DIARRHEA VIRUS (grech, diarrheoa diarrhea; synonym: epidemic virus gastroenteritis, Hanover disease, Spencer's disease, intestinal flu, winter emetic disease, epidemic diarrhea, virus gastroenteritis etc.) — the acute infectious disease which is shown symptoms of a gastroenteritis and pharyngitis.
Overseeing epid, is conducted by D.'s flashes since 1904 century, but the description of a disease was published only in the 20th [G. H. Fellman, 1921; G. Jttrgens, 1922; Boone (F. N of Boone), 1928]. Messages on D. of century appeared only in connection with emergence of large outbreaks of this disease. The disease was given various names according to names of the place where there was a flash (the Hanover disease), or the author who described flash (Spencer's disease) or on conducting a wedge, to a symptom or epid, to a sign (an epidemic diarrhea) etc.
the Aetiology is not finalized. There are bases to assume that the causative agent of this disease is the virus. As a result of the researches conducted using again developed methods of N. R. Blacklow et al. (1972) came to conclusion that etiol, a factor is the so-called Normalk-agent to dia, less than 66 nanometers who does not have the external cover or a membrane containing lipids, resistant to - those (pH 2,7), rather thermostable (maintains heating to 60 ° within 30 min.). The Normalk-agent causes short-term immunity to reinfections and reminds viruses of parvoviral group.
the Source of contagiums — the sick person. It is impossible to exclude also roles of patients with the erased and atypical forms D. of century in maintenance epid, process. H. Reimann et al. (1945), V. M. Bolotovsky (1971) consider what the most probable way of transfer of the activator is airborne though V. M. Zhdanov (1955) does not exclude a fecal and oral and contact and household way. However the airborne way nevertheless remains to leaders as the most intensive.
The disease widely though because of an easy current not always draws attention to itself is widespread, it is not considered and therefore true incidence of D. of century is unknown. D.'s flashes are described in Germany, Denmark, England, Canada, the USA, India, Australia and other countries century. To of century in the territory of the USSR it is established by V. M. Zhdanov with sotr. (1955) also it is confirmed further by other researchers.
Of century strikes all age groups, tends to preferential distribution in organized collectives, especially at close communication of surrounding persons with the diseased. At flash in collective from 10 to 50% of his members, sometimes and more get sick [Adler and Tsikl (J. L. Adler, R. Zickl), 1969]. Also family flashes are observed. Rather higher incidence of medics of hospitals where there are sick D. century is noted. The begun epidemic can capture big territories with high incidence. D.'s flashes are observed usually during the winter and spring period century.
Is supposed what the place of implementation of the activator is went. - kish. a path, about the Crimea the main are connected functional morfol. disturbances at sick D. century. The diarrhea developing at patients is caused by disturbance of digestion and absorption, and also disturbance of motive function of intestines. Excess removal of water and salts with excrements causes dehydration only in patients with heavy disease. It is the most important premises of development of acute cardiovascular insufficiency. At sick D. is century with the phenomena of a hypovolemia and acute insufficiency of peripheric circulation the temporary renal failure can develop.
Morfol, changes of a mucous membrane of a stomach and sick D.' intestines of century are studied on the biopsy material received is intravital. As marks out N. B. Shalygin (1973), in a mucous membrane of a stomach the picture of acute Qatar with a congestive plethora of capillaries, moderate serous hypostasis of the fabric which is unsharply expressed by lymphocytic and eozinofilnoleykotsitarny infiltration of a mucous membrane, and also considerable damage of cellular elements of gastric (own) glands is observed. Morfol, changes of a mucous membrane of a small bowel are characterized by an acute capillary plethora up to a staz and development of plasmorrhagias in a stroma of intestinal fibers. The quantity of scyphoid cells in vorsina and setserniruyemy slime is excessive. Stroma of a mucous membrane considerably an infiltrirovana plasmocytes and lymphocytes with impurity of eosinophils. Occasionally about intestinal glands (crypts) small eosinophilic and leukocytic perivascular infiltrates meet. The epithelium of intestinal fibers sometimes vakuolizirovan, but in general is kept. Changes of a mucous membrane of a large intestine have no idiosyncrasies.
The clinical picture
the Incubation interval lasts usually 2 — 7 days. The easy current of D. of century is noted at 70 — 75%, medium-weight — at 20 — 25% and heavy — at 1 — 5% of patients. Duration of a disease in most cases 3 — 5 days. Onset of the illness acute. Its main sign — the diarrhea which at a half of patients is followed by vomiting of edge appears or along with a diarrhea, or is ahead of him a little. There is vomiting without nausea, 3 — 4 times repeat and lasts at the vast majority of patients no more days. Frequency of a chair, as a rule, does not exceed 10 times a day. Excrements are plentiful, watery, bright yellow color, a foamy view with a smell. At an easy current fecal masses has a kashitseobrazny consistence. At 5 — 8% of patients of an excrement have a muddy-white appearance, as at cholera. Impurity of slime and especially blood is not characteristic. Mild wavy pains in an upper half of a stomach are felt to 80% of patients. Loud abdominal murmur, audible at distance, a headache, bradycardia, the weakness passing into an adynamia is characteristic. In certain cases discrepancy between strong weakness and rather unsharply expressed phenomena is evident gastroenteritis (see). Temperature increase is observed no more than at 20% of patients. It usually does not exceed 38 ° and sticks to 1 — 2 day. A part of patients feels easy chilling without emergence of fever.
The hyperemia of a mucous membrane of a soft palate, palatal handles, a uvula and its puffiness is very often noted. Besides, on a hyperemic mucous membrane of these areas granularity can appear. Separate elements of its okrugla, have 1 — 2 mm in dia, and slightly tower over the level of a mucous membrane. The liver and a spleen are not increased. At rektoromanoskopiya (see) at certain patients the diffusion hyperemia and small puffiness of a mucous membrane are noted.
At heavy disease (1 — 2% of patients) have a circulatory unefficiency (collapse) with the subsequent development of an acute renal failure. At these patients moderate isotonic dehydration takes place. At a blood analysis at the height of a disease the leukopenia (at 60% of patients), a neutropenia with decrease in maintenance of band cells, a considerable lymphocytosis, a monocytopenia and an eosinophilia is noted. ROE does not change. Recovery occurs usually on 3 — the 7th day.
the Diagnosis is made on the basis a wedge. - epidemiol, given taking into account negative takes bacterial. inspections on intestinal infectious diseases of the patients and persons adjoining to them. The sudden beginning, acute gastroenteritis, watery foamy chair without impurity of blood are most characteristic: hyperemia and granularity of a mucous membrane of a soft palate, palatal handles and uvula; leukopenia, eosinophilia, relative lymphocytosis, monocytopenia.
Of century should be differentiated with dysentery (see), cholera (see), food toxicoinfections (see. Toxicoinfections food ), intestinal form adenoviral diseases (see) and enteroviral diseases (see) and other diseases which are followed by a diarrhea.
for the period of the acute period of a disease appoint the 4th table to lay down. food. It is possible to use the drugs containing digestive enzymes. Use of antibacterial agents in uncomplicated cases is inexpedient. At dehydration of an organism (see) rehydration therapy is carried out.
Forecast, as a rule, favorable.
Early identification and isolation of patients, wet cleaning and airing of rooms. Wearing gauze masks by the medics communicating with patients is reasonable.
Bibliography: Zhdanov V. M., Gavrilov V. I. and Muzhenkova N. P. To an etiology of a virus gastroenteritis, Zhurn., mikr., epid, and immun., No. 6, page 78, 1955; Carpenter S. idr. Clinical and physiological observations during the epidemic outbreak of a nevibri-onny choleroid disease in Calcutta, Bulletin WHO, t. 33, No. 5, page 695, 1965; Mashilov V. P. An epidemic gastroenteritis and its recognition, in book: Aktualn, vopr. epid, and infekts. diseases, under the editorship of V. I. Pokrovsky, p.1, page 132, M., 1975; Mashilov V. P. idr. A functional condition of a small bowel at patients with an epidemic gastroenteritis, in book; Aktualn, vopr, epid., under the editorship of V. I. Pokrovsky, century 3, page 281, M., 1973; Plankina E. A. To epidemiology of a virus gastroenteritis, Zhurn, mikr., epid, and immun., No. 6, page 86, 1955; A d-1 e of J. L. a. Z i with k 1 R. Winter vomiting disease, J. infect. Dis., v. 119, p. 668, 1969; A g u s S. G. a. o. Increased jejunal Jg, synthesis in vitro during acute infections nonbacterial gastroenteritis, Amer. J. dig. Dis., v. 19, p. 127, 1974; Black-low N. R. a. o. Acute infections nonbacterial gastroenteritis, etiology and pathogenesis, Ann. intern. Med., v 76, p. 993, 1972, bibliogr.
V. P. Mashilov.