The tongue is dry, covered with white or brown plaque, often trembles when protruding.
Typhoid fever (historical or classical) is a type of a large group of rickettsial human diseases, which include endemic (rat) typhus, tick-borne typhus (North Asian ixodoriketsiosis) and Ku fever, as well as Brill’s disease.
Etiology. The causative agent of typhus is Rickettsia prowazek, which is constantly found in the cells of the vascular endothelium in patients with typhus. They are named after the scientist Provacek, who studied the cause of typhus and died of it in 1915. The causative agent of typhus can be cultivated in the lung tissue of white mice and on the chorion-allantoic membrane of developing chicken embryos.
Epidemiology. A person suffering from typhus is the only source of infection. It is dangerous at the end of the incubation period, the entire feverish period and for another 2 days after normalization of body temperature. In some cases, a patient with typhus remains contagious for another 10 days.
Typhoid fever is not transmitted directly from a sick person to a healthy one. The transmission of rickettsiae is due to the presence of vectors – lice (mainly clothing lice). Lice, having sucked the blood of a typhoid patient, becomes able to transmit the disease no earlier than 4-5 days. During this time, there is a reproduction of rickettsiae in the epithelial cells of her intestine, where they are found in large numbers. This fact is of great epidemiological importance.
So, at hospitalization of the patient in the first 5 days of an illness and simultaneous processing of the epidemiological center (destruction of lice) there will be no new cases of a disease in this center. The maximum lifespan of infected lice is 40 – 45 days; therefore, it is able to transmit the infection within 35-40 days.
In 5 days the cells of the intestinal epithelium of the infected lice are overflowing with Provacek rickettsiae, as a result of which they are destroyed and the causative agent of typhus together with feces comes out, contaminating human skin and linen. The integrity of the skin is violated by lice bites and combs; when scratching the inflamed area, rickettsiae are rubbed into the skin, which then penetrate into the bloodstream.
Clinical signs. Rickettsiae, having penetrated into the blood, are spread throughout the body. As intracellular parasites, they take root in the endothelium of arterioles and capillaries, causing specific changes there. The endothelial cells of the affected vessels swell sharply, which leads to narrowing or complete blockage. Such changes in blood vessels (granulomas) are observed in all organs, including the central nervous system, especially in the medulla oblongata. These lesions cause severe disorders of the cardiovascular and nervous systems (meningoencephalitis), which, along with the toxic effects of the pathogen, determines the clinical picture of this disease.
The incubation period of typhus is on average 14-15 days; sometimes it is reduced to 7 or lasts up to 23 days. The disease begins acutely. In some cases, within 1-2 days there is a general malaise, poor appetite. Then the body temperature rises, reaching in the first 2 days 39-40 ° C. Often the rise in temperature is accompanied by chills.
From the first day the patient complains of unbearable growing headache, restless, intermittent sleep with dreams. These phenomena quickly force the patient to go to bed. Its appearance is quite typical. The face is hyperemic, swollen, conjunctivitis is sharply hyperemic, scleral vessels are dilated, injected ("rabbit eyes"). The skin is hot.
On the 5th day of the disease (rarely on the 4th-6th), a rash appears in the lateral surfaces of the chest, on the flexor surface of the forearms, elbow joints and quickly spreads throughout the torso and lower extremities. The rash is polymorphic (different in size and shape); at first it may be roseolysis (disappears when pressed or stretched skin), quickly turns into petechial, which no longer disappears when pressed and stretched skin. In severe disease, the rash may be petechial from the beginning.
The diameter of the rash elements is from 2 to 5 mm. Occasionally, small hemorrhages (Chiari-Avtsin symptom) occur before the rash appears on the transitional fold of the conjunctiva; Examination of the pharynx can be found on the mucous membrane of the soft palate, as well as near the root of the tongue single spot hemorrhages (enanthema). Prior to a pronounced rash, petechiae can be detected by applying a rubber band on the patient’s shoulder; at the same time below a place of constriction point hemorrhages are formed.
The period of rash is accompanied by deterioration of the patient’s condition. Nervous system phenomena (typhoid status) are growing. In severe cases, there are dizziness, agitation, delirium, hallucinations. In such cases, the medical staff requires particularly careful supervision of the seriously ill, as they can get up, run away, even throw themselves out the window and so on. The disease occurs with the phenomena of meningoencephalitis (inflammation of the brain and its membranes).
In critically ill patients, stool and urination may be unconscious. Sometimes there is a delay of urine or paradoxical urination, when with an overflowing bladder, urine is excreted in small portions.
Disorders of the cardiovascular system are characterized by deafness of heart sounds, rapid heart rate, progressive drop in blood pressure, sometimes to the point of collapse. In the midst of the disease there are symptoms of bronchitis and sometimes bronchopneumonia.
The patient’s appetite is poor. The tongue is dry, covered with white or brown plaque, often trembles when protruding. Sometimes the patient can’t stick out his tongue "stumbles" through the lower teeth (symptom of Govorov – Godelier). There is usually a tendency to delay stool. From the 4th to the 5th day, the spleen is palpated and the liver is enlarged.
With a favorable course of the disease, body temperature normalizes on the 12th-15th day (later as an exception); it falls lytically (gradually) within 2-3 days, less often critically, ie immediately. The patient’s consciousness clears, the rash disappears, appetite appears. Gradually normalizes blood pressure, sleep becomes calm, strength is restored. In a progressive condition, on the 7th-8th day of normal body temperature the patient is allowed to get out of bed and on the 13th day he can be discharged.
Emergency aid. Pre-medical care: when the temperature rises, put a cold compress on the head, give 0.5 g of acetylsalicylic acid or 0.25 g of amidopyrine. Medical care: at a hyperthermia cold on a head, antipyretics is shown; 0.5 g of acetylsalicylic acid or 0.25 g of amidopyrine; cardiovascular drugs (2 ml of 20% camphor solution or 1-2 ml of cordiamine subcutaneously), with sharp excitation – 1 ml of 2.5% aminazine solution intramuscularly.
Complication. Among the possible complications of typhus should be noted primarily neurotrophic tissue lesions (skin necrosis, bedsores) and thrombophlebitis (often affecting the veins of the lower extremities). In some patients, especially in the presence of previous depletion of the body or poor care of the oral cavity, the development of purulent mumps is possible. Occasionally, limited bilateral focal pneumonia develops; otitis may occur in children. Toxic neuritis of the auditory nerve is not uncommon, although in these patients rapidly (usually at the time of discharge from the hospital) hearing acuity is fully restored. In some cases, the development of typhoid meningoencephalitis.
The transferred disease leaves steady immunity. Recurrent typhus is observed not earlier than 1.5 years after the primary. Mortality does not exceed 0.1-0.2%.
Prevention. Following the hospitalization of a patient with typhus, the district sanitary organizations and the sanitary-epidemiological station (SES) are immediately notified about each such patient. The apartment or dormitory where the patient lived is disinfected and at the same time an epidemiological examination is carried out in the center.
All the patient’s underwear is boiled and washed with soap, and outerwear, blankets and mattresses are treated in disinfection chambers.
All persons living in the patient’s environment, immediately after hospitalization, the patient is washed in the bath-pass, and their linen, clothes and bedding are subjected to the same disinsection treatment as the patient’s belongings.
It is necessary to ensure a comprehensive simultaneous implementation of all these measures, repeating the sanitation in the cell after 8 days.
Within 25 days from the moment of hospitalization of the patient medical workers should measure daily temperature of all who live in this center, and in each 3 days, besides, to carry out the general medical inspection.
Clinical and epidemiological surveillance of persons in the center of typhus is carried out within 71 days from the appearance of the first case of the disease.
Early diagnosis and hospitalization of the patient play an extremely important role in the fight against the spread of typhus. If the patient is hospitalized before the 5th day of typhus, and the center provides simultaneous re-circular disinsection and sanitation of all residents of the apartment or dormitory, it should be assumed that new cases of typhus in this center compare and contrast essay 123helpme will not occur.
Vaccine vaccination plays a supporting role in the prevention of typhus. Immunity develops 3 weeks after vaccination and lasts for 8-10 months. Vaccinations should be given to those who are exposed to the risk of infection by their nature (infectious disease hospital staff, disinfectants, carriers on rail and water transport, hairdressers, sanitary workers, etc.).
Bunin KV Infectious diseases. – Moscow: Medicine, 1977 .– 492 pp. Pokrovsky VI, Bulkina IG Infectious diseases with care for patients and the basics of epidemiology. – M .: Medicine, 1985 .– 240 pp. Handbook of emergency and emergency care / Ed. EI Chazova. – M .: Medicine, 1975 .– 672 p.
Organizations and enterprises: reporting on labor protection. Abstract
The owner is obliged to inform employees about the state of labor protection, the causes of accidents, accidents and occupational diseases and about the measures taken to eliminate them and to ensure working conditions and safety at the enterprise at the level of regulatory requirements.
State labor protection management bodies inform the population of Ukraine, the relevant region, industry workers and labor collectives about the implementation of state policy on labor protection, implementation of national, territorial or sectoral programs on these issues, the level and causes of accidents, occupational injuries and diseases, their decisions on the protection of life and health of workers.