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Methodical instruction for students

June 1, 2024

Methodical instruction for students

of the V course medical faculty

Lesson N 12 (practical – 6 hours)

Theme 1. Infectious diseases with the dominant involvement of skin: erysipelas, felinosis (cat-scratch fever). Erysipelas suis (erysipeloid). Rat-bite fever (sodoku).

Theme 2. TORCH-infections. Toxoplasmosis. Hospital (-acquired) or nosocomial infections.

Aim: to study clinical and laboratory manifestation, diagnostics, treatment and prophylaxis of typhoid fever and paratyphoid, salmonellosis, food poisoning.

Theme 1 Infectious diseases with the dominant involvement of skin: erysipelas, felinosis (cat-scratch fever). Erysipelas suis (erysipeloid). Rat-bite fever (sodoku).

Professional orientation of students: The external covers of man protect the inner organs from negative factors of environment. Skin and mucous membranes is reliable barrier on the way to agent’s penetration. However, frequent injuring of skin cause the declining of protective possibilities. Some agents can damage the skin, causing various diseases. Such illnesses are erysipelas and felinities.

Erysipelas is not a dangerous infection, it can’t cause to death. However, it has a relapse course and strikes the lymphatic capillaries of skin coursing elephantiasis as a result. Women suffer with erysipelas more frequent by than men.

Cats are living everywhere with men, they are the potential source of infection. The invasion of Bartonella hensella into the skin occurs themselves from bites, and scratches inflicted by cats. Local damages of skin are combined with the defeat of regional lymph nodes. This disease is called fellinosis or benign limphoreticulosis or cat scratch diseases.

Erysipelas and fellinosis are observed everywhere.

Study purpose of practical studies:

Students have to know:

· etiology of erysipelas, pathogenic factors of the agent;

· ways of streptococcus penetration into the skin;

· pathogenesis erysipelas;

· classification of erysipelas;

· clinical displays of different forms of erysipelas;

· complication of erysipelas;

· principles of clinical diagnostics and differential diagnosis;

· principles of treatment of erysipelas;

· principles of primary prophylaxis of erysipelas and relapse prophylaxis;

· dispensary of patients with the relapsive erysipelas over the health centre;

· etiology, source of infection and ways of invasion of cat-scratch diseases;

· pathogenesis and clinical displays of fellinosis;

· classification of clinical forms of fellinosis;

· criteria of diagnosis and specific methods of it’s confirmation;

· treatment and prophylaxis of fellinosis.

Students have to be able:

· To follow work rules bedside a patient with erisipelas and fellinos;

· to take history of illness and appraisaling the information of epidemiologic history;

· to examine a patient and find out basic symptoms and syndromes of erysipelas and cat-scratch diseases;

· to differential to erysipelas and cat-scratch diseases;

· to recognize different clinical forms of erysipelas and cat-scratch diseases;

· to fill in a medical document: an urgent report about infectious patient to a district epidemiology branch by fact of previous diagnosis “Erysipelas”, “Fellinosis”;

· to work out a plan of laboratory and instrumental examine of patient;

· to interpret the results of laboratory examination;

· to analyze the results of specific methods of diagnostics;

· to work out an individual plan of treatment taking into consideration: weight, the sex, clinical form of disease, allergic history, concomitant pathology;

· to work out a plan of clinical observation and treatment against the relapse of erysipelas;

· to give recommendations for to the measures of the unspecific prophylaxis of erysipelas and fellinosis;

Methodology of practical class

Using the algorithm of communicative skills during practical work:

1. To prepare to communication with a patient and examination (mask, clean warm hands, cutoff nails, if necessary ‑ gloves, spatula, needed instruments).

2. Greeting and identification (name, level of competence), get the agreement of patient.

3. At the receiving of agreement of patient to set confidential mutual relations (a friendly face, respect and concern, soft talk during conversation).

4. To collect complaints, anamnesis of illness and epidemiologic anamnesis, to explain to the patient the reason of finding out of separate questions (contact with an infectious patient, home and wild animals, use of poor quality meal and others like that).

5. To explain the results of questioning.

6. To explain to the patient, what examination will be done and its reasonability, to get an agreement.

7. To notify about the possibility of the occurrence of unpleasant feelings during examination.

8. To conduct the examination of patient (to estimate the general state, consciousness status, position of patient in the bed, state of skin and mucus, physical examination), demonstrating practical skills.

9. To explain the results of examination understandably for patient.

10. To finish a conversation, thank for communication, wish favourable flow of illness and rapid convalescence.

Self-control materials

Questions to be answered

1. Determination of concept “erysipelas”.

2. What group of microorganisms are the exciters of erysipelas

3. What group of microorganisms are the exciters of felinosis.

4. Ways of agent penetration into a skin.

5. Pathogenesis of inflammatory process is derma while erysipelas.

6. Classification of erysipelas clinical forms.

7. Complication of erysipelas.

8. Differential signs of erysipelas and phlegmona and other diseases.

9. Etiotropic therapy of erysipelas: medications, doses, and duration of course.

10. Prophylaxis of relapses erysipelas.

11. Clinical observation of reconverting persons.

12. Clinical observation of patients with recurrent erysipelas.

13. Source and pathogenesis of felinosis.

14. Classification of felinosis clinical forms.

15. Felinosis clinical symptoms and diagnoses.

16. Complication of felinosis.

17. Ethiotropic therapy of felinosis: medications, doses.

18. Ethiotropic therapy of felinosis – duration of course.

19. Differential signs of felinosis and phlegmona and other diseases.

20. Prophylaxis of relapses felinosis.

Self-control tests

Choose right answers:

1. Patients suffering from erysipelas have the following changes in the blood

A. neutrophilic leukocytes and accelerated erythrocyte sedimentation rate (ESR)

B. leucopenia with lymphomonocytosis

C. leukocytes with lymphocytes

D. leucopenia and slowed-down ESR

E. leukocytosis with lymphomonocytic blood reaction

2. The agent of felinosis is:

A. Streptococcus pneumonias;

B. Spirocheta minus;

C. Bartonella hensela;

D. Clostridium perfringens;

E. Chlamydia pneumonias.

3. Felinosis belongs to the group of infections:

A.zoonosis;

B. external covers;

C. intestinal;

D. respiratory tracts;

E. bloody.

Keys

1 –A

2 – C

3 – A,B

Self-control task

Task

58 year old patient, who saffers-burst chronically thrombophlebitis of lower extremity, III-d stage obesity. Fever and skin rash appeared after the trauma of foot. Objective: temperature up to 38,8⁰C, bright red crush skin, hot zone of hyperemia is dearly separated, boarded by no equal fire-like toughs. The inguinal nodes are middle increased.

1. Preliminary diagnosis.

2. Investigation plan.

3. Treatment plan.

Materials for class self- training.

List of practical tasks for class self-training:

To study the method of erysipelas and fellinosis patient clinical examination
to administrate patient with erysipelas
to differentiate erysipelas with fellinosis and other skin diseases
to create a plan of laboratory examination
to interpret the results of specific examination patient with erysipelas
to recognize erysipelas complications
to create a plan of treatment for patients with erysipelas and fellinosis
to prescribe curative drugs for patients with erysipelas and fellinosis
to fill in medical documentation

Theme 2. TORCH-infections. Toxoplasmosis. Hospital (-acquired) or nosocomial infections (NI).

Professional orientation of students: Recognition of toxoplasmosis in pregnant women is important because of the risk of transmission to the fetus. This risk is limited almost exclusively to those fetuses whose mother acquire the infection for the first time during gestation. The earlier in gestation a mother is infected with T.gondii, the more severe is the disease in the fetus and newborn, despite the lower frequency with which transmission occurs with shorter period of gestation. Finding include chorioretinitis with blindness, epilepsy, psychomotor disorders and developmental delay, hearing loss, jaundice, rash, hematologic abnormalities and pneumonia. The classic triad of hydrocephalus, chorioretinitis, and cerebral calcification is seen rarely.

Inbred toxoplasmosis arises up in connection with the presence of toxoplasma of certain invasion for mothers. From data of Institute of pediatrics, obstetrics and gynecology of AMS of Ukraine spontaneous abortions took place in 50,5% women from toxoplasmosis, artificial abortions on call of pregnant – in 19,5%. Deadborns comprises 22% from the number of births. While contamination with nfection of toxoplasmosis pregnant women toxoplasma gets to the fetus in 66% cases.

Toxoplasmosis is dangerous especially for immunocompromised patients: uncontrolled reproduction of toxoplasma can develop defeat of organs, that can lead even to death.

The problem of NI the last years purchased exceptionally great importance in the entire countries of the world. Stormy rates of growth of medical establishments, creation of new type of medical equipment, application of row of new medicines which possess immunodepressive properties, and many other factors strengthen the threat of distribution of infections among patients and personnel of medical establishments. NI conduce treatment to lengthening of terms, to the chronisation process, disability, and in the heaviest cases – to death of patient.

Study purpose of practical studies:

Students have to know:

· etiology of toxoplasmosis, specific of different germ forms;

· specific of toxoplasma life cycle;

· epidemiology of toxoplasmosis;

· pathogenesis of disease;

· clinical classification of toxoplasmosis;

· variants of toxoplasmosis clinical displays whyle different forms of infectious process;

· specific of toxoplasmosis course in pregnant and inbred toxoplasmosis;

· specific of toxoplasmosis course in HIV-infected patients;

· complications and consequences of toxoplasmosis;

· laboratory diagnosis of toxoplasmosis;

· differential diagnosis of toxoplasmosis with other diseases;

· treatment principles of patients with toxoplasmosis;

· principles of disease prophylaxis.

Student have to be able:

· to gather anamnesis of illness with the estimation of epidemiology information;

· to inspect a patient and find out basic symptoms and syndromes of toxoplasmosis;

· to substantiate clinical diagnosis for on time referral of patient in the hospital;

· to differentiate toxoplasmosis;

· to fill in a medical document by fact of “toxoplasmosis” previous diagnosis indication (an urgent report for the

epidemiology department of SES);

· to work out a plan of laboratory and additional examination of patient;

· to interpret the results of laboratory inspection for determination of process activity and determination of necessity in etiology treatment prescription;

· to work out an individual plan of treatment taking into consideration epidemiology data, process activity, presence of complications, severity of the state, allergy anamnesis, concomitant pathology;

· to work out a plan of epidemiological and prophylactic measures in the focus of infection;

Materials for self-control

Qquestions for self-control

1. What group of infectious diseases does toksoplasmosis belong according to the source of infection?Ways of toxoplasmosis transmission.

2. Biocycle of Toxoplasma gondii.

3. Pathogenesis of toxoplasmosis.

4. Clinical classification of toxoplasmosis.

5. Basic symptoms of aquired toxoplasmosis (acute, second-latent, primary chronic and the second-chronic toksoplasmosis).

6. Specific of toxoplasmosis in HIV-infected persons.

7. Specific of inbred toxoplasmosis.

8. Features of motion of newborn toxoplasmosis.

9. Specific of toxoplasmosis in ptregnant.

10. Complications of toxoplasmosis.

11. Consequences of toxoplasmosis.

12. Additional methods of inspections at toxoplasmosis.

13. Specific diagnostics of toxoplasmosis.

14. Estimation of laboratory indexes patients with toxoplasmosis.

15. Diagnosis substantiation of toxoplasmosis different forms.

16. Differential diagnostics with other infectious diseases.

17. Treatment principles of patients with toxoplasmosis.

18. Specialities of toxoplasmosis treatment in pregnant.

19. Treatment of patients is with inbred toxoplasmosis.

20. Specific of treatment HIV-infected patients with tosoplasmosis.

Self-control tests

To choose right answers:

1. It is possible to use for specific diagnostics

A. The stroke of blood painted by Romanovskiy-Gimza

B. Sebin-Fel’dman reaction

C. Paul-Bunel reaction

D. Vidal reaction

E. Rayt reaction

2. What clinical symptoms are typical for acute aquired toxoplasmosis:

A. Pain in joints and muscles

B. Signs of myocarditis

C. Hepatolienal syndrome

D. Double vision

E. Bland roseola-papule rash

3. The characteristic sign of eyes affect at chronic aquired toksoplasmosis is:

A. Conjunctivitis

B. Iridocyclitis

C. Creeping ulcer of cornea

D. Glaucoma

E. Chorioretinitis

Keys

1. A, B

2. A, B, C, D

3. E

Self-control task

14 year old patient entered an infectious hospital with complains for head ache, increasing of body temperature up to subfebril , attacks of cramps which became more frequent lately. She is ill during last 4 years. While examining: all groups lymphoadenopathy. Heart tones are hollowed, HBF- 100 beats a minute. The lower edge of liver comes out from under the costal edge on 5 cm, lower edge of spleen – on 1 cm. A Nose-lip fold is smoothed on the left. Reflexes of tendons are alive, there are no pathological reflexes. Attacks of cramps happen for 2-3 times per hour. Consciousness during attacks is stored KGR with toksoplazma antigen is positive.

1. To propose a previous diagnosis.

2. Additional methods of investigation

3. To work out a plan of treatment

Materials for class self- training.

List of practical tasks for class self-training:

· To lay hands on the method of inspection sick on toxoplasmosis

· To provide examinations of patient with toxoplasmosis

· To perform differential diagnostics of toxoplasmosis

· To work out a plan of laboratory examinations

· To interpret the results of specific examinations of patient with toxoplasmosis

· To work out a plan of treatment sick on toxoplasmosis

· To define medical tactic in the case of toxoplasmosis for pregnant.