INFECTIOUS_DISEASES

The acute phase of Kawasaki disease commonly lasts 10 to 14 days or more. Most children recover fully. The likelihood of developing coronary artery disease later in life is not known, and remains the subject of medical investigation.

Cause. The cause of Kawasaki disease is unknown. It does not appear to be hereditary or contagious. Because the illness frequently occurs in outbreaks, an infectious agent (such as a virus) is likely the cause. It is very rare for more than one child in a family to develop Kawasaki disease.

Signs and Symptoms. Fever and irritability are often the first indications of the disease. Fever ranged from moderate ( 1 0 1 ° to

103° F) to high (above 104° F). The lymph glands in the neck may become swollen. A rash usually appears on the back, chest, and abdomen early in the illness; in infants it may develop in the groin. In some cases, the rash may spread to the face. The rash appears as poorly defined spots of various sizes, often bright red. Fever continues to rise and fall, sometimes for as long as 3 weeks.Bloodshot eyes (conjunctivitis) may develop, and the eyes can become sensitive to light.

The child's tongue may be coated, slightly swollen, and resemble the surface of a strawberry, sometimes referred to as "strawberry tongue". The lips may become red, dry, and cracked; the inside of the mouth may turn darker red than usual.

The palms of the hands and soles of the feet often become red, and hands and feet may swell. Occasionally, a stiff neck will develop. Abdominal pain and diarrhea occur in some children.

When the fever subsides, the rash and swollen lym ph glands usually disappear. The skin around the toenails and fingernails often peels painlessly, usually during the second or third week of illness. The skin on the hands or feet may peel in large pieces.

The knees, hips, and ankles may become swollen and painful. Occasionally, joint pain and swelling persist after other symptoms have disappeared, but permanent joint damage does not occur. Lines or ridges on fingernails and toenails, formed during the illness, may be seen for weeks or months.

Diagnosis. The diagnosis of Kawasaki disease cannot be made by a single laboratory test or combination of tests. Physicians make the diagnosis after carefully examining a child, observing signs and symptoms, and eliminating the possibility of other diseases that are similar. Blood tests are used to detect mild anemia, an elevated white blood cell count, and an elevated sedimentation rate, indicating inflammation. A sharp increase in the number of platelets, a major clotting element in blood, may also be found.

Urine tests may reveal the presence of protein (albumin) and white blood cells. An irregular heartbeat and evidence of heart muscle involvement can be detected by electrocardiogram (ECG). An echocardiogram (or echo) is used to look for possible damage to the h e a r t o r t o t h e c o r o n a r y a r t e r i e s t h a t s u p p l y b l o o d t o the heart muscle. Other blood tests or diagnostic studies may be requested by the physician.

Complications. The possibility of heart and coronary artery involvement makes Kawasaki disease unpredictable, but these problems usually are not serious and disappear with time. However, on occasion aneurisms of coronary or other arteries of the body can occur, and some may require medical or surgical treatment. Very rarely, complications may include heart attacks, which can be fatal.

Treatment. Kawasaki disease is frequently treated in the hospital, with a stay from a few days to a few weeks. Some children may receive care at home without hospitalization.

Since the cause of Kawasaki disease is unknown, no specific medication is available. Aspirin is often used to reduce fever, rash, joint inflammation, and pain, and to prevent formation of blood clots. Recent studies from Japan arid the United States suggest that another medication, intravenous gamma globulin, may decrease the risk of developing heart disease when given early in the illness. A major goal of treatment both in the hospital and at home is to make a child as comfortable as possible while the illness runs its course.

If tests reveal an aneurysm or other heart or blood vessel abnormality, repeated echocardiograms or other tests may be necessary for several years following recovery from Kawasaki disease. Almost all children return to completely normal activity after the acute phase of the illness.

Prevention. There is no known prevention for Kawasaki disease. Approximately one child in a hundred may develop the disease a second time. Parents should know that nothing they could have done would have prevented the disease.

Лексический текст.

Вставьте пропущенные слова в тексте

KD (Kawasaki Disease)

Kawasaki disease is an 1... vasculitis of infants and children that results in coronary artery 2... in 15% to 25% of those

affected. 3... of KD with aspirin plus high 4... doses of y-globulin, instituted within the first 10 days of 5... reduces cardiovascular sequelae, 6... it is highly desirable to identify patients with KD early in the 7... of their illness. In the absence of a definitive laboratory test result, the diagnosis of KD is dependent on the 8... of clinical features that may be mimicked by other disease processes. Indeed, the differentiation of KD from other 9... and immunologic diseases constitutes a major challenge for the practi - tioner. The purpose of our study was 10... those diseases that most closely mimic KD in the United States and 1 1 . . . the details of the history, 12... examination, and laboratory investigation that influenced 13... clinicians to exclude the diagnosis of KD. We also used this 14... to compare certain epidemiologic 15... of KD patients and of those patients referred for evaluation of possible KD in whom 16... diagnoses were established.

1. assessment	2. lesions	3. alternative	4.	features
5. treatment	6. course	7. infectious	8. to		examine
9. opportunity	10. experienced	11. acute	12.	to	determine
13. physical	14. illness	15. thus	16.	intravenous.

Самостоятельная работа З

Тезирование статьи

All About Aspirin

Modern medicine is devoting considerable time and money to the primary prevention of coronary artery disease — before it becomes a problem. But when primary prevention" fails, the next logical step is secondary prevention of recurrent heart attacks and death. For some people who fall into this category ... enter aspirin.

Aspirin or acetylsalicylic acid — is one of the safest and least expensive medications available today. An early form of the drug, which was extracted from the bark of a willow tree, was first prescribed by the ancient Greek physician Hippocrates some 2300 years ago.

Over the years aspirin has probably been used more widely than any other medication for such problems as headaches, fever, and menstrual discomfort. Recently the United States Food and Drug Administration approved yet another use: Aspirin is now indicated for preventive treatment in some patients with cardio - vascular disease. Aspirin — in the dosages prescribed by your doctor — may be effective in preventing heart attacks and stroke.

Heart attacks are usually the result of impeded blood flow through the vessels that carry blood to the heart. One possible cause of this impeded flow is a blood clot created by the buildup of platelets — tiny blood components that play an important role during blood clotting.

As a rule, blood clot formation is a desirable condition. The formation of blood clots at the site of a wound is a normal — and necessary — response to injury. If your blood did not clot, you would bleed to death following the infliction of even a small wound. However, blood clotting within the circulating bloodstream — a process that is promoted by platelet aggregation or clumping — is undesirable. Such platelet activity can lead to the formation of those blood cells that are responsible for strokes, heart attacks , and other potentially fatal circulatory problems.

Why aspirin for heart attacks? The rationale for administering aspirin" to patients who are at high risk for heart attack is that some patients with CAD have greater-than-normal platelet activity. This increased platelet activity may result in an increase in the formation of blood clots in the circulation — and. thus increase blockage in the blood vessels.

How does aspirin do it? In 1971, Dr. John R. Vane—an English scientist who received the Nobel Prize for Medicine for this work — found that aspirin interferes with the production of certain pro - staglandins, chemicals that occur naturally in the body and that are involved in platelet clumping. This, in turn, inhibits the accumulation

of platelets within a blood vessel and reduces the platelets' tendency to adhere to the vessel walls. In patients with a tendency toward platelet aggregation, aspirin may prove life saving.

But remember — the general indications for aspirin that yo u will find listed on your aspirin bottle do not include prevention of cardiovascular disease. Taking aspirin for heart disease should be done only on the advice of your physician.

Самостоятельная работа 4

Ориентирование в тексте.

Укажите номера текстов, в которых содержатся ответы, на вопросы.

All about RSV: A guide for parents.

Questions:

1.What is RSV?

2.When does RSV occur?

3.What are the symptoms of RSV?

4.Can RSV be serious?

5.	How do I know if my child hasNa serious RSV infection?
6.	When should I call the doctor?
7.	If my child should get an RSV, how is it treated?

8.Where does RSV come from, and how can I prevent my child from being infected?

9.Can my child get RSV again?

10.Will RSV weaken my child's lungs and make him more

susceptible to pneumonia in the future? Texts:

1. Although a child can get a second RSV infection, it is very

likely	that the symptoms will be much milder than				the first		time.
2.	In the great majority of cases		RSV	infection	is self -limiting
and	requires	no specific therapy. If	your	child has	a	fever,	your
pediatrician		may prescribe some medication to control				it. If	he or

she develops an ear infection associated with RSV, antibiotics may be prescribed. Most children exhibiting the respiratory symptoms commonly associated with RSV {such as a stuffy nose and cough) require no treatment.

If, however, your child has more severe symptoms of RSV infection and needs hospitalization, then specific antiviral treatment with ribavitin may be administered Whether your physician decides to use this drug — which is administered in a mist form — will depend on the severity of the illness, any associated diseases or conditions, and several other factors.

3. A child who develops signs of more stressful breathing, deeper and more frequent coughing, and who generally acts sicker

by appearing tired, less playful, and less interested in food may have developed a more serious RSV infection. But only your doctor can tell for sure.

4. Most children recover completely and will handle their next respiratory infection with no more'difficulty than the average child. A few children, however, appear to be more susceptible to subsequent respiratory problems. Susceptibility may relate, however, to some other underlying medical condition or allergy.

5.RSV causes nasal stuffiness and discharge, cough, and sometimes ear infections. It is usually self-limiting and does not require hospitalization or specific treatment — even in the majority of those who also have lower respiratory tract involvement. Th ese children may have a low-grade fever for several days, respiratory symptoms that may last for 1 to 2 weeks, and a cough that sometimes persists beyond 2 weeks.

6.Children and adults of all ages can become infected. The infection-in older children and adults may be very mild, usually causing cold-like symptoms. A person becomes infected by coming in close contact with another infected person or with the secretions from an infected person. An infant usually acquires the infection from close contact with an older family member who may not be aware that

he or she is ill or who may have only mild, cold-like symptoms. As noted earlier, RSV occurs throughout the year, but because

it occurs in wide scale, sudden outbreaks, and is so prevalent in the winter months, it is not feasible or advisable to attempt to prevent the normal child's exposure to RSV infection. W hen a family member is infected, extra precautions may be taken by washing hands often and preventing the spread of infectious secretions on tissues and objects.

7.RSV occurs throughout the year and is most prevalent during the winter months.

8.RSV stands for respiratory syncytial virus, the most frequent cause of serious respiratory tract infections in "infants and children younger than 4 years of age. This is such a common virus that

virtually all children have			been	infected by RSV by the age of 3.
In most young children it			results		in a mild respiratory infection
that is	not	distinguishable	from	a	cold.
9.	As in	any case of illness,		you should call your pediatrician

whenever you are worried about your child. He or she can best decide with you whether the symptoms and behaviour you describe suggest that your baby should be seen.. In general, pediatricians prefer to examine ill infants in person, as severity may be impossible to determine over the phone.

Certainly, if the respiratory syptoms appear to interfer e with your baby's ability to sleep or drink, or if the baby appears to

have difficult or rapid breathing, you should call your pediatrician. If your child is younger than 1 year of age and has an underlying disease such as heart disease or lung disease or was premature, with lung disease developing after birth, you should let your physician know whenever the baby develops a respiratory infection.

10. Yes. An infant or young child who is experiencing his or her first RSV infection may develop a severe infection in the lower respiratory tract that is best managed in the hospital. Approximately

80,000 children	are	hospitalized with	these infections each year.
Most commonly,	the	ones requiring	hospitalization are newborns

and infants and those who have another complicating or underlying

condition, such as			congenital heart or lung disease.
		Самостоятельная					работа 5.
		8 уч. часов. На последнем занятии (2 ч.) — зачет
	Работа с текстом статьи "Внутрибольничная вспышка кори в
детской больнице во время общей						эпидемии в районе". Журнал
"Педиатрия", 1991			г., т!	119,	№	2, стр. 183-186.
	I. Прочитать всю статью, выписывая незнакомые слова.
	11. Прочитать статью второй раз, обращая внимание на сле
дующие грамматические элементы						текста, которые нужно уметь
правильно переводить на русский язык при сдаче зачета:
	а)Сказуемое в активе и в пассиве:
	(has occurred, were considered, died, should be instituted, was
given, led, acquired, etc).
	б) Причастие прошедшего времени правильных и неправильных
глаголов.
	Ь) Цепочку из двух и более существительных
	e.g. The infection control program						(p. 184).
	r) "No" перед подлежащим.
	e.g. No secondary cases of measles occurred in hospital
personnel.
	д)Синтаксическую конструкцию субъекта с инфинитивом:
	1.	Of the 37 patients, six were				not thought to have measles.
	2. Measles exposure was considered to have occurred in patients
and personnel... .
	3. If the exposure was assessed						to have been between 72
hours and б days... .
	4.	Therefore a	total	of 107 susceptible hospitalized patients
are known to have been				exposed		to measles during 1988.
	5.	Transmission	of measles		virus		in medical settings appears
to	be an important		factor in ongoing				outbreaks.
	6.	Hospital personnel born before				1957 are generally considered
to	be	immune to measles... .

III. Составить список всех производных от следующих глаголов. Уметь правильно произносить, переводить на русский язык.

1.	to expose	6.	to	vaccinate
2.	to infect	7.	to	respirate
3.	to hospitalize	8.	to	isolate
4.	to immunize	9.	to	identify
5.	to employ	10.	to	transmit

Зачет:

1. Студент выбирает билет, на котором указан № отрывка из статьи (№№ 1—9).

2.Чтение вслух 5*—б строчек текста на усмотрение препода вателя (из данного отрывка).

3.Правильно определить все упомянутые выше граматические

элементы в тексте. Если студент не различает "актив", "пассив" и причастие прошедшего времени от личной формы глагола, дальнейший опрос прекратить.

4.Перевести весь текст (отрывок из статьи) на русский язык, не заглядывая в свои записи.

5.Назвать все производные одного из 10 указанных глаголов.

NOSOCOMIAL MEASLES INFECTION IN A PEDIATRIC HOSPITAL DURING A COMMUNITY-WIDE EPIDEMIC

Martha Elisa Rivera, MD. Wilbert Henry Mason, MD. Lawrence Alan Ross. MD, and Harry Tucker Wright Jr. MD. MPH

From the Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Los Angeles and University of Southern California School of Medicine, Los Angeles, 1991, J. Ped. V. 119,

№ 2.

From Jan. 1, 1988, through Dec. 31, 1988, a total of 89 cases of measles were observed at Children's Hospital in Los Angeles, and 37 patients were admitted to the hospital. Of the 37 patients, six were not initially thought to have measles, which resulted in exposure of 107 patients and 24 personnel. Of the exposed patients, measles developed in four. One nospcomially infected infant died of pneumonia. Another exposed patient was subsequently admitted to another hospital with unrecognized measles, which led to exposure of an additional eight patients. Of seven employees in whom measles developed, two required hospitalization because of pneumonia. Two hundred eleven employee days were lost because of

measles exposure or infection. Infection control interventions included prophylaxis of exposed patients, employee education, and measles immunization for susceptible personnel. Of 1103 hospital personnel considered susceptible to measles, 800 received monovalent measles vaccine. No secondary cases of measles occurred in hospital personnel who received appropriate prophylaxis. We conclude that infection control programs aimed at mandating measles immunity in hospital employees at risk should be instituted. (J. Pediatr, 1991; 119; 183-6.)

Despite the introduction of measles vaccine in the United States in 1963, outbreaks continue to occur, especially in large urban areas. Such an outbreak has occurred in Los Angeles County since 1988. Although measles transmission in recent years has occurred mainly in schools or at home, as many as 3% to 5% of cases have resulted from nosocomial transmission to susceptible patients and employees in a variety of medical settings. We describe the impact of a measles epidemic in Los Angeles County on a children's hospital and how infection control measures were implemented to impede the spread of measles to both susceptible patients and employees.

BACKGROUND

In 1988 a measles outbreak occurred in Los Angeles County; a provisional total of 5 1 3 cases was reported to the Los Angeles County Public Health Department .between Jan. 1, 1988, and December 31, 1988. Sixty-three percent of the patients reported were younger than 5 years, and 42% were 15 months of age or younger. At Children's Hospital of Los Angeles (CHLA), a 331 -bed urban pediatric teaching hospital, 89 cases of measles were id entified in 1988.

METHODS

Epidemiologic investigation. Medical records of patients with suspected measles were reviewed for clinical or serologic confirmation of the diagnosis. Measles was diagnosed in patients having an acute febrile illness with morbilliform or maculopapular rash (persisting for 3 or more days), cough, coryza, conjunctivitis, or Koplik spots.

Patients and employees were considered susceptible to measles if they were born after 1956 and had not had physician-diagnosed measles or received live measles vaccine after 12 months of age. The same criteria for measles susceptibility were applied to patients who were immunodeficient as to those who were immunocompetent.

79

A search of personnel records was undertaken to identify susceptible employees, that is, those born after 1956, with no documentation of immunization with live measles vaccine or physician-diagnosed measles.

Measles exposure was.considered to have occurred in patients and personnel when they were in contact with persons in whom measles was! ultimately diagnosed and who were not in respiratory isolation at the time ofcontact. Patients and employees present on the same ward area (including contiguous units) with a patient with measles were considered exposed.

After the first case of nosocomial measles was recognized, the hospital infection control officer and the department of quality assurance developed a protocol aimed at controlling the further spread of measles to susceptible patients and employees. Prophylaxis for exposed susceptible patients was carried out in three ways as recommended in the Report of the Committee on Infectious Disease of the American Academy of Pediatrics:

1.Monovalent measles vaccine was given to children 6 to 12 months of age.

2.Measles-mumps-rubella Vaccine was given to children older than 12 months.

3.Patients from birth to 6 months of age who were exposed received intramuscularly administered^ y-globulin.

4.When live vaccines were contraindicated, y-globulin was administered intramuscularly.

The infection control program for hospital employees included vaccination and education. Monovalent measles vaccine was recommended for exposed susceptible hospital personnel if exposure was within 72 hours. If the exposure was assessed to have been between 72 hours and 6 days, y-globulin was given intramuscularly in an effort to prevent or modify the infection. An extensive educational program was initiated that included instructions to hospital admitting personnel and ward staff on the recognition and appropriate isolation of patients with measles.

RESULTS

From Jan. 1, 1988, to Dec. 3%1, 1988, a total of 89 cases of measles were observed at CHLA (Figure). Sixty-two percent of patients were <15 months of age (Table). The age and gender distribution, and ethnic background were similar to those in the community as reported by the Los Angeles County Department of Health Services. Thirty-seven patients were admitted to the hospital; of these, six were not recognized as having measles at the time of admission. The admitting diagnoses of these six patients were

sepsis, pneumonia, bacteremia, esophagitis, roseola infantum and mastoiditis. Lack of appropriate respiratory isolation of these patients led to exposure of susceptible patients and. employees.

Seventy-eight patients susceptible to measles were exposed to five of the six patients who were not appropriately isolated. An accurate assessment of exposures to the sixth patient was not available; this patient was first seen in the prodromal stage without rash, and many of the exposed patients were discharged home before the diagnosis of measles was established.

During the study period, seven hospital personnel had measles. Four cases resulted from exposure to patients, two occurred after household exposure, and a rotating surgical resident acquired the illness from an unknown source. A nurse had atypical measles after contact with a patient with acquired immunodeficiency syndrome with unrecognized measles, and a radiology technician was infected in the radiology suite by a child with unrecognized measles. These two hospital employees required hospitalization because of respi - ratory complications, including the nurse who had atypical measles. All hospital employees who acquired measles were born after 1956. The hospital employees who acquired measles subsequently exposed an additional 15 hospitalized patients, none of whom acquired measles.

A 10-morith-old girl hospitalized with intractable diarrhea of infancy was exposed in a waiting room area to a child with unrecognized measles. Measles-related pneumonia developed in the girl and she subsequently died. She exposed an additional 14 susceptible hospitalized patients, one of whom acquired measles. Therefore a total of 107 susceptible hospitalized patients are known to have been exposed to measles during 1988.

A teenage girl exposed to measles before discharge from CHLA was admitted to another hospital with fever and uncontrolled diabetes mellitus. Her febrile illness was subsequently diagnosed as measles, and during the admission she exposed eight additional patients.

Of оцг 107 exposed patients, 54 received prophylaxis: y-globulin was given intramuscularly to 31 patients, and measles vaccine, monovalent or combined with mumps and rubella va'ccines, was administered to 9 patients; an additional 14 patients received prophylaxis, but the type was not specified in the medical record. Measles was not recognized in the patients who received prophylaxis. Of the 53 patients who received no prophylaxis, 4 secondary cases of measles occurred, for an attack rate of 7.5%.

A hospital wide measles vaccination program was begun in September 1988. A complete search of personnel records revealed that 1108 employees were born after 1956, and these individuals