INFECTIOUS DISEASES(late lat. infectio infection) — the group of the diseases caused by pathogenic microorganisms, which is characterized by infectivity, existence of an incubation interval, reactions of the infected organism to the activator and, as a rule, the cyclic course and formation of postinfectious immunity.
The term «infectious diseases» was entered by K. Gufeland and gained the international distribution.
- 1 HISTORY
- 2 CLASSIFICATION
- 3 The STATISTICS
- 4 PHILOSOPHY of the ORGANIZATION of MEDICAL CARE
- 5 AETIOLOGY
- 6 PATHOGENY
- 7 IMMUNITY
- 8 PATHOLOGICAL ANATOMY
- 9 CLINICAL PICTURE
- 10 the DIAGNOSIS
- 11 TREATMENT
- 12 The OUTCOME
- 13 PREVENTION
- 14 INFECTIOUS DISEASES of ANIMALS
- 15 INFECTIOUS DISEASES of PLANTS
Archeological finds and written monuments of the remote past indicate that many And. were known to the ancient people. Owing to mass distribution and a high lethality from them And. called a craze, general diseases, morovy diseases. In Ancient Egyptian papyruses, ancient Chinese manuscripts, in Empedocles, Mark Terention Varron and Lution Kolumella's compositions malaria was described. Hippocrates, described clinic of tetanus, a typhinia, epid, parotitis, an ugly face, a malignant anthrax. Long ago also rage is known, Democritus, Aristotle wrote about it. In 6 century AD the first reliable pandemic of plague and a wedge, symptoms of this disease is described.
In 1546 there was J. Frakastoro's book «About kontagiya, contagious diseases and treatment» where it is said that activators I. are a so-called contagion — living beings. The Russian doctor D. S. Sa-moylovich on a basis epidemiol, observations proved infectivity of plague and carried out disinfection of things of patients.
In 17 century the first descriptions of yellow fever in Yucatan and in Central America appeared. In 16 — 18 centuries whooping cough, scarlet fever, measles, poliomyelitis, etc. are delimited from other diseases.
In 19 century Grizinger (W. Griesinger, 1857), Murchison (Ch. Murchison, 1862), S. P. Botkin (1868) differentiated typhus on separate nozol, forms. L. V. Popov in 1875 described specific pathoanatomical changes in a brain, and one year later O. O. Mochutkovsky autoinfection proved existence of pathogenic activators in blood of patients with a sapropyra.
There is a further differentiation And., forms are described and defined new nozol: rubella, chicken pox, brucellosis, ornithosis, etc.
In deep development of all sections of the doctrine on infectious pathology domestic scientists D. S. Samoylovich, M. Ya. Mudroye, N. I. Pirogov, S. P. Botkin, N. F. Filatov, N. P. Vasilyev, I. I. Mechnikov, N. Ya. Chistovich, etc. made the contribution.
The doctrine formulated by S. P. Botkin, G. A. Zakharyin, A. A. Ostroumov about unity of an organism in its reactions to disease-producing influence exerted a great influence on further successful studying And., in particular on understanding of a pathogeny and the choice of the correct therapeutic tactics. The world science appreciates N. F merits. Filatov who made an essential contribution to studying of so-called children's infectious diseases.
One of founders of the doctrine about infectious diseases in Russia is G. N. Minkh, widely known works to-rogo are devoted to a malignant anthrax, plague, a leprosy and a typhinia. Experience of autoinfection by a typhinia allowed G. N. Minkh to express an important role of blood-sicking carriers in transfer of returnable and sypny typhus.
The end of 19 century is characterized by rapid development of the medical microbiology which exerted huge impact on profound studying And. L. Pasteur, R. Koch and their numerous pupils and followers for rather short term opened and studied activators of many And. The domestic scientist F. A. Lesh (1875) for the first time proved etiol, a role of the parasitic simplest in pathology of the person and by that opened a new chapter — protozoan diseases. In 1892 D. I. Ivanovsky opened viruses.
Development of epidemiology, bacteriology, virology, protozoology led to widespread introduction in clinic And. mikrobiol, and immunol, methods of laboratory researches, promoted development of immunology. E. Jenner (1796) experiment on inoculations against smallpox served as an incentive for works of L. Pasteur who created the scientific principle of production of vaccines for safety inoculations. I. I. Mechnikov opened one of the most important protective mechanisms of reactions of an organism to implementation of a parasite — phagocytosis. Discovery of antitoxins by E. Bering led to development of a specific method of treatment and prevention — a serotherapy and a seroimmunity. Even earlier with to lay down. the purpose began to use various bacteritic drugs: tuberculine, filtrates of the killed typroid cultures, etc., and is later the vaccines made directly of microorganisms. Implementation in clinic in 30 — is the 40th 20 century of streptocides and antibiotics made a revolution in treatment of many And. However value gray and vaccinotherapies still remains for separate And.
A big contribution to theoretical development of questions of infectious pathology were N. F. Gamalei's works, A. D. Speransky, D. K. Zabolotny, P.F. Zdrodovsky, L. A. Zilber, L. V. Gromashevsky, I. V. Davydovsky, B. D. Timakov and other Soviet scientists who approved in this area the doctrine about unity of an organism and Wednesday, expanded idea of specific and nonspecific factors of protection, variability of microbes and gave fiziol, the analysis of infectious process. Value of works of the Soviet pathologists of A. I. Abrikosov, M. A. Skvortsova, A is big. P. Avtsyn, B. N. Mogilnitsky, etc., in many respects promoting studying of a pathogeny And.
Classical description wedge, currents of a row I. it is given in works N. To. Rosenberg, K. F. Flerov, A. A. Koltypin, S. I. Zlatogorov, G. A. Ivashentsov, etc. N. K. Rosenberg by right is considered an ancestor patofiziol, the scientific direction in development of the doctrine about And.
In 20 — the 30th 20 century the problem of a sapropyra is deeply studied. I. V. Davydovsky's works on a pathogeny and organopathology of a sapropyra, A. P. Avtsyna — on studying of a patogistologiya of rickettsial intoxication, L. V. Gromashevsky — on epidemiology were especially valuable.
Are studied as well other rickettsioses: flea local sapropyra (S. M. Kulagin, P.F. Zdrodovsky, etc.), Marseilles fever (A. Ya. Alymov, etc.), tick-borne sapropyra of Northern Asia (G. I. Feoktistov, E. A. Galperin, M. M. Lyskovtsev, etc.), vesicular rickettsiosis, Q fever and brucellosis (P.F. Zdrodovsky, P. A. Vershilova, etc.).
The Soviet clinical physicians B. N. Stradomsky, G. P. Rudnev, A. F. Bilibin, etc. described a wedge, forms of a tularemia. Along with deep development of epidemiology and microbiology of plague studying it a wedge, currents, early diagnosis and rational therapy is carried successfully out (S. I. Zlatogorov, G. P. Rudnev, H. N. Zhukov-Verezhnikov, V. N. Lobanov, E. I. Korobkova, etc.).
The accelerated laboratory diagnosis of cholera is developed (3. V. Ermolyeva and E. I. Korobkov) and modern principles of water-salt therapy of this disease [R. A. Phillips and sotr., 1963; B. I. Pokrovsky, V. N. Nikiforov, etc.]. The Kliniko-patogenetichesky characteristic of tifo-paratyphoid diseases is provided in G. F. Vogralik, N. I. Ragoza, N. Ya. Padalki, A. F. Bilibin, K. V. Bunin's works, etc.; salmonellezny food toxicoinfections — in G. A. Ivashentsov, M. D. Tushinsky, E. S. Gurevich, I. V. Schur's works.
After a number of complex scientific expeditions to taiga districts of the Far East in 1937 — 1939 the form — a tick-borne encephalitis was described new nozol (E. N. Pavlovsky, L. A. Zilber, A. A. Smorodintsev, M. P. Chumakov, E. N. Levkovich, A. K. Shubladze, V.D. Solovyov, etc.); the clinic of a disease, its various forms is studied, specific therapy is developed (N. V. Choubin, A. G. Panov, A. N. Shapoval, etc.). In 1938 — 1939 A. A. Smorodintsev, B. D. Neustroyev and K. P. Chagin described the mosquito encephalitis which gave flash in the Far East in 1938.
In 1934 — 1940 diseases of a hemorrhagic nephrosonephritis are for the first time recognizable and studied; in 1944 — 1945 the Crimean hemorrhagic fever, and in 1947 — the Omsk hemorrhagic fever is described (A. A. Smorodintsev, M. P. Chumakov, A. V. Churilov, V. G. Chudakov, to N. I. Hod Kean, N. A. Zeytlenok, I. R. Drobinsky).
In 1960 I. I. Grunin, G. P. Somov, I. Yu. Zalmover described the Far East scarlatiniform fever; the etiology of a disease is established to B. A. Znamensky and A. K. Vishnyakov (1965) who allocated a pseudotuberculous microbe from patients. For confirmation etiol, roles of the activator V. A. Znamensky in 1966 made experiment of autoinfection.
was widely adopted etiol, classification In due time And. Hübner, Gotshlikh, C. I. Zlatogorova, etc.: coccal, bacillar, spirokhetoza, rickettsioses, virus. In a wedge, practice the concepts «rickettsioses», «spirokhetoza», «leyshmanioza», «salmonelloses» and so forth are also nowadays used.
At the end of 19 century A. Weichselbaum suggested to divide And. the person on «the disease got from the person» and «diseases, got from animals» that meets expectations of antroponoza and zoonoza.
At the beginning of 20 century suggested to divide a number of researchers [I. Zeligman, D. K. Zabolotny, etc.] And. on localization of the activator in an organism of sick (carriers) on 4 groups: intestinal, respiratory tracts, blood and outside covers. L. V. Gromashevsky who was its basis the doctrine about gave theoretical justification of such classification mechanism of transmission of infection (see). Under natural conditions infection of the person is possible by means of four types of the mechanism of transfer: fecal and oral, airborne, transmissible and contact.
The mechanism of transfer of the activator and localization of the activator in an organism are mutually caused. So, preferential localization patol. process in intestines causes allocation of activators with excrements and their transfer through various environmental factors to the healthy person, to-rogo activators get into an organism through a mouth. At the airborne mechanism of transfer activators are allocated from respiratory tracts, and infection of the person results from inhalation of the air containing activators by it. Thus, the mechanism of transfer defines not only the main lines of epidemiology, but also feature of a pathogeny and clinic And.
The electee as a basis of classification And. the correspondence principle of the mechanism of transfer of the activator and its localization is the leading objective sign.
According to L. V. Gromashevsky, it is necessary to use designation of groups of diseases on the basis of localization, as found broad application in daily practice (tab).
The classification scheme of the main infectious diseases of the person (on the mechanism of transfer and sources of contagiums)
At intestinal infections the main localization of the activator during all infectious process or during its separate periods — intestines. To group intestinal And. belong: a typhoid, a paratyphoid And, a paratyphoid In, dysentery, cholera, toxicoinfections salmonellezny and staphylococcal, a brucellosis, leptospirosis, etc.
At respiratory infections activators are localized in mucous membranes of respiratory tracts (in alveoluses, bronchial tubes, a pharynx etc.) where primary inflammatory process develops. Enter into this group of diseases: measles, smallpox natural, chicken pox, rubella, whooping cough, parawhooping cough, diphtheria, scarlet fever, meningococcal infection, parotitis, quinsy, flu, parainfluenza, mycoplasmoses, big group of acute respiratory diseases, etc.
Causative agents of blood infections are localized preferential in blood and a lymph: a sapropyra (vshiny), tick-borne rickettsioses, the Q fever, a typhinia vshiny, a typhinia tick-borne, flebotomny fever, yellow fever, hemorrhagic fevers, plague, a tularemia, encephalitis — tick-borne, mosquito, etc.
Infections of outside covers include diseases of skin and its appendages, outside mucous membranes (eyes, a mouth, generative organs), and also wound And. The major nozol, forms of this group: scab, cutting deprive, trachoma, infectious conjunctivitis, an ugly face, tetanus, a mephitic gangrene, a pyoderma, a vaccine (vaccinia), an actinomycosis, a malignant anthrax, sap, a melioidosis, a foot-and-mouth disease, rage, a sodoka, etc.
However is And., which, except the main mechanism of transfer causing their group accessory can sometimes have other mechanism of transfer. It leads to the fact that the disease can be shown in different a wedge, forms, each of which corresponds to one of mechanisms of transfer.
So, the tularemia at the person proceeds more often in a bubonic form, but at an air and dust way of transfer of the activator the pulmonary form of a disease develops.
Depending on a source of activators infectious diseases are divided into antroponoza and zoonoza (tab).
This classification And. fullestly reflects obshchebiol. the nature of separate diseases is also most acceptable for epidemiol, is more whole. However not all And. it is possible with sufficient confidence to carry to this or that group (e.g., poliomyelitis, a leprosy, a tularemia, viral diarrhea, etc.). But the value of this classification also consists that in process of increasing knowledge of the nature of not enough studied diseases each of them finds the appropriate place in classification.
In the USSR the International classification of diseases is accepted. The first class of classification included infectious and parasitic diseases which are subdivided into groups on the mixed principle: 1) intestinal infections; 2) tuberculosis; 3) bacterial zoonoza; 4) other bacterial infections, 5) poliomyelitis and other enteroviral diseases of c. N of page; 6) the viral infections accompanied with rash; 7) the viral diseases transmitted by arthropods; 8) other viral diseases; 9) the rickettsioses and other diseases transmitted by arthropods; 10) syphilis and other venereal diseases; 11) other diseases caused by spirochetes; 12) mycoses; 13) helminthoses; 14) other infectious and parasitic diseases.
In the USSR some derogations from the International classification of diseases are made. So, flu and other acute respiratory diseases are carried to group of the first class — infectious diseases (in the International classification — to diseases of a respiratory organs).
For a wedge, the purposes development of classifications in which are considered a pathogeny, a form and option of disease, weight of a state, existence of complications, outcomes is of great importance.
Statistics is necessary for assessment of level and dynamics of incidence, definition epidemiol, environments in this or that territory, the choice of effective measures of fight with And.
Statistics And. in the USSR it is regulated by official system of registration, the account and reporting to lay down. - professional, institutions and bodies of health care. In the territory of the USSR diseases of a typhoid, a paratyphoid And, In and With, salmonellosises, a brucellosis, dysentery, a gastroenteritis and colitis (except ulcer), a viral hepatitis (separately infectious and serumal), scarlet fever, diphtheria, whooping cough (including bacteriological the confirmed para-whooping cough), flu, adenoviral diseases, a meningococcal infection, measles, chicken pox, parotitis epidemic, an ornithosis, a sapropyra and other rickettsioses, malaria, encephalitis, hemorrhagic fevers, a tularemia, rage, tetanus, a malignant anthrax, a hay fever are subject to obligatory registration.
At flashes of some And. and even single diseases quarantine And., in case of their emergence in the territory of the USSR, the special order of extraordinary reports is established.
The system of registration and the account is subordinated to the main objective — acceptance operational protivoepid, died in a focus of the disease. In this regard infectious diseases are registered in the place of detection (address) of the patient, but not in the place of his residence or estimated infection.
The main registration document — emergency notice (see). This primary document is filled and sent by the medic who revealed or suspected And. (except flu and acute And. upper respiratory tracts) during 12 hours in the corresponding territorial sanitary and epidemiologic station (see). The diagnosis is formulated according to the existing nomenclature of diseases. The emergency notice is made also in all cases of the acute poisonings for the first time revealed in the current year parazitonositely malaria and bacillicarriers of a typhoid, paratyphus, dysentery and diphtheria. Besides, revealed And. in addition bring in «The magazine of registration of infectious diseases» (a form No. 60-lech.), which is conducted in to lay down. - the prof. institutions. At change of the initial diagnosis (or its specifications) to lay down. - professional, establishment sends the corresponding notice to SES.
Medical institutions send the emergency notices only on those arrived infectious patients who passed others to lay down. - professional, institutions, and also at change or specification of the initial diagnosis and about the diseased directly in-tse. On the basis of the received emergency notices in city and regional SES pofamilny lists of patients are kept (form No. 60-SES).
On the basis of data of the magazine of registration of infectious diseases and statistical coupons for registration of the final (specified) diagnoses (form No. 25-v) to lay down. - professional, institutions of the USSR M3 system of the 2nd of the following for reporting submit month the monthly report on the movement of infectious patients in SES (a form No. 85-lech.).
The report joins only patients with finally established diagnosis. In addition to data on incidence And., being subject to obligatory registration, the report contains additional data on number of the bacillicarriers of dysentery, typhoid, paratyphus revealed for the reporting period And, In, With, diphtherias (including a toxic strain) and parazitonositely malaria.
According to reports on a form No. 85-lech., the emergency notices and magazines in a form No. 60-SES, regional (city) SES are made by monthly reports (form No. 85-SES) which no later than the 5th following reporting send in regional (regional), and in the absence of regional division — in republican SES. Regional (regional) and republican SES on the basis of the reports received from regional and city SES make the summary report on area (edge) or the ASSR and present it to statistical office of area (edge, the ASSR) and to the Ministry of Health of the federal republic, the last — to M3 of the USSR.
Aggregated data about incidence And. and mortality from them worldwide is published by WHO in year-books a world dignity. statistics.
The indicator of incidence is in direct dependence on negotiability of the population behind medical aid, and it, in turn, depends on a set of social factors: the state system of medical service of the population, security of the population with medical institutions and the qualified medical shots, a dignity. literacy of the population and according to the relation of the population to this or that disease, etc. Therefore indicators of incidence in the conditions of free and public medical aid to the population of the USSR and use of active methods of identification And. are incomparable to similar indicators in the capitalist countries where private medical practice and absolutely other system of collection of information about distribution prevails And.
The Soviet health system creates objective premises for scientific statistics And.; the analysis of statistical data on infectious incidence gives the chance: to predict incidence (e.g., at flu); to estimate efficiency separate preventive and protivoepid. actions and their complexes; to define a role of separate factors of transmission of infection; to plan preventive and protivoepid, actions taking into account features of epidemic process in certain territories.
PHILOSOPHY of the ORGANIZATION of MEDICAL CARE
Philosophy of the organization of medical care consist in early identification of infectious patients, their isolation (first of all timely hospitalization), early diagnosis, rational treatment and dispensary service of had. Extra hospital specialized medical aid by the patient I. the USSR renders the out-patient and polyclinic institutions incorporating offices of infectious diseases (see). The network of these offices, specialized infectious departments and BC is regulated established depending on level and structure of infectious incidence of the population, demographic, economic and geographical factors.
Infectious diseases hospital (see) is to lay down. and protivoepid, establishment as hospitalization of the patient defines also his most perfect isolation from the surrounding population.
Due to the improvement a dignity. - a gigabyte. conditions of settlements, increase dignity. literacy of the population, falloff of incidence And. further extension of indications to the organization of a stationary domiciliary care is perspective. It is recommended generally to that patients who on the nature of a disease do not need difficult diagnostic testings and to lay down. manipulations. Out-patient and polyclinic service of infectious patients according to the contents, value and volume is an extremely important link. Its main objectives is identification of the diseased, specification of the diagnosis, treatment of patients, carrying out protivoepid, actions.
Activators I. bacteria, spirochetes, viruses, rickettsiae, mycoplasmas, fungi are. The diseases caused by protozoa, helminths, insects and mites carry to so-called invasive, or parasitic (see. Parasitic diseases ).
Ability of a microorganism to get into a human body, to breed in it and to cause patol, changes of bodies and fabrics is subject to big fluctuations in various conditions. It depends on many factors: virulence of a microbe, its pathogenicity, invasiveness, organotropy, cytopathogenic effect, toxigenicity, etc. Activators I. possess a number of the mechanisms providing overcoming natural barriers of a macroorganism and existence in it. It is mobility, agressina, kapsulyarny factors, production of various enzymes: hyaluronidases, neuraminidases, deoxyribonucleases, mucinase, fibrinolysin, collagenase, etc. Not a smaller role is played also by properties of the struck organism, a condition of its protective mechanisms, including barrier functions, immunol, the status, absorption function of reticuloendothelial system, a trophicity of the struck fabrics, adaptation and compensatory functions. The organism in the course of a disease represents a whole that is reached by the regulating influence first of all of nervous and endocrine systems.
The direct damaging effect on body tissues of the owner is had toxins (see). Despite a certain convention of division on ekzo-and endotoxins, it is recognized that exotoxins have high specificity of action, as the wedge, displays of a disease causes specifics. So, cholera exotoxin (enterotoxin-choleragen) causes hypersecretion of intestines; exotoxin of botulism selectively affects peripheral nerve terminations; diphtheritic exotoxin affects a muscle of heart, adrenal glands; the spasmotoxin affects interneuronels of a spinal cord (tetanospasmin) and (tetanohemolysin) causes hemolysis of erythrocytes. Endotoxin has smaller specificity of impact on a macro-organism. So, endotoxins of salmonellas, shigellas, escherichias have in many respects similar effect on a macroorganism, causing fever, leading to defeat went. - kish. path, to disturbance of activity of cardiovascular system and other systems and bodies.
Evolution of pathogenic microorganisms as the most important factor of evolution nozol, forms I. the nek-eye by easing of pathogenic properties of activators, first of all intestinal is characterized And., what finds reflection in growth of number of easy and oligosymptomatic forms of a disease (see. Dysentery , Cholera ), and increase of medicinal resistance to the himiopreparata leading to decrease in efficiency of treatment and deterioration in the forecast (see. Malaria , Staphylococcal infection ). These evolutionary changes of microorganisms happen first of all under the influence of environmental factors, change social and economic and a dignity. - a gigabyte. conditions.
So, bacterial dysentery evolved from hard proceeding with the expressed toxicosis, caused by Grigoriev's shigellas — Shigi, to less heavy, caused Fleksner's shigellas, and to the dysentery caused by shigellas of Zonne proceeding even more easily. These so jumps in etiologies and a wedge, the course of bacterial dysentery are reflection of the changing conditions of the environment which become adverse and even unacceptable for some species of microbes, and they disappear in the majority of territories (e.g., Grigoriev's shigellas — Shigi), and, on the contrary, quite suitable for others, and they widely extend (e.g., Zonne's shigellas).
And. the same as infectious process, can be caused by two or more species of microorganisms. In such cases speak about multi-infection. Infection can occur at the same time two activators or accession to the initial, main, already developed disease new — secondary takes place. Combinations of such viral diseases as the measles and flu to a bacterial flora (staphylococcus, streptococci) causing complications are most frequent.
Wide and often wrong (small doses, long breaks between introductions) use of antibiotics and other himiopreparat led to emergence of microorganisms, resistant to them — activators of many And., and also to formation of the changed forms of the microorganisms (filtered and L-forms) causing diseases with changed a wedge, a picture thanks to what there are difficulties in their diagnosis and treatment.
Proximate cause of emergence And. implementation in a human body of pathogenic activators is (sometimes hit, hl. obr. with food, toxins), with cells and fabrics to-rogo they enter interaction.
And. have an exogenous and endogenous origin.
Infection is followed by development of infectious process which not in all cases comes to the end with a course of a disease. Infectious process is the phenomenon of interaction micro and a macroorganism, to-rogo significant effect render conditions of the environment on development. Under the influence of many factors (feature of the activator, the infecting dose, immunol, and nonspecific fiziol. reactivity of an organism, preventive treatment etc.) infectious process can be interrupted or not be followed by development a wedge, symptoms of a disease or to reach a wedge, expressivenesses, i.e. to be followed by consecutive change a wedge, the symptoms testimonial of development And. Depending on existence and expressiveness a wedge, manifestations distinguish explicit (typical), erased, a subwedge., or asymptomatic, forms of disease. However even at absence a wedge, symptoms of a disease infectious process is characterized by existence biochemical, immunol, and morfol, reactions of an organism which identification becomes more and more available in connection with increase in the allowing opportunities of methods of a research.
The human body or an animal answers implementation of the activator difficult patofiziol., immune and morfol, reactions. The microorganism activator is the main reason for emergence of infectious process, defines its specificity connected with the nature of pathogenic impact on an organism (see. Infection ).
Ability of microorganisms to parasitizing in an organism of the owner is caused limited (according to L. V. Gromashevsky), and is frequent also a specific prisposobitelnost to dwelling in its certain bodies or fabrics (organotropy or fabric tropism). So, e.g., the causative agent of trachoma, parasitizing on a mucous membrane of an eye, causes its inflammation, the causative agent of whooping cough affects a mucous membrane of respiratory tracts that causes a characteristic symptom complex, and a cholera vibrio, breeding in intestines, causes diarrhea.
The microbe activator at penetration into a macroorganism meets a complex system of the protective and adaptive reactions directed finally to elimination of the activator and a reparation of the functional and structural disturbances which arose during infectious process. Defense reactions of an organism (see), mobilized under the influence of infectious process, on the one hand, provide optimal conditions of neutralization of a microorganism and its toxins, with another — constancy of internal environment of an organism, its genetic and antigenic structure (homeostasis). At the same time infectious process proceeds with constant change of cause and effect relationship.
A variety of the processes resulting from interaction of a microbe and a macroorganism also defines a current and an outcome And. Considerable impact on the course of infectious process (disease) is exerted also by therapeutic means. According to domestic and foreign researchers, direct dependence between resistance to antibiotics and degree of virulence of stafilokokk is observed. The infectious process caused by resistant stafilokokka proceeds, as a rule, heavier, than the diseases caused by antibiotikochuvstvitelny strains.
Significantly the wedge, the course of infectious diseases under the influence of extreme climatic conditions, radiative effects, preventive inoculations and other factors changes.
The mechanisms of protection of a macroorganism interfering penetration and the subsequent reproduction of the activator are also various. In development a human body and animals developed natural resistance to many activators. The natural resistance to many activators having specific character is descended, as well as others morfol, and biol, signs. It includes the cellular and humoral factors providing protection of an organism against action of microbic aggression. These factors enter hereditary property of a look or the genetic line, to a cut this organism belongs. Along with it such natural barriers as skin and mucous membranes, impenetrable are of great importance for many activators, the secrets of glands (slime, a gastric juice, bile, tears and so forth) having bactericidal and virulitsidny properties (antibacterial agents like a lysozyme, etc.). Also reticuloendothelial system and leukocytes, inhibitors of microorganisms (system of a complement, normal antibodies, etc.), the interferon possessing antiviral action and other mechanisms concern to them. Protective properties of skin and mucous membranes are in many respects caused by their normal microflora.
Quantitative and qualitative specific) the structure of the microorganisms living in hollow bodies and body tissues is rather constant in the conditions of so-called norm. Protective action autoflor, value a cut was noted by I. I. Mechnikov, is caused by hl. obr. its antagonistic relations with the pathogenic microorganisms connected with the competition and also with ability of a microorganism to products of antibiotic substances. One more mechanism of protective action of normal microflora, essence is defined to-rogo consists in induction by these microorganisms of synthesis of so-called normal antibodies (hl. obr. the secretory, present at various secrets and presented IgA).
The important role of a normal autoflora in maintenance of a microbic homeostasis of an organism is established, e.g., by the observations showing that treatment of some is long proceeding intestinal And. (dysentery, etc.) it can be reached only due to recovery of a normal ratio of intestinal microflora — an eubioz. Qualitative or quantitative changes autoflor (disbioz, dysbacteriosis), on the contrary, promote development in an organism of activators I.
Degree of protective action of various factors of nonspecific resistance of a macroorganism, like any other phenotypical sign, is to a certain extent predetermined genetically, but is exposed to also very significant influence of the diverse conditions of the environment — food, including degree of security with vitamins, climatic factors and so forth. Huge impact on nonspecific resistance is exerted by infectious and noninfectious diseases, and also other states demanding special tension of processes of life activity — pregnancy, considerable physical. and mental loadings, loss of blood and so forth. Nonspecific resistance has the expressed age and seasonal variability. Considerable fluctuations at separate individuals of level of the nonspecific resistance playing a large role in development of infectious process are explained by it (e.g., heavier course of the majority And. at early children's and senile age, and also at the faces weakened by associated diseases, intoxications, alimentary exhaustion and so forth).
At the diseases caused by obligate pathogenic microorganisms, first of all these factors define character of a course of infectious process.
Nonspecific resistance of a macroorganism has a bigger value at And., caused by opportunistic microbes when it defines not only the nature of infectious process, but it is frequent also a possibility of its development. Relative frequency of developing of diseases at action of various factors lowering the level of nonspecific resistance of a macroorganism is known, e.g. — radiation exposure, starvation and avitaminosis, cooling and other extreme states, development of superinfections in the postoperative period.
Along with existence of natural resistance a human body and animals reacts to implementation of pathogenic microorganisms development of reactions of immunity. Intensity of formation of immunity in process And. in many respects defines features of a current and an outcome of the disease.
Allergic processes also matter in a pathogeny of many And. also can be a pathogenetic basis of the earliest, heaviest displays of a disease, and also promote recuring, an exacerbation of a disease or its transition in hron, a current. So, extremely rough (fulminant, hypertoxical) the course of a meningococcal infection, dysentery and many others quite often speaks specific or nonspecific (as Sanarelli's phenomenon — Shvarttsmana) a hyper sensitization of a macroorganism, at a cut mobilization of its protective forces directed to localization and elimination of the activator accepts inadequate (giperergichesky) expressiveness and puts an organism on a side of death. The allergic and especially autoallergichesky processes connected with emergence of antigenic properties of fabrics for the struck organism and which are quite often arising during infectious process, probably, can also promote its transition in hron, a current (see. Allergy , Autoallergy ).
Achievements of molecular biology and biochemistry allowed to approach closely studying of nature of disturbance of various metabolic reactions at And. So, it is established that cholera exotoxin causes intensive secretion of water and salts in a small intestine through activation of the adenyl cyclase leading to strengthening of cyclic adenosine-3,5-monophosphate. Lipopolisakharida (endotoxins E. coli, S. typhosa) can also stimulate adeniltsiklazny activity, but at the same time there is an involvement prostaglandins (see). Local formation of prostaglandins and their bystry inactivation testify to their role in focal lesions. Influence of prostaglandins on absorbing function of intestines and their possible role in a pathogeny intestinal is studied And., proceeding with a syndrome of diarrhea. The main role in genesis of fever is assigned to prostaglandin E (leukocytic pyrogen increases synthesis or release of prostaglandin E in a hypothalamus). The majority of the specified researches are executed in an experiment by modeling of a disease. Molecular bases of a pathogeny And., especially in a wedge, conditions, only begin to be developed actively. Better they are studied at virus And.
Viruses are strict intracellular parasites. Therefore interaction of a virus with cells of an organism of the owner, a reproduction of a virus in them is the cornerstone of a pathogeny of viral diseases that defines some features of a pathogeny virus And. Development of viruses usually brings in cells to considerable functional and morfol, to disturbances of the last. The cells affected with a virus either perish, or lose ability to share; metabolism inherent to cells is significantly broken or perverted. The viral infection far is not exhausted by damage of cells by them and proceeds with various frustration of an organism in general in which genesis virus toxins and disturbances of cellular metabolism have great value.
The ability of some viruses to a persistention, i.e. to long stay in certain bodies and fabrics which is followed in some cases after a long incubation by development heavy patol, process with the isolated defeat of these fabrics is established. The first message about so-called. slow viral infections (see) it was made Sigurdson (V. Sigurdson) in 1954. Carry to number of slow infections of the person a chicken, the subacute sclerosing panencephalitis caused probably by a virus of measles, ugliness of newborns from mothers who had a rubella, slowly developing defeat of c in the period of pregnancy. and. the page at animals caused by a rhabdovirus, etc.
I.b., caused by rickettsiae, on a pathogeny and a wedge, to a current have much in common with virus And. Because rickettsiae are intracellular parasites with preferential defeat of an endothelium, characteristic morfol, manifestations first of all are found in an endothelium of vessels, and the disease proceeds with considerable circulatory disturbances — with the phenomena of a paralytic hyperemia, especially in small vessels.
At the majority postponed And. resistant specific forms immunity (see), providing immunity of an organism to this activator at repeated infection. Tension and duration of artificial immunity significantly differ at separate And. — from the expressed and resistant, almost excluding an opportunity recurrent disease during all life (natural smallpox, measles, etc.), to the weak and short-term, causing an opportunity recurrent diseases even later a short time term (dysentery, cholera, etc.). At some diseases not formation of immunity, i.e. immunity, but development of the hypersensitivity to the activator defining a possibility of a recurrence and reinfections is result of infectious process.
the Main data about patol, anatomy And. the person are received by opening of corpses. Posthumous diagnosis demands not only the macroscopic characteristic, but also use gistol, and mikrobiol, methods of a research taking into account a wedge, data.
Assessment of an origin and essence of the changes found on openings at P1., presents considerable difficulty as at the heart of the same patol, processes absolutely various reasons can lie. So, dystrophy and a necrosis can be caused by both a circulatory disturbance, and disturbance of a nervous trophicity, and effect of bacterial or other toxicants, and other harmful factors. At the same time at each nozol. to a form defeats, rather continuous, typical for it, are observed. The main localization of defeats at And. usually corresponds biol, to features of the activator and ways of its transfer. It is very evident at so-called drop (e.g., flu, whooping cough) and intestinal (salmonellosises, dysentery, etc.) And.
Localization of these or those defeats at And. it is generally caused by properties of activators. Distinctions in localization patol, processes, observed at same And., depend on a macroorganism (including and at autoinfektsionny diseases), but proceed not always equally.
The general changes arising at PI., usually are caused not by microorganisms, but products of their life activity or disintegration.
At And., the coming to an end death of the diseased, the general intoxication (specific and nonspecific — secondary due to disturbance of activity of bodies and systems of an organism) is shown by dystrophic changes of parenchymatous bodies, disintegration of cells of an adenoid tissue, damage of blood vessels and a circulatory disturbance (hypostasis, hemorrhages, disturbance of microcirculation and so forth) and other signs. Such defeats can be followed by the inflammatory reaction which does not have a direct bearing on this activator. Nevertheless some exotoxins (e.g., diphtheritic) find explicit selectivity of action. The damages of a myocardium which are observed at diphtheria, adrenal glands and nerves can be caused not only toxin. The substances which are formed at disintegration of cells of the organism or as a result of that difficult biochemical, changes which happen in the centers of an inflammation can appear not less toxic.
The general changes in an organism caused by toxins are expressed not only by damages, but also the reactive phenomena (e.g., the leukocytosis which is shown in vascular network of internals more clearly than in peripheral blood).
Substance of the antigenic nature, without being even toxic, but causing a sensitization, can serve as the reason special, sometimes very heavy allergic phenomena. At last, many pathoanatomical changes which are observed at P1., are only a consequence of the defeats which are directly connected with infectious process. Here not only results of a circulatory disturbance, disbolism etc., but also various complications (e.g., a perforation of intestines belong at a typhoid).
Along with it specific (and nonspecific) the changes in an organism connected with initial infectious process can give a reason for emergence of new, preferential autoinfektsionny processes (see. Autoinfection ). So, the pneumonia complicating many infectious diseases is caused by the microflora inhabiting respiratory tracts. At some And. in cases of death their «secondary» infection is almost the rule (e.g., flu, whooping cough) and caused by it morfol, changes prevail.
At And. often the most essential changes happen in the fabrics delimiting internal environment of an organism from surrounding — in mucous membranes of respiratory tracts, in a digestive tract partly in skin. Changes in mucous membranes are shown in the form of a catarral and fibrinous inflammation, is frequent with nekro zy an epithelium and subjects of fabrics. The expressed selectivity of defeats is noted enough clearly. For example, the fibrinous inflammation arising at diphtheria is usually limited to a pharynx and a throat, but can take also a trachea and bronchial tubes. The pharynx is surprised and at scarlet fever, but the inflammation which is followed by a necrosis, sometimes very deep if extends in breadth, then only on sidewalls of a throat, on a gullet and even on a stomach, usually passing a throat and bronchial tubes. The catarrh of upper respiratory tracts and a pharynx at measles takes a throat, a trachea and bronchial tubes, but reaches the largest force in the smallest bronchial branchings (fibrinous and necrotic endo-, meso - and pan-bronchitis), passing to the next pulmonary fabric (a peribronchitis and clumsy peribronchial pneumonia).
At many And. there is pneumonia. They are shown in various forms, differ as on composition of exudate in alveoluses (catarral, desquamative, fibrinous, etc.), and on topographical signs (lobar, lobular, acinous, juxtaspinal etc.), and also on a way of emergence (aspiration, hematogenous, etc.). At some And. pneumonia has the distinctiveness (e.g., at tuberculosis, plague, ornithoses), but is more often, representing result of consecutive pneumococcal or other banal infection, is deprived of any specificity.
At food toxicoinfections the inflammation in the form of acute Qatar takes hl. obr. a mucous membrane of a small bowel, the catarral and fibrinous and necrotic inflammation characteristic of bacterial dysentery, it is localized preferential in the descending departments of a large intestine, and the most essential changes at a typhoid (partly and at paratyphus) occur in a lower part of a small bowel, in its lymphoid educations — in follicles and peyerovy plaques.
Integuments are the place of development infectious ekzanty which cornerstone inflammatory processes (roseolas, papules, pustules), local circulatory disturbances (erythematic rashes) or hemorrhages (petechias and ecchymomas) are. The form and localization ekzanty is various at different diseases. There are differences and in the outcomes ekzanty: a scaly peeling of rash at measles and amotio layers of cells of epidermis at scarlet fever, the hems remaining after natural smallpox and traceless healing of pustules at chicken pox that is defined by character and depth of the being available damages.
The special attention is drawn patol. processes in c. N of page. The most important role of a nervous system in all vital signs defines its known security from those adverse effects which are possible at And. Nevertheless the brain and its covers sometimes are the main place of development of infectious processes. Defeats of covers of a brain — exudative, are more rare productive, making morfol, a basis of meningitis — are in most cases connected with bacterial activators (meningokokk, a pneumococcus, a tubercular stick). Encephalitis has preferential virus or Rickettsial nature or is caused by protozoa. The inflammation at infectious encephalitis usually happens focal, being shown in the form of small knots, granulomas and perivascular infiltrates. More or less expressed selective localization in certain departments of a head and spinal cord is inherent in each of neuroinfections that (even in the absence of specificity of defeat of neurons, vascular and gliozny reaction) gives the chance to carry out differential morfol, diagnosis [H. Spatz, Yu. M. Zhabotinsky].
In internals selectivity of defeats is noted: myocardites are especially characteristic of a sapropyra, diphtheria, rheumatism; endocarditises — for rheumatism and septic diseases; nephrites — for scarlet fever etc. However tuberculosis * can affect various bodies and fabrics though some (lungs, bones and joints, generative organs) are surprised more often.
In most cases in internals at And. nonspecific changes prevail. Quite usual find on opening are dystrophic processes — proteinaceous, fatty dystrophy etc. (see. Dystrophy of cells and fabrics ), the most expressed at severe forms and is the brightest shown in parenchymatous elements of a liver, kidneys and a myocardium; circulatory disturbances with their effects — staza (see), hemorrhages (see), ischemia (see), disturbances pigmental exchange (see), etc.
Almost everything And. are followed by hyperplastic processes in limf, nodes, having widespread, regional character. At the same time there is a hyperemia of nodes, sometimes loss of fibrin in a gleam of sine, infiltration of nodes various granulocytes. These changes are considered usually as lymphadenitis (see). The similar changes happening in a spleen lead to its short-term or continuous increase (so-called infectious swelling of a spleen). The hyperplastic processes in these bodies covering hl. obr. elements of reticuloendothelial system, are followed quite often by development of elements of a myeloid row, plasmocytes, etc. Many of these elements are display immunol, processes.
For many And. development of so-called infectious is characteristic granulomas (see), differing in the known specificity of a structure and also being result immunol. the processes delimiting further distribution of the activator. Ability to an otgranicheniye of infectious process depends on a condition of a macroorganism and is clearly expressed only at high-organized representatives of fauna enough. At animals, especially the lowest, And. much more often than at the person, proceed as sepsis. This pattern is shown as well in ontogenesis: at newborns the delimiting ability is expressed more weakly, than at adults.
Outcomes morfol, changes at And. are defined by result of infectious process and the nature of the damages caused by it. After suppression of life activity of pathogenic activators, as a rule, there is a resorption of exudates and the damaged fabrics and more or less full regeneration (see). This process demands the known time and therefore a wedge, recovery (e.g., crisis after a lung fever or improvement of the general state after normalization of a chair at patients with dysentery) can not match recovery in morfol, sense. At the same time therapeutic actions, especially use of antibiotics and sulfanamide drugs, significantly affect on patol, processes, reducing them to a minimum or giving them a long current (e.g., at tubercular meningitis). In the absence of an opportunity to regeneration after recovery the residual phenomena can be observed (e.g., paralyzes after poliomyelitis) or even to develop patol. the states gaining the nature of an independent disease (e.g., heart disease after a rheumatic endocarditis).
to the Majority And. recurrence — a certain sequence of development, increase and decrease of symptoms of a disease is inherent.
Recurrence of a current And. it is caused first of all by patterns of an immunogenesis.
Distinguish the next periods of a course of a disease: 1) incubatory (hidden); 2) prodromal (initial); 3) main displays of a disease; 4) fading of symptoms of a disease (early period of reconvalescence); 5) recovery (reconvalescence).
An incubation interval — a time term from the moment of infection before manifestation of the first a wedge, symptoms of a disease (see. Incubation interval ). In this period the activator adapts to internal environment of the infected organism and overcomes its protective mechanisms; there is a reproduction and accumulation in an organism of activators, their movement and selective accumulation in certain bodies and fabrics (fabric or organ tropism) most of which of all and are damaged. In an incubation period microbes of diphtheria, tetanus and some other emit the toxins which are spreading on an organism and fixed on cells, sensitive to them. Rhabdoviruss, poliomyelitis, toxin of tetanus extend on nervous trunks towards nervous cells. S. typhi get through limf, the device of intestines (peyerova of a plaque and solitary follicles) into mezenteralny limf, nodes where there is their reproduction. The causative agent of plague of the person from the place of penetration through skin extends in the lymphogenous way to regional limf, nodes where is late and intensively breeds.
From a macroorganism in an incubation interval there is a mobilization of protective forces of an organism, it fiziol., humoral and cellular means of protection, oxidizing processes, a glycogenolysis amplify. Changes happen also in funkts, a condition of c. N of page and century of N of page, in system a hypothalamus — a hypophysis — bark of adrenal glands.
Almost at everyone And. the incubation interval has the certain duration subject to fluctuations.
Prodromal, or initial, the period is followed by the general manifestations And.: an indisposition, frequent a fever, temperature increase, a headache, sometimes nausea, small muscular and joint pains, i.e. the symptoms of a disease which do not have some accurate specific manifestations. On site entrance infection atriums quite often there is an inflammatory process — primary center, or primary affect (see. Affect primary ). If at the same time noticeable (but often subclinical) part is taken also regional limf, nodes, speak about primary complex (see). The prodromal stage is observed not at all And. also 1 — 2 days last usually.
The period of the main displays of a disease is characterized by emergence of the most essential and specific symptoms of a disease, morfol, and biochemical changes. Specific pathogenic properties of the activator and responses of a macroorganism find the fullest expression in this period. This period is quite often subdivided into three stages: 1) increase wedge, manifestations (stadium incrementi); 2) their maximum expressiveness (stadium fastigii); 3) easing wedge, manifestations (stadium decrementi).
Duration of the period of the main displays of a disease significantly differs at separate And. (of several o'clock — days up to several months). During the main manifestations there can come the death of the patient or the disease passes into the next period.
During fading of a disease there is a disappearance of the main symptoms. Normalization of temperature can gradually happen — a lysis or very quickly, within several hours — crisis. Crisis, often observable at patients sypny and returnable typhus, pneumonia, quite often is followed by considerable dysfunctions of cardiovascular system, plentiful sweating.
Fading the wedge, symptoms begins the period of reconvalescence (see. Recovery ). Duration of the period of reconvalescence even at the same disease widely varies and depends on a form of a disease, weight of a current, immunol, features of an organism, efficiency of treatment. At some diseases (e.g., at a typhoid, a viral hepatitis, etc.) the period of recovery drags on for several weeks, at others it is much shorter. Sometimes reconvalescences is followed by the expressed weakness, often increased appetite and recovery of the weight lost during a disease. The wedge, recovery almost never matches a complete recovery morfol, damages, quite often dragging on for more long time.
Recovery can be full when all broken functions are recovered, or incomplete if the residual phenomena remain.
In addition to aggravations and a recurrence, in any period And. complications which can conditionally be divided on specific and nonspecific, the early and late periods can develop. Specific complications result from operation of the main activator this And. are also a consequence or extraordinary expressiveness typical a wedge, and morfol, displays of a disease (perforation of ulcers of intestines at a typhoid, a hepatic coma at a viral hepatitis), or atypical localization of fabric damages (a salmonellezny endocarditis, otitis at a typhoid, etc.). Such division is very conditional as well as definition of the concept «specific» and «nonspecific» a complication. The same syndromes can be considered and as manifestation of basic process of a disease, and as a complication. E.g., parenkhimatozno - subarachnoidal hemorrhage or an acute renal failure can be taken with good reason for symptoms of a meningococcal infection and for a specific complication of the early period of this disease. The complications caused by microorganisms of other look are called usually «consecutive infections», «virus or bacterial superinfections» (see. Superinfection ). It is necessary to distinguish from the last reinfections (see), the representing recurrent diseases arising after repeated infection with the same activator. Reinfections are possible at patients with scarlet fever, brucellosis, malaria, etc.
the Diagnosis is based on use anamnestic and epidemiol, data, on results an all-wedge., laboratory and tool methods of a research. Not all of them have equivalent diagnostic value. As a rule, the diagnosis is established on a data set, received by all methods.
Irrespective of the subsequent types of inspection first of all specify anamnestic data. Find out character of the beginning of a disease, the main complaints of the patient on days of a disease, the sequence of emergence of symptoms, the nature of fever, existence of a fever, perspiration, vomiting, diarrhea, cough, cold, a pain syndrome and other symptoms of a disease.
Is of exclusively great importance epidemiol. anamnesis (see) which allows to find out possible contacts of the diseased with a probable source of contagiums and to define possible factors of transfer (contact with patients, stay in the area, unsuccessful in epid, the relation, the conditions of life and food, a profession postponed earlier And., time and character of preventive inoculations etc.).
At a wedge, inspection of the patient (see) objective symptoms of a disease are established. All symptoms on their diagnostic importance can be divided into three groups conditionally: absolute, basic and directing.
Absolute (obligate, decisive, pathognomonic) symptoms — the symptoms which are found only at one certain disease. Existence them allows to make surely the diagnosis though their absence does not exclude a disease. Treat similar symptoms: Velsky's symptom — Filatova — Koplika at measles, a lockjaw and an opisthotonos at tetanus, typical rash at patients with a meningokoktsemiya, localization and the nature of a rash at smallpox, etc.
Basic (optional) symptoms are characteristic of this disease, but are observed also at some other. Existence of basic symptoms does the diagnosis of a disease probable, but doubtful. The laid-over reinforced language with pure edges and a tip, meets with the prints of teeth («typhus language») which are accurately delimited on it at patients with a typhoid more often, but can be observed also at a typhus, an enteroviral infection, sepsis. The diarrhea with slime and blood is characteristic of dysentery, but can be observed also at an amebiasis, a balanthidiasis, nonspecific ulcer colitis and some other diseases with damage of a large intestine. Muscle tension of a nape, a Kernig's sign are observed not only at serous and purulent meningitis, meningoentsefalita, but also at subarachnoidal hemorrhage.
The directing symptoms — the symptoms which are often found at various And. Their existence is not enough even for the presumable diagnosis, but they prompt a further way of a research. The headache is characteristic of meningitis, meningoentsefalit, a sapropyra, but meets also at flu, an enteroviral infection, a typhoid, malaria. Increase in a liver is observed at a viral hepatitis, belly and a typhus, sepsis, malaria and so forth.
For the correct diagnosis it is necessary to reveal not only separate symptoms, but also their set, i.e. syndromes. So, existence of rozeolezny rash does not allow to diagnose a typhoid yet. However existence of the roseolas which appeared on 8 — the 10th day of a disease, the typhus status which is laid over by a white plaque of edematous language with prints of teeth, rumblings in the right ileal area at a palpation do the diagnosis rather reasonable. Primary diagnosis based on data of the anamnesis and objective inspection of the patient defines the choice of further methods of a laboratory and tool research of the patient. Huge value for specification of the diagnosis has also dynamic overseeing by the patient.
Quite often data of a laboratory research are the only reliable way of confirmation of the diagnosis.
Efficiency of laboratory diagnosis is defined by use of a complex of laboratory tests, carrying out researches in course of disease, comparison of the obtained data with results a wedge. - epidemiol., and if necessary and special tool inspection of patients.
Material for a laboratory research usually are various allocations of the patient (kcal, urine, emetic masses, a phlegm, slime from a nasopharynx), contents went. - kish. a path (bile, duodenal contents), biopsy material, blood, cerebrospinal liquid, washouts, skarifikata or prints from mucous membranes, contents of buboes, pustules, ulcers, aft, ekzanty; section material; the infected foodstuff; sometimes objects of the environment.
Laboratory researches are conducted with use of a large number bacterial., virusol., immunol., morfol., biochemical, biol, methods. The choice of separate methods or their combinations is defined primary a wedge. - epidemiol, the diagnosis and features of an estimated nosological form.
At arrival of the infectious patient, irrespective of the subsequent types of inspection, are surely carried out to a hospital an all-wedge. blood tests, urine, calla. Results of these researches can supply with the important information on the general condition of the patient.
Detection (identification) of activators in materials from patients or carriers is most often decisive for the diagnosis (see. Identification of microbes ). Material for these researches undertakes from patients prior to the beginning of or upon termination of antimicrobic therapy taking into account time of removal of germicides from an organism. The allocated and identified activator if necessary is investigated further on sensitivity to antibiotics or other germicides.
Assessment of results bacterial, (virusol.) researches shall be differentiated. Negative, especially single, the analysis does not exclude an estimated disease, and positive is absolute only at allocation of the activator from blood, marrow, cerebrospinal liquid, contents of buboes, pustules or elements of rash. Allocation of the activator only from excrements, bile, less often than urine can lead to wrong conclusions. So, e.g., the patient with flu can be the typroid bacillicarrier.
Separate methods of allocation of activators are difficult and inaccessible or demand a long time for release of pure growths, are seldom used in clinic as do not provide early confirmation of the diagnosis (allocation of a virus of measles in culture of cells, allocation of brucellas, etc.).
Prost is also available bakterioskopichesky a method of a research native (in a dark field, phase-contrast microscopy) or stained preparations, applied in diagnosis of a typhinia, tuberculosis, malaria, bartonellosis, etc. Sensitivity and specificity of this method increase during the use of antibodies, specific to this activator, marked flyuorokhromam, with a research of drugs in a luminescent microscope.
An immunofluorescent method (see. Immunofluorescence ) it is especially widely applied in virusol, practice. More rare for detection of the activator in biol, substrates the submicroscopy or immunoelectron microscopy when as a marker of the activator apply specific antibodies, marked salts of heavy metals or enzymes is used.
Immunological, serological, immunochemical, biological and combined (e.g., biological and immunological) methods allow to reveal specific antigens (toxins) of the activator in materials from patients, in foodstuff or objects of the environment. Detection of specific antigens in blood, cerebrospinal liquid, biopsy material, urine is the most evidential. Indication of specific antigens of the activator in materials allows with sufficient reliability to make the indicative diagnosis in the first days of a disease, sometimes during the first hours and even at the end of an incubation interval (e.g., at hepatitis B). Important advantage of this group of methods is what they with success allow to find both the live, and killed activator, including and products of its disintegration — soluble antigens. As the revealed antigens are in biol, substrates from patients usually in very insignificant quantity, it is necessary to use the most sensitive immunol, tests (the unit hemagglutination, braking of passive hemagglutination, radio immunological or immunoenzimologichesky). The specified researches are used in diagnosis of infectious and parasitic diseases (a brucellosis, dysentery, cholera, plague, malaria, a schistosomatosis, etc.) - Quite often antigen can be connected by a specific antibody (immunizirovanny persons, patients in the period of a heat of a disease or reconvalescence) and therefore the research of serum in such cases demands preliminary destruction of a complex antigen — an antibody, i.e. special processing of serum.
Owing to simplicity and availability also a little sensitive pretsipitatsionny methods found application (see. Precipitation ). So, for detection of the Australian antigen in blood serum and meningococcal antigen in cerebrospinal liquid reaction of a counter immunoelektroosmoforez and reaction of immunoprecipitation in gel of an agar or agarose is used; for diagnosis of botulism — reaction of an interfacia. In clinic also other ways of indication of antigens (toxins) pass tests; e.g., the so-called limulyus-test based on gelatinization of protoplasm of amoebocides of a crab of Limulus polyphemus under the influence of endotoxin of the gram-negative bacteria which are contained in blood serum of some patients with sepsis.
Researches on detection of specific antibodies in blood serum are widely used immunol. Vhole and monovalent antibodies are defined; antibodies of one specificity, but differing on physical. - the chemical nature (7S and 19S); antibodies are precipitant, agglutinating, complement-linked, etc. Such sensitive methods as reaction of passive are more often used hemagglutinations (see), reaction of binding complement (see), radio immunological, etc. Kept value and traditional, less sensitive methods, napr, an agglutination test with bacterial diagnosticums at a typhoid or paratyphus (see. Vidalya reaction ), Wright and Haddlson's reactions at a brucellosis (see. Wright reaction , Haddlsona reaction ), etc. Usually antibodies begin to be registered in blood serum since the end of the first week of a disease with further increase in the course of its development therefore the repeated research is necessary. Only certain levels of antibodies have diagnostic value (credits). So, for serol, diagnoses of a typhoid in THRESHING BARN conditionally diagnostic level of O-antibodies is the positive caption 1: 640 and above, and for diagnosis of a typroid bacteriocarrier — a caption of Vi-antibodies not less than 1: 80. It is established also that as a part of their Vi-antibodies 78 version are more characteristic of chronic carriers. The increasing role is got by definition of antibodies in various classes of immunoglobulins (A, G, M, etc.).
Are rather simple in statement allergol. the tests based on intradermal administration of various allergens prepared from activators (e.g., an antraksina — for diagnosis of a malignant anthrax, tuberculine, brucellin, tularin, etc.).
The increasing value is gained by the tests which are not demanding administration of drugs in an organism of the patient (in vitro tests), tests of alteration of leukocytes, the test of damage of neutrophils, Shelley's test estimating extent of degranulation of basophiles of blood (see. basphilic test ), reaction blastotransformation of lymphocytes (see), etc.
In a wedge, assessment of the reactions revealing a condition of hypersensitivity or cellular immunity needs to consider hypersensitivity of the patient to proteinaceous drugs, the previous treatment with antihistaminic, immunodepressive means.
Also the reactions based on neutralization by antibodies of an organism of the toxin of activators entered vnutrikozhno are applied (e.g., the Schick's test — Is wild for definition of existence according to antidiphtherial or antiscarlatinal immunity).
Enzimologichesky methods (definition of activity of various enzymes in blood) found the greatest application preferential in complex diagnosis of a viral hepatitis. The diagnostic value of such indicators comes down, in essence, only to definition funkts, opportunities in activity of bodies, systems.
Morphological (histologic) methods have limited use practically only in combination with other methods (e.g., detection of activators, their antigens or antibodies).
Biological methods rank high in diagnosis And.
With their help find toxins in the substrates taken from patients, or at a research of the infected foodstuff. These methods, including and combined use preferential in virusol, practice for allocation and identification of viruses (use of animals, embryos of birds — see. Virologic researches ).
Tool methods of a research: endoscopic (rektoromanoskopiya, gastroduodenoskopiya, laparoscopy, etc.). Electrophysiologic (electrocardiography, electroencephalography, etc.), radiological and radiological. These methods find broad application in clinic. Carrying out tool researches, their choice are defined primary a wedge, the diagnosis. So, a rektoromanoskopiya apply a wedge to diagnosis of dysentery and specification. - morfol, options of disease, the spinal puncture is used for examination morfol, composition of cerebrospinal liquid, and rentgenol. a method — for detection of the organ defeats (lungs, bones, joints, etc.) inherent defined nozol, to forms (a tularemia, the Q fever, a brucellosis, etc.).
Complexity of diagnosis, difficulty at complex assessment of a large number of symptoms resulted in need of quantitative assessment of separate diagnostic characters and clarifications of objective value and the place of each of them. For this purpose began to apply various mathematical methods based on the law of probability. The greatest distribution in diagnosis And. found a sequential analysis of Wald (A. Wald, 1960). The philosophy of a method consists in comparison of probabilities (frequencies) of distribution of symptoms at two diseases or states, definition of differential and diagnostic informational content of symptoms and calculation of diagnostic coefficients.
Treatment of the infectious patient shall be complex and be based on the deep analysis of its state. The full complex to lay down. actions it is carried out according to the following scheme: influence on the activator (an antibioticotherapia, chemotherapy, an immunotherapy, a phagotherapy, etc.); neutralization of toxins (specific and nonspecific); recovery of the broken vital functions of an organism (artificial ventilation of the lungs, a hemodialysis, blood substitution, infusional therapy, operative measures, etc.); recovery of normal parameters of a homeostasis of an organism (correction of a hypovolemia, acidosis, cardiovascular and respiratory insufficiency, fight against a hyperthermia, diarrhea, oliguria, etc.); increase fiziol, resilience (reactivity) of an organism (immunotherapy, including gammaglobu-linoterapiya, vaccinotherapy, hormonal therapy, hemotransfusions, proteinotherapy and others biol, stimulators, physical therapy); the hyposensibilizing therapy (the corticosteroids desensibilizing means, vaccinotherapy, etc.); symptomatic therapy (anesthetics, tranquilizers, somnolent, anticonvulsant therapy, etc.); dietotherapy; guarding and recovery mode.
During each certain period of a disease, in each case appoint therapy taking into account an etiology and the pathogenetic mechanism of pathology.
The choice to lay down. means, their dosage, a method of introduction depend on a state and age of the patient, a form of disease, associated diseases and complications. At treatment of the majority And., caused by bacteria, rickettsiae, protozoa, the basic is influence on the activator (causal treatment). Most widely antibiotics and himiopreparata are for this purpose applied. At purpose of these means it is necessary to meet a number of conditions: 1) to use the drug possessing the greatest bacteriostatic or bactericidal action in relation to the causative agent of this disease; 2) to use drug in such dosage or to enter it in such a way that in the main inflammatory center therapeutic concentration of drug were constantly created, and duration of treatment would provide full suppression of life activity of the activator; 3) it is necessary to appoint himiopreparata and antibiotics in the doses which do not have toxic effect on an organism of the patient.
For a right choice of an antibiotic and a himiopreparat it is necessary to establish an etiology of a disease. If etiology And. it is unknown as it is often observed at polietiol. diseases (purulent meningitis, sepsis, etc.), urgentny polyetiotropic treatment, and after establishment etiol is carried out, the diagnosis of a disease pass to monoetiotropic treatment. At the same time sensitivity of this activator to the applied antibiotics and himiopreparata is considered. At the same time it is impossible to transfer experimental data to a wedge, practice unconditionally. Quite often from the patient microbes, resistant to an antibiotic, can be allocated, and treatment by the same antibiotic is effective and vice versa. If activator I. or its sensitivity to antibiotics are unknown, use of several drugs taking into account a synergism of their action is allowed. It is necessary to appoint antibiotics and himiopreparata as soon as possible, severe defeats of various bodies and systems did not develop yet. At the same time at some And. (dysentery, whooping cough, scarlet fever, etc.), proceeding easily, without essential disturbance of a condition of the patient, it is better not to appoint etiotropic means. It is necessary to avoid so-called shock doses of germicides since they pose potential threat of development of infectious and toxic shock in connection with death of a large number of microorganisms and release of endotoxins (as Gerksgeymer's reaction — Yarish, Lukashevich).
Treat number of the means influencing on the activator also bacteriophages (see), antimicrobic serums and gamma-globulins. As antiviral drug use interferon and a number of interferonogen (e.g., the anti-influenza vaccine A2B) for stimulation of development by an organism of interferon. (Botulism, diphtheria, tetanus, etc.) apply specific anti-toxic serums to neutralization of exotoxins. Serums neutralize only freely circulating toxin therefore they are applied in the first days of a disease. Specific gamma-globulins (immunoglobulins) apply at many And. (flu, tick-borne encephalitis, measles, etc.). To a nek-swarm of degree colloid and crystalloid solutions, especially a blood plasma, fresh blood, Haemodesum, reopoliglyukin, and also steroid hormones reduce intoxication.
Modern technical means expanded possibilities of pathogenetic therapy, promoted implementation in clinic of infectious diseases of methods intensive care (see) and resuscitation (see) at terminal states. In many cases pathogenetic therapy plays in treatment of the patient not a smaller role, than etiotropic, and only thanks to its timely carrying out the patient manages to save life. During the use of this or that scheme of treatment there is a need of its constant correction in relation to the specific patient.
Many drugs used for treatment And., are not free from side effect, especially if they are applied in high doses and a long course. So, toksiko-allergic reactions are well-known, dysbacteriosis (see), Candidiasis (see), oppression of function of marrow (e.g., a leukopenia at treatment by levomycetinum in high doses), etc. at an antibioticotherapia. Fears that bacteriostatic action of antibiotics leads to decrease in antigenic irritation and, therefore, to weakening of an immunogenesis, did not come true as treatment And. usually the wedge, symptoms of a disease when the antigenic immunizatorny irritation of immunocompetent systems of an organism is already reached in the natural way begins at a stage of development.
An antibioticotherapia not always guarantees against a recurrence or formation of a bacteriocarrier (a typhoid, a brucellosis, dysentery). Therefore the combined schemes of treatment are offered by antibiotics and vaccines, antibiotics, and nonspecific stimulators of immunity (pentoxyl, Prodigiosanum, etc.).
Glucocorticosteroid hormones (Prednisolonum, etc.) at prolonged use can cause various damages and complications, also activation of a bacterial flora from its hidden centers or development of superinfection is possible.
During the use of serumal drugs (especially heterological) the by-effects which are expressed in development of allergic reactions up to are possible acute anaphylaxis (see). The similar phenomena at purpose of protein hydrolyzates of blood are less expressed (Amincrovinum, ampnopeptid, etc.).
Regidratation of patients (e.g., at cholera) various solutions without control of electrolytes and an acid-base state can result in converse effect, break a homeostasis of an organism.
At And. recovery, transition in hron, a current or death is possible.
At inferiority of formation of immunity the disease can accept an acyclic current or process develops hron. The aggravations representing strengthening of the main a wedge, displays of a disease in the period of fading or reconvalescence are possible. Aggravations are observed preferential at is long proceeding And. (typhoid, brucellosis, viral hepatitis, etc.).
The recurrence is observed in the period of recovery after disappearance a wedge, symptoms of a disease. At the same time again there is full (or almost full) a symptom complex And. A recurrence can be caused by a development cycle of the activator in an organism of the patient (malaria, typhinias) and to be typical manifestation of the natural course of a disease. In other cases a recurrence arises also under the influence of additional adverse effects on an organism of the patient (cooling, disturbance of food, psikhich. stress, etc.). A recurrence is observed at a typhoid, an ugly face, a brucellosis, etc.
In some cases the patient after recovery can remain a bakteriovydelitel (see. Carriage of contagiums ), and also as a result of resistant residual effects to lose partially or completely working capacity (poliomyelitis, a brucellosis, a meningococcal infection, diphtheria).
Efficiency of fight against infectious incidence is defined by the level of scientific knowledge in this area, a condition of material and technical resources, development of network a dignity. - epid, institutions and, the main thing, the state health system.
In pre-revolutionary Russia And. were eurysynusic. In the first fifteen years 20 century annually more than 100 thousand people, malaria of 5 — 7 million people and natural smallpox of 50 — 100 thousand people had a typhus. Constantly there were epidemics of cholera at which hundreds of thousands of diseases were registered (e.g., in 1910 230 232 persons got sick, from them 109 560 died). In premilitary 1913 it is registered patients with a typhoid — 423 791, scarlet fever — 446 060, by diphtheria — 499 512. Imperial Russia had practically no centralized a dignity. - epid, the organizations: number dignity. did not exceed doctors in 1913 — 1914 600, there was all the 28th dignity. - a gigabyte. laboratories.
World War I, and then civil war and foreign intervention considerably worsened epid. a situation in the country. Sharply incidence belly and especially a sapropyra increased. Epidemic of a sapropyra in 1918 — 1922 when the number of had reached 20 million people is well-known.
Since the first years of the Soviet power prevention And. became in the center of attention of party and the government. The problem of fight against infectious incidence found the reflection in the Party program. In 1919 I. Lenin signed the decree «About sanitary protection of dwellings». In 1921 the decree of the government «About measures but to improvement of water supply, the sewerage and sewage disposal in the republic», in 1922 — the decree «About sanitary bodies of the republic» — the first legalization of system a dignity is issued. supervision.
By efforts of party, Soviet, economic and medical organizations, hard work of medics mass spread of sypny and belly typhus and others And. it was suspended. By 1925 — 1927 incidence of natural smallpox, typhus was reduced to level lower, than in 1914.
With strengthening of economy of the Soviet state, growth of material and cultural level of the population, development of network a dignity. - epid, institutions infectious incidence in the 30th continues to decrease. Cholera (1925), a dracunculosis (1932), natural smallpox (1937) were liquidated.
The Great Patriotic War of 1941 — 1945 not only detained further decrease in infectious incidence in the country, but also created conditions for emergence of epidemics. However nation-wide character protivoepid, actions, the developed system a dignity. - epid, institutions, experience of specialists in this area, the combined scheduled maintenance among the population and in troops provided relative epidemiol, wellbeing both in the country, and in field army; And. did not gain big distribution, there were no epidemics which were usually accompanying wars.
During the post-war period the consecutive growth of economic power of the country and welfare of the Soviet people, further development of the Soviet health care, the gained long-term experience in fight with And., intense work of epidemiologists, dignity. doctors, microbiologists, etc. were led to elimination in the country as well malaria, a sap, a typhinia. Poliomyelitis, diphtheria are close to elimination. Incidence of measles, brucellosis, tularemia is sharply reduced. In comparison with 1913 rate of mortality at scarlet fever by 1300 times is lowered, at diphtheria and whooping cough — by 300 times.
In our country systematic work on the maximum decrease in infectious incidence, on elimination separate is conducted And., what is promoted by growth of material and cultural level of the population, environment protection (free air, water and the soil), statement of public catering on a scientific gigabyte. to a basis, broad financing protivoepid. actions state, public free medical aid, creation of powerful network dignity. - epid. institutions, progressive Soviet dignity. legislation. Everything told is defined by the Program of the CPSU where it is written down: «The socialist state — the only state which undertakes care of protection and continuous improvement of health of all population. It is provided with system of social and economic and medical actions. The wide program directed to the prevention and resolute reduction of diseases, elimination of mass infectious diseases on further increase in life expectancy is carried out».
In fight against infectious incidence the level of medical knowledge allowing to build evidence-based system of actions is of great importance. In particular, scientific achievements in the field of epidemiology, microbiology and virology, immunology, parasitology, clinic of infectious diseases are important in this sense. In the Soviet Union big scope was received by scientific research in the field of infectious pathology and epidemiology (78 research institutes only epidemiol, and a gigabyte. profile), what caused creation of the theory epid, process, the formulation of fundamental laws of epidemiology, allowed to construct the evidence-based program of fight against infectious incidence in our country. In 1976 in the Soviet Union there was a St. 4,7 thousand a dignity. - epid, stations which part was the 4256th bacterial., 179 virusol., 1168 gigabyte. and other laboratories (see. Health care , sanitarnoepidemiologichesky service ).
Actually medical actions in fight against infectious incidence can be divided into the preventive events held irrespective of existence And., and anti-epidemic actions (see), carried out during the developing of diseases.
Preventive actions: 1) establishment of evidence-based maximum allowable concentrations of harmful substances in free air and in air of rooms, participation in development of measures for the prevention of pollution, control of carrying out died on a dignity. to protection of free air and air in premises of the enterprises; 2) dignity. supervision of water supply of the inhabited places and operation of water sources, establishment zones of sanitary protection (see) water sources, dignity. supervision of treatment facilities at waterworks, bacterial, and a dignity. - chemical researches of water from water sources of water supply of the population; 3) dignity. supervision of construction of industrial and inhabited facilities, participation in development dignity. norms of design; 4) supervision for a dignity. a condition of the inhabited places. - of stations, sea, river and aviation ports, hotels, movie theaters, laundries, control of cleaning of the inhabited places; 5) supervision of performance of safety arrangements and accident prevention (dust content, humidity, noise, etc.); 6) dignity. supervision of the enterprises of the food industry, trade in foodstuff, catering establishments; supervision for a dignity. a condition of the markets, markets, behind transportation of foodstuff; 7) identification and sanitation of carriers of contagiums, especially among employees of the food enterprises, public catering and water supply, child care facilities, obstetric and maternity medical institutions; 8) together with vt. service dignity. supervision of livestock farms, improvement of farms, unsuccessful on a brucellosis, a sap, the Q fever, etc.; 9) dignity. patrolling for the prevention of a drift of quarantine infectious diseases from abroad; 10) the organization of preventive disinfection in places of constant accumulation of people (stations, ports, automobiles, the spectacular enterprises) and in livestock farms, unsuccessful on infections; 11) if necessary protection of people against attack of insects and ticks — carriers of contagiums: use of protective clothes (see. Clothes protective ), protecting screens (see), repellents (see), zasetchivaniye of rooms, destruction of arthropod carriers of activators I. in certain territories, destruction of rodents in zones of a natural ochagovost And.; 12) planned immunization (see) the population, immunization of the population of certain territories (e.g., in districts of a natural ochagovost of some And.), separate collectives (participants of field expeditions, hunters and field men, etc.); 13) dignity. - epidemiol. observation, studying of regional infectious pathology, drawing up dignity. - epidemiol, descriptions of territories, forecasting epidemiol. situations, planning preventive and protivoepid, actions for the near and remote future; 14) promotion of scientific knowledge among the population of prevention And.
Anti-epidemic actions are directed to three links of epidemic process: on active identification of sources of an infection (patients and carriers) and their neutralization (hospitalization and treatment of patients, sanitation of carriers of an infection), neutralization or destruction (according to indications) sources of an infection — animals; on a rupture of ways of transfer of contagiums — disinfecting of objects of the environment, extermination of insects and mites — carriers of contagiums or protection of people against blood-sicking arthropods, a strict dignity. supervision of the food enterprises, institutions of public catering, subjects to water supply; on creation of specific immunity (active or passive immunization, the emergency prevention). These actions are as follows: 1) immediate hospitalization of patients (according to indications); 2) registration of the arisen diseases, the emergency notice of the higher organizations on the arisen disease (diseases, flash, epidemic); 3) epidemiol, inspection of each case, establishment of a source of an infection, possible ways of infection (at epid, flash — ways and the reasons of distribution), establishment of the most effective protivoepid, actions in this specific situation; 4) active identification in the center of possible patients and their hospitalization, identification (at a number of infections) carriers, their sanitation, and at cholera strict isolation; 5) transportation And. on special transport, every time disinfected in to lay down. establishment where the patient is brought; 6) identification of the persons adjoining to the patient, carrying out measures concerning adjoining — epid, observation, laboratory inspection, thermometry, the emergency prevention, isolation etc. (see. Isolation of infectious patients ) in some cases holding quarantine actions in the settlement, the house, the hostel, children's collective, etc.; 8) an observation of the persons leaving the karantinirovanny district, the inhabited place; 9) disinfection, disinsection, deratization in the center (depending on nozol, forms); 10) carrying out a wide range dignity. - professional, died in the inhabited place; 11) if necessary immunization of members of collective, in Krom there was a disease, or inhabitants of the inhabited place (the district, area, the border district); 12) the strengthened promotion among the population of measures of personal prevention And., especially among the persons who are looking after the patients who are treated at home.
INFECTIOUS DISEASES of ANIMALS
Infectious diseases of animals on the origin more ancient, than And. person. The general sign for them is ability to be transferred from a sick animal healthy and in the presence of certain conditions to accept epizootic distribution. For a long time And. animals, causing their mass death, sharply worsened living conditions of people, forced them to change the occupations and habitals.
And. animals can be inherent to one species of animals (a paratyphoid of birds, an ugly face of pigs, sap and infectious encephalomyelitis of horses, plague of cattle, plague of dogs etc.), to many animal species (rage, a brucellosis, leptospirosis, smallpox, a malignant anthrax, a foot-and-mouth disease, etc.) or to strike all views of the village - x. animals (Auyeski's disease, nekrobatsilleza, pasteurellosis, etc.). To a nek-eye And. animals (rage, a brucellosis, leptospirosis, the Q fever, listeriosis, an ornithosis, a malignant anthrax, a tularemia, plague, etc.) also the person is susceptible (see. Zoonoza ).
L. V. Gromashevsky defined the following conditions of infection of the person from animals: household proximity — feeding of dogs from the ware, general with the person, drink of water and consumption of the products contaminated by allocations of animals, etc.; care of animals — contact with the allocations of animals or objects contaminated by them, rendering a vetpomoshcha to animals; sting sick animals; hunting, slaughter, removal of skins; processing of animal products (hair, skin, feather, furs, wool, bristle); consumption of meat and milk of sick animals in a crude or half-baked look; transfer of activators blood-sicking arthropods, ectoparasites of animals.
In epidemiol, the relation the animals who are near the person are most dangerous — domestic animals (see), rodents (see). Much less often diseases result from contact with wildings. Among the most often meeting And. zoonotic diseases occupy the person apprx. 20%.
Diagnosis And. animals the wedge, and epizootol is based on use. yielded, results of a laboratory research, pathoanatomical openings and gistol. researches. At diagnosis, especially difficult recognizable diseases, resort sometimes to infection of animals of the same look as to this activator there are no sensitive laboratory animals (e.g., infectious anemia of horses, plague of pigs). At emergence of especially dangerous diseases (e.g., general pneumonia, plague of cattle) slaughter and opening of 2 — 3 patients of animals is allowed for the correct and timely diagnosis. Are applied also allergic (at a sapa, tuberculosis, a brucellosis and others) and serol, (at a brucellosis, a sapa, a malignant anthrax, etc.) diagnostic methods.
Treatment of sick animals is carried out in infectious departments of veterinary clinics or in the specially allotted isolated rooms. Pay attention to detention regime and feedings of sick animals and creation of the conditions excluding spread of an infection. At especially dangerous diseases treatment is forbidden (e.g., at a sapa, plague of cattle and some other), animals are slaughtered.
The recovered animals depending on the nature of a disease contain for some time separately from healthy and are gradually transferred to usual conditions.
Are among the general preventive actions: protection of borders of the USSR, the prevention of possible delivery of sick animals from abroad for what on borders of the country control vetpunkta are organized; veterinary supervision behind movement of animals and transportation of animal raw materials within the country, and also behind places of accumulation of animals (markets, fairs, exhibitions of animals etc.); veterinary sanitary inspection (see) in places of slaughter of animals (meat-processing plants, slaughters, crushing points) and in the markets (myasokontrolny and molochnokontrolny stations); in the industry processing animal raw materials; supervision of the correct cleaning of corpses of animals (utilization plants, disposal plants, cattle mortuaries, etc.).
Universal have important preventive value vt. surveys of animals using allergic and serol, diagnostic methods, certification of the cattle, medical examination of productive animals in farms. The cattle entered into farms is exposed to a 30-day preventive quarantine. Widely vaccination of animals is implemented into practice.
At emergence of diseases actions for their elimination are implemented. Point (a separate farm, economy, the settlement, sometimes group of farms or the whole district) where diseases are established, appears unsuccessful, in necessary cases the quarantine is imposed, the wedge, inspection of animals is carried out universal. Depending on results of inspection the livestock of animals is divided into three groups: obviously sick, suspicious on a disease and all other animals. Obviously sick animals are isolated (group isolation is allowed); at especially dangerous diseases and lack of effective remedies of treatment of sick animals destroy or if it is provided by instructions, chuck in meat; suspicious on a disease in addition inspect for the purpose of specification of the diagnosis; for all other animals who were in contact with sick animals establish a wedge, observation, conduct periodic examination serol, and allergic methods, and also immunization.
Terms of a quarantine are defined by duration of an incubation interval and carriage of activators after recovery. Before removal of a quarantine carry out final disinfection.
At And. the animals who are characterized by high infectivity or special danger to livestock production around karantinirovanny point the threatened zone where systematic is carried out is established vt. observation, immunization of animals and some other restrictive actions.
INFECTIOUS DISEASES of PLANTS
Infectious diseases of plants are caused by bacteria, viruses, fungi, mycoplasmas, pathogenic for them. Existence of pathogenic viruses is for the first time open D. I. Ivanovsky (1892) during the studying of diseases of tobacco. The viruses causing mosaic (uneven) coloring of leaves received the name of mosaic. At mottles the form of a sheet plate changes, the plant lags behind in growth. In chlorophyll-bearing fabrics are observed patol, changes, the maintenance of a chlorophyll decreases. The disease is easily transmitted through seeds or juice of sick plants. Mechanical carriers of the activator — a plant louse, bugs, mites, soil nematodes. Except tobacco, viruses affect tomatoes, potatoes, beet and other cultures. And. plants lead to decrease in a harvest and deterioration of grain, fruits etc.
Some And. plants do the food stuffs prepared from them, unsuitable to the use, napr, a toxic bacteriosis of water-melons, intoxication of grain by fungi-fuzariyami. «drunk bread», an agranulocytosis, etc. are most known. The last has distribution at overdue cleaning of grain crops when at the plants which are long standing on a root ears are surprised the fungi causing intoxication of grain.
Fight against diseases of plants is directed to destruction of the causative agent of diseases, disinfecting of seeds by chemicals, spraying and dusting of plants chemical drugs, use biol, means of protection.
Cultivation of plant varieties, steady against diseases, is of great importance.
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