2. Diphtheria
•Corynebacterium diphtheriae (isolated in pure a culture in 1884 by Leffler)
•Gram (+) stick, motionless, does not form a dispute.
•Size 0.3-1.8 µm, arranged at an angle to one another (V, X)
•Specifically painted according to Naseru
•Stable in the external environment: at t<0°C for up to 15 days.
•Optimum of growth at 37°C, death at 58°C
•Sensitive to the action of disinfectants.
•Aerobic or facultative anaerobic
•Cultivated on the media containing blood or serum with the addition of
potassium tellurite or chinosol
•According to cultural properties of the 4th types: gravis, mitis, intermedius,
minimus
Non-toxigenic Toxigenic
tox +
in Corynebacterium diphtheriae DNA
persistent hereditary trait of
diphtheritic
tox +
in the DNA of a
lysogenic phage
3. The epidemiology Diphtheria
The source:severe
anthroponosis
The ways of the
transmission:
The susceptible
organism:
sick and carriers of the toxic diphtheria sticks, especially
with the localization of the pathogen in the upper respiratory
tract, less-outside the respiratory tract (skin, wounds)
•1) airborne
•2) household contact
•3) alimony (milk)
Susceptibility-15-20%
Children and adults who do not have antitoxic immunity or
having it's low tension
(blood antitoxin content < 0.03 AE in 1 ml).
The duration of immunity after the disease is determined by the
transferred form.
Treatment of patients are treated with serum and antibiotics but
that reduces immunogenesis, so it is possible for-diphtheria
disease be repected.
Seasonality - autumn-winter.
4. The Pathogenesis
Entrance gate
mucosa of the mouth
and nasopharynx,
respiratory tract,
genitals, conjunctiva of
the eye, damaged skin
local reproduction
and production of
exotoxin
the presence of
antitoxic
immunity
formation of
carriaging
local focus of tissue damage
exotoxin,
hyaluronidase,
neuraminidase
exudation -
coagulation
necrosis of
tissue
increased
permeability of
the vascular
wall
thrombokinase fibrinous
inflammation
Diphtheric inflammation is th multilayered flat
epithelium of lesion cells of necrosis of epithelium and
underlying submucosal tissue.The film is dense,
difficult to separate, leaving a bleeding surface
Coarse inflammation-defeat of a single layer of
cylindrical epithelium (respiratory tract). The film is
easily separated, it contributes to to reduce the
absorption of toxin
toxemia
Heart muscle-contractile and conductive myocytes interstitial, parenchymal myocarditis.
Kidneys – interstitial tissue, epithelium of the glomeruli, nefrosa-jade
Nervous system – swelling of the axis cylinders, dissolution of myelin sheaths – neuritis
Adrenal glands-destruction of cells up to their complete necrosis
5. Clinical manifestations
Incubation period 2-7 days
diphtheria of the oropharynx 79,4%
with the localization of the process
outside of the tonsils
20,6%
combined forms 16,9%
6. Diphtheria of the oropharynx (localized
form)
•sick vaccinated, raids are only on the tonsils).
•signs is acute,with minor of ailments, loss of
appetite. Complaints of minor pain when onset.
The symptoms of intoxication are mild. T-37,5-
38°C for 2 days and them normalizes.
•on examination of the oropharynx: there is are:
swelling of the tonsils, mild hyperemia of the
tonsils and arches. Fibrinous films appear on the
tonsils at the end of the first beginning and of
thed days from the moment of the disease.
•Point-raids in the form of points.
•Islet-raids in the form of Islands
•Most often they disappear spontaneously
•during 2-5 days.
•Film-at the begining raids have the form
•in the cource of a translucent film and web films.
•Treatment of raids disappear during 2-3 days
Catarrhal
No complications
7. Diphtheria of the oropharynx (common form)
•Occurs mainly in unvaccinated children (90%). In young
children, often in combination with diphtheria of the larynx or
nose.
•Pain in the throat of raids are outside the tonsils - Palatine
arch, uvula, posterior pharyngeal wall.
•The onset is acute, symptoms of intoxication are moderately
pronounced. Sore throat in the moment, headache,
decreased appetite. T-38-39.5 S in the first 2 days, then
subfebrile or normal to the 3th-4th days.
•On examination on can notice moderate swelling of the
tonsils, arches, soft palate + raids. Raids first appear on the
tonsils and are more pronounced.
•There enlargement and tenderness of lymph nodes up to 2
cm.
•Raids persist longer than in the film form ( in untreated to 10-
14 days; with the introduction of serum - 5-8 days).
•Complications are rare and are not severe.
8. Diphtheria of the oropharynx (toxic form)
• Unvaccinated or had lost their immunity are ill
• 1. It begins immediately as toxic and is characterized by the
rapid development of all symptoms.
• 2. May be a progression of a lighter form.
• The onset of acute (means the hour of the onset of the
disease) with the simultaneous appearance and progressive
increase of temperature, intoxication, pain and regional
lymphadenitis.
• Temperature-39-40 C (for 3-5 days) and reduced
spontaneously, despite the continuing raids.
• Intoxication: headache, chills, General weakness, anorexia,
pale skin, repeated vomiting, abdominal pain. Bouts of
excitement (delirium), alternating with by weakness.
• Acute pain during swallowing, pain in the neck, pain in the
region of the lymph nodes, masticatory muscles. (With
subtoxic-the severity of these symptoms is not sharp, with
toxic - sharp).
• During examination the of oropharynx: swelling of the
oropharynx begins with the tonsils, then goes to the arms,
tongue, soft and firm palate. The rate of its progression and
size correspond to the degree of severity.
• Features of edema in the oropharynx: diffuse without sharp
boundaries and local swelling, its rapid increase (compared
with edema of subcutaneous tissue).
• Redness over the swelling: bright with a cyanotic shade.
9. Diphtheria of the respiratory tract
(diphtheria croup)
•Croupous inflammation on the
mucous membrane
•Isolated (airway only)
•Combined (oropharynx, nose).
•Localized (diphtheria of the
larynx).
•Widespread A; B.
•Beginning is gradual: temperature up to 38°C, mild symptoms of
intoxication (malaise),
•Catarrhal stage: the appearance of rough, "barking" cough",
hoarseness of the voice.
•Duration 1-2 days.
10. THE DIAGNOSTICS
The material taken in the zone of inflammation
along the edges of the fibrin film is
investigated.
BACTERIOSCOPIC
STUDY
•BACTERIOLOGICAL
EXAMINATION
•trice from tonsils
and nose
SEROLOGICAL STUDY:
1. Determination of the level
of antimicrobial antibodies
(RPG)
2. Determination of the level
of antitoxic antibodies
before the introduction of
PDS (in the diagnosis of
atypical forms). A number
of antivenoms are less
than 0.5 AU / ml confirms
diphtheria
12. The prophylaxis
• The specific – AKDS
• * Vaccination 3 months. - 4.5
months. - 6 months.
• * I revaccination-18 months.
• * * II revaccination-7 years
(ADS)
• • III revaccination - 14 years
(ADS).
• * Further every 10 years.
• * Immunization of patients.
•The nonspecific
•On contact in the hearth - isolation for 7
days once bacteriological examination
(smear from the tonsils and nose)
•examination the otorhinolaryngologist
•final disinfection.
•For early diagnosis of diphtheria -
monitoring of patients with angina for 3 days
with a mandatory 1 fold. bacteriological
examination for diphtheria.
•Prophylactic single bacteriological
examination for diphtheria (smear with the
mucosa of the tonsils and nose) are the
children in children's homes, boarding
schools, sanatoriums, as well as persons
who are admitted to children's
psychoneurological hospitals, tuberculosis
clinics and staff, job seekers in these offices.
14. Measles
•The disease belongs to the group of large micro viruses,
the genus Morbillivirus.
•* RNA-containing, has an irregular spherical shape with a
virion diameter of 120-150 nm.
•* Unstable in the external environment. It has great
volatility.
causative agent of
measles
The epidemiology
•The source is a sick man. Contagion from the last days of incubation, catarrhal and rash period
(up to 5 days).
•The transmission path is airborne.
•Susceptibility is universal.
•The contagiousness index is 95-96%.
•Immunity-persistent.
•In the pre-vaccination period, 90% of people had measles before the age of 10 years.
• During the vaccination period, teenagers and adults are ill. There is no frequency of the disease.
15. The pathogenesis
Entrance gate: mucous membranes of the upper respiratory tract, mucous membrane of the
eye
Fixation of the virus spread in the submucosa and regional lymph nodes
Primary reproduction in the lymph nodes and entering the blood
Virus reproduction in cells
the reticuloendothelial system:
tonsils, lymph nodes, spleen, liver,
lymphoid nodules of various organs
Central nervous system
diseases: serous meningitis,
meningoencephalitis
Diseases of the intestinal tract
Skin diseases: foci of
perivascular inflammation
(rash)
Diseases of the mucous
membranes of the lips,
cheeks: superficial necrosis
of the epithelium (spots
Filatov-Koplik)
Diseases of the respiratory
tract: inflammation of the
nasal mucosa, larynx,
trachea, bronchi, bronchioles,
alveoli, and underlying
tissues
16. Clinical manifestations
• Incubation period: 9-21 days.
• Catarrhal period: 3-4 days (5-6 days)
• Temperature rise to 38.5-39ºC, with lesions of the upper respiratory tract and conjunctiva, symptoms of
intoxication. Abundant discharge from the nose, obsessive cough. Photophobia, conjunctival hyperemia.
• Rash period 4-5 days of the disease.
• The appearance of a spotted-papular rash with a
• tendency to merge.Stages of rash. Pigmentation
Injection of vascular sclera and
conjunctiva
Spots Belsky-Filatov-Koplik
Maculopapular rash: 1 day Maculopapular rash: day 2 The period of pigmentation
17. The classification of measles
The Form: The Severity: The Current:
1. Typical.
2. Atypical:
- mitigated;
- abortive;
- erased;
- asymptomatic.
1. Light.
2. Medium-heavy
3.Heavy
1. Smooth.
2. Uneven:
- with complications:
- layering of secondary infection;
- with the exacerbation of chronic
diseases.
The Mitigated
The Mitigated
Is reduced or falls separate periods, of wear symptoms
Catarrhal period-absent or 1 day with mild catarrhal phenomena, no spots Filatov. The rash is pale,
small, abundant. No phasing
Severity is determined by the severity of symptoms of intoxication, local phenomena, as well as the
presence and severity of early complications.
Light-symptoms of intoxication are weak, T - up to 38.5 with a Rash with a weak tendency to merge.
Catarrhal phenomena are moderately expressed.
Moderate-symptoms of intoxication and catarrhal phenomena are expressed, the Temperature is up to
39 C. the rash is abundant, bright.
Severe-symptoms of intoxication are expressed, the temperature is up to 40 C, vomiting. The rash is
abundant with a cyanotic tint. Pneumonias.
18. Measles
Measles in vaccinated:
There are no differences from the typical forms (no development of immunity)
* More rarely-when immunity is lost by the time of contact-get sick easily
Measles in newborns and children of the first months of life: occurs as a mitigated, but can
be typical with the development of severe complications.
Measles in adults: retains typical symptoms and severity due to specific expressed
intoxication.
Laboratory diagnostics
Virus isolation-PCR diagnosis
Serological examination- enzyme immunoassay (IgM, IgG),
RPG (studies are carried out twice - at the beginning of the
disease, again after 10-14 days.).
Diagnostic is the increase in antibody titer
4 times or more.
Complications: • Caused by the measles virus.
• The accession of a bacterial infection.
19. Differential diagnosis
Catarrhal period
SARS – adenovirus infection
Precipitation period
Rubella
Allergic rash
Pseudotuberculosis
Spotty-papular allergic
rash on chest and arms
Allergic shown by fine spotty papular rash with isolated
large elements on the shaft
Maculopapular rash on the hips and shins, cyanotic feet
20. Measles
Prophylaxis
Isolation of
patients
is carried out until the 5th day after the rash, in the presence of pneumonia-
up to 10 days.
The contact
is a child or an adult is not vaccinated (or vaccinated only once) and
without a history of this infection. Quarantine for 21 days from the
moment of separation from the patient.
Children older than 2 years and adults who have had contact, previously unvaccinated carry out
urgent vaccination no later than 72 hours from the moment of detection of the patient.
Children under 2 years of age are administered immunoglobulin (3-5 days after contact).
Specific prophylaxis:
•vaccination in 12 months,
•revaccination at 6 years;
•children 15-17 years. including adults up to 35 years.
•After the introduction of the vaccine protective titer of antibodies in RGA
1: 10, the maximum-1: 80,
•Rtga-protective titer 1:4, maximum – 1: 64.
22. Paramyxovirus parotitidis
Size 100— 200 nm.
•Contains
•RNA membrane of matrix protein
(M),double layer of lipids, outer
glycoprotein, antigenic structure is
stable.
•Sensitive
•to heating (+18-20°C-from 4 to 7 days)
•disinfectant.
•UFO
•Resistant to low temperature (-20°C-6-8
months)
Released from saliva, blood, liquor
Immunity persistent
23. Severe anthroponosis
Contagious from the last days
of incubation to 9 days from
the onset of the disease
Infection by airborne droplets
Эпидемиологически важны
больные со стертыми и
бессимптомными формами!!!
Possibly a healthy viral carrier
Possibly a healthy viral carrier
Age structure of patients Seasonality
24. The incubation period is from 11 to 21 days.
Sometimes it is 23-26 days, but more often 15-19 days.
Can be 1-2 days prodrom:
General malaise, lethargy,
headache, sleep disturbance
The beginning of more often acute
Temperature rise to 38-39°C
and above
the appearance of signs of
organ damage
The defeat of any organ (most glands) may be primary or secondary
The process can be isolated (only in one gland):
often in the parotid or submandibular glands
rarely in the sublingual, pancreas and genital glands is rare.
25. PAROTITIS
•pain when chewing, swallowing;
•* dry mouth (the function of the glands is restored after 3-4
weeks.);
•* swelling in the front of the ear (along the ascending branch of
the lower jaw), under the ear lobe and behind the auricle (ear lobe
- in the center of the tumor);
•• filled the hole between the branch of mandible and mastoid
process (fossa retromaxillaris);
•* swelling of the fiber, extending down to the neck, anterior to the
cheek and posterior to the mastoid process
•Painful point:
•* in front of the ear lobe (at the lower edge of the external
auditory canal)
•* in the fossa between the anterior margin of the mastoid process
and the branch of the lower jaw
•Sign Mursu (frequency from 50 to 80%).
•• in the first days of the disease and persists for
4-6 days.
•• limited hyperemia of the mucosa in the area the
ductless 5-7 mm in diameter
•* oedema of the excretory duct
26. The process on the second side usually appears 2-3 days
after the onset of the disease
Swelling of the glands usually lasts 5-7 days (from 2-3 to 7-
10).
* more often bilateral
* a tumor in the form of an oblong or rounded formation from
the inside edge of the lower jaw
* swelling extends down to the neck and even the chest
• Rarely occurs in isolation
* swelling and soreness in the chin and under the tongue
* swelling extends to the upper part of the neck
SUBMAXILLARY
SUBLINGUAL
27. •Virological isolation of the
virus from the washouts
from the pharynx, blood,
saliva and cerebrospinal
fluid and urine
•pmfa detects a viral
antigen directly in the cells
of the nasopharynx.
•RSC and RNA in paired
sera: 1 sample-on the day of
primary diagnosis, 2-in 2-3
weeks. The diagnostic titer
of 1:80, an increase of titer.
•ELISA - detection of IgM by
7-9 day from the onset of the
disease, remaining 2-4
months, and by the end of
the month – IgG – for life.
SEROLOGICAL DIAGNOSIS:
CLINICAL DIAGNOSTICS:
IDENTIFICATION OF THE
PATHOGEN:
LABORATORY DIAGNOSTICS
General blood test
General urine test
•Diastasis in the urine, increased to
20-30 days of the disease.
•Attention! High levels of amylolytic
enzymes in the blood may be
associated with a violation of their
outflow from the salivary glands.
•Glycemic curve
•Cerebrospinal fluid increased
pressure, opalescent fluid, weakly
positive Pandi reaction, lymphocytic
cytosis from 300-700 to 2000 cells
per 1 mkl, protein and sugar are
normal or somewhat elevated
28. Toxic mumps
it is an occupational disease of adults
occur in acute and chronic
poisoning with mercury, lead, iodine
develop slowly
do not have cyclic current
* other typical for the corresponding
poisoning lesions are detected
Mikulich Disease
* more often in persons 20-30
years
bilateral disease
* symmetrical defeat
no fever
* characterized by dry mouth
the absence of local inflammation
* long-term progressive course
Salivary stone disease
* tumor of the gland, more often on
one side
* gradual development of the
disease
no temperature
* recurrent course
sialography with contrast
DIFFERENTIAL DIAGNOSIS
Lymphadenitis
* presence of an inflammatory
focus in the oropharynx
* localization of swelling in the
lymph nodes
redness of the skin over the lymph
node
* appearance of fluctuation
* neutrophilic leukocytosis
Secondary mumps
* on the background of purulent infection,
usually in its midst.
* usually unilateral
more pronounced General intoxication
sharp pain cancer
* pronounced gland seal
* hyperemia of the skin over the gland
* appearance of fluctuation
* neutrophilic leukocytosis
Toxic diphtheria of the oropharynx
Cytomegalovirus infection
Infectious mononucleosis
Serous meningitis
Meningitis of other etiology
(tuberculosis, viral)
29. •Vaccination in 12 months. the booster is
6 years old.
•Vaccines: live mumps (Russia), combined
mumps-measles (Russia), live mumps
Imovax Oreion (France), combined mumps-
measles-rubella Priorix (Belgium), MMP-II
(USA).
•Seroconversion in more than 80% of
vaccinated.
Isolation of patients
•* glandular form up to 9 days of the
disease (last localization)
•* nervous form - at least - 21 days.
•Disinfection is not performed.
•In the children's institution -
quarantine for 21 days
•The admission of patients to the
work after clinical recovery.
Contact is considered to be a child
or an adult who has communicated
with a patient with a mumps
infection, not vaccinated (or once
vaccinated) and not sick with this
infection.
Contact in the hearth, not previously
vaccinated and not ill, vaccinated from the
age of 1 year no later than the 7th day from
the date of detection of the first patient.
PROPHYLAXIS
