Mononucleosis

The reasons

Classification

Manifestations of mononucleosis

Diagnostics

Mononucleosis treatment

Complications

Prognosis and prevention

Mononucleosis is called an acute infection of viral origin, affecting the reticulo-endothelial system, which leads to a multiple increase in lymph nodes, involvement in the process of the liver and spleen, as well as changes in the blood system.

This leads to a decrease in immunity and the development of a typical clinical picture of the disease, toxicosis and tonsillitis.

The reasons

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Today it is precisely known that the disease is caused by the Ebbstein- Barr virus – a virus that affects mainly the lymphocytic unit of the immune system, belongs to the group of herpes viruses, 4 types. The virus is referred to as DNA-containing, in addition to mononucleosis, it can cause Burkitt ‘s lymphomas , carcinomas and lymphomas in immunodeficient patients.

In children, the entry of a virus causes infectious mononucleosis, and then the virus circulates in the body for a long time, sometimes for life, while in a state of latent infection.

The source of infection is a sick child in a typical or erased form, although the disease is slightly infectious and requires prolonged and close contact, kisses, transfusion of blood components, use of common utensils.

The carriers of the virus can excrete it at primary infection up to one and a half years, and in the future asymptomatic periods of virus excretion may occur.

Most children and adults suffer mononucleosis in erased form, typical forms mainly occur in frequently or long-term ill children from 5 to 14 years old.

Classification

Today there is no single way to classify mononucleosis. Today, there are typical and atypical forms that have a clinic that differs from the traditional one.

They also distinguish acute (acutely bright, occurring within a few weeks) and chronic mononucleosis (a process lasting up to six months).

Separately allocated infection with Ebbstein- Barr virus in immunodeficiency states and HIV.

Manifestations of mononucleosis

The incubation period for mononucleosis can last from several days to 2 weeks, usually a week.

  • The disease begins with a high fever, reaching 38-40 ° C, dramatically arising against the background of full health.
  • For 2-3 days fever with symptoms of toxemia reach a maximum, there is a strong weakness and headaches, pain in muscles and joints, then there is a strong pain in the throat when swallowing and at rest.
  • The temperature fluctuates during the day, having no definite patterns, is poorly amenable to antipyretic therapy, on average, the fever lasts for about a week, gradually diminishing.

The main symptom of mononucleosis is typical   tonsillitis , sore throat on the background of fever and toxicosis. A sore throat can be catarrhal or lacunar in nature (i.e. be purulent or not), less often – membranous or necrotic, especially strong angina occurs when granulocytes decrease in blood. Characterized by severe pain in the throat when swallowing, there may be severe tingling, itching and dry throat.

Another of the typical manifestations is an increase in lymph nodes in the jaw and neck, axillary and inguinal lymph nodes. There may also be lesions of the intrathoracic and mesenteric lymph nodes, which gives cough and severe abdominal pain.

Approximately half of the patients with mononucleosis develop a rash on the body, which has a different character depending on the day of the disease – in 3-5 days of illness it may have a cortical pattern, may be in the form of roseol, papules or small hemorrhages. The rash can hold on the skin for 1-3 days and disappears without a trace without pigmentation and flaking. New rash does not appear additionally.

Against the background of mononucleosis in children, the size of the liver and spleen increases dramatically, they are detected from 3-5 days of illness and can be in this state for up to 4 weeks. The icteric forms are particularly difficult, with damage to the liver tissue and an increase in the number bilirubin, the level of liver enzymes, especially alkaline phosphatase.

Changes in the analysis of peripheral blood of children with mononucleosis are typical – there is not a pronounced leukocytosis to 10 * 10 9 / l of leukocytes, while the number of lymphocytes and   monocytes , in the blood they reveal specific cells – atypical mononuclears, which confirm the diagnosis.

Changes in the blood hold the most, imbalance of leukocytes and lymphocytes can persist up to six months.Against the background of mononucleosis, immunity decreases, which leads to an increased incidence of respiratory infections.

Diagnostics

The basis of the diagnosis is the clinical picture of the disease with the typical manifestations described earlier. Of particular importance for the diagnosis is a blood test with the identification of atypical mononuclear cells in combination with an increase in lymphocytes and a decrease in leukocytes.

Today, the most popular are the definition of antibodies to the Ebbstein- Barr class virus.Igm (antibodies of fresh infection) and   IgG class that confirm post- factum infection.

It is necessary to distinguish mononucleosis from banal tonsillitis, diphtheria and cytomegalovirus lesions, HIV infection, hepatitis  with liver damage and measles, rubella andother childhood infections with a rash.

Mononucleosis treatment

Pediatricians and infectious disease specialists are engaged in the treatment of mononucleosis.

Specific therapy against Ebbstein- Barr virus has not been developed, therefore, non-specific therapy with antiviral drugs and immunomodulators (arbidol, Viferon , acyclovir, imudon ) is used.

The treatment is mainly aimed at combating the symptoms of the disease – the use of local antiseptics and painkillers for sore throat (bioparox, hexoral , pharyngosept ), antipyretic (paracetamol, nurofen ).

Close attention is paid to the restoration of the liver.

When the risk of complications are often used antibiotics to prevent secondary infection on the background of reduced immunity. Basically, the treatment is carried out at home, in rare cases of severe course inpatient treatment is carried out.

Complications

Mononucleosis is dangerous because of its complications   hemolytic anemia. The most dangerous complication is spontaneous rupture of the spleen due to its sharp increase. In children, airway lesions with bronchial obstruction and the occurrence of pneumonia.

Prognosis and prevention

With mononucleosis, the prognosis is favorable, but after the infection that has been transferred, there is a long-lasting decrease in immunity, which leads to an increase in the incidence of colds. Reduced immunity lasts up to six months.

Specific vaccines and drugs for the prevention of mononucleosis has not been developed, general preventive measures are being taken – hardening, taking multivitamins, washing the mucous membranes of the nose and throat.

Leptospirosis

The reasons

Distribution and transmission routes

Symptoms of leptospirosis

Diagnostics

Treatment of leptospirosis

Complications

Treatment projections

Leptospirosis or water fever Weil-Vasiliev is called an acute infectious disease that is transmitted from animals.

Leptospirosis is manifested by intoxication, pronounced muscle pain and kidney damage. It also affects the nervous system, liver and blood vessels. Likely jaundice.

The reasons

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The main causes of the disease are parasitic microorganisms – leptospira. Parasitic leptospira live in water and it is with the aquatic environment that the features of the spread of infection are associated. There are about thirty pathogenic forms of leptospira, which are common in certain areas and climates.

Leptospira has a thin convoluted body, up to 300 nm long, which is why parasites are not visible to the naked eye. They are active and move; when destroyed, they are able to release a special toxin. They can be attached to the walls of blood vessels, blood cells.  

Parasites are resistant to low temperatures, live well in water, in soil, on food. Leptospira die during boiling, ultraviolet irradiation, and treatment with disinfectants.

Distribution and transmission routes

Leptospirosis can occur anywhere except in Antarctica, the most common disease in the tropics. The source of infection is wild and domestic animals, rodents, dogs, cows and pigs. Sick people are not contagious to others.

A person becomes infected through the skin and mucous membranes by contact with contaminated water, by contact with the soil, by slaughtering livestock, cutting meat, eating unprocessed foods – milk and meat. The disease has a professional character, people of agricultural professions are suffering. The peak of the disease occurs in August.

Leptospira through microdefects of the skin are introduced into the body, through the lymphatic system enters the body and spreads to the spleen and liver, kidneys and lungs, and the nervous system. There, microorganisms multiply and accumulate. The period of incubation and accumulation of leptospira lasts from one to two weeks.

Symptoms of leptospirosis

Leptospirosis can occur with varying degrees of severity.

The disease begins acutely – there is fever with chills, insomnia, headaches and thirst.

Patients are concerned about pain in the muscles, especially in the calf, thigh and lower back, which prevent normal movement.

The face and neck reddens, swells, giving a “hood symptom”, the whites of the eyes redden, there is a feeling of sand in the eyes.

Fever lasts up to 5 days or more and then decreases sharply, but repeated 1-2 peaks of fever are possible.

In severe leptospirosis, jaundice occurs with yellowing of the sclera and skin; there may be a rash on the skin, such as measles or rubella, less often scarlet. The rash is prone to fusion, can turn into hemorrhagic elements – hemorrhages in the skin, sclera and mucosal bleeding.

When leptospirosis, there are lesions of the heart with a decrease in pressure and bradycardia, with myocardial damage up to myocarditis. There is also rhinopharyngitis, pneumonia, the liver and spleen sharply increase – they are painful when probing. The nervous system is often affected with the development of meningeal symptoms, signs of serous encephalitis, although it can sometimes be purulent encephalitis.

In many patients with leptospirosis, the kidneys are affected – the amount of urine decreases sharply; a lot of protein, cylinders and epithelial cells – this indicates severe kidney damage.

Impaired kidney filtration function with a change in the level of urea creatinine, residual nitrogen. Severe leptospirosis gives signs of toxicosis with uremia, ulcerative lesions of the intestine, pericarditis, convulsions and disorders of consciousness up to a coma. Patients perish mainly from acute renal failure.

Diagnostics

The basis of the diagnosis is an indication of the profession and season, as well as contact with animals, epidemiological problems with leptospirosis in the region. Also, typical symptoms may indicate a disease, but with jaundice, leptospirosis is difficult to distinguish from viral hepatitis.

The diagnosis is confirmed by laboratory tests – in blood tests, leukocytosis due to neutrophilic with accelerated ESR, typical changes in urine with protein and cylinders, an increase in the amount of residual nitrogen and bilirubin.

However, the final diagnosis is made on the basis of specific methods – detect the pathogen in biological fluids or detect the growth of antibodies to Leptospira. Microscopy and cultures are used only before the start of antibiotics.

Serological methods for the detection of parasites in the serum are common, they are carried out twice, for 5-7 days, and then a week later. Antibody titer increases to 1:20 and above.

Treatment of leptospirosis

Leptospirosis is treated by infectious disease doctors. Leptospira are sensitive to antibiotics and specific immunoglobulin.

The basis of the treatment is penicillins or, if they are intolerant, tetracyclines. They are especially effective in high doses up to the 4th day of illness. Drugs are used orally, less intramuscularly, with a strong toxicosis in combination with hormonal drugs.

Immunoglobulin anti- leptospira is effective, it is administered according to the scheme from the 1st to the 3rd day, after preliminary testing.

Apply a complex of vitamins and symptomatic treatment. If complications arise, hospitalization in an intensive care unit with treatment of complications is indicated.

Complications

Complications of leptospirosis can be caused by leptospirae themselves, as well as by a stratified secondary bacterial infection. The first are meningitis, encephalitis, polyneuritis. Associated with secondary infection are pneumonia, otitis, pyelitis, parotiditis.

Complications that are observed only in children include high blood pressure, cholecystitis, pancreatitis. The combination of such manifestations as myocarditis, dropsy of the gallbladder, rash, redness and swelling of the palms and soles, followed by desquamating of the skin, fit into the picture of Kawasaki syndrome (Kawasaki disease). In recent years, complications have become more frequent.

Treatment projections

On average, treatment of leptospirosis lasts 2 -3 weeks. The outcome of the disease depends on the severity of the process. With the development of jaundice, the prognosis is the most unfavorable, mortality can reach 40%, especially in the elderly.

In terms of infection, rodent carriers are dangerous; a person with leptospirosis is not contagious to others.

With an unfavorable epidemiological situation, people, especially those engaged in agriculture, are vaccinated.

Rubella

The reasons

Rubella Symptoms

Pregnancy complications

Diagnostics

Rubella treatment

Prevention

Rubella is an acute viral infection, predominantly found in children, and belonging to the category of childhood infections. It is manifested by respiratory manifestations, intoxication and a specific rash.

The disease is of particular importance, since during pregnancy it can cause severe multiple fetal malformations.

Rubella is a controlled infection, that is, a vaccine has been developed from it, which is included in the national calendar of many countries of the world.

The reasons

Rubella is caused by a special small virus from the Togavirus family.Due to its structure, the virus is unstable in the external environment, therefore, infection is especially important with close contact and in organized groups. The susceptibility of non-vaccinated individuals reaches 90%, and therefore rubella is classified as a quarantine infection.

The rubella virus is sensitive to the action of disinfectants, to high temperature, to drying and ultraviolet, poorly preserved in the external environment.

Most often, the incidence occurs during the change of seasons. Children from 2 to 10 years are most susceptible, epidemic outbreaks are recorded every 10 years.

Immunity after rubella is lifelong and persistent; antibodies remain in the blood for life.

Children with congenital forms of rubella are also dangerous in terms of infection from an adult or child, both with typical and erased forms. Contagiousness begins a week before the onset of the rash and the entire period of clinical manifestations, plus another 7 days from the moment the rubella signs disappear.

Infection occurs through airborne droplets when talking, crying, sneezing. Pregnant women are infected the same way, and the fetus is transplacental.

By origin, rubella is congenital (intrauterine infection of the fetus), and acquired.

Rubella Symptoms

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The incubation period for rubella can last for 2-3 weeks, and in the last week of incubation the patient is contagious to others. At the end of the incubation period, there may be a light cold and light redness of the throat, these phenomena persist for one day or several.

Fever gradually develops up to 37.5-38 ° C, lymph nodes are enlarged in the neck and neck, enlarged lymph nodes can then persist for up to 2 weeks.

Then there are small pink spots on the face, extensor surfaces of the arms and legs and on the buttocks. The rash lasts up to 4 days (less often – up to 7 days), itching for rubella rash is not characteristic.

The rash is abundant, in the form of small specks. In adults, rubella may cause swelling and painful joints.

Pregnancy complications

In the early stages of pregnancy, rubella can cause miscarriages, embryo death, congenital deformities.

To read separate article about rubella during pregnancy.

Signs of Congenital Rubella

Congenital rubella is a severe combined lesion of the fetus, especially serious when the mother is infected in the first trimester of pregnancy with the laying of all organs and tissues. The manifestations are called the Gregg triad:

  • double-sided cataract or clouding of the lens of the eyes, with a decrease in the size of the eyeball,
  • heart defects with stenoses of large trunks, defects of valves and partitions of the heart,
  • deafness.

Nervous tissue malformations with hydrocephalus, the defeat of the substance of the brain with a sharp delay of development, defects of the hard and soft palate.

Diagnostics

The basis of the diagnosis is epidemiological data on the presence of rubella in the region, as well as indications of typical rash, an increase in lymph nodes.

To confirm the diagnosis, rubella virus isolation is necessary, but it will only be shown until a rash appears. At a later date, the diagnosis is made on the basis of data on antibody titer:

  • IgM class antibodies are detected in patients with the presence of fresh infection and rubella activity,
  • class antibodies IgG in the presence of previous rubella or chronic infection with intrauterine infection,

It is important to determine rubella antibodies during pregnancy planning, if a woman is not vaccinated against rubella and there is no indication in her rubella card. If there is no antibody to rubella, a woman’s vaccination is shown three months before the planned conception.

Rubella treatment

There are no specific antiviral drugs for rubella, treatment is carried out symptomatically.

Shows bed rest with full-age nutrition and abundant drink. Antiviral and immunomodulatory drugs are used – arbidol, viferon , influenza , anaferon.

The rest of the therapy is based on the symptoms – antitussive agents, remedies for the common cold, febrifugal. The rash does not need to be treated, as well as the use of antihistamines.

Prevention

Developed specific prevention of rubella in the form of vaccination. It is carried out in conjunction with the mumps and measles, MMR triple vaccine in age 1 year and 6 years old, girls are also 14 if they have not been vaccinated before.

There are also rubella monovaccines ( Rudivax ), they are administered to women who do not have antibodies to rubella during pregnancy planning.

In case of detection of rubella cases, contacts are quarantined for 21 days, patients are isolated for a week after the appearance of the rash.

Measles

The reasons

Vaccination for measles adults

Symptoms of measles

Diagnostics

Measles treatment

Consequences and complications

When they put a measles vaccine on children

Measles is a highly infectious disease. If a person has had measles, then a strong immunity is formed.

The reasons

The causative agent of measles is an RNA-containing virus. The source of infection is a sick person. The most infectious patient in the early days of the disease.

Measles is transmitted by airborne droplets. Getting to the mucous membranes of the respiratory tract, the virus through the bloodstream spreads through the body.

Vaccination for measles adults

Since in adults the disease is more severe and the risk of complications is high, it is imperative that you vaccinate.

The national immunization schedule provides for compulsory vaccination of adults under 35 years of age, as well as persons working with children regardless of age.

Vaccination ensures the formation of immunity in humans, which guarantees protection against measles for about 20 years.

You can get vaccinated in both state and commercial clinics. At the moment, one-, two- or three-component vaccinations can be vaccinated (measles, measles-parotitis, measles-parotitis-rubella). The feasibility of each of these vaccinations is determined by the doctor individually.

Vaccination is carried out twice with an interval of 3 months.

Complications after vaccination

The most common complications of measles vaccination in adults are:

  • temperature rise for 5-15 days (sometimes up to 40 degrees), which lasts up to four days. It can be shot down with antipyretic drugs such as paracetomol.
  • In addition to fever, rhinitis, cough, and a small rash can be of concern.

Since the vaccine contains antibiotics and egg white fragments, an allergic reaction may develop (provided that there is an allergy to these components before).

Exacerbation of chronic diseases is also possible.

Severe complications are rare.

Both domestic and foreign vaccines are transferred equally.

Symptoms of measles

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During the course of the disease there are four periods:

  • incubation;
  • catarrhal;
  • period of rash;
  • recovery period.

Typical course of measles

During the incubation period there are no clinical manifestations. It usually lasts from 7 to 14 days, rarely up to 21 days.

Clinical signs of measles appear during catarrhal manifestations. The catarrhal period is characterized by the following symptoms:

  • general weakness, body aches;
  • headaches;
  • increase in body temperature from 38 to 40 degrees;
  • runny nose with copious mucous discharge;
  • viral conjunctivitis (inflammation of the mucous membranes of the eyes);
  • agonizing dry cough;
  • enlarged cervical lymph nodes;
  • sore throat when swallowing;
  • on the second day, the appearance of whitish spots with a red rim – spots on the mucous membrane of the cheeks   Belsky-Filatov-Koplik.

The period of catarrhal manifestations lasts up to 5 days, at the end of this period the patient’s well-being improves, the symptoms of intoxication decrease.

But after about a day, the patient’s body temperature rises again and his state of health worsens. The period of rash begins.  

For the period of rash is characterized by the appearance of a rash, rash – maculopapular, lesions lesions prone to fusion.

At the beginning of the rash appear on the head, neck, upper chest.

Later, the rash spreads to the whole body, limbs.

A rash on the patient’s body lasts for three days, then the elements of the rash turn pale.

When the rash on the body is paler, the patient begins to recover. In place   elements of the rash appear patches of skin pigmentation. Body temperature is normal.

This pattern is typical of a typical measles course, sometimes an atypical course is found.

Atypical measles

The atypical forms of measles include the following:

  • mitigated;
  • hypertoxic;
  • hemorrhagic.

When mitigated form in a patient

  • light catarrhal phenomena appear;
  • the temperature rises to subfebrile level (up to 38 degrees);
  • elements of rash single and pale.

This form of measles can develop when gamma globulin is administered to a patient, in individuals with weak measles immunity.

For hypertoxic form

  • the presence of high body temperature (febrile),
  • severe intoxication of the body,
  • manifestations of acute cardiovascular insufficiency (shortness of breath, cyanosis of the nasolabial triangle and fingertips),
  • manifestations of meningoencephalitis (severe headache, movement disorders, sensitivity disorders).

For hemorrhagic forms of general intoxication and the appearance of multiple hemorrhages on the skin, mucous membranes, the appearance of blood in the urine, feces. This form is very difficult and often leads to the death of the patient.

Diagnostics

Diagnosis is primarily based on:

  • carefully collecting the patient’s history
  • characteristic rash and spreading through the body (the beginning of the process from the head),
  • the duration of the period of rash (in most cases, 3 days).

To confirm the diagnosis, the following laboratory tests are performed:

In the early stages of the disease, you can donate blood from a vein and determine immunoglobulin M (IgM, early antibodies) for the measles virus. Detection of this type of antibody indicates the initial stage of measles virus infection. The body has already begun to fight the disease.

When infected with measles, there is an increase in IgM titer (antibodies) against the measles virus four or more times. A blood test is performed when clinical signs appear and after 2-3 weeks, this is a reliable criterion for measles infection.

Late antibodies to measles virus (immunoglobulin G, IgG ) does not need to be determined during diagnosis, as they are formed both after vaccination and after the disease. The production of G-immunoglobulins occurs 1-2 months after suffering a measles infection. If a person has never been vaccinated against measles, then their appearance suggests that he once suffered measles. The presence of IgG protects a person from reinfection.

Measles treatment

If signs of disease appear, it is necessary to consult a general practitioner, a dermatologist or an infectious diseases specialist.

If the patient has no signs of measles complication, then the patient is treated on an outpatient basis. Persons with a complicated course of measles are hospitalized, if it is impossible to isolate the patient (living in a hostel, military units).

Patients are hospitalized in the infectious disease ward.

There is no specific treatment for measles.

The measles gammaglobulin is used only with established contact and no vaccination during the incubation period.

Treatment of measles is only symptomatic.

If the patient has a body temperature of more than 38.5 degrees, antipyretic drugs are prescribed:

  • paracetamol;
  • ibuprofen;
  • ibuklin.

Antiviral drugs are prescribed:

  • cycloferon;
  • kagotsel;
  • ingavirin.

In case of rhinitis, vasoconstrictor agents are prescribed:

  • rhinonorm;
  • vibracil;
  • tizin.

To relieve inflammation in the oropharynx is used:

  • miramistin;
  • ingalipt;
  • gargle with chamomile, sage, calendula.

Antibacterial therapy is prescribed only with the development of bacterial complications (for example, pneumonia, otitis). Antibiotics for measles are prescribed only after identifying the pathogen and taking into account its sensitivity to these antibiotics.

Consequences and complications

In most cases, the disease proceeds favorably, recovery without negative consequences. However, older people experience measles much more heavily than children, and this increases the risk of complications.

The following effects of measles carried in adulthood are possible:

  • bacterial complications ( bronchitis, pneumonia, otitis media );
  • hearing loss;
  • corneal ulcers, keratitis ;
  • damage to the intra-abdominal lymph nodes (manifested by abdominal pain);
  • encephalomyelitis, is the cause of death of the sick;
  • thrombocytopenic purpura (the presence of bleeding in the oral cavity, in the intestine, urinary tract);
  • rarely – ascending and transverse myelitis.

To prevent the development of complications must be vaccinated. Since even if a person becomes sick, the disease will be mild and without complications.

When they put a measles vaccine on children

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  • Vaccination with a live vaccine (possibly as part of a combination drug) to healthy children from 12 months of age. Revaccination is indicated to children before they enter school. During the first three days after contact with the patient, vaccination is used as an emergency prophylaxis (preferably within the first 72 hours after contact with the patient). In individuals for the introduction of a live vaccine (on the 4-5th day after the injection), the development of a symptom complex that looks like the erased version of the disease is possible (these children are not dangerous for others).
  • The alternative prophylaxis after contact with the patient (the first 5 days) is a normal human immunoglobulin (0.25 ml / kg, not more than 15 ml) for children under 1 year old, immunodeficient patients and pregnant women.
  • Children from organized groups are separated for 17 days, with the introduction of immunoglobulin – on the 21st day after isolation of the first patient.
  • Quarantine does not apply to vaccinated, previously experienced measles and adults.

Vaccine administration to persons who have previously had measles is not indicated (due to the development of persistent post-infectious immunity).

Tick-borne encephalitis

The reasons

Kinds

Symptoms of tick-borne encephalitis

Diagnostics

Tick-borne encephalitis treatment

Forecast

Prevention

Tick-borne encephalitis is a specific viral inflammation of the brain with simultaneous damage to the central and peripheral nervous system.

Tick-borne encephalitis virus is transmitted by the bites of special types of ticks, has an unfavorable course and even death.

The reasons

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Tick-borne encephalitis is caused by a special type of virus. In nature, the virus is transmitted by Ixodes ticks – taiga and European. Mostly these species are found in Siberia, the Far East, the Urals. Encephalitis as a natural focal infection occurs in spring and summer, with a peak in May-June and August-September, when ticks are highly active.

People become infected when tick saliva enters the blood. The female tick can be on the human body for several days, until it is completely saturated with blood, while the bite itself is not painful. Less commonly, tick-borne encephalitis is transmitted through the consumption of raw milk ofcows and goats infected with a virus.

Kinds

Specialists identify three types of virus and, accordingly, three subspecies of tick-borne encephalitis:

  • Far Eastern encephalitis, with severe course and mortality of up to 30-40%
  • European, with a mild course and relatively low mortality,
  • Siberian.

The severity of the disease depends largely on the age of the patient, his immune system, and the ability of the virus to enter the brain.

Symptoms of tick-borne encephalitis

After a tick bite, the virus multiplies in the tissues, penetrates the lymph nodes and blood. When the virus multiplies and when it enters the bloodstream, flu-like symptoms develop.

The virus penetrates the blood-brain barrier and infects brain tissue, and neurological symptoms occur.

The incubation period lasts from 2 days to 3 weeks, the infection develops depending on the infectious dose and features of the immune system. Prodromal (previous) period is manifested by chills with fever up to 40 degrees, body aches, and general toxicosis.

There are several separate forms of encephalitis:

  • feverish form without penetration of the virus into the nervous system: manifestations of severe viral infection with fever, severe weakness and body aches, and symptoms very similar to the flu. They last up to 10 days, there are no changes in the cerebrospinal fluid (brain fluid). Atthisstage, thepatientsalwaysrecover.
  • meningeal form: after a period of fever, there is a temporary decrease in temperature, the virus at this time penetrates into the nervous system, and again the temperature rises sharply, there are signs of neurological disorders. There are headaches with vomiting, strong photophobia and stiffness of the muscles of the neck, symptoms of irritation of the brain membranes, there are changes in the cerebrospinal fluid.
  • encephalitic form: the defeat of the substance of the brain with the formation of focal signs. Mental disorders, disturbances of consciousness, paresis and paralysis, convulsions join all of the above symptoms. Thisformisthemostseveregiveshighmortality.
  • poliomyelitis form: leads to the defeat of neurons in the area of ​​the motor areas of the spinal cord, like   poliomyelitis . This leads to flaccid paralysis of the neck and muscles, which leads to disability.

Diagnostics

Tick-borne encephalitis can be suspected in the case of nature trips in endemic areas, with tick bites, in the presence of fever, headache, and neurological symptoms. But the clinic does not make a diagnosis.

In order to accurately confirm the diagnosis, it is necessary to identify specific antibodies –

  • class M immunoglobulin for encephalitis (Ig M) – presence indicates acute infection,
  • IgG – presence indicates contact with the infection in the past, or the formation of immunity.

If both types of antibodies are present, this is the current infection.

Also determine the virus in the blood by PCR and PCR liquor.

In addition, another infection in the blood is determined in parallel – tick-borne borreliosis.

Tick-borne encephalitis treatment

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The specific cure for tick-borne encephalitis has not yet been developed, so all treatments are aimed at alleviating the symptoms of encephalitis. For a patient with suspected tick-borne encephalitis, hospitalization in the infectious disease ward is necessary.

Hold:

  • symptomatic therapy – the introduction of detoxification drugs, glucose, diuretic, antiviral drugs,
  • fighting fever and complications, especially neurological ones.
  • strict bed rest, intensive care unit,
  • as the condition improves, light food, physiotherapy treatments and massages are shown.

Sometimes, according to the indications, anti-tick immunoglobulin is administered to fight the virus and stimulate its own immunity to the virus.

Forecast

The patient is not contagious to others, the virus is not transmitted from person to another person.

With damage to the brain and spinal cord, predictions are dubious, paralysis and focal symptoms, mental disorders can occur, and deaths are sometimes possible. After recovery, long-term headaches, paralysis, a sharp decrease in memory can remain. Formed persistent lifelong immunity.

Prevention

The basis of tick-borne encephalitis prevention is the introduction of a specific vaccine and the prevention of tick bites.

Vaccinated children from 12-24 months old and adults with special vaccines – encepur , entsevir . When tick bites are carried out emergency prophylaxis – injected immunoglobulin and jodantipirin.

Candidiasis

Causes of candidiasis
Symptoms of candidiasis
Diagnostics
Candidiasis during pregnancy
Treatment
Complications of candidiasis
Prevention


Candidiasis or thrush is a disease in which mucous membranes and skin are affected by a yeast-like fungus of the genus Candida. 

These microorganisms belong to the conditionally pathogenic microflora, that is, in a small amount they constantly inhabit the skin, the mucous membranes of the mouth, genital organs of healthy people, and their growth is restrained by the immune system of the body. With its weakening begins rapid reproduction of the fungus, which leads to the occurrence of the disease.
The most common forms of candidiasis are   vaginal   and oral .
Vaginal candidiasis is a female form, and the disease can occur at almost any age.
Oral candidiasis is usually found in infants, most often in newborns.
Candidiasis is also found in men, most often after unprotected intercourse.


Causes of candidiasis

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Many factors can provoke an intensive reproduction of a fungus. For example, hypothermia, illness, stress, hormonal changes (during pregnancy or taking hormonal drugs).
When taking antibiotics, along with pathogenic bacteria, the beneficial microflora of the intestine and vagina, which controls the growth and development of Candida fungi, also dies . The presence of a chronic disease that reduces the activity of the immune system (HIV, sexually transmitted diseases, infections) very often causes candidiasis.
Endocrine diseases ( diabetes ,   obesity , dysfunction of the thyroid gland).
Finally, a hot climate or wearing uncomfortable cramped or synthetic underwear can be a cause of candida.


Symptoms of candidiasis


Manifestations depend on the localization of the disease.
Candidosis of the oral mucosa   (oral candidiasis, children’s thrush) is most common in children, as a rule, they are infected from the mother through the birth canal. At the same time, the mucous membrane of the cheeks, the pharynx, tongue and gums become red, puffiness appears, then foci of white cheeky plaque appear on the mucous membrane of the oral cavity. Over time, their number increases, forming films. Under the coating detected erosion. In chronic candidiasis, the mucous membranes of the nose, lips, pharynx and esophagus can be affected.
 
Vaginal candidiasis   (vaginal candidiasis) is most common in women of reproductive age, but can occur in girls and even in men. In this case, the female vagina and external genital organs are affected, in men, the glans penis and the foreskin. In pregnant women, candidiasis occurs 2-3 times more often due to the increased level of sex hormones and weakened immunity.
Symptoms of candidiasis in women:

  • redness and swelling of the mucous membranes of the genital organs
  • burning and itching, worse in the evening, with hypothermia, with untimely hygiene, before or after menstruation
  • rich white   discharge of curd consistency with a sour odor and pain and burning during urination
  • discomfort during sexual intercourse

 


Symptoms of candidiasis in men:

  • redness, itching and soreness in the glans penis
  • edema foreskin
  • white cheesy plaque on the head of the penis
  • pain when urinating
  • pain during intercourse
  • Intestinal candidiasis   ( dysbacteriosis ) often accompanies vaginal candidiasis or develops in isolation. Usually, intestinal candidiasis appears after taking antibiotics or transferred intestinal infections. Fungi of the genus Candida settle in the small intestine.


Diagnostics

Contrary to popular belief, the main method for the diagnosis of candidiasis is still a smear microscopy from the affected areas of the mucosa. PCR (DNA – diagnostics), popular recently, as a rule, is poorly suited for the diagnosis of candidiasis.

Laboratory diagnosis of the disease includes:

  • smear microscopy
  • culture diagnostics (seeding)
  • -fermentny immunosorbent assay (ELISA)
  • polymerase chain reaction (PCR)


Candidiasis during pregnancy


Candidiasis occurs frequently in pregnant women, but the effects may be more severe, because approximately 70% of cases of fetal infection. During pregnancy, candidiasis is transmitted in an ascending way and can affect the umbilical cord, skin, mucous membranes, and even entire organs and systems. With severe  sepsis   even the death of the fetus is possible. The situation is often complicated by the fact that during pregnancy, many drugs are contraindicated, so the treatment of candidiasis in pregnancy is carried out according to a special scheme (see paragraph “Treatment of candidiasis in pregnancy”).


Treatment


In the treatment of candidiasis, it is very important to choose the right drugs, depending on the type of fungus (the candida genus includes about 80 species, of which more than 10 can cause disease). Otherwise, the risk of obtaining a drug-resistant strain is high, which makes further treatment difficult. Therefore, home treatment of candidiasis is unacceptable, and folk remedies are effective only in combination with competent drug therapy.
Treatment of candidiasis in women
Usually, with mild candidiasis, local treatment is sufficient. To do this, use antifungal creams, vaginal tablets or suppositories:

  • Clotrimazole (Canison, kandibene, antifungol) – the most used drug
  • Miconazole ( Klion -D)
  • Natamycin
  • Nystatin and others.
  • Candles and creams cure candidiasis in 6-7 days, drugs of a new generation – in 1-2 days.

The course of treatment for a full guarantee of recovery is repeated twice. After applying local remedies, it is necessary to be at rest for 30 minutes, for greater effectiveness of the drug. Therefore, candles and vaginal tablets are best used at night.

Partner recommendations

According to modern standards, the treatment of thrush (vaginal candidiasis) should be carried out in two stages. The first stage uses the system (capsules, tablets)   and / or local (vaginal suppositories, gels and tablets)   antifungal drugs, often used complex drugs containing antifungal and antibacterial component to destroy pathogens. The second step is to restore the local immunity and the balance of beneficial vaginal microflora of the vagina to reduce the risk of re-exacerbation. If you do not make a rapid recovery of lactoflora , activation of conditionally pathogenic or pathogenic microorganisms is possible, which may cause recurrence of thrush or bacterial infections. Frequent relapses of thrush often cause chronic inflammatory diseases of the pelvic organs, which subsequently lead to impaired reproductive function of women (infertility). That is why two-stage therapy is a more reasonable solution compared with regular use of antimicrobial agents only. To restore the microflora used local probiotics. Many doctors prefer the French drug Laktozhinal . It is the only drug registered on the territory of the Russian Federation – tribiotic with the direct indication “prevention of vulvovaginal candidiasis ” (thrush). Lactozinal contains special lactobacilli, contributes to the normalization of beneficial vaginal microflora and pH , and also forms local immunity. An important aspect is the long-term preservation of the correct   microflora balance and reducing the risk of disease recurrence.

Two-stage therapy with probiotics, for example, the drug Lactozinal   as a stage 2, it has recently become the gold standard for treating conditions involving pathological secretions, such as vulvovaginal candidiasis (thrush) and bacterial vaginosis. Many experts believe that only such a method can provide a pronounced and long-lasting therapeutic effect and strengthen local immunity.


Instead of drugs for the topical treatment or in conjunction with prescribed a single reception of fluconazole (Diflucan, Flucostat, Forkan, mikomaks et al.) Dose of 150mg vnutr.Esli woman case of recurrence of infection, candida treatment is aimed not only to have to remove the symptoms of the disease, but and subsequent prophylaxis.
In addition to local treatment necessarily prescribed drugs for oral administration. It is important to select them individually, given the resistance of a particular type of mushroom. For relapses, it is prescribed local preparations (suppositories or vaginal tablets with clotrimazole ) 1 time per week for several months and fluconazole 100 mg orally once a week for several months. A regular follow up with a doctor is required.
To maintain immunity, it is recommended to increase the consumption of bifidobacteria and limit irritating foods.
At the time of treatment of candidiasis, it is necessary to abandon sexual contact.
Treatment in men


Most often, for the treatment of candidiasis in men enough local antifungal agents. Assign ointment or creams with clotrimazole , twice a day for a week. If the treatment is ineffective, additionally use drugs of general effect. Sexual contact at the time of treatment is also excluded.
Candidiasis during pregnancy
During pregnancy, many drugs for the treatment of candidiasis ( fluconazole , clotrimazole ) are contraindicated due to side effects. Possible to receive nystatin and pimafucin . The latter is not toxic even in high doses.
Candidiasis in children
In children of small age in the treatment of candidiasis a great role is played by proper nutrition with a sufficient amount of vitamins. The affected areas are treated with an aqueous solution of brilliant green, Castellani liquid ( fucorcin ), Mikoseptin , nystatin ointment, solutions of tannin and iodolipol are used . In severe cases, treatment with nystatin .
Treatment of folk remedies
Need to remember that   traditional medicine is effective only with complex therapy . 

Vaginal douching and mouth rinsing with herbs are a good anti-inflammatory effect:

  • Collection number 255:
  • Juniper ordinary (berries) – 1 part
  • Yarrow (grass) – 1 part
  • Salvia officinalis (leaf) – 1 part
  • Eucalyptus Prune (leaf) – 1 part
  • Chamomile (flowers) – 1 part
  • Calendula officinalis (flowers) – 1 part
  • Hanging birch (buds) – 1 part
  • Black poplar (kidney) – 1 part
  • For use, 2 tablespoons of the collection pour a glass of boiling water, insist for 12 hours and take 100-150 ml for a day 30 minutes before meals, or used for douching and rinsing the mouth.
  • Broth roots wormwood ordinary: 20gr roots pour a glass of boiling water, take 1 tablespoon 3 times a day
  • Decoction of Hypericum grass: 2-4 tablespoons of grass, pour 2 liters of water, boil for 20 minutes, drain. Use for douching


Complications of candidiasis


With timely treatment, candidiasis does not cause special harm to health. But the symptoms of candidiasis can deliver a lot of discomfort. Long-existing, it can lead to damage to other organs, most often the urethra, bladder and kidneys. In severe cases, the progressive disease can affect the reproductive organs, leading to infertility in both men and women. But candidiasis is the greatest danger for pregnant women, because very high risk of injury to the fetus.


Prevention

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Prevention of candidiasis includes limiting contact with the carriers of the disease, careful hygiene measures, monitoring with antibiotics, taking probiotics if necessary, wearing cotton underwear, avoiding casual sex, and timely treatment of diseases of the genitourinary system.
With timely treatment, the prognosis is favorable, cure usually occurs within a week. With complicated forms and lesions of the internal organs, the treatment of candidiasis is difficult.

Staphylococcus aureus

What is dangerous Staphylococcus aureus

The reasons

Types of staph infection

Symptoms depending on the affected organ

Diagnostics

Treatment

Complications and prognosis

Staphylococcus aureus ( Staphylococcus aureus ) is a spherical, immobile and aerobic (capable of existing in the air) bacteria, positively Gram-stained, which causes various diseases in children and less often in adults.

Its name “golden” Staphylococcus received from the golden glow, which publishes when sown on a nutrient medium. Translated from the Greek slaphyle – “bunch” and coccus – “spherical”, staphylococcus under a microscope resembles a bunch of grapes. Staphylococcus aureus is widespread in the environment, it can be sown from household items, from toys, from medical instruments, from breast milk and affected skin and mucous membranes of a sick and healthy person.

What is dangerous Staphylococcus aureus

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Normally, Staphylococcus aureus lives on the skin and mucous membranes of almost all people. But healthy people with good immunity do not suffer from staphylococcal infection, since normal microflora inhibits the growth of staphylococcus and does not show its pathogenic essence. But with the weakening of the body’s defenses, the microbe “raises its head” and causes various diseases, including infection of blood or sepsis.

High pathogenicity of Staphylococcus aureus is associated with three factors.

  • First, the microorganism is highly resistant to antiseptics and environmental factors (can withstand boiling for 10 minutes, drying, freezing, ethyl alcohol, hydrogen peroxide, with the exception of “green water”).
  • Secondly, Staphylococcus aureus produces penicillinase and lidazu enzymes , which makes it protected from almost all penicillin-type antibiotics and helps to melt the skin, including the sweat glands, and penetrate deep into the body.
  • And thirdly, the microbe produces endotoxin, which leads to both food poisoning and the syndrome of general intoxication of the body, up to the development of toxic shock.

And, of course, it should be noted that immunity to Staphylococcus aureus is absent, and a person who has had a staphylococcal infection may become infected with it again.

Staphylococcus aureus is especially dangerous for infants in the hospital. It is in hospitals that the concentration of this microbe in the environment is high, to which the violation of the rules of asepsis and the sterilization of instruments and carriage of staphylococcus among honey gives considerable importance. staff.

The reasons

There is no doubt that the cause of a staph infection is usually Staphylococcus aureus. Infection occurs with a decrease in immunity, which is facilitated by a number of factors:

  • antibiotics and hormonal drugs;
  • stress;
  • unhealthy diet;
  • hypo – and avitaminosis;
  • infections;
  • intestinal dysbiosis;
  • non-compliance with personal hygiene;
  • prematurity;
  • the immaturity of the child at birth;
  • artificial feeding;
  • late attachment to the chest.

Types of staph infection

There are generalized and local forms of staphylococcal infection.

Generalized forms include sepsis ( septicopyemia and septicocemia ).

Local forms include diseases of the skin, mucous membranes, internal organs, bones, joints, mammary glands and umbilical cord. Also, a separate column is to highlight food poisoning with Staphylococcus endotoxin.

In addition, a staph infection can be primary and secondary (in the presence of a primary focus). The course of acute, protracted and chronic forms, and the severity of staphylococcal infections mild, moderate and severe.

Symptoms depending on the affected organ

The symptoms of a staph infection depend on the location of the staphylococcus in the child’s body and on the degree of reduction of the body’s defenses. The main signs of staph infection are

  • fever
  • pronounced intoxication syndrome (lethargy, weakness, lack of appetite, nausea).

Omphalite

Microbial lesion of the umbilical wound, which is accompanied by swelling of the umbilical ring, purulent discharge from the wound. With the involvement of the umbilical vein, a compacted and thickened vein is palpable. There is also hyperemia, which extends upwards, towards the sternum.

Skin lesions

  • When pseudofurunculosis (damage to the sweat, but not the sebaceous glands) there are dense, red nodules in the skin folds (accumulation of sweat glands), which then suppurate.
  • Vesiculopustosis characterized by the formation of bubbles with liquid contents, which spontaneously open and a crust forms in their place.
  • Exfoliative dermatitis (Ritter’s disease), or “scalded skin syndrome” is characterized by the formation of large blisters that look like burns, then the skin is exfoliated and unprotected wounds are formed.
  • Abscess – damage to the deep layers of the skin with visible redness and compaction. Formed cavity containing pus.
  • Felon – the defeat of the extreme phalanx of the finger.
  • Cellulum – in addition to the skin, the subcutaneous tissue is involved, which suppuate.

Eye damage

At damage of a mucous eye develops conjunctivitis (photophobia, tearing, eyelid edema, purulent discharge from the eyes).

Lesion of the airways

Rhinitis – redness of the mucous membrane with copious purulent discharge from the nose. With the penetration of infection below develops sore throat, characterized by sore throat, pharyngitis , tracheitis with a dry and painful cough.

Infection of the bronchi and lungs leads to bronchitis and pneumonia. As a rule, bronchitis and pneumonia occur combined with pharyngitis, rhinitis, tracheitis.

There is a significant increase in temperature (up to 39-40 ° C), dry cough, shortness of breath.

Possible development of stenosis of the respiratory tract.

Central nervous system damage

Penetration of Staphylococcus aureus into the brain leads to the development of meningitis and brain abscess. Diseases in children are difficult, with high fever and intoxication.

Characterized by “brain” vomiting, headaches, positive meningeal symptoms, episyndrome and skin rash. When spinal puncture fluid flows under pressure, has a greenish hue with an admixture of pus.

Damage to the urinary tract

Develop   urethritis,   cystitis,   pyelonephritis. Typical symptoms: frequent and painful urination, pain in the lumbar region, high fever. In urine tests are determined protein, a large number leukocyte count , Staphylococcus aureus is inoculated.

Damage to the bones and joints

When infections of bones and joints develop arthritis and   osteomyelitis .

Foodborne Disease Infection

It develops when eating contaminated or spoiled food and proceeds with symptoms of acute enterocolitis. Characterized by fever, nausea, vomiting up to 10 or more times a day, loose stools with a touch of green.

Sepsis

Infection of blood or sepsis, occurs when severe immunodeficiency. The course of the disease is severe, with a very high temperature, severe symptoms of intoxication, impaired consciousness (from agitation to lethargy).

With the development of toxic shock sharply decreases blood pressure, the patient loses consciousness and may fall into a coma.

Septicopyemia is the circulation of Staphylococcus aureus in the blood with the formation of purulent foci, both on the skin of the child and in the internal organs.

When septicemia is characterized by the development of infectious toxicosis. Septicemia may be complicated by the accession of pneumonia, the development of DIC syndrome   And so on.

Diagnostics

Differential diagnosis of staphylococcal infection should be carried out with streptococcal infection. In the diagnosis of diseases of staphylococcal etiology using the following serological methods, characterized by speed and high accuracy:

  • Standard coagulase test in vitro, which lasts 4 hours, but with a negative result is extended for a day.
  • Latex agglutination, which uses commercial sets of latex particles associated with antibodies to staphylococcus (A-protein, adhesion factor and a number of surface antigens), which makes it also useful for species and strain identification of the pathogen

Also used:

  • General blood and urine tests (leukocytosis, neutrophilia,increased ESR, and urine protein, leukocytes, staphylococcus).
  • Sowing biological material on nutrient media.

Sowing on nutrient media is carried out in order to identify the causative agent of the disease and determine its sensitivity and resistance to antibiotics.

Sowing feces should be done no later than 3 hours after defecation, smears from the mucous membranes of the mouth and nasopharynx should be taken on an empty stomach, before brushing your teeth and before taking medicine.

Smear with staphylococcal conjunctivitis is taken from the lower eyelid with a sterile swab dipped in distilled water and before washing.

In skin diseases, smears are taken after pre-treating the skin around the wound with an antiseptic solution and removing the necrotic areas (crusts) from the wound.

  • Vidal agglutination reaction

Allows you to determine the dynamics of the disease and the effectiveness of treatment. It is held 2 or more times with intervals of 7-10 days. The increase in antibody titer in the blood of more than 1: 100 indicates the progression of infection.

  • Phagotyping of isolated staphylococci

Allows you to determine the sensitivity of the microbe to phage viruses for the appointment of appropriate treatment.

Treatment

In milder forms of staphylococcal infection, antibiotics are not required.

In moderate and severe forms, semi-synthetic penicillins ( amoxiclav ) are prescribed , which are effective for the resistance of the microorganism to penicillins and cephalosporins ( kefzol , ceftriaxone ).

The duration of treatment depends on the severity of the disease and infection of the skin or internal organs (from 7 days to several months).

In case of purulent-inflammatory skin diseases (furunculosis, carbuncle, impetigo), local treatment is prescribed – mupirocin or pleuromutilin derivatives . In their absence, wounds can be treated with antiseptic solutions: brilliant green, hydrogen peroxide, potassium permanganate and antibacterial ointments (synthomycin , oleandomycin ointment, baktroban ).

With conjunctivitis The eyes are washed daily with a weak solution of potassium permanganate, and a 30% solution of albucide 4-5 times a day is instilled .

In case of purulent skin lesions ( abscesses, cellulitis), surgical opening of abscesses for the outflow of pus is performed.

In addition, the prescription of antistaphylococcal bacteriophage, antistaphylococcal plasma and immunoglobulin (in sepsis and severe disease) is shown.

When staphylococcal food toxicoinfection antibiotics are not prescribed, used antistaphylococcal toxoid. Gastric lavage and replenishment of the circulating blood volume with intravenous infusions of saline solutions (physical solution, glucose solution, rehydron and others) are carried out .

For the prevention of intestinal dysbiosis, the use of antifungal drugs ( Diflucan, Nystatin ) in parallel with antibiotics is recommended .

Immunocorrective therapy is prescribed simultaneously (vitamins of group B, C, levamisole, Taktivin and others).

The treatment of a staph infection in children is performed by a pediatric infectious diseases specialist.

Methods of treatment are selected depending on the damage of certain organs. The child is hospitalized in a separate ward-box, where the daily change of bed and underwear and the daily shower of the patient.

Complications and prognosis

Staphylococcus aureus is especially dangerous for infants. Possible complications:

  • sepsis;
  • infectious toxic shock;
  • coma;
  • death.

The prognosis depends on the severity of the disease and the effectiveness of treatment.

With light lesions of the skin and mucous membranes, the prognosis is favorable. Massive infection with Staphylococcus aureus, especially with the development of sepsis in 50% is fatal.

Dysentery

The reasons

Complications

Diagnostics

Dysentery treatment

Prevention

Dysentery – an infectious disease characterized by lesions of the gastrointestinal tract, mainly the colon.

The disease is caused by Shigella spp. With the destruction of microbes, a toxin is released, which plays a large role in the development of the disease and causes its manifestations.

Dysentery pathogens are characterized by high survival in the environment. Depending on the temperature and humidity conditions, they persist from 3-4 days to 1-2 months, and in some cases up to 3-4 months or even more. Under favorable conditions, shigella are capable of reproduction in food products (salads, vinaigrettes, boiled meat, minced meat, boiled fish, milk and dairy products, compotes and jelly).

The reasons

Dysentery is transmitted only from a person through food contaminated with faeces, water, and also upon contact.

The source of the causative agent of infection in dysentery are patients, as well as bacterial carriers, which secrete shigella into the external environment with feces. Patients with dysentery are infectious since the onset of the disease. The duration of the isolation of the pathogen by patients, as a rule, does not exceed a week, but can be delayed up to 2-3 weeks.

Most susceptible to infection in individuals with blood group A (II).

The leading factor in the development of the disease is the entry of bacteria into the bloodstream. First of all, the nervous and the cardiovascular system, adrenal glands and digestive organs are affected.

Shigella can be in the stomach from several hours to several days (in rare cases). Overcoming the acidic barrier of the stomach, shigella enter the intestine. In the small intestine, they attach to intestinal cells and release a toxin, which causes an increased secretion of fluid and salts into the intestinal lumen. Shigella actively move, causing an inflammatory process in the small intestine, which is supported and aggravated by the action of the toxin produced by shigella. Shigella Toxin, enters the bloodstream and causes the development of intoxication.

In the large intestine Shigella get a little later, but massive. This leads to a more significant effect of toxins.

Recovery from dysentery is usually accompanied by the release of the body from the pathogen. However, when the immune system is insufficient, cleansing the body from the pathogen is delayed up to 1 month or more. Carriage is formed, and in some of those who have been ill, the disease becomes chronic.

After suffering the disease formed a short immunity.

The incubation period is 1-7 (on average 2-3) days, but can be reduced to 2-12 hours.

The form, variant and severity of dysentery depend on the ways and methods of infection, the number of microbes in the body, the level of body immunity.

The disease begins quickly. In the beginning, a general intoxication syndrome develops, characterized by fever, chills, fever, weakness, loss of appetite, headache, and lower blood pressure.

The defeat of the gastrointestinal tract is manifested by abdominal pain, initially dull, diffuse throughout the abdomen, having a permanent character. Then they become sharper, cramping, localized in the lower abdomen, often to the left. Pain is usually worse before bowel movements.

Mild form of dysentery

With a mild course of the disease, fever is short-lived, from several hours to 1-2 days, the body temperature, as a rule, rises to 38 ° C.

Patients are concerned about moderate abdominal pain, mainly before the act of emptying the bowel.

The feces have a pasty or semi-fluid consistency, the frequency of bowel movements up to 10 times a day, an admixture of mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs in 2-3 weeks.

Moderate form

The onset of this form of dysentery quick The body temperature with chills rises to 38 ~ 39 ° C and stays at this level from several hours to 2-4 days.

Patients are worried about general weakness, headache, dizziness, lack of appetite. Intestinal disorders usually join in the next 2-3 hours from the onset of the disease.

Patients appear periodic cramping pain in the lower abdomen, frequent false urge to defecate, a feeling of incompleteness of the act of defecation. Stool frequency reaches 10-20 times per day. The feces are scanty, often composed of a single mucus with streaks of blood.

There is irritability, pallor of the skin. Tongue covered with thick white bloom, dryish. Intoxication and diarrhea last from 2 to 4-5 days. Full healing of the mucous membrane of the intestine and the normalization of all body functions occur no earlier than 1-1.5 months.

Heavy form

Severe dysentery is characterized by a very rapid development of the disease, pronounced intoxication, and deep disturbances in the activity of the cardiovascular system.

The disease begins extremely quickly. The body temperature with chills quickly rises to 40 ° C and higher, patients complain of severe headache, severe general weakness, increased chilliness, especially in the limbs, dizziness when rising from bed, a complete lack of appetite.

Often, nausea, vomiting, hiccups. Patients suffer from abdominal pain, accompanied by frequent urge to defecate and urination. A chair more than 20 times a day, often the number of bowel movements is difficult to count (“chair without an account”). The height of the illness lasts 5-10 days.Recovery occurs slowly, up to 3-4 weeks, the full normalization of the intestinal mucosa occurs after 2 months or more.

The diagnosis of chronic dysentery is established if the disease lasts more than 3 months.

Complications

Among the complications of the disease, the most frequent are:

  • infectious toxic shock,
  • infectious-toxic damage to the nervous system,
  • peritonitis,
  • pneumonia.

Diagnostics

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Diagnosis   based on the results of the examination of the patient. Of great diagnostic importance is the examination of feces, which can detect the admixture of mucus with streaks of blood.

Laboratory confirmation of dysentery is carried out by bacteriological and serological methods. The bacteriological method (seeding shigella from stool) with a 3-fold study provides confirmation of the diagnosis in 40-60% of patients.

Accelerated diagnosis of acute intestinal diarrheal infections can be carried out by detecting pathogens’ antigens and their toxins in biosubstrates — saliva, urine, feces, and blood. For this purpose, use immunological methods with high sensitivity and specificity: -fermentny immunosorbentassay (ELISA), latex agglutination reaction (RAL), the reaction koagglyutinatsii (PKA), immunofluorescence (IFA), polymerase chain reaction (PCR).

Dysentery treatment

Treatment of patients with dysentery should be comprehensive and strictly individualized. Bed rest is necessary, as a rule, only for patients with severe forms of the disease. Patients with moderate forms are allowed to go to the toilet. Patients with mild forms of ward prescribed and physical therapy.

One of the most important components in the complex therapy of intestinal patients is medical nutrition. In the acute period with significant intestinal disorders appoint table number 4; with an improvement in the condition, a decrease in intestinal dysfunction and the appetite of patients, they are transferred to table No. 2, and 2-3 days before discharge from the hospital – to the common table.

It is necessary to prescribe an antibacterial drug to a patient, taking into account information about the “territorial landscape of drug resistance”, i.e. Shigella sensitivity to it , allocated from patients in the area in recent times. Combinations of two or more antibiotics (chemotherapy drugs) are prescribed only in severe cases.

The duration of the course of treatment of dysentery is determined by the improvement of the patient’s condition, the normalization of body temperature, the decrease in intestinal disorders.

In moderately severe dysentery, the course of therapy may be limited to 3–4 days, and in severe, 4–5 days. Mild intestinal dysfunction (pasty stools up to 2–3 times a day, moderate phenomena  flatulence ) should not be a reason for the continuation of antibacterial treatment.

Patients with mild dysentery in the midst of a disease that occurs with an admixture of mucus and blood in the feces are prescribed one of the following drugs:

  • nitrofurans ( furazolidone, furadonin 0.1 g 4 times a day,
  • ersefuril ( nifuroxazide) 0.2 g 4 times a day),
  • cotrimoxazole, 2 tablets, 2 times a day,
  • hydroxyquinoline (nitroksolin 0.1 g 4 times a day, intetriks 1-2 tablets three times a day).

With moderate dysentery, fluoroquinolone drugs are prescribed: ofloxacin , 0.2 g, 2 times a day, or ciprofloxacin, 0.25 g, 2 times a day;

  • cotrimoxazole, 2 tablets, 2 times a day;
  • Intrix 2 tablets 3 times a day.

With severe dysentery prescribed

  • Ofloxacin, 0.4 g, 2 times a day, or ciprofloxacin, 0.5 g, 2 times a day;
  • fluoroquinolones in combination with aminoglycosides;
  • aminoglycosides in combination with cephalosporins.

In Flexner and Zonne dysentery, polyvalent dysenteric bacteriophage is prescribed. The drug is available in liquid form and in tablets with an acid-resistant coating. Take for 1 hour before meals inside 30-40 ml 3 times a day or 2-3 tablets 3 times a day.

With mild dysentery Compensation for fluid loss is carried out by one of the ready-made compositions ( cytoglucosalan, rehydron, touring, etc.). These solutions give to drink in small portions. The amount of fluid consumed should be 1.5 times its loss with feces and urine.

Patients with moderate diarrhea are advised to drink plenty of sweet tea or 5% glucose solution, or one of the ready-made solutions ( citroglucous salane, rehydron, touring , etc.) up to 2–4 l / day.

For severe intoxication, intravenous drip infusion of 10% albumin, hemodez and other crystalloid solutions ( trisol , lactasol , acesol , chlorol ), 5-10% glucose solution with insulin is indicated . In most cases, the introduction of 1000-1500 ml of one or two of these solutions is enough to achieve a significant improvement in the patient’s condition.

To bind and remove toxin from the intestine, one of the enterosorbents is prescribed – polyphepan 1 tablespoon 3 times a day, activated carbon 15-20 g 3 times a day, enterodez 5 g 3 times a day, Polysorb MP 3 g 3 times per day, smecta 1 sachet 3 times a day or others.

Enzyme preparations are used for the neutralization of toxins: pancreatin, panzinorm in combination with calcium preparations.

In the acute period of diarrhea to eliminate spasm of the colon shows the use of:

  • Drotaverine hydrochloride (no-spa) to 0.04 g, 3 times a day,
  • papaverine hydrochloride, 0.02 g, 3 times a day.

With significant pain syndrome prescribed no-silos in 2 ml of a 2% solution intramuscularly or 1-2 ml of a 0.2% solution of platifillin Hydrotartrate subcutaneously.

During the entire period of treatment, patients are prescribed a complex of vitamins.

In order to correct the intestinal biocenosis, biosporin, baktisporin, baktisubtil, flivivin- BS are prescribed in 2 doses, 2 times a day for 5-7 days. When choosing a drug preference should be given a modern complex preparations -. Linex, bifidumbacterin -Fort, vitaflor and other drugs are administered in the standard dose. With good tolerability shown in convalescence period fermented therapeutic and dietetic bifidus – lactate and products which have a high therapeutic efficiency.

Treatment of patients with chronic dysentery (recurrent and continuous) is carried out in an infectious diseases hospital. Treatment includes:

  • fluoroquinolones ciprofloxacin 0.5 g 2 times a day or ofloxacin 0.2 g 2 times a day for 7 days;
  • immunotherapy depending on the state of immunity – thymalin, timogen, levamisole, dibazol, etc .;
  • Panzinorm , Festal , Pancreatin, Pepsin, etc .;
  • increased daily doses of vitamins;
  • treatment of associated diseases, helminthic and protozoal intestinal invasions;
  • to restore intestinal biocenosis prescribed biosporin, baktisporin, lineks, bifidumbakterin -Fort, vitaflor, lacto bacterin; These drugs are prescribed in a standard dosage for 2 weeks after etiotropic therapy simultaneously with pathogenetic agents.

The prognosis for treating patients with dysentery is usually favorable.

Prevention

Those who have had acute dysentery are discharged from the hospital no earlier than 3 days after clinical recovery (normalization of body temperature, stool, disappearance of signs of intoxication, abdominal pain, spasm and bowel pain) in the absence of pathological changes in laboratory tests. Chemoprophylaxis in contact with patients is not carried out.

Influenza

Types of flu

Flu symptoms

Diagnostics

Flu treatment

Flu Vaccination

Prevention

Influenza – an acute respiratory viral infection caused by viruses of group A, B or C, which occurs with severe toxicosis, fever, lesions of the upper and lower respiratory tract.

Influenza often causes complications, including death, causing epidemics.

Types of flu

There are three groups of the virus:

  • group A with numerous strains. It has a severe course, a high percentage of complications, it mutates strongly.
  • group B – relatively unreliable, rarely gives complications, strongly mutates.
  • group C – proceeds relatively easily, practically does not mutate, occurs mainly in children.

Causes and mechanism of development

Influenza virus belongs to the group of ARVI, has a similar distribution, seasonality and course, but has more pronounced clinical manifestations, course and outcomes.

Influenza is prone to epidemic spread. The source of infection is sick people in the period of incubation and height. Infection occurs through airborne droplets, from the moment of infection to clinical manifestations it takes from 6 hours to 2 days. Penetrates the virus through the mucous membranes of the eyes, respiratory tract. Less commonly, infection occurs through general hygiene items and dishes.

Flu symptoms

The onset of the flu is acute, with severe malaise, a rise in temperature to high numbers, sometimes up to 39-40 ° C. In the beginning, there is also a strong chill, intoxication, catarrhal phenomena (redness, sore throat).

There is a severe headache, with localization in the forehead and nose, aggravated by eye movement. There is a strong weakness, muscle aches, pain in the lower back and joints, loss of appetite with nausea. Fever persists up to 3-5 days.

There are also runny nose and sore throat, dryness and tickling, dry cough without sputum, pain in the eyes, their redness, tearing, hoarseness and congestion of the ears.

Also, with severe flu, hemorrhagic manifestations can occur – vasodilation on the sclera, minor hemorrhages, nosebleeds, redness of the face against the background of general pallor, hemorrhages on the skin in the form of small dots.

In severe cases, there is a fever over 40 ° C, sharp headaches with vomiting, shortness of breath   noisy breathing, oblivion and delirium, impaired consciousness, convulsions, hemorrhagic rash on the skin.

Especially severe flu occurs in children of the first two years, debilitated patients, pregnant women and the elderly.

Diagnostics

The basis of the diagnosis of influenza – a typical clinic with an indication of epidemic data. Confirms the diagnosis of influenza smear imprint from the throat and nose with the release of the virus strain. In the period of the flu epidemic, the diagnosis is made on the basis of clinical data.

Flu treatment

Common influenza treatment guidelines are similar to treatment.   ARVI , but in addition to that, antiviral drugs are indicated – rimantadine, oseltamivir , amantadine , zanamivir .

Bed rest, antipyretic drugs, excessive drinking, diet, interferon preparations, symptomatic therapy according to indications are shown.

In severe cases, specific anti-influenza immunoglobulin is indicated.

  • Amantadine and rimantadine are only effective against influenza A virus, provided treatment is started in the first 48 hours after the first signs of the disease appear. The drugs cause shortening of the febrile period, weakening of the manifestations of the flu. In recent years, resistance of the causative agent of influenza to rimantadine has been noted.
  • Tamiflu has established itself as a highly effective and safe drug. In clinical studies it has been shown that the drug penetrates well into the main foci of infection, including the lungs, middle ear, sinuses, and is characterized by good tolerance by both children and adults of all age groups. The effectiveness of tamiflu largely depends on the timing of its admission – at the start of treatment in the first 12 hours after the onset of fever, the average duration of the flu is reduced by 3 days compared to the more recently started therapy. Early treatment also led to the rapid disappearance of intoxication, a significant reduction in the duration of the fever and the severity of the flu.
  • Anti-influenza immunoglobulin 0.2 ml / kg (for the treatment and prevention of influenza in young children).
  • Vasoconstrictor remedies topically to facilitate nasal breathing. Naphazoline – adults 1-3 drops of 0.05% p pa into each nostril every 4-6 hours or xylometazoline in each half of the nose of 1-3 drops 0.1% p pa p 1-3 / day.. . (adult) or 1 drop of 0.1% pa p 1 p. / day. (children from 2 to 12 years).
  • Vitamins (ascorbic acid, rutoside ).

In uncomplicated cases, complete recovery occurs. Complicated flu can lead to death.

Flu Vaccination

Flu vaccination is a way to prevent infection. It is shown to all, especially risk groups – the elderly, children, pregnant women, people of social professions.

Vaccination is carried out annually, before the start of the epidemic season, from September-October, to form a strong immunity at the time of the epidemic. Regular vaccination increases the effectiveness of protection and the production of antibodies to influenza.

There are three types of vaccines.

  • All-virus , they can be both live and inactivated (killed). Indicated for vaccination of adults and healthy people, have an inexpensive cost, are effective in terms of the formation of immunity, but with the introduction give a high percentage of side effects, often cause fever, malaise and headaches.
  • Subunit vaccines are vaccines that contain not complete viral particles, but only fragments of a molecule to which the immune system forms immunity to influenza. They cost more, but they are much better tolerated than whole-virus . However, it is worth remembering that the virus has the specifics of mutation, and vaccines may lose their effectiveness.
  • Split vaccines – contain fragments of killed influenza viruses as their unstable and mutated membrane, and from the whole and constant core of the virus. They are the most expensive, but today the most effective, give the minimum number of side effects and have the highest efficiency.

Subunit and split vaccines can be used in children, debilitated patients and pregnant women. They are applied intramuscularly or subcutaneously. Vaccination is especially effective in the period before the start of the epidemic, from September to early December. Further vaccination is also applicable. But additionally, flu prevention with rimantadine is indicated.

With the introduction of the vaccine may be local (edema and redness at the injection site) and general reactions (malaise, drowsiness, mild temperature).

Prohibited vaccination in acute infections, exacerbation of chronic diseases and allergies to egg white, with previous negative reactions to vaccination.

Prevention

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In addition to vaccination, there is another preventive measure against influenza – a refusal to visit public places during an epidemic. Hand washing, regular washing and moistening of the nasal mucosa, rinsing mouth, taking immunostimulants and high doses of vitamin C.

In the period of epidemics, it is important to have good nutrition, warm clothes for the prevention of hypothermia, regular outdoor exercise and exercise. Good rest and sleep, quitting smoking and alcohol, and stress prevention are needed.

In rooms with an abundance of people, wearing a mask, applying oxolinic or viferon ointment on the threshold of the nose, instilling grippferon into the nose can help.

Prophylactic administration of arbidol, rimantadine, anaferon, oseltamivir is shown.

Herpes

The reasons

Symptoms of Herpes

Treatment of herpes

Complications

Herpes is one of the most common human viral infections. Over 90% of people in the world are infected with the herpes simplex virus (HSV) and up to 20% of them have certain manifestations of the infection.

Herpes simplex virus affects the skin and mucous membranes (most often on the face and in the genital area), the central nervous system ( meningitis, encephalitis ), eyes (conjunctivitis, keratitis ). The herpes virus causes the pathology of pregnancy and childbirth, often leading to   “spontaneous” abortions and fetal death, or causes a generalized infection in newborns; connection is marked genital herpes with cervical cancer and prostate cancer.

The reasons

Factors contributing to the manifestation and / or recurrence of herpes are:

  • reduced immunological reactivity
  • hypothermia or overheating of the body,
  • diseases,
  • medical manipulations, including abortion and the introduction of the intrauterine device,
  • some mental and physiological conditions.

The source of infection is a sick person, in which the herpes virus is present on the epithelium of the mucous membranes.

Symptoms of Herpes

The incubation period for herpes is, on average, from 2 to 10 days, sometimes reaching 3 weeks.

The primary symptoms are multiple blistering eruptions that are prone to fusion. Their appearance is accompanied by unpleasant sensations: itching, severe pain.

A significant proportion of the patients have common symptoms: weakness,   headache , muscle pain, fever. One-third of women and every tenth man with primary herpes develop complications, the most severe of which is herpetic meningitis (inflammation of the meninges).

In the absence of complications, the rash persists for 2-3 weeks, becomes covered with crusts and then disappears.

Treatment of herpes

Treatment of herpes patients, especially chronic recurrent forms, presents significant difficulties.

As shown by numerous clinical studies in recent years, the drug of first choice for the treatment of acute and recurrent forms of herpes caused by herpes simplex virus types 1 and 2 is acyclovir ( zovirax and its analogs), valacyclovir ( valtrex ), famciclovir ( famvir ).

For the treatment of the primary episode and recurrence of genital herpes in patients with unchanged immune system, acyclovir is prescribed in a dose of 200 mg 5 times a day for 5-10 days or until resolution of clinical manifestations.

5% – s cream acyclovir is prescribed to patients herpes simplex on the skin in the early stages of the disease 5 times a day for 5-7 days.

With genital herpes, valaciclovir is prescribed at 0.5 g 2 times a day for 5-10 days.

Famvir is prescribed for acute herpes infection of 0.25 g 3 times a day for 7 days. During pregnancy and lactation, the drug can be prescribed only for health reasons.

Alpizarin is used to treat herpetic lesions of various localization. Appliques 2% ointment produced at mucosal 4-6 times a day for 5-10 days, 5% – Naja ointment applied to the skin 4-6 times a day 5-10 days. For a more severe course of herpes infection, alpizarin (0.1 g) is prescribed orally, 1–3 tablets 3-4 times a day for 7–10 days.

Vir-IP (vidarabine phosphate) -10% – ing gel. Apply on the affected areas 4 times a day for 7 days.

Gelpin ( brivudin ) – tablets 0.125 g, 1 tablet orally 4 times a day for 5-7 days (after meals with plenty of fluids.

Oxolin. 1% – or 2% – Naya ointment is applied to the affected areas 3 times a day.

Ryodoxol. It is used for mild herpes infections of the skin and mucous membranes in the form of applications of 0.25% -, 0.5% – or 1% ointment (depending on the localization of the process and the nature of the disease) for 5-10 days.

Tromantadine . The drug in the form of a 1% ointment is applied to the affected areas 3 times a day for 7-10 days. For a more successful use of thromantadine, it is prescribed when the first signs of herpes appear.

Flacozid – flavonoid, obtained from the leaves of Amur velvet and Laval velvet, is administered orally after meals in 0.1-0.5 g 3 times a day for 10 days.

Helepin in the form of a 1% ointment is applied to the affected mucous membranes 3_raz per day for 7-10 days. When skin lesions applied 5% – Naja ointment. In severe cases, Helepin (0.1 g) is prescribed orally, 3 tablets per day for 10-15 days.

Epigen- intim (water extract of licorice root). It is applied 6 times a day for 5-10 days.

As a means of preventing the recurrence of genital herpes in various countries, various antiherpetic vaccines have been created and tested . The currently available domestic herpetic polyvaccine includes vaccination cycles (1-2 per year), consisting of intracutaneous injections of the drug in 0.2 ml every 5-10 days, for a total of 5 injections per cycle. Research to improve the method of vaccination of patients with herpes infection continues.

In case of genital herpes, the patient should be advised to refrain from sexual activity until the clinical manifestations disappear. For this period, the use of condoms should be mandatory for all sexual intercourse. The sexual partners of patients with genital herpes should be examined and treated if they have signs of herpes.

Treatment of herpes during pregnancy

Treatment of pregnant women is necessary in the development of disseminated forms of herpes infection (encephalitis,   hepatitis   etc.); Acyclovir is used in standard dosages. Caesarean section as a prophylaxis of neonatal herpes is indicated in the presence of herpetic lesions on the genitals or in the case of a primary genital herpes infection in the mother within 1 month before delivery. In other cases, natural delivery is possible.

Complications

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With a weakened immune system, herpes recurs up to 3-6 times per year. Groups of painful blisters appear on the affected area. A few days before, some patients experience discomfort in the area of ​​the appearance of rashes. General symptoms and an increase in nodes for the period of exacerbation is uncharacteristic.The duration of the recurrence of the disease most often is 7-10 days.

The insidiousness of the herpes virus consists in the fact that, once rooted into the body, it almost always remains in it for life. At the same time, the herpes carriage is by no means fatal: almost 100% of adults have antibodies to it (this means that we have ever met this virus and received a natural “vaccination”).

With a good intensity of immunity (or with its correct correction), while observing certain norms of a healthy lifestyle, the body does not allow a small number of dormant viruses to leave the cells, where the causative agents are doomed to be for life.

When immunity is weakened (a characteristic case is after a cold, although there may be a lot of reasons), the herpes viruses become active, multiply, and along the processes of the affected nerve cells enter the latter innervated areas of the epithelium, causing a characteristic clinical picture of herpes infection aggravation.

The consequences of the complications of herpes in women

In addition to periodic exacerbations, the persistence of HSV on the mucous female genital organs is fraught with a number of very unpleasant consequences: persistent itching in the external genital organs and vagina (65%), mucous discharge (58%),  “cervical erosion (sixteen%), habitual miscarriage in the early stages (21%).

If infection of the fetus in the early stages can lead to spontaneous abortion, then infection at a later time can cause damage to the skin, eyes, nervous system, followed by delayed development. It should be noted that such severe consequences are characteristic of the primary infection of a woman during pregnancy, with the presence of immunity (which the overwhelming percentage of Russian women have) even its temporary decline during pregnancy is not so dangerous.

The consequences of herpes during pregnancy

Pregnancy is very often a physiological immunosuppressive factor (a natural decrease in immunity occurs). The presence of herpes simplex virus in the cervical canal of pregnant women significantly increases the risk of intrauterine infection of the fetus, as well as infection of the child during childbirth.

Therefore, before the expected pregnancy, we recommend that expectant mothers be tested for HSV (and CMV) on mucous genital organs, determine the presence and level of antibodies to these viruses and, if necessary, receive a course of prophylactic treatment. It is desirable to re-study during pregnancy, given the above-mentioned changes in immunity. Detection of genital herpes simplex virus in the last weeks before delivery is the basis for caesarean section.

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