SALMONELLOSIS

From Big Medical Encyclopedia

SALMONELLOSIS (salmonellosis) — the acute infectious disease which is characterized by a preferential gastrointestinal tract disease.

Till 70th 20 century carried a salmonellosis to food toxicoinfections (see. Toxicoinfections food ), in the subsequent this disease was allocated in an independent nosological form.

Distinguish the following a wedge, forms C.: gastrointestinal, proceeding by gastritichesky, gastroenteritichesky and gastroenteroko-lytic options; a generalized form with a typhus-like shch septicopyemic options of a current; bacteriocarrier (acute, chronic, tranzitorny).

History

Bollinger (O. of Bollinger, 1876), etc. paid attention that observed «food poisonings» are connected with the use of meat of the animals having septicopyemic diseases.

In 1885 an amer. researcher Smith (Th. Smith) allocated from bodies of the pigs of a disease-producing factor of Bacterium suipestifer (Salmonella cholerae suis) who died from plague and afterwards carried out studying it morfol. and biochemical properties. The message on this opening was published by Sal-mon and Smith (D. E. Salmon, Th. Smith).

In 1888 S. enteritidis Gaertneri allocated from bodies of the person who died of «food poisoning» and from the meat eaten by sick people, the microbe close on the properties to V. suipestifer and called afterwards by his name — S. enteritidis Gaertneri's stick. Later at investigation of outbreaks of similar diseases some other bacteria, morfol was open. and biol. properties to-rykh were similar to properties of a stick of Gertner. In 1900 the fr. researcher J. Lignites suggested to call the bacteria described by Salmon and Smith, salmonellas. In 1934. The international nomenclature commission made the official decision to call this group of activators salmonellas.

An etiology

Activators C. are the microorganisms relating to the family Salmonella of family of intestinal (Enterobacteriaceae) of a tribe Escherichieae. It is known apprx. 2000 serological types (options) of the salmonellas differing on antigenic properties (see. Salmonella ); from people more than 700 serotypes are allocated. Salmonellas are characterized by the expressed polypathogenicity, i.e. ability to cause diseases both in various animals, and in people.

The diseases caused by such salmonellas as S. typhi, S. paratyphi A, S. schottmuelleri, S. hirsch-feldii are allocated in independent nosological forms (see. Typhoid , Paratify ).

From people, sick S., in our country are most often allocated S. typhimurium, S. virchov, S. infantis, S. bovis-morbificans, S. anatum, S. haifa, S. enteritidis, etc.

Epidemiology

the Source of an infection at S. are various animals: cattle, pigs, horses, dogs, cats, rodents (rats and mice), poultry, especially natatorial (ducks, geese); perhaps also infection from the person — the patient and the carrier of salmonellas. Value of these or those animals as sources of an infection is not identical. It is known that nearly a half of all diseases of the person S. is connected with the use of meat of cattle, and also pigs and horses. Infection of meat can be both intravital, and postmortalny (after a face of animals). Intravital infection is connected with the animal S.'s disease proceeding quite often in the form of a septicopyemia. At animals the activator gets into blood from intestines at strong exhaustion and defective food that is observed during their long transportations or stages on meat-processing plants and slaughters. The bacteria which got into muscles of the tired animals at rest of the last die off, and on third day the majority of animals is usually exempted from them. Meat of healthy animals has bactericidal properties whereas at the tired animals it has no bactericidal properties. In S.'s epidemiology important value has the fact that animal S.'s disease quite often leads to forced slaughter it out of a slaughter and implementation of meat without due health control.

Postmortalny infection of meat can occur in the course of slaughter and cutting of hulks, at storage, transportation and the subsequent culinary processing. Cutting of carcasses of sick and healthy animals the same tool leads possible disturbance of an integrity of intestines to it; infection of meat with rodents at its storage.

The role of dogs and cats as sources of an infection, apparently, is limited though these animals and can be carriers of salmonellas. Rodents, to-rye are ill S. and at the same time within several months salmonellas with excrements and urine allocate, products in warehouses and objects of public catering infect. Most of researchers nevertheless allocates to gruzyna the limited place in distribution of Page.

S. given to prevalence among birds are rather extensive. It is known that eggs of birds, first of all natatorial, are often infected by salmonellas. Infection of carcasses of birds can occur during the cutting of a sick and healthy bird one tool, at their wrong culinary processing.

About the person as a source of an infection at S. there are contradictory judgments. One researchers consider the sick person and the carrier of salmonellas dangerous in the epidemic relation. Others claim that the person in S.'s epidemiology does not play an essential role. The contact intrahospital flashes of S. described in literature, at to-rykh infection occurred from again arriving sick children, confirm the epidemic importance of the person as source of an infection.

Factors of transfer of S. are various products, but the meat and meat products, milk and dairy products, confectionery produced with use of milk, melanzhy and egg powder is preferential. Less often the activator is transmitted through fish products and vegetables. Water as a way of transfer of salmonellas, apparently, has no essential value. The majority of diseases is connected with use of the products infected at storage and culinary processing. In these cases the greatest danger is constituted by mincemeat, pastes, boiled sausages, jellies, milk. S.'s diseases people are quite often connected also with consumption is intravital the infected meat and eggs of a waterfowl. There are data on detection of salmonellas in dust of hospital chambers that allows to assume a possibility of transmission of infection in the air and dust way.

The page can arise as intrahospital infection (see) in children's hospitals and obstetrical institutions as a result of gross violations by personnel of the sanitary and preventive and anti-epidemic mode. At intrahospital flashes children of the first year of life get sick more often.

Adults and children are equally susceptible to S. By page it is extended everywhere. In the cities meets more often than in rural areas. Noticeable dominance of diseases of S. among people of certain professions is not observed.

A pathogeny

the Salmonellas who got to an organism live not only in a gleam of intestines, they are implemented into enterocytes (a cell of an epithelium of a mucous membrane of a small bowel), moving from a brush border of epithelial cells to the basis in lysosomic vacuoles. Essential morfol. damages of cells at the same time are not observed. Also the possibility of penetration of salmonellas through intercellular spaces of an epithelial layer is not rejected. Absorption of waste products and disintegration of salmonellas is caused only after change of permeability of an intestinal barrier by implementation of salmonellas in enterocytes and influences on them of the enzymes formed by salmonellas — decarboxylases, proteases, mucin z, etc.

At hit in own layer, or own plate, a mucous membrane of a small bowel of a salmonella are taken neutrophils and macrophages, breed in them and perish, but in some cases can it is long to remain. At death of phagocytes mediators of an inflammation — kinina, a histamine, serotonina, etc. are released. On limf, to ways of a salmonella get to mesenteric limf, nodes, at generalization of process get into blood and at nek-ry patients breed in various internals. At patients also decrease in bactericidal activity of blood serum, deficit of IgM is noted (see. Immunoglobulins ), disturbance of a normal ratio of T - and V-lymphocytes (see. Immunocompetent cells ) and macrophages (see).

Toxins of salmonellas and excess amount of the formed biologically active agents lead to disturbance of funktsionalnoadaptivny mechanisms and exchange processes at the molecular, cellular and organ levels.

At contact of toxins of salmonellas with enterocytes there are complex molecular changes in membrane structures of enterocytes leading, eventually, to diarrhea. During the first hours diseases intracellular concentration cyclic 3,5 adenosinemonophosphates, prostaglandins, phospholipids increases, and the quantity of a guano-zinmonofosfat decreases that leads to disturbance of permeability of cellular membranes and promotes development of intoxication, diarrhea,

dehydration and other symptoms. Apparently, the live activator and its toxins play a role of a releaser in a difficult pathogeny of a salmonellosis. In the subsequent the dominating value in development a wedge, manifestations is gained by disorders of functions of digestive, cardiovascular, nervous systems.

As a result of disturbance of permeability of vessels a large amount of water and salts comes to a gleam of intestines that leads to disturbance of water and electrolytic balance (see. Water salt metabolism ).

At a generalized form C. reproduction and accumulation of salmonellas happens in internals that is followed by long fever, increase in a liver and spleen with formation of suppurative focuses.

The pathological anatomy

Expressiveness of pathoanatomical changes at S. depends on a form of a disease and not always corresponds to its weight. At a gastrointestinal form in the first 3 — 4 days of a disease note hypostasis, sometimes increase single limf, follicles, small hemorrhages, a hyperemia of a mucous membrane of intestines and a plethora of internals. At longer disease in intestines superficial necroses with a scaly plaque, occasionally — insignificant increase mesenteric limf, nodes are found various size of hemorrhage, sometimes.

The spleen is usually not increased. In other bodies — a sharp plethora and dystrophic changes. At gistol. a research in intestines supersecretion of slime, desquamation of an epithelium, superficial necroses, vascular frustration, nonspecific cellular infiltration are found.

At a generalized form C. note increase in a liver, spleen, limf, nodes; find multiple metastatic abscesses in internals, especially in lungs, and also considerable changes in adrenal glands, kidneys, heart. Changes in intestines can vary from signs of an easy inflammation to the expressed hemorrhagic enteritis. Microscopically vascular frustration, a hyperplasia of cells of a reticuloendothelium of an adenoid tissue and a mucous membrane are defined. In fabric and covers of a brain the sharp plethora of vessels, small hemorrhages, staza can be observed, infiltration by leukocytes of a soft cover of a head and spinal cord microscopically comes to light. Purulent meningitis, encephalomeningitis, pneumonia, endocarditis are sometimes noted.

Immunity

the Had S. do not gain enough hyperimmunity owing to what perhaps long bacteriocarrier. An important role in emergence of a specific immune response of an organism is played biol. properties of the activator, in particular its full value About - and N-antigens. As well as at other intestinal infections, at S. in formation immunity (see) humoral and cellular factors participate. Humoral immunity, apparently, provides neutralization of endotoxin of bacteria, but does not interfere with their reproduction. Antibodyformation at S. is considerably connected with so-called immunological memory. During the early period of a disease IgM prevail, then concentration of IgG and IgA increases; at later stages IgG and IgA prevail. At hron. carriers high content About - and N-antibodies of the class IgG is noted. Cellular immunity is probably of great importance for localization and elimination of salmonellas from an organism. Existence of local immunity in intestines of patients is proved. So, at a gastrointestinal form C. the increased accumulation of secretory IgA in a gleam of a gut is noted; along with it the maintenance of IgG increases and there is serumal IgA that, apparently, demonstrates disturbance of permeability of vessels of a mucous membrane of a gut. The question of a ratio of factors of humoral and cellular, and also specific and nonspecific immunity at S. remains insufficiently studied.

The clinical picture

the Incubation interval fluctuates of several hours to 2 — 3 days, hour is more often apprx. the 24th.

At a gastrointestinal form C. in a wedge, a picture dis-peptpchesky symptoms, intoxication, fever dominate. The disease in most cases begins sharply. It is preceded short-term (30 — 60 min.) by feeling of discomfort (weight in epigastric area, nausea, etc.) and weakness. There are vomiting, colicy pains in a stomach, a diarrhea, a fever, body temperature increases, increases eksikoz.

The Gastritichesky option is characterized by repeated vomiting, feeling of weight and pains in epigastric area, an eructation, the loss of appetite moderated by dehydration. Body temperature normal or subfebrile. Duration of a disease — 3 — 4 days. At easy disease the single or double vomiting which is followed by an easy indisposition, podtashniva-niy within 1 — 2 days can be observed. Occasionally gastritichesky option C. accepts heavier current with repeated vomiting.

At gastroenteritichesky option along with symptoms of gastritis there is a plentiful chair to 10 — 15 times a day, an excrement watery, brown or greenish color, with a pungent fetid smell and impurity of slime. Duration of a diarrhea is up to 4 — 7 days. Development of a disease is followed by rise in temperature to 38 — 39 °v a current of 2 — 4 days, a fever, diffusion abdominal pains. Cardiac sounds are muffled, is lowered by the ABP, signs appear dehydration of an organism (see) — strong thirst, reduction of a diuresis, hoarseness of a voice. Profuse repeated vomiting is characteristic of heavy disease. The chair is more often than 10 — 15 times a day, is followed by megalgias in paraumbilical or epigastric areas, in some cases pains extend on all stomach; temperature 39 — 40 ° is observed within 5 days and more. In patol. process the liver, biliary tract, a pancreas, kidneys and other internals can be involved; disorders of function of cardiovascular system are characteristic (dullness of cordial tones, decrease in the maximum ABP is lower than 70 mm rt. column, premature ventricular contraction). The dehydration which is followed by development develops hyponatremias (see), hypopotassemias (see) and hypochloraemia (see).

At gastroenterokolitichesky option C. along with the symptoms characteristic of a salmonellezny gastroenteritis, in the first days of a disease, and sometimes later, pains in the bottom of a stomach, in most cases skhvatkoobrazny character develop. Excrements at the height of a disease become scanty, consist of muddy green slime, sometimes with impurity of blood, tenesmus are possible. At an endoscopic research the diffusion hyperemia, bleeding, hemorrhages come to light and erosion of a mucous membrane of a large intestine are more rare. Normalization of excrements at the majority bo l of ny hectares with tro an enter ok about l it ichesk to them option C. occurs within the first week of a disease; vomiting stops earlier. Elevated temperature of a body keeps 2 — 4 days. Normalization of a functional condition of intestines occurs much later, sometimes in several months. At heavy disease the chair is noted more than 10 times a day. The diarrhea proceeds 7 — 10 days, there comes dehydration of an organism. Intoxication (temperature increase, dullness of cordial tones, premature ventricular contraction, decrease in the ABP etc.) is sharply expressed.

The generalized form C. is characterized by the relative duration of the feverish period and dominance in a wedge, a picture of symptoms of intoxication. At typhus-like option the disease can begin both with the phenomena of a gastroenteritis, and from the fever which is followed by oznoba without any signs of defeat went. - kish. path. Fever of wavy or wrong type (temperature to 38 — 39 °) proceeds within 10 — 14 days. The septicopyemic option usually develops owing to generalization of process at a gastrointestinal form of a disease, but can arise and without the previous signs of defeat went. - kish. path. Suppurative focuses with presence of salmonellas are formed in lungs, a pleura, a pericardium, kidneys, a meninx, bones and hypodermic cellulose, a liver, a spleen and other bodies that is shown by the relevant clinic (see. Sepsis ). This option C. develops usually at the faces weakened by other diseases and newborns. The current is long, to 4 — 8 weeks, heavy, with remittiruyushchy fever, a tremendous fever. This option C. can also proceed as a hroniosepsis with defeat of separate bodies.

After the postponed S. the bacteriocarrier can be created acute (the activator is allocated up to 3 months) or chronic (the activator is allocated more than 3 months). Perhaps tranzitorny bacteriocarrier, when at absence a wedge, symptoms of a disease and to them-munol. shifts in an organism from excrements once or twice the activator was allocated.

Complications

Complications are noted at 5 — 6% of adults and 20 — 40% of the children sick with S. Vozmozhno development infectious and toxic shock (see), acute renal failure (see), fibrinferment of vessels, more often mesenteries (see), meningitis (see), endocarditis (see), vasculitis (see), osteomyelitis (see), hepatitis (see), pneumonia (see), etc. At children, is more rare at adults, hypochromia anemia develops (see. Iron deficiency anemia ). The intestinal dysbiosis is often observed (see. Dysbacteriosis ).

The diagnosis

the Diagnosis is established on the basis epidemiol. the anamnesis (e.g., communication of a disease with reception of substandard food, a single-step disease of group of the people eating the same products), a wedge, pictures, and also these laboratory researches. In blood at the height of a disease the expressed leukocytosis and often a neutrocytosis with shift is quite often noted to the left. ROE normal or slightly accelerated.

As S. is characterized by a variety a wedge, forms, the basic and the most reliable method of establishment of the diagnosis is allocation of activators. Along with it significant assistance in S.'s diagnosis, and also at establishment of character of a bacteriocarrier is rendered by serological researches (see). The activator can be allocated from blood, excrements, emetic mass and rinsing waters of a stomach, urine, bile (duodenal contents), pus and exudate of the inflammatory centers, cerebrospinal liquid (see. Typhoid, laboratory diagnosis ). Identification allocated at bacterial. a research of microbic cultures begin with the accounting of their enzymatic properties (see the Typhoid, a lab. diagnosis). The cultures which are not fermenting lactose, not splitting urea, mobile and fermenting glucose with formation of gas, are suspicious on a salmonella and therefore are subject to testing in an agglutination test with a set of the salmonellezny monoreceptor agglutinating serums (see. O-agglutination ).

The serological research consists in identification with 5 — the 8th day of a disease in blood serum of sick specific antibodies to the corresponding activators or from the first days of a disease — antigens of salmonellas. Antigens can be found also in urine of patients. Most often use an agglutination test and passive hemagglutinations (see).

Serological identification of salmonellas begins with their testing in an agglutination test on glass with the mix of O-serums including agglutinins to Au - An-tigenam 2; 4; 7; 8; 9 and 3, 10 groups A, B, C, D, E according to an antigenic structure on Kauffmanna — to Whyte (see. Salmonella ). In the absence of agglutination the culture is tested with the mix of O-serums including antibodies to antigens 15, 19, 11, 18, 21 of salmonellas of the rare groups E2, E4, G, K, L, etc. During the receiving positive takes of an agglutination test with mix of O-serums the culture is tested from each of the O-serums entering mix, install accessory it to one of Au-group separately and define full structure of its O-antigen, then test culture with monoretsep-even N-serums. Identification is begun with N-serums of the first (specific) phase (see the Salmonella), after establishment the cut is defined by antigenic components of the second (nonspecific) phase, and thus establish an antigenic formula of the marked-out culture, i.e. its belonging to a certain serological type (option). For the 4th day carry out the accounting of enzymatic activity of culture, subjecting to its serological studying repeated (in case of need) then issue the answer about results of a research — allocation (or absence) cultures of salmonellas of a certain serological type. In conclusion of culture of nek-ry serotypes (e.g., S. typhimurium, etc.) subject to a lysotypy (see).

In an agglutination test as antigens apply production salmonellezny corpuscular bacterial mono-receptor About - and N-diagnosticums (see. Diagnosticums ). For statement of an agglutination test blood is taken from an intermediate vein of an elbow or from a finger. After a blood coagulation suck away serum (not less than 0,2 ml) and prepare from it a number of serial dilutions in isotonic solution of sodium chloride (1:100, 1:200, 1:400, 1:800, 1:1600, 1:3200), to-rye test in a probirochny agglutination test. A conditional and diagnostic caption cultivation of serum not less than 1:200 is considered. Important diagnostic value has increase of a caption of agglutinins not less than on two cultivations in course of disease. In reaction of passive hemagglutination as antigens use formalinizirovanny erythrocyte O-diagnosticums of the basic serological groups of salmonellas — A, B, C1, C2, D and Ekh (see the Salmonella), and also the complex (polyvalent) diagnosticum including receptors of antigens of the specified groups. Reaction of passive hemagglutination is put on plastic (polystyrene) plates with holes. Isotonic solution of sodium chloride is spilled in holes on 0,5 ml by means of the syringe (volume of 1 ml) of the Record type of continuous action. Then pipettes bring 0,5 ml of the studied blood sera in the first holes of each row, divorced 1:50, and the same syringe mix three times contents of the first hole and transfer 0,5 ml to the second hole, from the second — in the third etc., that is consistently dissolve the studied blood sera to an estimated caption then add 2 — 3 drops of an erythrocyte diagnosticum to all holes. Each experience shall be followed by control of a diagnosticum in isotonic solution of sodium chloride. In case of lack of a continuous-action syringe it is possible to use usual volume pipettes. After introduction of a diagnosticum of a plate carefully stir up for uniform hashing of contents of holes and place in the thermostat at t ° 37 ° for 2 — 3 hours or leave at the room temperature for the night. The agglutination test is considered positive if erythrocytes were completely agglutinated and are located on a bottom of a hole. At a negative take there is no agglutinate, all erythrocytes settle at the bottom of a hole in the form of a button or an equal ring. In the beginning blood serum is titrated with a complex diagnosticum, and then with each of group. A conditional and diagnostic caption cultivation of serum 1:200 — 1:400 is considered. The diagnostic value of reaction increases at a research of pair blood sera and increase of a caption not less than on 2 cultivations of serum.

For diagnosis of a disease and retrospective establishment of the diagnosis use also radio immunol. reactions (see. Radio immunological method ) and enzimmecheny antibodies of reaction (see. Enzimimmunologichesky method ).

Differential diagnosis carry out with food toxicoinfections (see. Toxicoinfections food ), dysentery (see), cholera (see), a virus gastroenteritis (see. Diarrhea virus ), a typhoid (see), paratyphus (see), flu (see), meningitis (see), myocardial infarction (see), acute appendicitis (see), pancreatitis (see), acute cholecystitis (see), thrombosis of mezenterialny vessels, and also poisonings with various poisons and salts of heavy metals (see. Poisonings ).

Treatment

Patients are hospitalized on a wedge, and epid. to indications. Treatment is begun with careful gastric lavages (see). At easy and medium-weight disease peroral therapy is carried out by glyukozoelektrolitny solution (sodium chloride — 3,5 g, sodium bicarbonate — 2,5 g, potassium chloride — 1,5 g, glucose — 20 g on 1 l of drinking water). Solution is allowed to drink in the small portions or entered via the nazogastralny probe. The volume of the entered liquid shall correspond to its losses.

At continuous vomiting, watery excrements, dehydration of an organism intravenous administration of salt electrolytic solutions (trisol, laktasol, Acesolum, Ringera — Locke) and isotonic solutions of glucose at the rate of 0,6 — 1,5 ml/min. on 1 kg of weight, and then on 40 — 60 drops in 1 min. is shown. After normalization of the ABP pass to enteral administration of glyukozoelektrolitny solution. Adult patients with a medium-weight current of S. have usually enough 2 — 4 l, with a heavy current — 5 — 8 h.p. the purpose of desintoxication use colloid solutions (Haemodesum, Neocompensanum, Polydesum) in usual therapeutic doses. At sick S.' treatment, the complicated infektsionnotoksichesky shock, it is necessary to try to obtain normalization of a hemodynamics, recovery of microcirculation and a homeostasis (see. Shock ).

Appoint a sparing diet; fermental drugs are shown (festal, panzinorm, etc.).

Antibacterial therapy by the patient with a gastrointestinal form C., and also at acute and tranzitor-number a bacteriocarrier is not shown as it promotes formation of polyresistant strains of salmonellas and detains terms of recovery.

At a generalized form C. appoint antibiotics taking into account sensitivity of salmonellas to them: levomycetinum, ampicillin, gentamycin, etc. in therapeutic doses within 10 — 12 days. At a septicopyemic form C. ampicillin is appointed at the rate of 200 — 300 mg to 1 kg of body weight a day, and the dose of levomycetinum of sodium succinate is increased to 70 — 100 mg by 1 kg of body weight a day.

Treatment hron. carriers shall be complex. Use of various antibacterial drugs does not give effect therefore paramount value has use of the means influencing the general reactivity of an organism — drugs of a pirimidinovy row (pentoxyl and methyluracil), an autohemotherapy, and also treatment of associated diseases went. - kish. path.

Forecast

Forecast in most cases favorable. However at a number of had it is long, quite often enzymatic insufficiency of intestines, pancreas for life remains, processes of digestion and absorption of food are broken (hron. gastroenteritis, enteritis, pancreatitis).

Prevention

For fight against S. carry out a complex veterinary and sanitary (see Veterinary sanitary inspection), medical and sanitary (see. Sanitary inspection ) and anti-epidemic actions (see).

The wide spread occurance of S. and a carriage of salmonellas at animals, and also a possibility of intravital infection of meat of animals result in need to carry out vt. - a dignity. actions in two directions. First, systematic work on improvement of a livestock of the cattle in stock-raising and birds in птице^ vodchesky farms, according to the prevention S.'s disease and to a carriage of salmonellas at animals is conducted. Secondly, it is supposed strict vt. - a dignity. supervision on meat-processing plants (see). The cattle which arrived on meat-processing plant passes vt. - a dignity. survey. Sick animals are isolated, their slaughter is made on a sanitary slaughter. After long transportations (stages) the cattle is maintained on vacation by 2 — 3 days (the last days without forage). In day of slaughter the cattle passes again vt. - a dignity. survey and thermometry. On meat-processing plants the strict dignity is observed. the mode on purpose not to allow infection of meat in the course of slaughter of animals, a rezdelka of hulks, storage and the subsequent transportation of meat products. Meat and dairy and food control stations (see) carry out vt. - a dignity. control in the markets. Sale duck and goose eggs is prohibited.

Control of observance of the technological and sanitary mode at the enterprises of the food industry belongs to medical and sanitary actions and public catering (see), behind observance of rules of transportation, storage foodstuff (see). Especially important measure is observance of rules of culinary processing of products, preparations and storages of ready food. Meat and meat products, fish and other perishable goods are given from a warehouse just before their culinary processing. Cutting of meat and fish is made on different tables with use separate for meat and fish of stock (knives, chopping boards, etc.). If ready food has to be stored 1 — 2 hour, then it is kept in the refrigerator and before distribution repeatedly well boiled or fried thoroughly. Eggs for melanzhy and cold sauces use only from the checked farms. Kitchen and utility rooms it is necessary to contain in good a dignity. state; it is necessary to control strictly washing of hands by personnel after visit of a toilet. The personnel of food objects at revenues to work are inspected on a bacteriocarrier. It is necessary to carry out extermination of flies and rodents.

Anti-epidemic actions include: hospitalization of patients on clinical (disease severity) and to epidemic indications (employees of the food industry, public catering, water supply, patients from boarding schools, kindergartens if children spend to them the whole week, from hostels); extract of patients from a hospital on a wedge, to indications and after obligatory bacterial. inspections; establishment for convalescents of medical observation within 3 months with monthly bacterial. inspection; carrying out in the epidemic center disinfection (see). The prevention of intrahospital flashes of S. in a hospital is reached by early identification of sick S. and their isolation, and also observance of the anti-epidemic mode (wet cleaning of rooms, their regular airing, separate ware for patients, boiling of ware, etc.). Persistent work on education at personnel is necessary to lay down. institutions of feeling of high responsibility for observance of the anti-epidemic mode in a hospital (washing of hands, frequent change of towels, boiling of ware, disinfecting of linen and allocations of patients, fight against flies etc.).

Specific prevention of S. is not developed.



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V. I. Pokrovsky, H. D. Yushchuk; V. A. Kilesso (etiol., mt. issl.).

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