DIPHTHERIA

In the immediate vicinity of the affected lymph nodes there is swelling of the subcutaneous tissue of the neck.

This edema is caused by serous inflammation with numerous cellular infiltrates, and the general toxicity is caused by a toxin entering the blood

Initial problem situation: Given the mechanism and ways of transferring diphtheria, compile a list of sources, justifying each of them. Express any ideas! All proposals are recorded by secretaries. Do not think about whether they are real or not real. Do not criticize other suggestions!

the correct solution of the problem situation: The source of diphtheria can be man and domestic animals (cows, horses, sheep, etc.): The patient (0.5 points) Carrier of toxigenic strains (0.5 points) Carrier of nontoxigenic strains (0.5 points) Transit carrier (0.5 points) Short-term carrier (0.5 points) Media of medium duration (0.5 points) Protractor carrier (0.5 points)

Localized diphtheria of the oropharynx is the most common form. With a localized form, the raids are located only on the tonsils and do not go beyond them.

Toxic form is the most severe form of diphtheria of throat. Already on the 2nd-3rd day of the disease, the raids are thick, dirty - gray, completely cover the surface of the tonsils, go over the arches, small tongue, soft and hard palate.

Diphtheria of the 1st degree edema of the cervical fat reaches the middle of the neck;

Diphtheria of the 2nd degree edema of the cervical tissue to the clavicle

Diphtheria of the 3rd degree edema of the cervical tissue below the clavicle, "bovine neck"

Diphtheria croup breathing becomes difficult, noisy, there is an entrainment of pliable places of the chest (intercostal, supra- and subclavian depressions, jugular fossa), tension of the respiratory musculature of the chest-clavic-mastoid, trapezoidal, etc.).

The most characteristic complications of diphtheria myocarditis (1 point) neuritis and polyneuritis (1 point) nephrotic syndrome (1 point). hemorrhages in the adrenal glands. (1 point) paralysis of the larynx (1 point) defeat of pharynx (1 point) diaphragm paralysis (1 point) death (1 point)

Correct solution of the problem situation: The diagnosis of diphtheria is based on the detection of characteristic fibrinous, dense whitish-grayish raids located on the surface of the mucous membrane or skin. (1 point) Clinical diagnosis is crucial, as delay with the introduction of antidiphtheria serum and wait for the results of laboratory testing is not possible. (1 point) Of the methods of laboratory diagnosis, bacteriological research is of the greatest importance. (1 point) To determine the toxicity of corynebacteria can be in vivo on guinea pigs, (1 point)

Correct solution of the problem situation: Serological methods of investigation are based on the detection of antimicrobial antibodies in the RPHA. (1 point) To determine the intensity of antitoxic antidiphtheria immunity, the response of Schick (1 point determination of blood antitoxin by Jensen (1 point) However, in practice, the determination is carried out in vitro - on dense nutrient media by Ochterlony agar precipitation method. (1 point)

Correct solution of the problem situation: The source of infection for the child most likely was the mother who had suffered angina several days before her child's illness. (1 point)

Correct solution of the problem situation: Activities in the outbreak: 2.1. Call an ambulance for hospitalization of the child in an infectious hospital. Sick child to be hospitalized. (1 point) 2.2.The mother of the child is subjected to a bacteriological examination for diphtheria (smear from the pharynx and nose) and, before obtaining a negative result of the laboratory examination, be removed from work. (2 points) 2.3. The neighbors: the saleswoman of the children's toys department and the medical attendant of the children's somatic hospital should be subjected to a bacteriological examination for diphtheria (smear from the pharynx and nose), and be removed from work until a negative result of the laboratory test is obtained. (2 points)

Correct solution of the problem situation: 2.4.Two children 4 and 10 years of age to put a sample of Shik to determine whether they have immunity to diphtheria. (1 point) The child is 11 years old and all adults are vaccinated against diphtheria and tetanus by vaccine ADS subcutaneously 0.5 ml (1 point) 2.6. In the first class, where the mother of the sick person is working, carry out the whole complex of activities among those who are in contact with the patient with diphtheria. (1 point) 2.7.Ustanovat medical supervision of all contact within 7days from the time of hospitalization of the patient (temperature, condition of throat). (1 point)