviralAdenoviral
infectioninfection
Progressive,Progressive,
acuteacute
Febrile (mayFebrile (may
present > 5present > 5
days, minimumdays, minimum
5 days)5 days)
MildMild
Pharyngitis,Pharyngitis,
rhinitisrhinitis
PneumoniaPneumonia
Kerato-conjuctivitis,Kerato-conjuctivitis,
lymphoadenopathy,lymphoadenopathy,
hepato-hepato-
splenomegaly.splenomegaly.
RespiratoryRespiratory
synctal viralsynctal viral
infectioninfection
Acute andAcute and
progressiveprogressive
Sub-febrile,Sub-febrile,
rarely high (1-2rarely high (1-2
weeks)weeks)
MildMild BronchiolitisBronchiolitis
Rhino-Rhino-
pharyngitis,pharyngitis,
laryngitis,laryngitis,
bronchitis,bronchitis,
pneumoniapneumonia
RhinoviralRhinoviral
infectioninfection
AcuteAcute
Normal or sub-Normal or sub-
febrile (1-3 days)febrile (1-3 days)
AbsentAbsent
Rhinitis,Rhinitis,
serousserous
secretionssecretions
-- --

24. Differential diagnosis:Differential diagnosis:
tonsillitis;tonsillitis;
ornitosis;ornitosis;
measles;measles;
enterovirous illness;enterovirous illness;
typhoid;typhoid;
viral hepatitis;viral hepatitis;
pneumonia;pneumonia;
inflammation of additional cavities ofinflammation of additional cavities of
nose.nose.

25. TreatmentTreatment
 amantadineamantadine
 rimantadinerimantadine
 Zanamivir (Relenza)Zanamivir (Relenza)
 oseltamivir (Tamiflu)oseltamivir (Tamiflu)
 ribavirinribavirin

26. WHO recommends annualWHO recommends annual
vaccination for (in order of priority)vaccination for (in order of priority)
 nursing-home residents (the elderly ornursing-home residents (the elderly or
disabled)disabled)
 elderly individualselderly individuals
 people with chronic medical conditionspeople with chronic medical conditions
 other groups such as pregnant women,other groups such as pregnant women,
health care workers, those with essentialhealth care workers, those with essential
functions in society, as well as childrenfunctions in society, as well as children
from ages six months to two years.from ages six months to two years.

27. Influenza vaccines areInfluenza vaccines are
available in two forms:available in two forms:
 an intramuscular preparationan intramuscular preparation
containing formalin-inactivatedcontaining formalin-inactivated
virus and purified surface antigenvirus and purified surface antigen
 an intranasal spray containing livean intranasal spray containing live
attenuated virusesattenuated viruses

28. VaccinesVaccines ::
 The “Vaxigrip” firms of Paster MarkThe “Vaxigrip” firms of Paster Mark
 ““Fluorix” firms SmithClyayn BichemFluorix” firms SmithClyayn Bichem
 ““Influvac” firms Solvey FarmaInfluvac” firms Solvey Farma
 Influenza vaccine “Influvac”: componentsInfluenza vaccine “Influvac”: components
A/Sydney/455/97/H3N3, A/Beijing/263/95/H1N1A/Sydney/455/97/H3N3, A/Beijing/263/95/H1N1
and B/Beijing/184/93.and B/Beijing/184/93.
 It is intended for adults children. EnterIt is intended for adults children. Enter
intramuscular or deeply hypodermic. A protectiveintramuscular or deeply hypodermic. A protective
effect is achieved in 10 days after introduction.effect is achieved in 10 days after introduction.
Proceeds during 1 year.Proceeds during 1 year.

29. This preliminary negative stained transmission electronThis preliminary negative stained transmission electron
micrograph depicts some of the ultrastructuralmicrograph depicts some of the ultrastructural
morphology of the A/CA/4/09 swine flu virus.morphology of the A/CA/4/09 swine flu virus. Courtesy ofCourtesy of
CDC/ C. S. Goldsmith and A. Balish.CDC/ C. S. Goldsmith and A. Balish.

30. Phase 6 criteria: the same virus has caused sustainedPhase 6 criteria: the same virus has caused sustained
community-level outbreaks in at least one other country incommunity-level outbreaks in at least one other country in
another WHO region.another WHO region.

31. AdenovirusAdenovirus

32. Conjunctivitis during adenoviralConjunctivitis during adenoviral
infections:infections:

33. Pharyngo-conjunctivitis feverPharyngo-conjunctivitis fever

34. Treatment:Treatment:
 Bed regimenBed regimen
 milk-vegetable vitamin dietmilk-vegetable vitamin diet
 inhalations with addition in the aerosol ofinhalations with addition in the aerosol of
lemon acid 1:1000 or juice of lemon, boriclemon acid 1:1000 or juice of lemon, boric
acid 1:100acid 1:100
 reflex-therapy and laser-therapyreflex-therapy and laser-therapy
 antiviral preparations: remantadin,antiviral preparations: remantadin,
leucocytic interferon, amixin, cycloferon,leucocytic interferon, amixin, cycloferon,
amizonamizon

35. Indication for antibioticIndication for antibiotic
therapytherapy
 Very severe flu (hyper toxic form with theVery severe flu (hyper toxic form with the
phenomena of encephalitis, beginningphenomena of encephalitis, beginning
from pneumonia)from pneumonia)
 flu in the first 2 years of life children,flu in the first 2 years of life children,
pregnant, very weakened, persons senilepregnant, very weakened, persons senile
and old ageand old age
 bacterial complicationsbacterial complications
 accompanying chronic diseasesaccompanying chronic diseases

36. Prophylaxis of flu and other ARI:Prophylaxis of flu and other ARI:
SeasonalSeasonal
measuresmeasures
 Increasing the resistanceIncreasing the resistance
of persons,of persons,
reflexotherapy, UV-raysreflexotherapy, UV-rays
 Inductors of interferonInductors of interferon
secretionsecretion
 adaptogens (extractadaptogens (extract
eleoterococa, tinctureeleoterococa, tincture
arali, gin-sing)arali, gin-sing)
Urgent measuresUrgent measures
 Antiviral drugsAntiviral drugs
 ImmunostimulatorsImmunostimulators
 ointment of oxolineointment of oxoline
 Leukocytic interferonLeukocytic interferon
 Anti-influenzaAnti-influenza
immunoglobulinimmunoglobulin

37. IMMUNOPROPHYLAXISIMMUNOPROPHYLAXIS
Sturdy (Sturdy (perpetualperpetual) immunity after the) immunity after the
diseasedisease (measles, rubella, chickenpox at al.)(measles, rubella, chickenpox at al.)
Planned vaccinationPlanned vaccination – Immunizations schedule– Immunizations schedule
Collective immunityCollective immunity (immune «layer» –(immune «layer» –
95-98 % of the population)95-98 % of the population)
The immunization by the epidemic directionsThe immunization by the epidemic directions
– the increasing of morbidity rate, the threat of epidemy,– the increasing of morbidity rate, the threat of epidemy,
professional riskprofessional risk

38. EPIDEMIOLOGICAL CHARACTERISTIC OFEPIDEMIOLOGICAL CHARACTERISTIC OF
MENINGOCOCCAL INFECTIONMENINGOCOCCAL INFECTION
 The morbidity rate is not high,The morbidity rate is not high, the durationthe duration of generalized formsof generalized forms
isis severe, with high invalidity and mortalitysevere, with high invalidity and mortality
 The source – health carrier, nasopharyngitis patient (20 %),The source – health carrier, nasopharyngitis patient (20 %),
generalized form (1 %)generalized form (1 %)
The correlation ill / carriers – 1:2000The correlation ill / carriers – 1:2000
 For the infection is neededFor the infection is needed close and longtime conversation withclose and longtime conversation with
the source (not far then 0,5 м)the source (not far then 0,5 м)
 Among patients dominate childrenAmong patients dominate children
 SeasonalitySeasonality – February-April– February-April
 Cyclicity –Cyclicity – 10-30 year10-30 year

39. MENINGOCOCCAL INFECTIONMENINGOCOCCAL INFECTION
 Incubation period - 2-10 daysIncubation period - 2-10 days
 Clinical formsClinical forms –– nasopharyngitis, meningococcemia, purulent meningitisnasopharyngitis, meningococcemia, purulent meningitis
 HospitalizationHospitalization – the directions are clinical and epidemiological. The– the directions are clinical and epidemiological. The
hospitalization in the separate room is enable (not necessary into the box)hospitalization in the separate room is enable (not necessary into the box)..
 The terms of discharging – the clinical recovery. The admission into theThe terms of discharging – the clinical recovery. The admission into the
collective – after one control bacterial investigation on thecollective – after one control bacterial investigation on the
meningococcal carriage in 5 days after disgargingmeningococcal carriage in 5 days after disgarging
 The dispensary control after generalized forms – 2 yearsThe dispensary control after generalized forms – 2 years

40. MENINGOCOCCAL INFECTIONMENINGOCOCCAL INFECTION
Laboratory confirmation of the diagnosisLaboratory confirmation of the diagnosis
Detection of agent in the smear fromDetection of agent in the smear from
oropharynx, blood, spinal fluidoropharynx, blood, spinal fluid
intake the material from oropharynx by curveintake the material from oropharynx by curve
sterile wadding plug, do not touchsterile wadding plug, do not touch
mucous (lysozyme!)mucous (lysozyme!)
delivery it into the laboratory at thedelivery it into the laboratory at the
temperature 35-37 °Сtemperature 35-37 °С
sowing on the medium with the adding ofsowing on the medium with the adding of
proteinprotein
At microscopy – Gram-negative diplococci,At microscopy – Gram-negative diplococci,
situated intracellularsituated intracellular
Serologic investigation of blood (in dynamicsSerologic investigation of blood (in dynamics
with interval 5-7 days)with interval 5-7 days)

41. MENINGOCOCCAL INFECTIONMENINGOCOCCAL INFECTION
 Antiepidemic measures in the nidus:Antiepidemic measures in the nidus:
at the collective disease and in the closed collectives –at the collective disease and in the closed collectives –
quarantine 10 daysquarantine 10 days
thermometry,thermometry,
ENT-examination,ENT-examination,
bacteriological investigation (children-twice, adults – 1bacteriological investigation (children-twice, adults – 1
time),time),
sanation of the detected carrierssanation of the detected carriers
 Vaccination by the epidemic directionsVaccination by the epidemic directions

42. DiphtheriaDiphtheria
 is an acute infectious disease caused byis an acute infectious disease caused by
Leffler bacilliLeffler bacilli, transmitted mainly in an air-, transmitted mainly in an air-
drop way and characterized by thedrop way and characterized by the
symptoms of general intoxication, localsymptoms of general intoxication, local
inflammation of the mucous membranesinflammation of the mucous membranes
mainly with the formation of fibrinous filmmainly with the formation of fibrinous film
and typical complications of the nervousand typical complications of the nervous
and cardiovascular systems.and cardiovascular systems.

43. EPIDEMIOLOGICAL CHARACTERISTIC OFEPIDEMIOLOGICAL CHARACTERISTIC OF
THE DIPHTHERIATHE DIPHTHERIA
 «Controlled» infection«Controlled» infection
 SourceSource –– ill person, convalescent, carrierill person, convalescent, carrier
 Ways of transmissionWays of transmission –– aerosol, through the householdaerosol, through the household
articles, with foodarticles, with food
 SusceptibilitySusceptibility –– high, 80 % of patients – adults andhigh, 80 % of patients – adults and
incorrectly vaccinated childrenincorrectly vaccinated children
 ImmunityImmunity аntitoxic, нтитоксический, single for allаntitoxic, нтитоксический, single for all
types of agent, postvaccinaltypes of agent, postvaccinal
 Antibacterial cross immunity absentAntibacterial cross immunity absent

44. DIPHTHERIADIPHTHERIA
 Incubation period – 2-10 daysIncubation period – 2-10 days
 Clinical forms –diphtheria of oropharinx, nose,Clinical forms –diphtheria of oropharinx, nose,
larynx, trachea and bronchi, rare localizationslarynx, trachea and bronchi, rare localizations
 Hospitalization - immediateHospitalization - immediate, into the separate room, into the separate room
 TreatmentTreatment – specific (– specific (antidiphtheric serumantidiphtheric serum),),
etiologic, pathogenicetiologic, pathogenic

45. DIPHTHERIADIPHTHERIA
Laboratory diagnosticLaboratory diagnostic
 –– the detection of the agent in the smears fromthe detection of the agent in the smears from
oropharynx and nose (intake of the material on theoropharynx and nose (intake of the material on the
border of film and healthy tissue)border of film and healthy tissue)
 microscopymicroscopy (colouring by Neisser)(colouring by Neisser)
–– typical location of the rods like wide apart fingerstypical location of the rods like wide apart fingers
–– the sowing of material on the coagulated serum orthe sowing of material on the coagulated serum or
blood agarblood agar
Serological reactionsSerological reactions represent only the state ofrepresent only the state of
preceding immunity (effectiveness of vaccination)preceding immunity (effectiveness of vaccination)

46. DIPHTHERIADIPHTHERIA
 Terms of discharging - Условия выпискиTerms of discharging - Условия выписки ––
clinical recovering, 2 negative results of controlclinical recovering, 2 negative results of control
bacteriologic investigation on BL with two daysbacteriologic investigation on BL with two days
interval in 2 days after cancel of antibioticsinterval in 2 days after cancel of antibiotics
 Admittance to the professional abilityAdmittance to the professional ability afterafter
twice additional bacteriologic investigation ontwice additional bacteriologic investigation on
BL in the outpatients conditionsBL in the outpatients conditions
 Dispensary controlDispensary control 1 year, at complications –1 year, at complications –
cardiologist, neurologistcardiologist, neurologist

47. PROPYLAXIS OF DIPHTHERIAPROPYLAXIS OF DIPHTHERIA
 Planned vaccination –Planned vaccination – 3-4-5, 18 mth., 6, 14, 18 years,3-4-5, 18 mth., 6, 14, 18 years,
22-23 years and every 10 years22-23 years and every 10 years
 In spite of the recovering after diphtheria,In spite of the recovering after diphtheria, thethe
immunization is needed to continue in normal regimeimmunization is needed to continue in normal regime
 Antiepidemic measures in the nidus:Antiepidemic measures in the nidus:
observation by the contacts 7 days,observation by the contacts 7 days,
ENT-examination,ENT-examination,
bacteriologic investigation,bacteriologic investigation,
sanation of the carriers,sanation of the carriers,
revaccinationrevaccination

48. ЭПИДЕМИОЛОГИЧЕСКАЯЭПИДЕМИОЛОГИЧЕСКАЯ
ХАРАКТЕРИСТИКА ГРИППАХАРАКТЕРИСТИКА ГРИППА
 ВозбудителиВозбудители –– вирусы гриппа Авирусы гриппа А (неоднородность(неоднородность
структуры по Н0-Н3 и N1, N2; антигенный дрейф (вструктуры по Н0-Н3 и N1, N2; антигенный дрейф (в
пределах одного подтипа), антигенный шифтпределах одного подтипа), антигенный шифт
(возникновение нового подтипа).(возникновение нового подтипа). Н5N1,Н5N1,
А/Н1N1/Калифорния, В, СА/Н1N1/Калифорния, В, С
 Эпидемический процессЭпидемический процесс
 Источник возбудителяИсточник возбудителя –– больной с первых часов и вбольной с первых часов и в
течение всего заболевания, изредка – в инкубационномтечение всего заболевания, изредка – в инкубационном
периоде; реконвалесцент (иногда возможна длительнаяпериоде; реконвалесцент (иногда возможна длительная
персистенция вируса – до 150-180 дней)персистенция вируса – до 150-180 дней)
 ВосприимчивостьВосприимчивость –– высокая, инфекционный процесс ввысокая, инфекционный процесс в
клинически выраженной форме (возможныклинически выраженной форме (возможны
бессимптомные формы)бессимптомные формы)

49. ГРИПП, ОРВИГРИПП, ОРВИ
Клинические проявленияКлинические проявления
Грипп –Грипп – начало внезапное, наличие двух ведущих синдромов –начало внезапное, наличие двух ведущих синдромов –
токсикоза и катаральных явлений со стороны верхнихтоксикоза и катаральных явлений со стороны верхних
дыхательных путей (дыхательных путей (приступы трахеита, зернистаяприступы трахеита, зернистая
энантема на мягком небеэнантема на мягком небе). Лихорадка 3-5 суток.). Лихорадка 3-5 суток.
Аденовирусная инфекцияАденовирусная инфекция – начало постепенное,– начало постепенное,
интоксикация умеренная, горячка длительная,интоксикация умеренная, горячка длительная,
поражение глотки, конъюнктив, лимфаденопатия,поражение глотки, конъюнктив, лимфаденопатия,
гепатоспленомегалиягепатоспленомегалия
ПарагриппПарагрипп - ларингит (- ларингит (изменения голоса, “лающий”изменения голоса, “лающий”
кашель, ложный крупкашель, ложный круп))
Респираторно-синцитиальная инфекцияРеспираторно-синцитиальная инфекция ––
бронхиолитбронхиолит

50. ГРИПП, ОРВИГРИПП, ОРВИ
Лабораторная диагностикаЛабораторная диагностика
Выявление возбудителяВыявление возбудителя в смывах из рото- и носоглотки (прив смывах из рото- и носоглотки (при
аденовирусной инфекции – также с конъюнктив и кала)аденовирусной инфекции – также с конъюнктив и кала)
(культивирование на куриных эмбрионах или культуре тканей,(культивирование на куриных эмбрионах или культуре тканей,
иммунофлюоресценция, ПЦР)иммунофлюоресценция, ПЦР)
Серологические исследованияСерологические исследования кровикрови (РТГА, РСК в динамике)(РТГА, РСК в динамике)
ГоспитализацияГоспитализация – по клиническим показаниям– по клиническим показаниям
ЛечениеЛечение – патогенетическое, противовирусные препараты, по– патогенетическое, противовирусные препараты, по
показаниям – антибиотикипоказаниям – антибиотики
ВыпискаВыписка – клиническое выздоровление– клиническое выздоровление
ДиспансеризацияДиспансеризация не проводитсяне проводится

51. ПРОФИЛАКТИКА ГРИППАПРОФИЛАКТИКА ГРИППА
Ограничительные, санитарно-гигиенические, дезинфекционныеОграничительные, санитарно-гигиенические, дезинфекционные
мероприятиямероприятия
 Раннее выявление больных, их изоляцияРаннее выявление больных, их изоляция
 Дезинфекция (УФО, хлорсодержащие препараты)Дезинфекция (УФО, хлорсодержащие препараты)
 Отмена массовых мероприятий на период повышеннойОтмена массовых мероприятий на период повышенной
заболеваемостизаболеваемости
 Экстренная профилактика (химиопрепараты, интерфероны,Экстренная профилактика (химиопрепараты, интерфероны,
специфический иммуноглобулин)специфический иммуноглобулин)
 Специфическая профилактика (живые и инактивированные вакциныСпецифическая профилактика (живые и инактивированные вакцины
–– из эпидемично актуальных штаммов вирусов гриппа)из эпидемично актуальных штаммов вирусов гриппа)
 Плановая неспецифическая профилактика – закаливание, УФ иПлановая неспецифическая профилактика – закаливание, УФ и
лазерное облучение рефлексогенных зон, иммунокоррекциялазерное облучение рефлексогенных зон, иммунокоррекция