INFECTIOUS_DISEASES

symptoms the parents must put the child into bed and call the doctor in.

The disease is characterized by a rash which appears on the 4th day,at first on the mucous membrane of the mouth, it is known as Filatov-Koplik's spots . T hese are tiny white spots on a bright red back ground. T hen red m aculopapular rash appears on the sk in, at first behind the ears, then on the face, body and limbs. After the disappearance of the rash desquamation begins.

The patient begins to feel much worse. The cough and cold in the head become aggravated, the eyes get purulent.

If the disease is not complicated, the patient recovers quickly.

Proper treatment and good nursing may prevent complications. The patient's room must be aired as often as possible, because fresh air prevents further infection, and it must be cleaned with a wet duster. The patient's bed must be placed so that the day light should not fall on his face, but the room must never be darkened because the sun rays kill bacteria.

It is necessary to keep the patient's mouth clean. For this purpose the patient should rinse his mouth after meals. Little children must drink boiled water instead of rinsing. If the child has no complications he must be bathed as usual. The temperature of the water must be about 36—37 °C. As the sick child has poor appetite he sh ould take soft diet in small amounts 5 —6 times a day. The patient's hands must often be washed and he must not be allowed to rub his eyes. It is good to wash his eyes out with tea (green tea is better) or an appropriate disinfecting solution several times a day. It is necessary to isolate the sick child from healthy children. When it is impossible for the child to have proper nursing at home, he should be taken to the hospital where there are proper conditions to aid his recovery.

Words to be memorised
N o u n s : measles, membrane, limb,	nursing, diet, amount, solution,
condition.
V e r b s : to prevent, to protect,	to clean, to place, to kill, to

darken, to drink, to rinse, to bathe, to wash out, to isolate, to expose.

A d j e c t i v e s : widespread, grave, mucous, sick, clean, boiled

O t h e r	w o r d s	a n d	e x p r e s s i o n s : to	put into bed, to
call -a	doctor in,	at first,	instead of, for this	purpose, to get

purulent — гноиться, to be vaccinated — сделать прививку Filatov-Koplik's spots — пятна Филатова-Коплика

				Exercises
I. Answer the following					questions:
1.	What kind	of		disease is measles?
2.	In what way		is	it	spread?
3.	How long	is	the		incubation period?
4.	What are	the		prodromal symptoms?

5.What must be done with the appearance of these symptoms?

6.What is the disease characterized by?

7. Which is the most characteristic symptom of this disease?

8.Where does the rash appear first?

9.What preventive measures must be taken to exposed

children?

10.When does desquamation begin?

11.What is the prognosis of the disease if it is not complicated?

12.What measures usually prevent complications?

13.How must the sick child be nursed?

14. In what case is the patient taken to the hospital?

II. Translate the following sentences:

a) 1. Taken in time, any general well-known measures for given

disease bring good		results.
2. The	physician	observed marked improvement obtained due
to proper	treatment.

3.If vaccinated in time, children do not develop dangerous complications.

4.The child exposed contracted measles.

b)1.Measles being an infectious disease, the sick child must be isolated as soon as possible.

2.Measles begins like a bad cold, catarrhal symptoms such as a runny or blocked nose, sneezing, coughing and others being present through the illness.

3.Measles appears to have been known from an early period in the history of medicine, it being mentioned in the writings of the Arabian physicians.

4.Measles is believed to be one of the most contagious diseases, its main symptom being a specific macular eruption which first appears on the mucous membranes of the mouth.

c)1. One of the worst complications of measles, but fortunately

a	rare one		is gangrenous stomatitis.
	2.	Mild	cases	of measles are as contagious as severe ones.
	3.	If one finds		characteristic spots on the mucous membrane
of	the mouth, one should suspect measles.

4.One must keep in mind all measures that may prevent complications.

5.Measles is more prevalent than any other eruptive fever and one to which human beings are universally susceptible. d)1.Считается, что корь – одно из самых опасных заболеваний детства.

2.Корь распространяется воздушно-капельным путём, причём дети легко заражаются, даже после короткого контакта.

3.Противокоревую вакцину рекомендуют вводить в

возрасте 9-10 месяцев.

4.Если корь протекает тяжело, за ней могут последовать осложнения, такие как пневмония, бронхит и др.

5.Больного ребёнка можно лечить дома, но хороший уход крайне важен.

III.Read the text and say what new information it contains as compared with the previous text:

Measles is the commonest infectious disease of childhood. It is characterised by catarrhal symptoms of the eyes, nose and throat, fever and a typical eruption located on the mucous membranes and on the skin. Very young infants are relatively unsusceptible, especially if they are breast-fed. They become more susceptible after the sixth month and there is no infectious disease to which there is less natural immunity than to measles. The most frequent and most important complication of measles is the involvement of the respiratory tract (pneumonia, bronchitis). Middle ear inflammation sometimes occurs.

IV. Say what mother should do while looking		after the baby
who has measles; speak about the	period of rash
.
V. Using the Table of Infectious Diseases on		p. 95 write
down the facts about chickenpox,	scarlet fever,	measles.

Comparing the facts speak about a) the way of transmission; b) The duration of incubation period and complications of these three diseases, c) Eruptive stage of chicken-pox and scarlet fever, scarlet fever and measles.

VI. Read the text and speak about the diagnosis and treatment of meningococcal infections

Meningococcaemia

Meningococcal septicaemia ihas a high mortality. It is an acute septicaemia with shock and a purpuric rash. Blood cultures should be taken. Antigen testing is very useful, particularly when antibodies have already been given. Lumbar culture should be considered, but may be contraindicated in a very ill child.

High-dosage penicillin should be started at once to any child with a suspicious rash.

Meningitis

The disease has specific signs such as headache and neck stiffness in older children, but they are often absent in young infants. Infants often present with non-specific signs of irritability, drowsiness, vomiting, anorexia, convulsions or fever. Bulging fontanelle, high-pitched cry and arching of the back are late signs. Any ill child with unexplained fever or convulsions should be suspected. Cerebrospinal fluid examination and culture will confirm the diagnosis.

Broad spectrum antibiotics should be given until the specific organism and sensitivities are known.

VII. Retell this text in English

Менингококковая инфекция Менингококковая инфекция – одно из тяжелейших инфекционных

завоеваний. Заболевают люди любого возраста, но больше всех страдают дети и молодёжь. В С.Петербурге от этой инфекции ежегодно погибают дети.

Возбудитель – Neisseria meninggitidis, грамотрицательная палочка, неустойчивая во внешней среде. Переносится людьми, особенно оласны бессимптомные носители и страдающие менингококковым назофарингитом, который трудно отличить от обычного ОРЗ. Инфекции свойственна осенне-зимняя сезонность, заболеваемость возрастает каждые 115 лет.

Заболевание протекает в форме менингита или в форме менингококкового сепсиса (менингококцемии), при котором симптомов менингита может не быть. Эта форма болезни часто протекает молниеносно и в 12.5% случаев заканчивается летально из-за тяжёлых гемодинамических нарушений Заболевание начинается внезапно, часто мама называет даже час

начала болезни. Сильная головная боль, высокая температура, рвота, светобоязнь, вялость, сонливость и характерная сыпь – основные симптомы. Детям старше 1 года бывает трудно наклонить голову так, чтобы подбородок коснулся груди. Иногда отмечаются боли в суставах. Маленькие дети становятся очень вялыми и плаксивыми, отказываются от еды, могут стонать при прикосновении. Возможны генерализованные судороги или отдельные подёргивания мышц.

Высыпания носят геморрагический характер (петехии, экхимозы) и не всегда появляются в самом начале болезни.Часто элементы сыпи единичны и вначале присутствуют только на нижней половине туловища, бёдрах, в области гениталий. Поэтому необходимо полностью раздевать и тщательно осматривать кожные покровы больного ребёнка.В тяжёлых случаях количество высыпаний быстро нарастаетБ что указывает на плохой прогноз.

Ошибки в диагнозе с тяжёлыми последствиями происходят из-за недооценки тяжести состояния ребёнка и пропущенных высыпаний. При подозрении на менингококковую инфекцию немедленно следует ввести больному большую дозу антибиотика (пенициллин или певомицетин) и препараты, препятствующие сосудистому коллапсу (преднизолон, гидрокортизон) и доставить в специализированную больницу в сопровождении врача.

PART II

THE ORIGIN OF		INFECTIONS
The infectious diseases of	man	are usually divided into two
' large groups. Some diseases	aftect	only man, others affect both

man and animals, with man most frequently infected from animals. Every infectious disease has not only characteristic clinical manifestations but also its own specific way of invasion into the

human body.

Such a disease as dysentery, which is one of the diseases of the intestinal infections, is spread through the intestines and stools.

The infections of the respiratory tract compose the second subgroup. During coughing or talking the pathogens are discharged from the infected organism with the mucus from the membranes^ of the respiratory tract into the air in the form of drops. The infection is spread when the air containing drops of mucus with the pathogens in it, is, breathed in. The diseases of this subgroup are diphtheria, smallpox, etc.

The diseases of the third subgroup are spread through the skin and the mucosa in which the pathogens multiply. In some cases it is the skin, in others it is the mucous membrane of the eye. Direct contact and various things belonging to the sick may be responsible for spreading the infective agent.

The diseases of the fourth subgroup are spread by living insects. The pathogens causing these infections circulate in the blood or lymph and are not discharged from the organism. The insects become infected as they ingest the blood of a diseased man. They become infectious for other people after the pathogens have multiplied in their organism.. All these diseases, of which encephalitis is an example, are called blood infections.

INFECTIONS IN CHILDREN

Once healthy children are past the first few months of life they are able to combat infections as well as adults. During the first few months the child may not have developed a sufficient number of antibodies to be able to combat successfully the many bacteria in his environment.

The process of developing antibodies takes place rapidly after six months of age, and healthy children may show an even greater resistance to the ordinary bacterial infections than adults.

Children tend to develop an immunity to the bacteria that flourish in their environment. However, such bacteria as staphylococcus, streptococcus, colon bacillus, and others can cause an

77

infection if	they gain	access, to the child's body through a break
in the skin	or through	one of his apertures.

There are some conditions which can affect a child's ability to combat an infection.

1. If a child is undernourished and lacks sufficient body proteins, vitamins and essential minerals, he will be poorly equipped to

combat infections.
2.	An anemic child will find it more difficult to mobilize his
body	resources	to		combat infections.
3.	If there	is	a	disease in one of the major organs,	such as
liver,	kidneys,	or	bone marrow, a child will be less able		to fight
off the invasion of				bacteria.

Any infection may cause temperatures as high as 105 °F to 106 °F in a, child. This is not a bad indication, as it demonstrates the child's ability to mobilize his defence mechanisms.

It is necessary to give a patient large quantities of fluids because most generalized infections are associated with temperature elevation and profuse sweating. Furthermore, large quantities of fluids tend to dilute the toxins produced by the bacteria.

Bed rest and prompt treatment of minor infections su ch as head colds or other upper respiratory infections will often prevent the onset of a more serious infection such as pneumonia.

It must be remembered that antibiotics are usually ineffective in ridding the body of a viral infection. However, they may be given to prevent a secondary invasion of bacteria that would complicate the original viral infection.

In certain instances the vaccines are effective in preventing the viral infection but not in curing it. For example, the measles virus can be prevented from taking hold within the body by vaccinating the child against it.

DISEASE

DISEASE is the unhealthy state of a body part, a physiological system, or the body as a whole. A disease may be a structural anomaly, such as a congenital heart defect, or a functional condition such as high blood pressure or trauma.

An important aspect of any disease is its etiology. Many diseases are known to be caused by infectious agents for example, childhood infectious diseases; the common cold and the flu and catarrhal jaundice are considered to be viral infections while inflamatory processes and abscesses being caused by bacteria. Another important aspect of a disease is the way of its manifes - tation — the symptoms and signs.

Diagnosis, the determination of the nature of a disease, is based on many factors including the signs, symptoms and often, laboratory arid clinical findings. To make a diagnosis a physician obtains information from a physical examination, from interviewing the patient or a family member, as well as from a medical history of the patient.

The physician having made a diagnosis states the possible prognosis of the disease, the course it is to take and an outcome of the disease.

The treatment considered most effective should be prescrib ed and may include medication, surgery, radiation therapy, etc.

Physicians know the course of the disease often to vary. It may have a sudden onset and a short duration in which case it is stated to be an abute disease. A disease may begin insidiousl y curable one or have a fatal outcome.

Acute Tonsillitis

Acute tonsillitis is a systemic infection characterized by an acute inflammatory process, it may have drastic effect on many vital organs of the body.

Acute tonsillitis may be due to differ ent bacteria. The most common cause is the haemolytic streptococcus. Its highest, incidence is between October and March. Care must be taken to prevent spread of infection. In the early stages it may be difficult to differentiate from diphtheria, and if th ere is any doubt as to diagnosis, a throat swab must be taken to determine the infecting organism. Acute tonsillitis is caused by the contact with infectious patients, through articles. The child may carry a dormant infection in his decayed teeth or chronically inflamed tonsils. And when his body is weakened or he is subjected to prolonged chilling he falls ill.

Protection against tonsillitis includes elimination of factors that lower resistance to disease. An important factor in the prevention of tonsillitis is the protection of healthy children against exposure to it and as well as to other diseases, such as upper respiratory catarrhs, grippe, colds.

There are several forms of acute tonsillitis, depending on the nature of the lesion: catarrhal, follicular and lacunar tonsillitis.

The onset of tonsillitis is usually sudden with malaise, pain on swallowing, a sensation of chilliness, .fever, impaired sleep and appetite. On examination one or both tonsils are found to be enlarged and covered with whitish or grey material.

This material or exudate consists of purulent discharge from the tonsil. The inflammatory process is seldom restricted to the tonsils, and the whole of the throat is reddened and inflamed. The tongue is covered with a th ick fur, and the breath has often an unpleasant odour. There is sometimes pain in the ear on the affected side, it may lead to infection of the ear with serious consequences.

The most frequent complications of acute tonsillitis are rheumatic fever and kidney trouble. A condition called chronic tonsillitis may develop following recurrent .attacks of acute tonsillitis.

A sick child must be put to bed immediately. Particular care should be taken to give the child a lot of vitamins, the patient's food must be soft and warm. The children have to gargle their throats with a solution of salt, soda and boric acid. Vapour inhalations through the mouth are sometimes comforting. Warm compresses to swollen lymph nodes are useful. The drugs usually prescribed for acute tonsillitis are streptocide (sulfanilamide) or other sulfonamides. The child is given drugs to bring the t°down.

Chronic tonsillitis is treated by irrigating the tonsils with various preparations or exposing them to ultraviolet rays. The to nsils may be removed surgically if treatment is of no avail.

DIPHTHERIA

Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae.The microorganism produces an exotoxin which is responsible for the resulting pathologic process. The disease is characterized clinically by a sore throat and a membrane which may cover the tonsils, pharynx and larynx.

Epidemiologic factors. The highest seasonal incidence occurs during the autumn and winter months.

Diphtheria is acquired by contact with either a case or carrier, the microorganisms being disseminated by the acts of coughing, sneezing or talking.

Pathogenesis and Pathology. Virulent diphtheria bacilli lodge in the nasopharynx of a susceptible individual. Bacterial growth taking place in the secretions and epithelial debris, a toxin is elaborated and absorbed by the local mucous membrane. The toxic effect on the cells causes tissue necrosis. In addition to the necrosis, an inflammatory and exudative reaction is also induced by the toxin. The necrotic epithelial cells, leucocytes, red cells, ftorinous material, diphtheria bacilli, and other bacterial inhabitants of the nasopharynx — all these elements combine to form the typical "membrane". It sloughs off during the recovery period.

Clinical Manifestations. Diphtheria develops after a short incubation period of 2 to 4 days.

For clinical purposes it is convenient to classify the disease in accordance with the anatomic location of the membrane. The following types of diphtheria may occur: (1) tonsillar (faucial), (2) laryngeal or laryngotracheal, (3) nasal and 4) nonrespiratory types including skin wounds, conjunctival and genital lesions.

Diagnosis. An early diagnosis of diphtheria is essential because delay of administration of antitoxin may impose a serious risk on the patient. The diagnosis of diphtheria must be made clinically.

The bacteriologic confirmation by means of culture is of the greatest importance. The method of accelerated bacteriolog ical diagnosis when the material secured with the aid of a specially prepared moist tampon is placed in a thermostat for 4 —6 hours should be more widely employed. A tellurium test has been recently employed as a method of rapid diphtheria diagnosis.

Treatment. It is necessary to isolate the patient at once. Diphtheria antitoxin must be given promptly and in adequate dosage. In severe toxic forms of diphtheria it is advisable in addition to the serum to administer intravenously a hypertonic glucose solution, give the patients vitamins in the form of nicotinic acid and ascorbic acid for a period of 2—3 weeks, some. authors recommending administration of atrychnine from the 1 -st days of the disease. Bed rest is very important. Other supportive measures include maintenance of hydration, a high caloric liquid or soft diet rich in vitamins, aspirin or codeine for sore throat and malaise. The patient must gargle his throat several times a day with a 2% boric acid solution. The patient's room must be aired.

Patients with laryngeal diphtheria require special treatment. In very advanced cases with severe symptoms of growing asphyxia, if there is increasing restlessness, irritability and anxiety, associated with progressive respiratory distress, a trache otomy is indicated for the relief of obstruction. It should be performed before the child becomes cyanotic and exhausted.

Prognosis and Complications, in spite of the low fatality rate sudden death may be caused by a variety of unpredictable events, such as ( 1 ) the sudden complete obstruction of the airway by a detached piece of membrane, (2) the development of myocarditis and heart failure, and (3) the late occurrence of the respiratory paralysis due to phrenic nerve involvement. Patients surviving following myocarditis and neuritis, the recovery is a rule.

Immunity. For determining immune status the Shick test is useful. Active immunity may be induced by either an attack of diphtheria or more commonly to-day by inoculations of diphtheria \ toxoid. Immunity following an attack of diphtheria may be either j, permanent or temporary; recurrent attacks of the disease are not \ unusual. The widespread and routine immunization of infants and

children having had a profound effect on the im mune status of the population at large, the incidence of diphtheria among inoculated children is lower, and the disease runs a milder course.

BRONCHITIS

This is probably the most common respiratory disorder of childhood. The inflammation affects the mucosa of the bronchial system. In the majority of cases it is harmless, but in very young patients or those weakened by ill health, it may develop into bronchopneumonia.

Bronchitis may be primary, but is very often an accompaniment of some other infection, as tuberculosis, pneumonia, influenza, whooping-cough, diphtheria. Bronchitis may occur at any age.

Etiology. Bronchitis is due to virus and bacterial infection. The microorganisms most frequently found are the staphylococcus, streptococcus, pneumococcus.

Pathology. Bronchitis is usually part of a general inflammation which may include any or all of the respiratory tract. The infection can begin at any point, and extend down as far as the alveoli, where it results in pneumonia. In a simple case the changes are usually minor: hyperemia of the bronchial mucosa and desquamation of ciliated epithelial cells, with loss of cilia; the mucous glands become distended, the bronchial secretion increases.

Symptoms. The mildest form is confined to the larger tubes. The onset may be sudden or gradual sometimes accompanied by slight fever, from 37.7 °C to 38.8 X, during the first day or two usually there are but few general symptoms. Respiration may be accelerated, and is usually audible. There may be either constipation or diarrhea. The child may be restless and irritable, though giving little evidence of being sick. Catarrh of the upper passages may be associated. Usually there is a dry, hoarse cough, either mild or severe, which may interfere with the taking of food. There may be pain under sternum. When the inflammation reaches the inter - mediate tubes, the fever is usually higher for the first two or three days, after which it gradually declines. Both respiration and pulse are accelerated. In children over three years old bronchitis is not unlike that in adults. There is not the same danger as in infants, of the infection passing over into the smaller bronchi. Often there is no fever, the patient feels well and has a good appetite. ;The symptoms are cough, which is worse at night and soreness over sternum. The cough is with a small amount of whitish expectoration. The cough usually lasts from one to two weeks. In severe cases older children may complain of headache, chilliness, pain in the back, and a feeling ef tightness in the chest.