Presentation on the topic of prevention of intestinal infections. Viral intestinal infections

Classification

Classification

Etiology of acute intestinal infections

Etiology of acute intestinal infections in children (in outpatients)

Etiology of acute intestinal infections in children (in hospital)

Causative agents of viral gastroenteritis

Prevalence of various viral pathogens of acute intestinal infections

Structure of viral gastroenteritis

Rotaviruses

Family Reoviridae - from English respiratory enteric orphan viruses (family of viruses of humans, animals and plants)

Classification of rotaviruses (according to Beards I.M., 1992; Molyneaux P.J., 1995)

Physico-chemical properties of rotaviruses

Cultural properties of human rotaviruses

Variability of rotaviruses

Universal sensitivity

Diagnosis of RVI

ELISA diagnostics of RVI

Rice. . Operating principle of the immunochromatographic rapid test. 1 – sample containing the analyte; 2 – conjugate; 3.4 –

Positive result of the rapid test RIDA Quick Verotoxin / O157 Combi Test format: at the top - test cassette, at the bottom -

Caliciviruses

Classification

Sapoviruses were separated into a separate genus in 1997 until 2002 called Sapo-like viruses (SLV) size 35-39 nm (divided into 3

Noroviruses

Noroviruses

Morphology of noroviruses

Physicochemical properties of noroviruses

The main routes of transmission of norovirus are:

Clinical picture of norovirus infection

Coronaviruses

MORPHOLOGY OF CORONAVIRUS (according to Holmes K.V., 2003)

Electron microscopic method

Classification of coronaviruses

Physico-chemical properties of coronaviruses

Epidemiology of coronaviruses

Susceptibility

Clinical picture of coronavirus infection

The role of coronaviruses in human pathology

Adenoviruses

Morphology of adenoviruses

Family Adenoviridae

Physicochemical properties of adenoviruses

Clinical picture of adenoviral infection

Astroviruses

Clinical picture of astrovirus infection

Diagnosis of viral diarrhea

Diagnosis of viral diarrhea

PCR (polymerase chain reaction) Detection of specific regions of RNA, DNA (RV, NV, AD, SV, AstV)

Application of multiplex RT-PCR method for differential diagnosis of intestinal viral infections

Advantages of the PCR method:

Prevention of viral intestinal infections

ENTEROVIRUSES

The structure of the enterovirus virion

Enterovirus genome

Enterovirus antigens

Epidemiology of enterovirus infections

Pathogenesis of enteroviral infections

Pathogenesis (continued)

Target organs for enteroviruses

Clinical forms of enteroviral infections

Polio virus

Epidemiology of polio

Pathogenesis of polio

Clinical forms of polio

A man with an atrophied right leg due to polio

Diagnostics

Laboratory diagnostics

Progress in polio eradication 1988 – 2005

Involvement of the country's top management in the program

Coxsackie and ECHO viruses

ECHO viruses

Pathogenesis

Laboratory diagnostics

Purpose: presentation in the lecture material of issues of cause-and-effect patterns, factors of occurrence, spread and clinical features of acute intestinal infections in children pursues the main goal of this lecture. Namely: to develop in students knowledge and practical skills in matters of etiology, epidemiology, anti-epidemic measures in hospitals and children's institutions in order to prevent the spread of acute intestinal infections in children.

Lecture plan Demonstration of the medical history of the thematic patient (complaints, medical history, life history, somatic status, laboratory data) with access to a preliminary diagnosis. Relevance and prevalence of acute intestinal infections in children. Additional laboratory diagnostic methods to clarify the etiological structure of the disease. Determination of links in the epidemiological chain (source, transmission mechanism, susceptibility, incidence, seasonality, frequency). Modern classification of OKI. Treatment of OKI.

Patient D., 5 months old, complains of frequent loose, watery stools up to 12 times a day, repeated vomiting, loss of appetite, temperature rise to 38.8 0C, slight weight loss. Weight before illness. From the anamnesis: ill for 2 days. The disease began with an increase in T to 38.50C, regurgitation appeared after feedings. Stools become more frequent up to 9 times a day - watery, orange in color with white lumps. In the following days, vomiting occurred, up to 2-3 times. Stools became more frequent up to 12 times a day, liquid, watery with pathological impurities in the form of mucus.

On examination: the condition is moderate, the skin is pale, somewhat dry, the skin fold straightens out quickly, elasticity and turgor are not reduced. The large fontanelle is unchanged. The mucous membranes of the oral cavity are pink and dry. He drinks liquids willingly. Heart sounds of medium sonority, 144 beats. in 1 min. The limbs are warm, the nail beds are pale pink. Hemodynamics are stable. The tongue is covered with a white coating. The abdomen is moderately swollen, rumbling along the small intestine. Sigma is not spasmodic. There is hyperemia and irritation around the anus. Weight upon admission: 7.450g. Weight loss is

Complete blood count: red blood cells – 4.0 x 1012 /l; hemoglobin – 120 g/l; CP – 0.8 Leukocytes – 12.5 x 109/l; eosinophils – 2; rod-nuclear – 5, segmented – 67; lymphocytes – 21; monocytes – 5; ESR – 11 mm/h. Coprogram: leukocytes – 20 in the field; no red blood cells, mucus - ++; neutral fat - +++, vegetable fiber - ++, soap - ++

Clinical example 2. A 4-year-old child became acutely ill: the temperature rose to 38.5 0C, and there was a single vomiting after eating. A few hours later, abdominal pain appeared and bowel movements became more frequent. The stool was initially copious, liquid, brown in color, but subsequently became scanty with a lot of mucus and streaks of blood. On examination, the skin was pale and the lips were somewhat dry. The tongue is covered with a white coating and is rather dry. Heart sounds are somewhat muffled, 100 beats per minute. In the lungs there are no features. The stomach is not bloated. Sigma is spasmodic, painful on palpation. The anus is pliable. Coprogram: leukocytes - completely in the p/z; erythrocytes - in the p/z; mucus - +++; This is the clinical and laboratory picture in the case patients.

Which of the following syndromes do you think are leading in the first and second cases: acute respiratory failure heart failure liver failure renal failure diarrhea syndrome exanthema syndrome intoxication syndrome

Relevance of the problem. In infectious pathology of childhood, acute intestinal infections (AI) play a leading role. In terms of prevalence, they are second only to acute respiratory viral infections (ARVI). Intestinal infections are common everywhere. There is a high incidence of acute intestinal infections in Kazakhstan, including among children. Children account for up to 70% of the total number of patients, and most of them are young children.

According to WHO, every child develops 2-4 acute intestinal infections per year. AEIs are characterized not only by high morbidity, but also by high mortality. Those who died from acute intestinal infections account for more than half of the children who died from infectious diseases. In the structure of infant mortality, ACIs occupy one of the first places. Every 4th child on Earth dies from diarrhea.

In % of cases, the death of children from acute respiratory infections could have been prevented. All this is unacceptable, since OKIs relate to sufficiently studied problems. Only in recent years and decades has the etiological role of many bacteria and viruses in acute intestinal infections been established, the clinical manifestations of relatively “new” intestinal infections have been studied, new approaches to treatment have been proposed that limit the use of antibiotics and propose replacing them with newer, more physiological drugs (complex immunoglobulin preparations , biological products).

Preventing the spread of acute intestinal infections is not only a medical, but also a national task, and the participation in this work of all persons involved in childhood problems will improve the conditions of the social environment and serve as the key to success in the fight against intestinal diseases. Acute intestinal infections in children are characterized not only by high morbidity, but also by high mortality. Those who died from acute intestinal infections account for more than half of the children who died from infectious diseases. In the structure of infant mortality, ACIs occupy one of the first places.

The causative agents of intestinal infections belong to various taxonomic groups. Bacteria (Shigella, Salmonella, diarrheagenic Escherichia, Yersinia, Campylobacter, Staphylococcus, Klebsiella, etc.) act as etiological agents; viruses (rota-, adeno-, entero-, astro-, corona-, toro-, caliciviruses, etc.); protozoa (giardia, cryptosporidium, etc.).

What is the epidemiological chain of intestinal infections? Source of infection, mechanism of transmission and susceptible organism. Intestinal infections have a number of epidemiological patterns: widespread distribution, high contagiousness, fecal-oral mechanism of infection, tendency to develop epidemic outbreaks.

In secretory intestinal infections (enterotoxigenic and enteropathogenic escherichiosis, cholera), the occurrence of diarrhea syndrome is associated with activation of adenylate cyclase of cell membranes, followed by increased secretory activity of the small intestinal epithelium and impaired reabsorption of water and electrolytes.

Osmotic diarrhea caused by rota-, adeno-, astroviruses, etc.; develop due to dysfunction of the enzymatic systems of enterocytes that break down carbohydrates. However, it should be noted that it is rarely possible to classify nosological forms accompanied by diarrhea syndrome depending on one mechanism of diarrhea; More often than not, several pathogenetic mechanisms are important.

Intestinal infections are clinically manifested by the following syndromes: intoxication (acute infectious toxicosis), dehydration (dehydration, exicosis), fever and gastrointestinal (gastritis, enteritis, gastroenteritis, enterocolitis, gastroenterocolitis, colitis)

Gastritis syndrome is characterized by nausea, repeated vomiting, pain and a feeling of heaviness in the epigastric region. Enteritis syndrome is manifested by frequent, profuse, loose, watery stools, flatulence, and abdominal pain, mainly in the umbilical region. Gastroenteritis syndrome is characterized by a combination of signs of gastritis and enteritis.

Enterocolitis syndrome is characterized by frequent, profuse loose stools mixed with mucus, sometimes blood, abdominal pain, pain on palpation and rumbling along the colon. Gastroenterocolitis syndrome is a combination of signs of gastritis and enterocolitis. Distal colitis syndrome – retracted “scaphoid” abdomen, cramping abdominal pain with predominant localization in the left iliac region, spasmodic painful rumbling sigmoid colon, compliance of the anal sphincter, tenesmus; change in the frequency and nature of stool (frequent, scanty with mucus, blood - such as “rectal spitting”).

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Buying pickled mushrooms from grandmothers near the metro, eating expired canned food, going on a trip and simply forgetting to wash our hands and fruits and vegetables before eating, we risk contracting an intestinal infection. At best, this means sitting in the restroom for many hours. At worst, an infectious diseases hospital and even death.

Intestinal infections - what is it? Intestinal infections are a whole group of contagious diseases that primarily damage the digestive tract. There are more than 30 such diseases in total. Of these, the most harmless is so-called food poisoning, and the most dangerous is cholera.

Causes of intestinal infections The causative agents of intestinal infections can be: bacteria (salmonellosis, dysentery, cholera), their toxins (botulism), and viruses (enterovirus). From patients and carriers of infection, microbes are released into the external environment with feces, vomit, and sometimes urine. Almost all pathogens of intestinal infections are extremely tenacious. They are able to exist for a long time in soil, water and even on various objects. For example, on spoons, plates, door handles and furniture. Intestinal microbes are not afraid of the cold, but still prefer to live where it is warm and humid. They multiply especially quickly in dairy products, minced meat, jelly, jelly, and also in water (especially in the summer). Causative agents of intestinal infections enter the body of a healthy person through the mouth: with food, water or through dirty hands.

What's happening? From the mouth, microbes enter the stomach, and then into the intestines, where they begin to multiply intensively. The cause of the disease is the poisons that microorganisms secrete and the damage to the digestive tract that they cause. After microbes enter the body, the disease begins within 6-48 hours. People get intestinal infections more often in the summer. This is due to the fact that in the heat we drink more liquid, which means that the gastric juice that kills harmful microbes is diluted. In addition, in the summer we often drink unboiled water (from springs and from the tap).

Why is it dangerous? All intestinal infections are dangerous because dehydration occurs due to vomiting or diarrhea. The result can be kidney failure and other serious complications. For example, from the nervous system (coma, cerebral edema), heart (cardiogenic shock) and liver.

How to recognize? Intestinal infections, like all other infectious diseases, always happen unexpectedly. At the very beginning of the disease, a person feels weak, lethargic, his appetite may deteriorate, he may get a headache, and even have a fever. Very similar to poisoning or even a banal acute respiratory infection. It’s okay, the person thinks, swallows aspirin or activated charcoal and waits for him to feel better. However, it doesn't get any better. On the contrary, new problems appear: nausea and vomiting, cramping abdominal pain, diarrhea. Thirst and chills may bother you.

Treatment of intestinal infections Treatment of intestinal infections is complex and includes: the fight against microbial poisons, the microbes themselves, as well as dehydration of the body. In addition, patients must follow a proper diet and, with the help of special medications, restore normal intestinal microflora.

Prevention To protect yourself from acute intestinal infections, it is enough to follow the following simple rules: drink water and milk only when boiled, wash vegetables and fruits with hot water and soap, follow the rules and shelf life of food products, wash your hands before eating and do not bite your nails.

Typhoid fever is an acute infectious disease caused by bacteria from the genus Salmonella. The pathogen can survive in soil and water for up to 1-5 months. Kills when heated and exposed to conventional disinfectants. The only source of infection spread is a sick person and a bacteria carrier. Typhoid fever bacilli are transmitted directly by dirty hands, flies, and sewage. Outbreaks associated with the consumption of contaminated foods (milk, cold meats, etc.) are dangerous.

Symptoms and course. The disease begins with a gradual increase in temperature to 39 o C, an increase in signs of severe intoxication - headache, weakness, mental retardation. The tongue takes on a rich red color. covered with a gray coating, increased in size, with teeth marks. At the height of the disease, severe mental disorders are observed - “typhoid status” (a state of stupor, apathy, up to a coma). On days 8-10, a rash appears on the skin of the chest and abdomen. When there is intestinal bleeding, the stool turns black.

Treatment. The main antimicrobial drug is chloramphenicol. Prescribe 0.5-0.75 g, 4 times a day for days until normal temperature. Patients must observe strict bed rest for at least 7-10 days. Even with the availability of modern medicines, typhoid fever remains a dangerous disease with a high mortality rate (12-30% in developing countries).

Prevention. Sanitary supervision of food enterprises, water supply, sewerage. Early identification of patients and their isolation. Disinfection of premises, linen, dishes that are boiled after use, control of flies. Dispensary observation of those who have had typhoid fever. Return to list of diseases

Sources of infection. The source of infection is a sick person. Infection with dysentery occurs when personal hygiene rules are not observed. Dysentery is a disease of dirty hands. However, you can get sick by drinking contaminated water or products washed with such water and not sufficiently thermally processed.

What's happening? The incubation period of the disease ranges from several hours to 2-3 days. The causative agent of the disease causes inflammation of the wall of the large intestine. The main symptom of dysentery is not very abundant, partial loose stools with mucus, pus, and blood. In addition, the patient’s general health is disturbed, nausea and vomiting appear, appetite decreases, and headaches occur. As the disease progresses, dehydration may develop.

Treatment Treatment of dysentery is carried out in a hospital. When treating dysentery, two tasks are solved: fighting the microbe that causes the disease (antibiotics are used) and compensating for fluid loss: drinking plenty of fluids and intravenous infusion of special solutions. With good body resistance, the disease is completely cured in 7-10 days, but sometimes it can take on a wave-like character. The immunity of those who have recovered is unstable, and repeated cases of infection are possible. Return to list of diseases

Symptoms and course. The onset of the disease is similar to the flu, often accompanied by diarrhea. Within 2 weeks the disease subsides, leaving weakness, sweating, and fatigue. Later, paralysis and paresis occur in the limbs, often in the legs. Then the movements are somewhat restored, and the muscles partially atrophy. At the first suspicion of polio, the patient should be immediately taken to an infectious diseases hospital, as he poses a danger to others. In addition, the phenomena of paralysis, more or less, always regress. In addition, pneumonia, urinary tract infection, etc. may occur, from which such patients often die.

Treatment. Since there is no specific treatment, prevention with a live vaccine is most important. In 30% of cases, polio ends in residual paralysis with muscle atrophy, in 30% - with milder complications. Complete recovery from the paralytic form without consequences occurs in 30% of cases and in 10% of cases (with damage to the respiratory system) - death. Return to list of diseases

Cholera Cholera is an acute infectious disease that is classified as a particularly dangerous infection. The classic picture of cholera is frequent, up to 10 or more times a day, diarrhea. Fluid loss is colossal, up to 20 liters per day, and each milliliter contains up to a billion vibrios.

Treatment The basis of treatment is replenishing the loss of fluid and microelements, maintaining water-electrolyte and acid-base balances in the body. Antibiotics are only an additional treatment. Thanks to complex therapy, the mortality rate from cholera currently does not exceed 1%. Return to list of diseases

Paratyphoid A and B Paratyphoid A and B are acute infectious diseases that are similar in clinical picture to typhoid fever. The causative agents are mobile bacteria from the genus Salmonella, stable in the external environment. Disinfectants in normal concentrations kill them within a few minutes. The only source of infection in case of paratyphoid A is patients and bacteria excretors, and in case of paratyphoid B it can also be animals (cattle, etc.). The routes of transmission are often fecal-oral, less often contact-household (including fly).

Symptoms Paratyphoid A and B, as a rule, begins gradually with an increase in signs of intoxication (fever, increasing weakness), dyspeptic symptoms (nausea, vomiting, loose stools), catarrhal (cough, runny nose), and ulcerative lesions of the intestinal lymphatic system.

Treatment. Prevention. Treatment should be comprehensive, including care, diet, immune and stimulant medications. Bed rest until 6-7 days of normal temperature, from 7-8 days it is allowed to sit and walk. The food is easily digestible, gentle on the gastrointestinal tract. Prevention comes down to general sanitary measures: improving the quality of water supply, sanitary cleaning of populated areas and sewage systems, fighting flies, etc. Dispensary observation of paratyphoid survivors is carried out for 3 months. Return to list of diseases

Botulism Botulism is a deadly infectious disease. The permanent place of residence of the causative agent of botulism is soil, where they can persist for many years. From the soil the microbe gets onto food products. Without air access (in canned or dense products such as balyk), the causative agent of botulism begins to produce botulinum toxin, the strongest known poison. It is several times stronger than rattlesnake venom. In 95% of cases, the cause of botulism is home-made canned mushrooms, since they are not heat-treated. In the same jar, botulinum toxin accumulates in clusters; infected areas are scattered throughout the contents of the jar. Therefore, not all people who eat canned food from the same can get sick.

Treatment. Prevention. The disease develops very quickly within 2-24 hours. The first symptoms: diarrhea, vomiting, fever, abdominal pain. The first specific manifestations of botulism are impaired visual acuity, double vision, and strabismus. Then comes speech impairment, weakness, dry mouth, difficulty swallowing, voice changes, etc. The temperature is normal or slightly elevated, consciousness is preserved. Treatment of botulism is carried out only in an infectious diseases hospital. First of all, the remains of food poisoned with botulinum toxin are removed from the patient’s intestines (a laxative and gastric lavage are used). The specific treatment for botulism is the urgent administration of anti-botulinum serum, which neutralizes the toxin. Immunity does not develop during botulism, which means you can get sick with this disease more than once. Prevention of botulism consists of careful heat treatment of food, strict adherence to sanitary standards for the preparation, storage and consumption of food. Return to list of diseases

Brucellosis Brucellosis is an infectious disease caused by Brucella - small pathogenic bacteria. A person becomes infected from domestic animals (cows, sheep, goats, pigs) when caring for them or when consuming infected products - milk, poorly aged cheese, poorly cooked or fried meat. The pathogen, penetrating the body through the digestive tract, cracks, scratches and other damage to the skin or mucous membrane, then spreads through the lymphatic tract and blood vessels, which makes any organ accessible to this disease.

Treatment. Prevention. The most effective remedy is antibiotics. In the stage of attenuation of acute inflammatory phenomena, physical therapy and warm paraffin applications to the joints are prescribed. In case of persistent remission - spa treatment, taking into account existing contraindications. Meat can also be eaten after boiling it in small pieces for 3 hours or salting it and keeping it in brine for at least 70 days. Milk from cows and goats in areas where there are cases of disease in large and small livestock can only be consumed after boiling. All dairy products (yogurt, cottage cheese, kefir, cream, butter) should be prepared from pasteurized milk. Brynza, made from sheep's milk, is aged for 70 days. Return to list of diseases

Salmonellosis In some products (milk, meat products), salmonella can not only survive, but also multiply without changing the appearance and taste of the product. Salting and smoking have a very weak effect on them, and freezing even increases the survival time of microorganisms in products. Salmonellosis is transmitted through the eggs of sick birds. Today this is one of the leading ways of spreading this disease. Salmonellosis is an infectious disease transmitted mainly through food. Caused by various microbes of the Salmonella genus.

Treatment. In the treatment of salmonellosis, there are several leading areas: antibiotics to combat salmonella, special solutions to compensate for fluid lost through vomiting and diarrhea, anti-inflammatory drugs - drugs to remove toxins, restoration of normal intestinal microflora. With persistent and competent treatment, salmonellosis can be completely eliminated. Return to list of diseases